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We aimed to identify factors associated with DAA treatment uptake and measure changes in their prevalence over time. We performed a time\u2010to\u2010treatment analysis on 2728 patients approved for hepatitis C Direct\u2010Acting Antiviral treatment in the North Central London region between January 2016 and October 2019. We investigated the association between treatment uptake and factors including assessment\/treatment setting (hospital, drug service or prison), patient age, gender, injection drug use, harmful alcohol use, cirrhosis status and previous treatment. The likelihood of treatment uptake was reduced by three independent risk factors. These included assessment setting: prison\u2010based or drug\u2010service pathways (aHR 0.29 or 0.81 vs. hospital outpatient pathway, 95% CI 0.21\u20130.40 and 0.70\u20130.94 respectively, <jats:italic>p<\/jats:italic>\u00a0&lt;\u2009.001); being UK\u2010born (aHR 0.89 vs. non\u2010UK born, 0.82\u20130.98, <jats:italic>p<\/jats:italic>\u00a0=\u2009.01); and history of harmful alcohol use (aHR 0.84 vs. no history, 0.72\u20130.99, <jats:italic>p<\/jats:italic>\u00a0=\u2009.04). The average number of these risk factors for not starting treatment per patient increased over time (<jats:italic>R<\/jats:italic><jats:sup>2<\/jats:sup>\u00a0=\u20090.66 <jats:italic>p<\/jats:italic>\u00a0&lt;\u2009.001). Independent of these, there was an additional 5% reduction in rate of treatment initiation in each successive year of the programme (aHR 0.95, 0.91\u20130.99, <jats:italic>p<\/jats:italic>\u00a0=\u2009.02). In conclusion, disengagement from care before treatment uptake was found to be a growing threat to elimination. Despite provision of community\u2010based test\u2010to\u2010cure pathways, there are persistent barriers to treatment uptake and these are increasing over time.<\/jats:p>","DOI":"10.1111\/jvh.13757","type":"journal-article","created":{"date-parts":[[2022,10,5]],"date-time":"2022-10-05T17:12:55Z","timestamp":1664989975000},"page":"46-55","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Falling treatment uptake in the hepatitis C care cascade is a growing threat to achieving elimination"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9348-999X","authenticated-orcid":false,"given":"Kathleen","family":"Bryce","sequence":"first","affiliation":[{"name":"Institute for Global Health University College London  London UK"},{"name":"Royal Free London NHS Foundation Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colette","family":"Smith","sequence":"additional","affiliation":[{"name":"Institute for Global Health University College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alison","family":"Rodger","sequence":"additional","affiliation":[{"name":"Institute for Global Health University College London  London UK"},{"name":"Royal Free London NHS Foundation Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas","family":"Macdonald","sequence":"additional","affiliation":[{"name":"Royal Free London NHS Foundation Trust  London UK"},{"name":"Institute for Liver and Digestive Health University College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,11,2]]},"reference":[{"key":"e_1_2_11_2_1","volume-title":"Global Health sector strategy on viral hepatitis 2016\u201021: Towards Ending Viral Hepatitis","author":"World Health Organization","year":"2016"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.7326\/M16-2575"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/add.14217"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-1253(18)30270-X"},{"key":"e_1_2_11_6_1","unstructured":"HarrisHE CostellaA CroxfordS et al.Hepatitis C in the UK 2020: Working to Eliminate Hepatitis C as a Major Public Health Threat;2020."},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/jvh.13063"},{"key":"e_1_2_11_8_1","unstructured":"Public Health England.Unlinked Anonymous Monitoring Survey of PWID in Contact with Specialist Drug Services;2020."},{"key":"e_1_2_11_9_1","unstructured":"HarrisHE CostellaA MandalS et al.Hepatitis C in England 2022: working to eliminate hepatitis C as a public health problem. 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