Cascade of Care Program Aids in Promoting Treatment for Hepatitis C Patients


Incarceration history and current opioid agonist treatment was associated with antibody testing.

Daisy Gibbs, MPH

Daisy Gibbs, MPH

A cascade of care program is aiding Australian people who inject drugs and are also hepatitis C virus (HCV) positive initiate and complete treatment.

A team, led by Daisy Gibbs, National Drug and Alcohol Research Centre, UNSW Sydney, identified the ongoing cascade of care plans among Australian patients with HCV who inject drugs and identified the factors associated with engagement at each of the stages.

Cascade of Care

Many countries worldwide need a better understanding of the factors linked to engagement across the hepatitis C virus cascade of care for individuals who inject drugs.

The investigators identified patients who were in the 2018 and 2019 Illicit Drug Reporting Systems, Australians who regularly inject drugs. Each participated reported lifetime HCV antibodies and RNA testing, treatment uptake, and completion. The investigators used multivariable logistic regression to identify the characteristics associated with outcomes.

People Who Inject Drugs

There were a total of 1499 participants, 87% of which reported antibody testing. Of this group, 70% of participants reported RNA testing of which 60% were RNA positive.

In this subgroup, 76% reported initiating treatment, 78% of which completed treatment.


The investigators also focused on a number of other external factors that increased the risk of hepatitis C virus infections.

For example, incarceration history (aOR, 1.90; 95% CI, 1.28-2.82) and current opioid agonist treatment (aOR, 1.99; 95% CI, 1.14-3.47) were both associated with antibody testing. Also, associated with antibody testing was recent alcohol and other drug counseling (aOR, 2.22; 95% CI, 1.27-3.88).

For RNA testing, there was an association with incarceration history (aOR, 1.42; 95% CI, 1.07-1.87) and current opioid agonist treatment (aOR, 2.07; 95% CI, 1.51-2.86).

There was also an association between current opioid agonist treatment (aOR, 192; 95% CI, 1.22-3.03) and recent alcohol and other drug counseling (aOR, 1.91; 95% CI. 1.16-3.13) and treatment uptake.

Finally, there was a trend with a specific injected drug.

Methamphetamine was the drug injected most often in the last month, which was associated with reduced odds of antibody (aOR, 0.41; 95% CI, 0.25-0.66) and RNA testing (aOR, 0.54; 95% CI, 0.40-0.74) compared to heroin.

“[Cascade of care] engagement amongst Australian [people who inject drugs] is encouraging, with [recent alcohol and other drug] service engagement associated with testing and treatment,” the authors wrote. “Further efforts to reach those not service engaged, particularly those not receiving [opioid agonist treatment] or who predominantly inject methamphetamine, are needed to achieve HCV elimination targets.”

Health Interventions

Earlier this year, a study suggests mobile health interventions among those with opioid use disorder may help increase uptake of HCV testing among high-risk patients.

A team led Karli Hochstatter, MPH, PhD, School of Social Work, Columbia University, used the Addiction-Comprehensive Health Enhancement Support System (A-CHESS), a smartphone-delivered relapse prevention system, to provide HCV-related and educational content to patients.

Furthermore, 44.2% were HCV Ab positive and 25.5% were considered untested at baseline.

The team noted no significant difference in HCV testing uptake between the intervention and control cohort.

However, among 109 participants who engaged in injection drug use, those in the intervention group (n = 63) had a greater rate of HCV testing uptake compared with those in control group (89% vs 85%, respectively; HR, 1.34; 95% CI, 0.87-2.05; P = .18).

This trend was even more pronounced in the subset of 32 patients (23 intervention, 9 control) who reported sharing injections (87% intervention vs 56% control; HR, 2.92; 95% CI, 0.959-8.86; P = .06).

The study, “Hepatitis C virus cascade of care among people who inject drugs in Australia: Factors associated with testing and treatment in a universal healthcare system,” was published online in Drug and Alcohol Dependence.

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