Treatment uptake among individuals notified with HCV infection 1990-2022 in Sweden.

Background: The WHO hepatitis C virus (HCV) elimination goal includes achieving ≥80% treatment coverage by 2030.

Objectives: This study aims to assess Sweden's progress toward elimination by estimating national HCV treatment uptake and identifying associated factors.

Methods: This nationwide register-based study includes individuals notified with HCV infection in Sweden 1990-2022. Treatment uptake was defined as at least one dispensation of HCV treatment recorded in the Swedish Prescribed Drug Register (SPDR) by the end of 2023. As the SPDR was initiated in 2005, treatment uptake was specifically analyzed in individuals notified 2005-2022. Median time from notification to treatment was analyzed annually.

Results: Among 29,815 included individuals, 24,007 (81%) had started treatment. Among notified 2005-2022, treatment uptake was 81% (13,155/16,241) by 2022 and 85% (13,548/15,930) by 2023. Factors associated with lower odds of treatment uptake were: amphetamine use diagnosis (adjusted odds ratio 0.71; 95% confidence interval 0.60-0.83), opioid use diagnosis (0.71; 0.60-0.84), combined amphetamine/opioid use diagnoses (0.75; 0.62-0.91), other drug use diagnoses (0.70; 0.60-0.81), coinfection with hepatitis B virus (0.54; 0.39-0.76), male sex (0.73; 0.67-0.81) and ≤9 years of education (0.81; 0.70-0.94). The odds were higher in individuals aged ≥60 (1.26; 1.10-1.44) years. Median time to treatment was 2.8 months (IQR 1.7-5.6) among individuals notified in 2022.

Conclusions: Sweden has reached the WHO treatment target, with treatment uptake ≥80%. In recent years, the median time to treatment has decreased to a few months. Continued efforts are needed to maintain this progress, particularly among people who inject drugs where HCV incidence remains high.