# The Hepatitis C Cascade of Care for Opioid Agonist Therapy Recipients in Australia

## TL;DR

This study examines how people on opioid treatment in Australia engage with hepatitis C care, finding that while testing and treatment rates are high among those diagnosed, many are not tested at all.

## Contribution

The study quantifies the hepatitis C care cascade specifically among opioid agonist therapy recipients in Australia using linked clinical data.

## Key findings

- 44% of opioid agonist therapy recipients had an HCV test after their first prescription.
- 69% of RNA-positive individuals were prescribed direct-acting antiviral treatment.
- Despite high HCV prevalence, many OAT recipients were not engaged in HCV care.

## Abstract

People prescribed opioid agonist therapy (OAT) are a key population for hepatitis C virus (HCV) elimination. Health service engagement associated with OAT provision may facilitate hepatitis C testing and treatment. We aimed to quantify the HCV care cascade among people receiving OAT in Australia.

We extracted linked data from individuals attending any of 58 clinics participating in the ACCESS national sentinel surveillance network of primary care and sexual health clinics from 1 January 2016 to 31 December 2023. Outcomes included evidence of any HCV test (antibody or RNA) or direct-acting antiviral (DAA) prescription at an ACCESS clinic after their first OAT prescription. RNA positive individuals were inferred antibody positive; individuals with a DAA prescription were inferred RNA and antibody positive. We determined the number of individuals at each stage of the following cascade by the end of the study period: (1) positive antibody, (2) positive RNA, and (3) DAA prescription.

Among 15 382 individuals prescribed OAT, 44% (6817) had an HCV antibody or RNA test after their first OAT prescription. Of these, 64% (4368/6817) were antibody positive by the end of the study period. Of these, 67% (2911/4368) were RNA positive, and of those, 69% (2007/2911) were prescribed DAAs.

A high proportion of people prescribed OAT were not engaged in care by their OAT provider or across ACCESS network clinics, but when diagnosed, rates of treatment were high. Given high HCV antibody and RNA prevalence, integrating HCV care into regular OAT care should be a priority for HCV elimination in Australia.

Despite high hepatitis C antibody and RNA positivity among people on opioid agonist therapy (OAT) in Australia, only 44% had a hepatitis C test after their OAT prescription, and 69% of those eligible for treatment were prescribed direct-acting antiviral treatment.