title: Low uptake of treatment for hepatitis C virus infection in a large community-based study of inner city residents.
abstract: Despite the availability of effective therapy for hepatitis C virus (HCV) infection, there are little data on the uptake of treatment. We evaluated factors associated with HCV infection and the uptake of HCV treatment in a large community-based inner city cohort in Vancouver, Canada. The Community Health and Safety Evaluation is a cohort study of inner city residents recruited from January 2003 to June 2004. HIV and HCV status and information on prescriptions for HCV treatment were determined through linkage with provincial databases. HCV prevalence was calculated and factors associated with HCV infection were identified. HCV treatment uptake and incidence of HCV infection from January 2000 to December 2004 were expressed in terms of person-years of observation. Among 2913 individuals, HCV antibody testing was performed in 2118 and the HCV seroprevalence was 64.2% (1360 of 2118). In total, 1.1% of HCV antibody-positive individuals (15 of 1360) initiated treatment for HCV infection from January 2000 to December 2004 [0.28 cases per 100 person-years (95% CI, 0.15-0.46)]. Three of 15 (20.0%) treated individuals achieved a sustained virological response. During the same period, the incidence of HCV infection was 7.26 cases (95% CI, 5.72-8.80) per 100 person-years. Overall, the rate of new HCV seroconversions in this cohort in the study period was about 25 times the rate of HCV treatment uptake. There are extremely low rates of HCV treatment initiation and very limited effectiveness, despite a high prevalence of HCV infection in this large community-based cohort of inner city residents with access to universal healthcare.
authors.affiliation: National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, NSW, Australia. jgrebely@nchecr.unsw.edu.au
authors.forename: J
authors.initials: J
authors.lastname: Grebely
authors.forename: J D
authors.initials: JD
authors.lastname: Raffa
authors.forename: C
authors.initials: C
authors.lastname: Lai
authors.forename: M
authors.initials: M
authors.lastname: Krajden
authors.forename: T
authors.initials: T
authors.lastname: Kerr
authors.forename: B
authors.initials: B
authors.lastname: Fischer
authors.forename: M W
authors.initials: MW
authors.lastname: Tyndall
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada / Q000453:epidemiology; D002947:Cities; D015897:Comorbidity; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004358:Drug Therapy / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology; D006526:Hepatitis C / Q000188:drug therapy* / Q000453:epidemiology*; D018937:Hepatitis C Antibodies / Q000097:blood; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016036:Seroepidemiologic Studies; D014505:Urban Population; D055815:Young Adult
chemical_list: D018937:Hepatitis C Antibodies