title: Continued low uptake of treatment for hepatitis C virus infection in a large community-based cohort of inner city residents.
abstract: OBJECTIVE
  Despite advances in HCV treatment, recent data on treatment uptake is sparse. HCV treatment uptake and associated factors were evaluated in a community-based cohort in Vancouver, Canada.
  
  
  METHODS
  The CHASE study is a cohort of inner city residents recruited from January 2003-June 2004. HCV status and treatment were retrospectively and prospectively determined through data linkages with provincial virology and pharmacy databases. Logistic regression analyses were used to identify factors associated with HCV treatment uptake.
  
  
  RESULTS
  Among 2913, HCV antibody testing was performed in 2405, 64% were HCV antibody-positive (n = 1533). Individuals with spontaneous clearance (18%, n = 276) were excluded. Among the remaining 1257 HCV antibody-positive participants (mean age 42, 71% male), 29% were Aboriginal. At enrolment, the majority reported recent injecting (60%) and non-injecting drug use (87%). Between January 1998 and March 2010, 6% (77 of 1257) initiated HCV treatment. In adjusted analyses, Aboriginal ethnicity [adjusted odds ratio (AOR) 0.23; 95% CI 0.10, 0.51] and crack cocaine use (AOR 0.61; 95% CI 0.37, 0.99) were associated with a decreased odds of receiving HCV treatment, while methamphetamine injecting (AOR 0.16; 95% CI 0.02, 1.18) trended towards a lower odds of receiving treatment. HCV treatment uptake ranged from 0.2 (95% CI 0.0, 0.7) per 100 person-years (PYs) in 2003 to 1.6 (95% CI 0.9, 2.6) per 100 PYs in 2009.
  
  
  CONCLUSIONS
  HCV treatment uptake remains low in this large community-based cohort of inner city residents with a high HCV prevalence and access to universal healthcare.
authors.affiliation: The Kirby Institute for Infection and Immunity in Society, The University of New South Wales, Sydney, Australia.
authors.forename: Maryam
authors.initials: M
authors.lastname: Alavi
authors.forename: Jesse D
authors.initials: JD
authors.lastname: Raffa
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Deans
authors.forename: Calvin
authors.initials: C
authors.lastname: Lai
authors.forename: Mel
authors.initials: M
authors.lastname: Krajden
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Dore
authors.forename: Mark W
authors.initials: MW
authors.lastname: Tyndall
authors.forename: Jason
authors.initials: J
authors.lastname: Grebely
mesh_terms: D000328:Adult; D001955:British Columbia / Q000453:epidemiology; D002947:Cities; D015331:Cohort Studies; D055812:Community-Based Participatory Research; D055030:Drug Users / Q000706:statistics & numerical data; D005260:Female; D006526:Hepatitis C / Q000453:epidemiology* / Q000628:therapy*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies
keywords: drug use; hepatitis C virus; people who inject drugs; treatment uptake