TY - JOUR
T1 - High Effectiveness of Broad Access Direct-Acting Antiviral Therapy for Hepatitis C in an Australian Real-World Cohort
T2 - The REACH-C Study
AU - Yee, Jasmine
AU - Carson, Joanne
AU - Hajarizadeh, Behzad
AU - Hanson, Joshua
AU - O’Beirne, James
AU - Iser, David
AU - Read, Phillip
AU - Balcomb, Anne
AU - Doyle, Joseph
AU - Davies, Jane
AU - Martinello, Marianne
AU - Marks, Philiipa
AU - Dore, Gregory
AU - Iser, David
AU - Matthews, Gail
AU - Matthews, Gail
AU - Dore, Gregory
AU - Hanson, Josh
AU - O’Beirne, James
AU - Read, Phillip
AU - Balcomb, Anne
AU - Carson, Joanne
AU - Yee, Jasmine
AU - Marks, Philippa
AU - Yee, Jasmine
AU - Carson, Joanne
AU - Matthews, Gail
AU - Dore, Gregory
AU - Hajarizadeh, Behzad
AU - Byrne, Marianne
AU - Marks, Philippa
AU - Post, Jeffery
AU - Doyle, Joseph
AU - Batey, Robert
AU - Smart, John
AU - Dawson, Olivia
AU - Hill, Sonja
AU - Douglas, Mark
AU - Martinello, Marianne
AU - Montebello, Mark
AU - Collie, Patricia
AU - Hallinan, Richard
AU - Hanson, Josh
AU - Snelgar, Gail
AU - Baker, David
AU - Galhenage, Sam
AU - Soo, Tuck Meng
AU - Read, Phillip
AU - Bopage, Rohan
AU - Faros, John
AU - Cooper, Lucy
AU - Balcomb, Anne
AU - Nelson, Renjy
AU - Shaw, David
AU - Davies, Jane
AU - Wilson, Mark
AU - Iser, David
AU - Pratt, William
AU - Hinton, Stephen
AU - Dore, Gregory
AU - O’Beirne, James
AU - Wade, Amanda
AU - Van Gessel, Helen
AU - Davidson, Leonie
AU - Dibdin, Miranda
AU - Lucas, Micaela
AU - Ahmad, Raghib
AU - Smith, Denise
AU - Tan, Khim
AU - Roder, Christine
AU - Harney, Brendan
AU - Holdaway, Susan
AU - Walsh, Jayde
AU - Fox, Penny
AU - Mousavi, Roshanak
AU - Lam, Wendy
AU - Dahal, Rupa Pudasaini
AU - Habel, Philip
AU - Gilliver, Rosie
AU - Silins, Edmund
AU - Ackerman, Jessica
AU - Deacon, Rachel
AU - Hall, Edmund
AU - Everson, Arlene
AU - Milner, Margery
AU - Ferguson, Catherine
AU - Tate-Baker, Jaclyn
AU - Bradshaw, Jane
AU - Duncan, Gai
AU - Baluran, Gilbert
AU - Watson, Belinda
AU - Hey, Camilla
AU - Hickey, Rebecca
AU - Orme, Clare
AU - Miczkova, Silvie
AU - the REACH-C Study Group
N1 - Funding Information:
Potential conflict of interest: Iser advises and is on the speakers’ bureau of AbbVie, Gilead Sciences, and MSD. Read is on the speakers’ bureau of and received grants from Gilead Sciences. He is on the speakers’ bureau of AbbVie. Dore received grants from Gilead Sciences and AbbVie. Doyle consults for and received grants from Gilead Sciences and AbbVie. He received grants from Merck. Matthews received grants from Gilead Sciences and AbbVie.
Funding Information:
Supported by the Australian Government Department of Health and Ageing.
Publisher Copyright:
© 2021 The Authors. Hepatology Communications published by Wiley Periodicals LLC on behalf of American Association for the Study of Liver Diseases.
