High hepatitis C treatment uptake among people with recent drug dependence in New South Wales, Australia.

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High HCV treatment among people at most risk of transmission is essential to achieve elimination. We aimed to characterise subpopulations of people with HCV based on drug dependence, to estimate direct-acting antiviral (DAA) uptake in an unrestricted treatment era, and evaluate factors associated with treatment uptake among people with recent drug dependence.HCV notifications in New South Wales, Australia (1995-2017) were linked to opioid agonist therapy (OAT), hospitalisations, incarcerations, HIV notifications, deaths, and prescription databases. Drug dependence was defined as hospitalisation due to injectable drugs or receipt of OAT, with these indicators in 2016-2018 considered recent. Records were weighted to account for spontaneous clearance. Logistic regression was used to analyse factors associated with treatment uptake among those with recent drug dependence.57,467 people were estimated to have chronic HCV throughout the DAA era. Treatment uptake was highest among those with recent (47%), compared to those with distant (38%), and no (33%) drug dependence. Among those with recent drug dependence, treatment was more likely among those with HIV (aOR: 1.71, 95%CI: 1.24, 2.36), recent incarceration (aOR: 1.10, 95%CI: 1.01, 1.19), and history of alcohol use disorder (aOR: 1.22, 95%CI: 1.13, 1.31). Treatment was less likely among women (aOR: 0.78, 95%CI: 0.72, 0.84), Indigenous (aOR: 0.75, 95%CI: 0.69, 0.81), foreign-born (aOR: 0.86, 95%CI: 0.78, 0.96), those with outer-metropolitan notifications (aOR: 0.90, 95%CI: 0.82, 0.98), HBV (aOR: 0.69, 95%CI: 0.59, 0.80), and >1 recent hospitalisation (aOR: 0.91, 95%CI: 0.84, 0.98).These data provide evidence of high DAA uptake among people with recent drug dependence, including those incarcerated. Enhancing this encouraging initial uptake among high-risk populations will be essential to achieve HCV elimination.

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