This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Research article
Christer Aas
Universitetet i Bergen Det medisinsk-odontologiske fakultet
Corresponding Author
ORCiD: https://orcid.org/0000-0002-6469-9354
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
The development of new direct-acting antiviral (DAA) medications together with opioid agonist therapy (OAT) have been put forward as having an important role in the management and elimination of chronic hepatitis C (HCV) infection. Yet, HCV treatment uptake and coverage have remained low among OAT populations. We aimed to calculate cumulative HCV treatment coverage among individuals enrolled in OAT in Norway between 2013 and 2017, and to document the treatment transition to interferon-free regimens. Moreover, we aimed to describe adherence to DAAs in the same cohort.
Methods
This observational study was based on data from The Norwegian Prescription Database (NorPD). We studied dispensed OAT and HCV treatment annually to calculate the cumulative frequency, and employed secondary sources to further calculate prevalence, incidence and HCV treatment coverage from 2013 to 2017, among the OAT population. Factors associated with adherence to DAAs were identified a priori and subject to logistic regression.
Results
10,371 individuals were identified with dispensed OAT, 1,475 individuals of these with dispensed HCV treatment. Annual HCV treatment coverage increased from 3.5% (95% CI: 3.2-4.4) in 2013 to 17% (95% CI: 17-20) in 2017, giving a cumulative HCV coverage among OAT patients in Norway of 38.5%. A complete shift to interferon-free treatment regimens occured, where DAAs accounting for 32% of HCV treatments in 2013 and 99% in 2017. About two-thirds of OAT patients were considered adherent to their DAA regimens across all genotypes. High-level of OAT continuity was associated with improved adherence to DAAs (aOR 1.4, 95% CI: 1-2, p=0.035).
Conclusions
A large increase in HCV treatment coverage attributed by a complete shift to interferon-free regimens among the Norwegian OAT population has been demonstrated. However, a further substantial scale-up in HCV treatment is required to reach the universal targets of controlling and eradicating the HCV endemic.
Keywords
Hepatitis C (HCV), treatment uptake, treatment coverage, direct-acting antivirals (DAAs), opioid agonist therapy (OAT), adherence
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This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Research article
Christer Aas
Universitetet i Bergen Det medisinsk-odontologiske fakultet
Corresponding Author
ORCiD: https://orcid.org/0000-0002-6469-9354
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
History
CURRENT STATUS: Posted
View the published article at BMJ Open.
Version 1
Posted 23 Aug, 2019
No community comments so far
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Health Economics & Outcomes Research
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMJ Open.
Background
The development of new direct-acting antiviral (DAA) medications together with opioid agonist therapy (OAT) have been put forward as having an important role in the management and elimination of chronic hepatitis C (HCV) infection. Yet, HCV treatment uptake and coverage have remained low among OAT populations. We aimed to calculate cumulative HCV treatment coverage among individuals enrolled in OAT in Norway between 2013 and 2017, and to document the treatment transition to interferon-free regimens. Moreover, we aimed to describe adherence to DAAs in the same cohort.
Methods
This observational study was based on data from The Norwegian Prescription Database (NorPD). We studied dispensed OAT and HCV treatment annually to calculate the cumulative frequency, and employed secondary sources to further calculate prevalence, incidence and HCV treatment coverage from 2013 to 2017, among the OAT population. Factors associated with adherence to DAAs were identified a priori and subject to logistic regression.
Results
10,371 individuals were identified with dispensed OAT, 1,475 individuals of these with dispensed HCV treatment. Annual HCV treatment coverage increased from 3.5% (95% CI: 3.2-4.4) in 2013 to 17% (95% CI: 17-20) in 2017, giving a cumulative HCV coverage among OAT patients in Norway of 38.5%. A complete shift to interferon-free treatment regimens occured, where DAAs accounting for 32% of HCV treatments in 2013 and 99% in 2017. About two-thirds of OAT patients were considered adherent to their DAA regimens across all genotypes. High-level of OAT continuity was associated with improved adherence to DAAs (aOR 1.4, 95% CI: 1-2, p=0.035).
Conclusions
A large increase in HCV treatment coverage attributed by a complete shift to interferon-free regimens among the Norwegian OAT population has been demonstrated. However, a further substantial scale-up in HCV treatment is required to reach the universal targets of controlling and eradicating the HCV endemic.
Figure 1
This is a list of supplementary files associated with this preprint. Click to download.
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