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2022/3/1
Y1 - 2022/3/1
N2 - Australia was one of the first countries with unrestricted access to government subsidized direct-acting antiviral (DAA) therapy for adults with chronic hepatitis C virus. This study assessed real-world DAA treatment outcomes across a diverse range of Australian clinical services and evaluated factors associated with successful treatment and loss to follow-up. Real-world Effectiveness of Antiviral therapy in Chronic Hepatitis C (REACH-C) consisted a national observational cohort of 96 clinical services including specialist clinics and less traditional settings such as general practice. Data were obtained on consecutive individuals who commenced DAAs from March 2016 to June 2019. Effectiveness was assessed by sustained virological response ≥12 weeks following treatment (SVR) using intention-to-treat (ITT) and per-protocol (PP) analyses. Within REACH-C, 10,843 individuals initiated DAAs (male 69%; ≥50 years 52%; cirrhosis 22%). SVR data were available in 85% (9,174 of 10,843). SVR was 81% (8,750 of 10,843) by ITT and 95% (8,750 of 9,174) by PP. High SVR (≥92%) was observed across all service types and participant characteristics. Male gender (adjusted odds ratio [aOR] 0.56, 95% confidence interval [CI] 0.43-0.72), cirrhosis (aOR 0.52, 95% CI 0.41-0.64), recent injecting drug use (IDU; aOR 0.64, 95% CI 0.46-0.91) and previous DAA treatment (aOR 0.50, 95% CI 0.28-0.90) decreased the likelihood of achieving SVR. Multiple factors modified the likelihood of loss to follow-up including IDU ± opioid agonist therapy (OAT; IDU only: aOR 1.75, 95% CI 1.44-2.11; IDU + OAT: aOR 1.39, 95% CI 1.11-1.74; OAT only, aOR 1.36; 95% CI 1.13-1.68) and age (aOR 0.97, 95% CI 0.97-0.98). Conclusion: Treatment response was high in a diverse population and through a broad range of services following universal access to DAA therapy. Loss to follow-up presents a real-world challenge. Younger people who inject drugs were more likely to disengage from care, requiring innovative strategies to retain them in follow-up.
AB - Australia was one of the first countries with unrestricted access to government subsidized direct-acting antiviral (DAA) therapy for adults with chronic hepatitis C virus. This study assessed real-world DAA treatment outcomes across a diverse range of Australian clinical services and evaluated factors associated with successful treatment and loss to follow-up. Real-world Effectiveness of Antiviral therapy in Chronic Hepatitis C (REACH-C) consisted a national observational cohort of 96 clinical services including specialist clinics and less traditional settings such as general practice. Data were obtained on consecutive individuals who commenced DAAs from March 2016 to June 2019. Effectiveness was assessed by sustained virological response ≥12 weeks following treatment (SVR) using intention-to-treat (ITT) and per-protocol (PP) analyses. Within REACH-C, 10,843 individuals initiated DAAs (male 69%; ≥50 years 52%; cirrhosis 22%). SVR data were available in 85% (9,174 of 10,843). SVR was 81% (8,750 of 10,843) by ITT and 95% (8,750 of 9,174) by PP. High SVR (≥92%) was observed across all service types and participant characteristics. Male gender (adjusted odds ratio [aOR] 0.56, 95% confidence interval [CI] 0.43-0.72), cirrhosis (aOR 0.52, 95% CI 0.41-0.64), recent injecting drug use (IDU; aOR 0.64, 95% CI 0.46-0.91) and previous DAA treatment (aOR 0.50, 95% CI 0.28-0.90) decreased the likelihood of achieving SVR. Multiple factors modified the likelihood of loss to follow-up including IDU ± opioid agonist therapy (OAT; IDU only: aOR 1.75, 95% CI 1.44-2.11; IDU + OAT: aOR 1.39, 95% CI 1.11-1.74; OAT only, aOR 1.36; 95% CI 1.13-1.68) and age (aOR 0.97, 95% CI 0.97-0.98). Conclusion: Treatment response was high in a diverse population and through a broad range of services following universal access to DAA therapy. Loss to follow-up presents a real-world challenge. Younger people who inject drugs were more likely to disengage from care, requiring innovative strategies to retain them in follow-up.
UR - http://www.scopus.com/inward/record.url?scp=85118656256&partnerID=8YFLogxK
U2 - 10.1002/hep4.1826
DO - 10.1002/hep4.1826
M3 - Article
C2 - 34729957
AN - SCOPUS:85118656256
VL - 6
SP - 496
EP - 512
JO - Hepatology Communications
JF - Hepatology Communications
SN - 2471-254X
IS - 3
ER -