Identifying barriers to Hepatitis C virus elimination in the era of direct-acting antivirals

Abstract Background Hepatitis C virus (HCV) infection elimination is possible through direct-acting antiviral (DAA) therapy. Retention in care remains challenging. We aimed to identify factors associated with failure to engage in care and achieve sustained virological response (SVR) following DAA therapy. Methods We conducted a retrospective review of 11 years of DAA outcomes (2014 – 2024) at a tertiary referral centre in Ireland. Associations with SVR in the total DAA cohort and in those who adhered to the treatment schedule were assessed. Univariate analysis and multivariable logistic regression models identified these factors. Results There were 881 treatment episodes. The majority were male (77%), with median age of 43. N=478 attended all scheduled appointments, with SVR of 96% in this cohort. However, the overall confirmed cohort SVR was 86%. Being housed (OR 1.62, p=0.03) and having a primary care provider (OR 1.68, p=0.02) were associated with achieving SVR. Failure to attend appointments was associated with young age (p<0.001), homelessness (p<0.001), prior intravenous drug use (<0.001), and being identified via opportunistic screening programmes (p<0.001). Conclusions We identify barriers to engagement with HCV DAA therapy. Failure to achieve cure is driven by disease-independent factors, and identifies the need to change the current model of care.