Yeung A, Palmateer NE, Dillon JF, et al. - Researchers sought to report on the extent of reinfection following scale-up of highly-effective direct-acting antivirals (DAAs) for hepatitis C virus (HCV) among people who inject drugs (PWID) in Scotland.

• Follow-up was performed of a retrospective cohort of PWID who initiated treatment between 2000-2018 and attained a sustained virological response (SVR) for reinfection to December 2019.

• Researchers identified data concerning 5,686 SVRs among 5,592 PWID, 4,126 of whom (73%) had an HCV RNA or antigen test post-SVR.

• The early phase of treatment scale-up with direct-acting antivirals showed an increase in HCV reinfection rates among PWID.

• Groups at high risk of reinfection, considered vital for elimination, are reached in community-based treatment pathways.

• There were low levels of retesting for HCV beyond the first year following successful treatment.

• In the early phase of treatment scale-up, substantial numbers of HCV reinfections may have not been detected.

• Concerted effort to ensure prompt diagnosis of reinfection needs to be integral to national strategies scaling up DAAs among PWID.