title: Shift in disparities in hepatitis C treatment from interferon to DAA era: A population-based cohort study.
abstract: We evaluated the shift in the characteristics of people who received interferon-based hepatitis C virus (HCV) treatments and those who received recently introduced direct-acting antivirals (DAAs) in British Columbia (BC), Canada. The BC Hepatitis Testers Cohort includes 1.5 million individuals tested for HCV or HIV, or reported cases of hepatitis B and active tuberculosis in BC from 1990 to 2013 linked to medical visits, hospitalization, cancer, prescription drugs and mortality data. This analysis included all patients who filled at least one prescription for HCV treatment until 31 July 2015. HCV treatments were classified as older interferon-based treatments including pegylated interferon/ribavirin (PegIFN/RBV) with/without boceprevir or telaprevir, DAAs with RBV or PegIFN/RBV, and newer interferon-free DAAs. Of 11 886 people treated for HCV between 2000 and 2015, 1164 (9.8%) received interferon-free DAAs (ledipasvir/sofosbuvir: n=1075; 92.4%), while 452 (3.8%) received a combination of DAAs and RBV or PegIFN/RBV. Compared to those receiving interferon-based treatment, people with HIV co-infection (adjusted odds ratio [aOR]: 2.96, 95% CI: 2.31-3.81), cirrhosis (aOR: 1.77, 95% CI: 1.45-2.15), decompensated cirrhosis (aOR: 1.72, 95% CI: 1.31-2.28), diabetes (aOR: 1.30, 95% CI: 1.10-1.54), a history of injection drug use (aOR: 1.34, 95% CI: 1.09-1.65) and opioid substitution therapy (aOR: 1.30, 95% CI: 1.01-1.67) were more likely to receive interferon-free DAAs. Socio-economically marginalized individuals were significantly less likely (most deprived vs most privileged: aOR: 0.71, 95% CI: 0.58-0.87) to receive DAAs. In conclusion, there is a shift in prescription of new HCV treatments to previously excluded groups (eg HIV-co-infected), although gaps remain for the socio-economically marginalized populations.
authors.affiliation: British Columbia Centre for Disease Control, Vancouver, BC, Canada.|School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
authors.forename: N Z
authors.initials: NZ
authors.lastname: Janjua
authors.affiliation: British Columbia Centre for Disease Control, Vancouver, BC, Canada.|School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
authors.forename: N
authors.initials: N
authors.lastname: Islam
authors.affiliation: British Columbia Centre for Disease Control, Vancouver, BC, Canada.|School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Wong
authors.affiliation: Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: E M
authors.initials: EM
authors.lastname: Yoshida
authors.affiliation: Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Ramji
authors.affiliation: British Columbia Centre for Disease Control, Vancouver, BC, Canada.
authors.forename: H
authors.initials: H
authors.lastname: Samji
authors.affiliation: British Columbia Centre for Disease Control, Vancouver, BC, Canada.|School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Z A
authors.initials: ZA
authors.lastname: Butt
authors.affiliation: British Columbia Centre for Disease Control, Vancouver, BC, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Chong
authors.affiliation: British Columbia Centre for Disease Control, Vancouver, BC, Canada.
authors.forename: D
authors.initials: D
authors.lastname: Cook
authors.affiliation: British Columbia Centre for Disease Control, Vancouver, BC, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Alvarez
authors.affiliation: British Columbia Centre for Disease Control, Vancouver, BC, Canada.|School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Darvishian
authors.affiliation: British Columbia Centre for Disease Control, Vancouver, BC, Canada.|School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Tyndall
authors.affiliation: British Columbia Centre for Disease Control, Vancouver, BC, Canada.|Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Krajden
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000627:therapeutic use*; D001955:British Columbia; D015331:Cohort Studies; D005260:Female; D054625:Healthcare Disparities; D019698:Hepatitis C, Chronic / Q000188:drug therapy*; D006801:Humans; D007372:Interferons / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009842:Oligopeptides / Q000627:therapeutic use*; D011392:Proline / Q000031:analogs & derivatives* / Q000627:therapeutic use; D012254:Ribavirin / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D009842:Oligopeptides; D012254:Ribavirin; C486464:telaprevir; C512204:N-(3-amino-1-(cyclobutylmethyl)-2,3-dioxopropyl)-3-(2-((((1,1-dimethylethyl)amino)carbonyl)amino)-3,3-dimethyl-1-oxobutyl)-6,6-dimethyl-3-azabicyclo(3.1.0)hexan-2-carboxamide; D007372:Interferons; D011392:Proline
keywords: 
  HIV
  ; direct-acting antivirals; hepatitis C virus; injection drug use; treatment access