The effect of spatial variation on linkage to care and treatment rates among patients with hepatitis C: A Canadian population-based study.

Introduction: Despite significant global efforts towards eliminating hepatitis C virus (HCV) infection, multiple challenges remain in achieving this goal. In this study, we assessed the impact of geographical variation on HCV diagnosis and treatment rates in Alberta, Canada.

Methods: Adults aged ≥20 years with a positive HCV antibody were identified from the provincial administrative sources from the fiscal years 2012 through 2017. To assess the differences across Alberta's rural-urban continuum, high-resolution spatial analyses using global and local spatial autocorrelation were applied to the HCV age- and sex-standardized prevalence rate at the sub-local geographic area level. We compared and tested differences in HCV RNA tests, HCV RNA positivity rates, and HCV treatment status across the different areas.

Results: Between 2012 and 2017, we identified 18,768 patients who had tested positive for HCV Ab. Within this cohort, only 63.1% had HCV RNA repetitive. The HCV RNA positivity rate was 42.1%, and 65.3% had received HCV treatment after testing as HCV RNA positive. HCV Ab positive case counts exhibited a spatial distribution consistent with that of the population at risk: 67.5% in metro, 11.1% in urban, 19.7% in rural, and 1.8% in remote areas. The metropolitan area of Edmonton's age-and sex-standardized prevalence of 8.2 (95% CI 8.0-8.4) per 1,000 persons was higher than Calgary's standardized prevalence of 5.0 (95% CI 5.1-5.4) per 1,000 persons (p < 0.001). HCV RNA and HCV treatment rates demonstrated significant spatial variation.

Conclusions: HCV prevalence, diagnosis, and treatment exhibit significant spatial variation across rural-urban Alberta. Implementation of geographically oriented screening and treatment interventions would result in a time- and cost-efficient HCV elimination strategy.