The impact of direct-acting antivirals on hepatitis C viraemia among people who inject drugs in England; real-world data 2011–2018

Megan Bardsley*, Ellen Heinsbroek, Ross Harris, Sara Croxford, Claire Edmundson, Vivian Hope, Nasra Hassan, Samreen Ijaz, Sema Mandal, Justin Shute, Sharon J. Hutchinson, Matthew Hickman, Katherine Sinka, Emily-Rose Phipps

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)
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Direct-acting antiviral (DAA) therapy for anybody with viraemic HCV infection has been scaled-up in England since 2017. To assess early impacts, we investigated trends in, and factors associated with, HCV viraemia among people who inject drugs (PWID). We also examined trends in self-reported treatment access. Bio-behavioural data from an annual, national surveillance survey of PWID (2011–2018) estimated trends in viraemic prevalence among HCV antibody-positive PWID. Multivariable logistic regression identified characteristics independently associated with viraemia. Trends in treatment access were examined for PWID with known infection. Between 2011 and 2016, viraemic prevalence among antibody-positive PWID remained stable (2011, 57.7%; 2016, 55.8%) but decreased in 2017 (49.4%) and 2018 (50.4%) (both p < 0.001). After adjustment for demographic and behavioural characteristics, there remained significant reduction in viraemia in 2017 (adjusted odds ratio [aOR] 0.79, 95% CI 0.65–0.94) and 2018 (aOR 0.79, 95% CI 0.66–0.93) compared to 2016. Other factors associated with viraemia were male gender (aOR 1.68, 95% CI 1.53–1.86), geographical region, injecting in past year (aOR 1.26, 95% CI 1.13–1.41), imprisonment (aOR 1.14, 95% CI 1.04–1.31) and homelessness (aOR 1.17, 95% CI 1.04–1.31). Among non-viraemic PWID with known infection, the proportion reporting ever receiving treatment increased in 2017 (28.7%, p < 0.001) and 2018 (38.9%, p < 0.001) compared to 2016 (14.5%). In conclusion, there has been a small reduction in HCV viraemia among antibody-positive PWID in England since 2016, alongside DAA scale-up, and some indication that treatment access has improved in the same period. Population-level monitoring and focus on harm reduction is critical for achieving and evaluating elimination.

Original languageEnglish
Pages (from-to)1452-1463
Number of pages12
JournalJournal of Viral Hepatitis
Issue number10
Early online date29 Jul 2021
Publication statusPublished - 21 Sep 2021

Bibliographical note

Funding Information: This study is funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme (Grant Reference Number RP‐PG‐0616‐20008). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care

Open Access: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Publisher Copyright: © 2021 Crown copyright. Journal of Viral Hepatitis published by John Wiley & Sons Ltd. This article is published with the permission of the Controller of HMSO and the Queen's Printer for Scotland.

Citation: Bardsley, M, Heinsbroek, E, Harris, R, et al. The impact of direct-acting antivirals on hepatitis C viraemia among people who inject drugs in England; real-world data 2011–2018. J Viral Hepat. 2021; 28: 1452– 1463.



  • direct-acting antivirals
  • elimination
  • hepatitis C virus
  • people who inject drugs
  • treatment as prevention


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