P139 Systematic review and meta-analysis of barriers and enablers to hepatitis C direct-acting antiviral treatment initiation

<h3></h3> Despite the successes of the direct-acting antiviral (DAA) programme for hepatitis C virus (HCV) infection, many groups still experience challenges to accessing care. We aimed to determine the barriers and enablers associated with hepatitis C DAA initiation and their relative impact. We performed a systematic review and meta-analysis of the barriers and enablers to HCV treatment initiation in the DAA era in high income settings with free universal healthcare. We searched eight bibliographic databases for studies published between 2014 and May 2022 using pre-defined keywords. We included quantitative studies investigating positive or negative associations with DAA treatment initiation. Data were extracted into a standardised form and a random-effects meta-analysis was conducted to pool the effects of variables on treatment initiation. The I2 statistic was used to measure heterogeneity across studies. Of 5198 articles identified, 42 studies conducted in Australia, Canada and Europe were included. Overall quality was ‘fair’ or ‘good’ in 37. Significant negative associations with DAA treatment included: unstable housing (14 studies, pooled odds ratio (OR) 0.48, 95% confidence interval (CI) 0.40–0.58, I2 = 21.1%); active injecting drug use (OR 0.54, CI 0.39–0.74, I2 = 97.5%); low income or socioeconomic status (seven studies, OR 0.75, CI 0.60–0.94, I2 = 73.7%) and female gender (26 studies, 0.78, CI 0.69–0.89, I2 = 89.9%). Positive associations included: increasing age (17 studies, OR 1.76, 95% CI 1.30–2.40, I2 = 95.4%); previous HCV treatment (nine studies, OR 2.20, CI 1.45–3.34, I2 = 85.8%); fibrosis stage (13 studies, OR 1.80, CI 1.15–2.79, I2 = 95.6%) and opioid substitution in people who inject drugs (12 studies, OR 1.54, 95% CI 1.15–2.05, I2 = 65.9%). There was no overall effect of high-risk alcohol use on treatment initiation when compared with lower (or no) alcohol use (13 studies, OR 0.91, 95% CI 0.64–1.27, I2 = 98.3%). The most impactful factors associated with DAA treatment initiation were socioeconomic and fixed demographic or disease characteristics. This should enable pre-emptive identification and intervention in those at risk of disengagement before treatment. Active injecting drug use was the only behavioural characteristic consistently associated with lower treatment initiation but this is significantly mitigated by opiate substitution therapy. <h3>References</h3> Doyle JS, Scott N, Sacks-Davis R,<i> et al</i>. Treatment access is only the first step to hepatitis C elimination: experience of universal anti-viral treatment access in Australia. <i>Aliment Pharmacol Ther</i> 2019;<b>49</b>:1223–9. Amoako A, Ortiz-Paredes D, Engler K, <i>et al</i>. Patient and provider perceived barriers and facilitators to direct acting antiviral hepatitis C treatment among priority populations in high income countries: a knowledge synthesis. <i>Int J Drug Policy.</i> 2021;<b>96</b>:103247. Hashim A, Macken L, Jones AM, <i>et al</i>. Community-based assessment and treatment of hepatitis C virus-related liver disease, injecting drug and alcohol use amongst people who are homeless: a systematic review and meta-analysis. <i>Int J Drug Policy</i> 2021;<b>96</b>:103342. Paisi M, Crombag N, Burns L, <i>et al</i>. Barriers and facilitators to hepatitis C screening and treatment for people with lived experience of homelessness: A mixed‐methods systematic review. <i>Health Expect</i> 2022;<b>25</b>:48–60.