REDUCTION IN THE POPULATION PREVALENCE OF HCV VIRAEMIA AMONG PEOPLE WHO INJECT DRUGS ASSOCIATED WITH SCALE-UP OF DIRECT-ACTING ANTIVIRAL THERAPY IN COMMUNITY DRUG SERVICES: REAL WORLD DATA.

BACKGROUND AND AIMS There has been little empirical evidence to show the 'real world' impact of scaling-up direct-acting antiviral (DAA) treatment among people who inject drugs (PWID) on hepatitis C virus (HCV) viraemia at a population level. We aimed to assess the population impact of rapid DAA scale-up to PWID delivered through community services - including drug treatment, pharmacies, needle exchanges, and prisons - in the Tayside region of Scotland, compared with Greater Glasgow & Clyde (GGC) and the Rest of Scotland (RoS). DESIGN Natural experiment, evaluated using data from national biennial surveys of PWID and national clinical data. SETTING Services providing injecting equipment (2010-2018) and HCV treatment clinics (2017-2018) across Scotland. PARTICIPANTS 12,492 PWID who completed a questionnaire and provided a blood spot (tested for HCV-antibodies and RNA); 4,105 individuals who initiated HCV treatment. INTERVENTION AND COMPARATOR The intervention was rapid DAA scale-up among PWID, which occurred in Tayside. The comparator was GGC/RoS. MEASUREMENTS Trends in HCV viraemia and uptake of HCV therapy over time; sustained viral response (SVR) rates to therapy by region and treatment setting FINDINGS: Uptake of HCV therapy (last year) among PWID between 2013-14 and 2017-18 increased from 15% to 43% in Tayside, 6% to 16% in GGC and 11% to 23% in RoS. Between 2010 and 2017-18, the prevalence of HCV viraemia (among antibody-positives) declined from 73% to 44% in Tayside, 67% to 58% in GGC and 64% to 55% in RoS. The decline in viraemia was greater in Tayside (2017-18 AOR 0·47, 95% CI 0·30-0·75, p=0.001) than elsewhere in Scotland (2017-18 AOR 0·89, 95% CI 0·74-1·07, p=0.220) relative to the baseline of 2013-14 in RoS (including GGC). Per-protocol SVR rates among PWID treated in community sites did not differ from those treated in hospital sites in Tayside (97·4% vs 100·0%, p=0·099). CONCLUSIONS Scale-up of direct-acting antiviral treatment among people who inject drugs can be achieved through hepatitis C virus (HCV) testing and treatment in community drug services whilst maintaining high sustained viral response rates and, in the Tayside region of Scotland, has led to a substantial reduction in chronic HCV in the population.