Effect of Combined Harm Reduction Strategies on HCV Incidence among People who Inject Drugs in Montreal, Canada

POSTER PRESENTATIONS (POCT) for HCV antibodies using the OraQuick® HCV Rapid Antibody oral fluid test. All patients testing “reactive” were referred to NHS Hepatology services for HCV RNA confirmation and those testing “non-reactive” were advised about the limitations of POCT, offered the opportunity of blood testing and counselled about harm reduction strategies. Results: Data collection for this pilot commenced in February 2015 and will conclude in January 2016. To date HCV screening has covered 48 sites across London with 379 tested. Of these 68 (17.9%) tested positive for HCV antibodies with 43 (63.2%) being new diagnoses and 22 (32.4%) having a recent history of injecting drug use. Conclusions: This confirms that there is a high prevalence of HCV among homeless people opportunistically screened at homeless residential hostels and day centres across London. A high proportion knew of their status but had disengaged from treatment services. This population therefore includes a high number of undiagnosed cases and previously known HCV positive cases who are not accessing treatment services and potentially contributing to transmission. FRI-416 EFFECT OF COMBINED HARM REDUCTION STRATEGIES ON HCV INCIDENCE AMONG PEOPLE WHO INJECT DRUGS IN MONTREAL, CANADA J. Bruneau1,2, D.J. Aswad1,3, G. Zang1, É. Roy4,5. 1Centre Hospitalier de l’Université de Montréal Research Center (CRCHUM); 2Departement of Family and Emergency Medicine; 3Department of Psychiatry, Université de Montréal, Montréal; 4Université de Sherbrooke, Longueuil; 5Institut National de Santé Publique, Montréal, Canada E-mail: [email protected] Background and Aims: It is largely acknowledged that an integrated harm reduction (HR) strategy involving broad coverage of a combination of interventions is required to control HCV transmission among people who inject drugs (PWID). Evidence of their relative or combined effectiveness for HCV prevention is, however, not well established. The aim was to examine the association between HCV incidence and exposure to two HR strategies, injection material coverage (IMC) and Opioid Agonist therapy (OAT), alone and in combination. Methods: HCV-seronegative PWIDs eligible to OAT were recruited in a prospective cohort between 2004 and 2014. At each semi-annual visit, participants completed interview-administered questionnaires and anti-HCV antibody testing. Exposure to IMC (100% safe sources vs. no) and to OAT (0, <60 mg methadone or suboxone, ≥60 mg methadone) were used to assess HR coverage. Full HR coverage was defined as OAT ≥60 mg methadone and full IMC (100% safe sources), minimal HR as no OAT and <100% safe sources IMC, and partial HR as other combinations. Time-to-event methods were used to estimate incidence rates. Time-updated Cox regression models adjusted for age and gender evaluated associations between incident HCV and HR strategies. Results: Of 313 HCV-seronegative PWIDs enrolled and with at least one follow-up visit (Baseline: 78% males, 43% under 30 years old, 58% IV cocaine, 48% IV prescription opioid, 48% IV heroin past month), 121 became HCV-positive during 699 person-years (p-y) (incidence = 17.3 per 100 p-y (95% CI = 14.4, 20.6)). Compared to no OAT, using OAT with ≥60 mg methadone was protective against HCV (adjusted Hazard Ratio (aHR) 0.38 (95%CI: 0.20, 0.74)), while <60 mg methadone or suboxone was not (aHR: 0.94 (95%CI: 0.58, 1.53)). Full IMC was not associated with HCV infection (aHR: 1.17 (95%CI: 0.79, 1.75)). When assessing HR combinations, a significant protective effect was found for PWIDs who used full HR (aHR: 0.36(95%CI: 0.16, 0.81)), but not for those with partial coverage (aHR: 1.02 (95%CI: 0.63, 1.66)), compared to those with minimal HR coverage. Conclusions: Montreal is still facing a high HCV incidence among PWIDs. Our data suggest that OAT programs using adequate dosing treatments are essential to better control HCV. While full injection material coverage is still paramount to reduce injection risk S462

behaviours, decrease HIV infection and other comorbidities, our data did not find a protective effect against HCV infection in this population. FRI-417 DOES ALCOHOL DEPENDENCY EXPLAIN DIFFERENCES IN RATES OF DECOMPENSATED CIRRHOSIS AMONG PEOPLE WITH A HEPATITIS C NOTIFICATION? AN INTERNATIONAL COMPARISON M. Alavi1,2,3, N. Janjua4,5, A. Yu5, J. Grebely1, E. Aspinall2,3, H. Innes2,3, H. Valerio2,3, P. Hayes6, M. Krajden4,5, J. Amin1, M. Law1, J. George7, D. Goldberg2,3, S. Hutchinson2,3, G. Dore1. 1The Kirby Institute, UNSW Australia, Sydney, Australia; 2Glasgow Caledonian University; 3National Services Scotland, Glasgow, United Kingdom; 4University of British Columbia; 5British Columbia Centre for Disease Control, Vancouver, Canada; 6Royal Infirmary Edinburgh, Edinburgh, United Kingdom; 7 University of Sydney and Westmead Hospital, Westmead, Australia E-mail: [email protected] Background and Aims: The burden of hepatitis C virus (HCV)-related liver disease is rising in most settings, including Scotland and New South Wales (NSW), Australia. However, whether this is driven by high alcohol use is unclear. Notably, up to the late 2000s, annual HCV treatment uptake has remained below 5% in NSW and Scotland. The aim of this study was to assess trends in decompensated cirrhosis (DC) and the association between alcohol dependency and DC. Methods: HCV notifications from NSW (1998–2012) and Scotland (1998–2013) were linked to hospital admissions (2001–2013 and 2001–2014, respectively) using record linkage. Alcohol dependency was defined by non-liver-related hospital admissions due to alcohol use. Age-adjusted incidence rates (reflecting individual-level risk) of first time DC admissions were plotted and associated factors were assessed using Cox regression. Results: Among 64,929 and 28,216 people with HCV in NSW and Scotland, 2,407 (3.7%) and 1,222 (4.3%) had a DC admission and 32% and 51% of those with DC had alcohol dependency, respectively. In NSW and Scotland, DC admissions increased from 145 and 58 in 2004 to 284 and 149 in 2012 (2.0 and 2.6 fold increase in burden, respectively) (Figure 1). In the same period, DC incidence rates were relatively stable, but consistently higher among those with alcohol dependency, particularly in Scotland (Figure 1). In NSW and Scotland, DC was independently associated with alcohol dependency (aHR 4.17, 95%CI 3.78, 4.61 and aHR 4.79, 95%CI 4.19, 5.49, respectively). Further, in NSW and Scotland, DC was associated with older age (born <1945) and male sex. In NSW, DC was also associated with birth in Asia Pacific.

Journal of Hepatology 2016 vol. 64 | S425–S630