The impact of highly efficacious treatments on hepatitis C prevalence and incidence in people who inject drugs in Melbourne, 2016-current.

Viral hepatitis is responsible for more deaths globally than HIV and malaria, with hepatitis C virus (HCV) accounting for a third of viral hepatitis-related deaths. In 2013 HCV treatment was transformed through the discovery of all-oral direct-acting antiviral therapy. With only 8–12 weeks of treatment, >95% of patients are cured of HCV, including HIV/HCV-coinfected individuals in whom cure rates with prior interferon-based therapies were <50%. In 2016, Australia was one of the first countries to make these the therapies to all people with chronic hepatitis C infection, without restrictions based on disease stage or ongoing risk behaviours, including for treatment of reinfections. In the same year, the World Health Organization (WHO) set targets for the elimination of HCV as a public health threat by 2030, including a 90% reduction in HCV incidence and 65% reduction in HCV-related mortality. People who inject drugs are the key group affected by hepatitis C globally. We have collected detailed behavioural, clinical and biological data on a cohort of people who inject drugs in Melbourne, Australia since 2005 . This cohort, known as SuperMIX, now includes over 1000 participants and is among the largest of its kind globally. This project will involve assessing the impact of direct-acting-antiviral therapies on hepatitis C prevalence and incidence in the SuperMIX cohort, and understanding ongoing risk of infection in this group. This is a unique opportunity to assess the impact of a major public health intervention in a highly-characterised longitudinal cohort.