ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2020
Eliminating Structural Barriers: The Impact of Unrestricted Access on Hepatitis C Treatment Uptake Among People Living With Human Immunodeficiency Virus.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
21 citing papers in PubMed, 1 synthesis or guideline pooled it, 35 citations in OpenAlex.
- Interventions to Improve Uptake of Direct-Acting Antivirals for Hepatitis C Virus in Priority Populations: A Systematic Review.Frontiers in public health · 2022Pooled it
- Direct-Acting Antiviral Initiation Among People With Hepatitis C Virus (HCV) and HIV on Antiretroviral Therapy in the United States and Canada: Factors Driving the HCV Treatment Gap.Open forum infectious diseases · 2025Article
- Progress Toward Hepatitis C Virus Elimination among People Living with HIV-Hepatitis C Virus Coinfection in Canada.Canadian liver journal · 2025Article
- Impact of Policy Changes Expanding Access to Direct-Acting Antivirals on Hepatitis C Virus-Related Hospitalizations in People With HIV: A Population-Based Study.Open forum infectious diseases · 2025Article
- Hepatitis C Diagnosis and Treatment Among Indigenous People in a Canadian Context: Challenges and Community-Led Solutions.Microorganisms · 2024Review
- Disengagement from Care Among People Co-Infected with HIV and HCV: A Scoping Review.AIDS and behavior · 2024Article
- Frequent Disengagement and Subsequent Mortality Among People With HIV and Hepatitis C in Canada: A Prospective Cohort Study.Open forum infectious diseases · 2024Article
- Article
- Cohort Profile: International Collaboration on Hepatitis C Elimination in HIV Cohorts (InCHEHC).International journal of epidemiology · 2024Article
- Accessing hepatitis C direct acting antivirals among people living with hepatitis C: a qualitative study.International journal for equity in health · 2023Article
- Time-to-hepatitis C treatment initiation among people who inject drugs in Melbourne, Australia.Epidemiology and infection · 2023Article
- Reducing Liver Cancer Risk through Dietary Change: Positive Results from a Community-Based Educational Initiative in Three Racial/Ethnic Groups.Nutrients · 2022Article
- Medicaid Hepatitis C Virus Treatment Policies: Impact on Testing and Treatment in the Commercially Insured.American journal of preventive medicine · 2022Article
- Regional differences in access to direct-acting antiviral treatments for hepatitis C across Ontario: A cross-sectional study.Canada communicable disease report = Releve des maladies transmissibles au Canada · 2022Article
- Barriers and facilitators related to HCV treatment uptake among HIV coinfected populations in Canada: Patient and treatment provider perceptions.Canadian liver journal · 2022Article
- Potential interventions to support HCV treatment uptake among HIV co-infected people in Canada: Perceptions of patients and health care providers.Canadian liver journal · 2022Article
- The hepatitis C epidemic in Canada: An overview of recent trends in surveillance, injection drug use, harm reduction and treatment.Canada communicable disease report = Releve des maladies transmissibles au Canada · 2021Article
- Adherence and sustained virologic response among vulnerable people initiating an hepatitis C treatment at a nurse-led clinic: A non-experimental prospective cohort study based on clinical records.International journal of nursing studies advances · 2021Article
- Disparities in Treatment with Direct-Acting Hepatitis C Virus Antivirals Persist Among Adults Coinfected with HIV and Hepatitis C Virus in US Clinics, 2010-2018.AIDS patient care and STDs · 2021Article
- Direct-acting antiviral treatment uptake and sustained virological response outcomes are not affected by alcohol use: A CANUHC analysis.Canadian liver journal · 2021Article
Corrections and comments
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Authors and funding
16 authors at 11 institutions in 1 country.
Funding
Abstract
backgroundHigh costs of direct-acting antivirals (DAAs) have led health-care insurers to limit access worldwide. Using a natural experiment, we evaluated the impact of removing fibrosis stage restrictions on hepatitis C (HCV) treatment initiation rates among people living with human immunodeficiency virus (HIV), and then examined who was left to be treated.
methodsUsing data from the Canadian HIV-HCV Coinfection Cohort, we applied a difference-in-differences approach. Changes in treatment initiation rates following the removal of fibrosis stage restrictions were assessed using a negative binomial regression with generalized estimating equations. The policy change was then specifically assessed among people who inject drugs (PWID). We then identified the characteristics of participants who remained to be treated using a modified Poisson regression.
resultsBetween 2010-2018, there were a total of 585 HCV initiations among 1130 eligible participants. After removing fibrosis stage restrictions, DAA initiations increased by 1.8-fold (95% confidence interval [CI] 1.3-2.4) controlling for time-invariant differences and secular trends. Among PWID the impact appeared even stronger, with an adjusted incidence rate ratio of 3.6 (95% CI 1.8-7.4). However, this increased treatment uptake was not sustained. At 1 year following universal access, treatment rates declined to 0.8 (95% CI .5-1.1). Marginalized participants (PWID and those of indigenous ethnicity) and those disengaged from care were more likely to remain HCV RNA positive.
conclusionsAfter the removal of fibrosis restrictions, HCV treatment initiations nearly doubled immediately, but this treatment rate was not sustained. To meet the World Health Organization elimination targets, the minimization of structural barriers and adoption of tailored interventions are needed to engage and treat all vulnerable populations.
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Registered trials
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