The Auckland Opioid Treatment Service (AOTS) carried out two pilot audits of the current Hepatitis C (HCV) status of people receiving opioid treatment in 2016 and 2017. The outcomes indicated that a significant proportion of people had current active HCV infection but were not engaged in treatment.
A 2018 audit of all people accessing the AOTS was then carried out as a summer studentship with the University of Auckland to develop an up-to-date picture of their current HCV status and any treatment received, and what follow up was needed to support their ongoing wellbeing. Of the 1,145 people engaged with the service, almost 90% had been tested for HCV and of those people tested 70% had tested antibody positive, indicating prior exposure to HCV. Two thirds of this group had either spontaneously cleared the virus or had already been successfully treated.
Of the 238 people with active HCV, 60 were currently in treatment and 61 had HCV genotypes for which there is no currently funded treatment available. PHARMAC are currently considering funding a highly successful multi genotype treatment but confirmation of funding is not likely before the end of 2018. The audit identified four distinct groups of people with HCV that would require specific strategies to engage them in treatment:
- Those who have never had a test.
- Those who have had no test for active HCV infection (viral load).
- Those with active HCV who have never been referred for treatment or who have not followed through with referral.
- Those who are at risk of infection or reinfection but have never had repeat HCV testing while on the programme.
AOTS will now be able to use this information to identify the people in these distinct groups to identify who needs treatment and to support active engagement with HCV treatment.
Written by Matthew Bell, 4th year medical student, University of Auckland and Dr Vicki Macfarlane (FRNZCGP, FAChAM), Lead Clinician at CADS Auckland.