Grant: Travel Awards - Institute Community Support

The new hepatitis C (HCV) drugs known as direct acting antivirals (DAAs) have revolutionized treatments because now almost everyone can be cured. However, it is not clear if everyone is accessing these treatments equally. Historically, HCV treatment rates among HIV-HCV coinfected individuals have been low, particularly among marginalized populations, such as people of Aboriginal decent and people who inject drugs (PWID). In a publically funded healthcare setting, we investigated DAA treatment initiation rates among key HIV-HCV co-infected populations (including women, Aboriginals and PWID). We used data from the Canadian HIV-HCV Co-Infection Cohort Study (a study that has been prospectively following more than 1650 participants from 19 centers for over 10 years). This cohort represents approximately a quarter of the total co-infected population in care in Canada. Among 812 participants eligible to receive treatment, 195 initiated DAAs. Overall DAA uptake was markedly lower among Aboriginals, women and active PWID. After controlling for a number of other factors that could explain why someone would or would not initiate treatment we found the group to have the lowest probability of initiating DAAs were female, Aboriginal, PWID; their chance of initiating treatment was about 3%. The group with the highest probability of initiating treatment was male, heterosexual, non-Aboriginal, non-PWID; their chance of initiating treatment was about 30%. DAAs have generated enthusiasm that HCV can be eradicated from the population. While treatment uptake has increased with the availability of DAAs, marginalized populations, engaged in care, are still failing to access treatment. Targeted strategies to expanded treatment to these groups are needed to avoid future inequities.