Moving towards Hepatitis C microelimination among people living with Human Immunodeficiency Virus in Australia: the CEASE study

Background: Microelimination of hepatitis C virus (HCV) among people living with human immunodeficiency virus (HIV) may be feasible in Australia, given unrestricted access to direct-acting antiviral (DAA) therapy from 2016. Our aim was to evaluate progress towards elimination goals within HIV/HCV-coinfected adults in Australia following universal DAA access. Methods: The CEASE prospective cohort study enrolled adults with HIV/HCV, irrespective of viremic status, from 14 primary and tertiary clinics in Australia. Annual and cumulative HCV treatment uptake, outcome, and HCV RNA prevalence were evaluated, with follow-up through May 2018 (median follow-up, 2.63 years). Factors associated with DAA uptake were analyzed. Results: Between July 2014 and March 2017, 402 participants who were HIV/HCV antibody positive were enrolled (95% male [80% gay and bisexual men,], 13% cirrhosis, 80% history of injecting drug use [39% currently injecting]). Following universal DAA access, annual HCV treatment uptake in those eligible increased from 7% and 11% per year in 2014 and 2015, respectively, to 80% in 2016. By 2018, cumulative HCV treatment uptake in those ever eligible for treatment was 91% (336/371). HCV viremic prevalence declined from 82% (95% CI, 78–86%) in 2014 to 8% (95% CI, 6–12%) in 2018. Reinfection was reported in only 5 participants for a reinfection incidence of 0.81 per 100 person-years (95% CI, 0.34–1.94). Conclusions: High uptake and effectiveness of unrestricted DAA therapy in Australia have permitted rapid treatment scale-up, with a dramatic reduction in HCV infection burden and low reinfection rate among people living with HIV, suggesting that microelimination is feasible.Marianne Martinello, Jasmine Yee, Sofia R. Bartlett, Phillip Read, David Baker, Jeffrey J. Post, Robert Finlayson, Mark Bloch, Joseph Doyle, David Shaw, Margaret Hellard, Kathy Petoumenos, Lanni Lin, Philippa Marks, Tanya Applegate, Gregory J. Dore, and Gail V. Matthews (for the CEASE study team

A Classification System for Colombian Wetlands: an Essential Step Forward in Open Environmental Policy-Making

Knowledge about the distribution and diversity of wetlands has become an essential tool for environmental management and policy-making. Yet, while recent estimates indicate that 27% of the area of Colombia is covered by wetlands and despite a number of regional studies, information about the diversity of wetlands nationally is scarce. In response, we present a national wetland classification system that is based on an ecological approach, from the perspective of wetland scientists, and which builds upon the assumptions underlying the flood pulse concept and hydrogeomorphic approach. Thus, the approach and structure of the Brazilian wetland classification system are used, with geomorphological adjustments made according to Colombia’s topography. The classification is hierarchical, multi-scale, functional, and organized according to four levels (system, macroregion, subsystem, and class), with the wetland diversity of Colombia represented nationally by 89 macrohabitats across marine-coastal, inland, and anthropogenic systems. The primary purpose of this classification is to provide integrated and organized information on the distribution and diversity of Colombian wetlands that will serve as a baseline for transparent environmental policy-making. © 2019, Society of Wetland Scientists