@article{7a251c7728ba45648e948eff30f6c2c9,
title = "Treatment as prevention effect of direct-acting antivirals on primary hepatitis C virus incidence: Findings from a multinational cohort between 2010 and 2019",
abstract = "Background: Broad direct-acting antiviral (DAA) access may reduce hepatitis C virus (HCV) incidence through a “treatment as prevention” (TasP) effect. We assessed changes in primary HCV incidence following DAA access among people living with HIV (PLHIV). Methods: We used pooled individual-level data from six cohorts from the International Collaboration on Hepatitis C Elimination in HIV Cohorts (InCHEHC). Follow-up started from the first recorded negative HCV antibody test date and ended at last negative antibody test or estimated infection date. Follow-up was restricted to 2010–2019. We used segmented Poisson regression to model trends across pre-, limited- (i.e., restrictions on access) and broad-DAA access periods. Findings: Overall, 45,942 participants had at least one HCV antibody negative result and follow-up between 2010 and 2019. We observed 2042 incident HCV infections over 248,189 person-years (PY). Pooled incidence decreased from 0.91 per 100 PY in 2015 to 0.41 per 100 PY in 2019. Compared to the average pre-DAA period incidence (0.90 per 100 PY), average incidence was similar during the limited-DAA access period (Incidence rate ratio [IRR] = 0.98; 95%CI = 0.87, 1.11), and 52% lower during the broad-DAA access period (IRR = 0.48; 95%CI = 0.42, 0.52). The average annual decline in HCV incidence was 2% in the pre-DAA period; an additional 9% annual decline in incidence was observed during the limited-DAA access period (IRR = 0.91; 95%CI = 0.82, 1.00) and a further 20% decline in the broad-DAA access period (IRR = 0.80, 95%CI = 0.73, 0.89). Interpretation: Our findings suggest that broad DAA access has a TasP effect on primary HCV incidence among PLHIV. Based on the initial years of DAA availability, the countries in the InCHEHC collaboration are on track to meet the World Health Organization's 80% HCV incidence reduction target for PLHIV by 2030. Funding: This study was funded by the Australian Government National Health and Medical Research Council (Grant number GNT1132902).",
keywords = "Direct-acting antivirals, Elimination, HIV, Hepatitis C virus, Incidence, Trends",
author = "{InCHEHC study group} and {van Santen}, {Daniela K.} and Rachel Sacks-Davis and Ashleigh Stewart and Anders Boyd and Jim Young and {van der Valk}, Marc and Colette Smit and Andri Rauch and Braun, {Dominique L.} and Inmaculada Jarrin and Juan Berenguer and Lazarus, {Jeffrey V.} and Karine Lacombe and Requena, {Maria Bernarda} and Linda Wittkop and Olivier Leleux and Dominique Salmon and Fabrice Bonnet and Gail Matthews and Doyle, {Joseph S.} and Tim Spelman and Klein, {Marina B.} and Maria Prins and Jason Asselin and Stoov{\'e}, {Mark A.} and Margaret Hellard",
note = "Funding Information: The authors thank the study participants for their contribution to the research. The authors acknowledge the contribution of the ACCESS team members and ACCESS advisory committee members who are not co-authors of this article. The authors also acknowledge all clinical services participating in ACCESS. The list of ACCESS team members, ACCESS advisory committee members and participating ACCESS services can be found on the ACCESS website (accessproject.org.au). ACCESS is a partnership between the Burnet Institute, Kirby Institute and National Reference Laboratory. The ATHENA database is maintained by Stichting HIV monitoring and supported by a grant from the Dutch Ministry of Health, Welfare and Sport through the Centre for Infectious Disease Control of the National Institute for Public Health and the Environment ( https://www.hiv-monitoring.nl/en/research-using-our-data/submit-research-proposal/rules-acknowledgement ). The authors acknowledge the contribution of the Swiss HIV Cohort Study participants and team members ( https://shcs.ch/184-for-shcs-publications ). This study has been financed within the framework of the Swiss HIV Cohort Study, supported by the Swiss National Science Foundation (grant #201369 ) and by the SHCS research foundation . Data from the SHCS are gathered by the Five Swiss University Hospitals, two Cantonal Hospitals, 15 affiliated hospitals and 36 private physicians (listed in http://www.shcs.ch/180-health-care-providers ). The authors would like to thank all clinicians and clinical research technicians participating to the SAIDCC database of the Infectious Diseases Unit of St Antoine Hospital, AP-HP, Paris, France. The authors acknowledge the contribution of the AQUITAINE (ANRS CO3 AQUITAINE/AquiVIH-NA) members their participants ( w ebsite: https://aquivih-na.fr/ ). The authors acknowledge the contribution of the CoRIS steering committee members their participants. We wish to thank Campbell Aitken for editing the manuscript. This study was funded by the Australian Government National Health and Medical Research Council (Grant number GNT1132902 ). The funders had no role in the study design, data collection, analyses or interpretation of the data. Publisher Copyright: {\textcopyright} 2022 The Authors",
year = "2023",
month = feb,
doi = "https://doi.org/10.1016/j.eclinm.2022.101810",
language = "English",
volume = "56",
journal = "EClinicalMedicine",
issn = "2589-5370",
publisher = "Lancet Publishing Group",
}