Prevalence of Hepatitis C Infection and Treatment Initiation Following Dried Blood Spot Testing in New South Wales, Australia

BACKGROUND AND AIMS: To achieve hepatitis C (HCV) elimination by 2030, testing and treatment must reach people most at risk. Dried blood spot (DBS) testing offers an alternative to venepuncture, suitable for community and prison settings. This study evaluated HCV infection prevalence and treatment initiation among people receiving DBS testing in New South Wales (NSW), Australia. METHODS: The NSW DBS Pilot was an observational study of people testing for HCV RNA from DBS samples collected across 36 community sites (including drug treatment clinics and needle and syringe programmes) and 21 prisons. Logistic regression identified factors associated with current HCV infection (detectable HCV RNA) and treatment initiation within 6 months. RESULTS: Between September 2019 and December 2023, 13 940 participants were tested for HCV (25% female, 33% Aboriginal and/or Torres Strait Islander, 36% injected drugs in the last month). Overall, 11% (1310/13940) had current infection, higher in community (12%) than prison (9%), and declining from 14% in 2019-2021 to 9% in 2022-2023. Among those with current infection, treatment initiation within 6 months was higher in prison settings (64%) compared to community (37%). In community settings, Aboriginal and/or Torres Strait Islander people had lower odds of treatment initiation (aOR 0.69, 95% CI: 0.51-0.92). In prison, treatment declined in 2022-2023 compared with 2019-2021 (aOR 0.64, 95% CI: 0.43-0.94). CONCLUSIONS: The NSW DBS Pilot provided broad access to HCV testing, but treatment initiation remained suboptimal, particularly in community settings. Declining prevalence indicates progress towards elimination; however, further efforts are needed to close remaining gaps along the care cascade.