A163 DIRECT ACTING ANTIVIRAL UPTAKE DISPARITIES IN HIV-HEPATITIS C CO-INFECTED POPULATIONS IN CANADA
Bibliographic record
Abstract
Direct acting antivirals (DAAs) have revolutionized hepatitis C (HCV) treatment with nearly 100% cure rates even in real-world studies, giving hope that HCV can be eliminated. Historically, HCV treatment initiation rates have been low, particularly among people who inject drugs (PWID) an important group to target if the goal is to reduce incident HCV infections. In a publically funded health care setting, we investigated DAA treatment uptake disparities among HIV-HCV co-infected key populations. The Canadian Co-Infection Cohort Study prospectively follows 1625 HIV/HCV co-infected participants from 19 centers, representing approximately a quarter of the total Canadian co-infected population in care. Among HCV RNA+ participants, we determined the incidence of HCV treatment initiation per year and stratified by different risk profiles (Aboriginals, women, PWID and men who have sex with men (MSM)). Multivariate Cox models were used to estimate adjusted hazard ratios (aHR) for DAA initiation accounting for age, sex, Aboriginal status, active (within 6 months) and past PWID, MSM, alcohol use, advanced fibrosis, HCV genotype, undetectable HIV RNA, province and income (a priori predictors of treatment initiation). Overall, HCV treatment initiations rose more than four times between 2013 and 2015, from 6 (95% CI: 5- 9) to 24 (95% CI: 20–29) per 100 person-years. After stratifying initiation by risk profiles, uptake was markedly lower among Aboriginals, women and active PWID. Among 854 HCV RNA+ participants, 195 initiated DAAs [128=ledipasvir/sofosbuvir (SOF); 28=SOF/ribavirin; 19=SOF/simeprevir; 13=SOF/ribavirin/interferon; 7=other all-oral regimens]. After adjustment (aHR, 95% CI), Aboriginals (0.56, 0.34–0.94), active PWID (0.54, 0.36–0.84) remained less likely to initiate HCV treatment. Women and past PWID tended to have lower treatment rates (0.80, 0.55, 1.15) and 0.73 (0.53, 1.02). Conversely, MSM were more likely to initiate DAAs (1.89, 1.41- 2.46). SVR rates were high in all sub-groups regardless of uptake: 100% in women and Aboriginals, 95% in active PWID and 91% in MSM compared to 93% for the cohort overall. Treatment uptake has increased dramatically with the availability of all oral DAAs, but marginalized populations are still failing to access treatment. Barriers to treating these subgroups, who can obtain high SVR rates, need to be addressed if DAAs are to impact HCV incidence and the overall burden of chronic liver disease. CIHRCanHepC, FRQS
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.005 |
| Science and technology studies | 0.004 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".