Determinants of hepatitis C antiviral effectiveness awareness among people who inject drugs in the direct-acting antiviral era

Background & aims: Although people who inject drugs (PWID) are at greatest risk of hepatitis C (HCV), treatment uptake in this population has historically been low. Highly effective direct acting antiviral (DAA) treatments for HCV have recently become available. Our aim was to assess the awareness among PWID of these new therapies and their effectiveness.

Methods: A national survey of PWID attending injecting equipment provision sites in Scotland during 2015-2016 included questions to gauge the awareness in this population of antiviral treatment and the high cure rates associated with new therapies (defined here as >80%).

Results: Among 2,623 PWID, 92% had ever been tested for HCV. After excluding those ever treated for HCV (n=226), 79% were aware of HCV treatment. Awareness was more likely among those who had ever been tested and self-reported either a positive (adjusted odds ratio: 16.04, 95%CI 10.57–24.33) or negative (3.11, 2.30–4.22) test result, compared to those who were never tested. The minority of all respondents (17%) were aware of high cure rates. This awareness was more likely among those who had ever been in HCV specialist care (9.76, 5.13–18.60) and those who had not been in specialist care but had been tested and self-reported either a positive (3.91, 2.20–7.53) or negative (2.55, 1.35–4.81) test result, compared to those who had never been tested.

Conclusion: We found poor awareness of the high cure rates associated with DAAs among PWID in Scotland, despite relatively high rates of HCV testing in this population. Increased effort is needed to ensure population groups with high risk of HCV infection are fully informed of the highly effective antiviral medications now available to treat this chronic disease.