Effectiveness of direct-acting antiviral therapy among Aboriginal and Torres Strait Islander peoples with HCV infection in Australia: A national real-world cohort (REACH-C).

Aboriginal and Torres Strait Islander peoples experience a disproportionate burden of hepatitis C virus (HCV) infection. This study assessed the effectiveness of direct-acting antiviral (DAA) therapy among Aboriginal peoples in the three years following universal access in Australia. REACH-C, a national multicentre prospective cohort study, evaluated HCV treatment outcomes from sequential DAA initiations across 33 health services between March 2016 and June 2019. DAA effectiveness was assessed by sustained virological response (SVR) in the total (full analysis set) and effectiveness (modified analysis set excluding those lost to follow-up) populations. Overall, 915 (10%) Aboriginal and 8095 (90%) non-Indigenous people commenced DAA therapy, of whom 30% and 16% reported current injecting drug use and 73% and 42% were treated in primary care, respectively. SVR in the total and effectiveness populations was 74% and 94% among Aboriginal people and 82% and 94% among non-Indigenous people, with loss to follow-up contributing to lower SVR in the total population analysis (22% Aboriginal, 13% non-Indigenous). Among Aboriginal people, returning for follow-up was positively associated with older age (aOR 1.20; 95% CI 1.04, 1.39) and SVR was negatively associated with cirrhosis (aOR 0.39; 95% CI 0.19, 0.80) and prior DAA treatment (aOR 0.14; 95% CI 0.04, 0.49). Factors reflecting higher vulnerability or inequity were not associated with returning for testing or SVR. DAA therapy was highly effective among Aboriginal peoples with HCV treated through primary and tertiary services. Tailored community-led interventions are necessary to optimize follow-up and engagement. Sustained DAA uptake and equitable access to care, treatment and prevention are required for HCV elimination.

Clostridium difficile laboratory testing in Australia and New Zealand: national survey results and Australasian Society for Infectious Diseases recommendations for best practice.

AIMS: In order to improve the future reliability of surveillance for Clostridium difficile infection (CDI), an Australia/New Zealand-wide survey was conducted to examine methods of laboratory diagnosis in use, identify deficiencies in practice and burden of CDI. METHODS: An online survey of 48 Australian and New Zealand microbiology laboratories (private and public) was conducted in late 2009 and 2010 to collect information about methods of detection in use and collective testing experience from July 2008 to June 2009. RESULTS: The overall prevalence (proportion positive of all faecal specimens tested) of C. difficile in 123,574 tested samples was 5.3%. The incidence rate across jurisdictions varied between 18.0 per 100,000 population in Victoria to 35.8 per 100,000 population in Tasmania, with a mean for Australia of 25.6 per 100,000 population. The incidence rate in New Zealand was 21.5 per 100,000 population. Most laboratories (60%) screened stools with an enzyme immunoassay (EIA) or equivalent that detected both toxins A and B. CONCLUSIONS: The low overall rates reported here may reflect the lack of sensitivity of diagnostic testing procedures currently used in Australia and New Zealand to detect C. difficile. Recommendations for best practice in diagnosis of C. difficile were developed by the Australasian Society for Infectious Diseases (ASID) C. difficile working party and later endorsed by ASID.