Community-based point-of-care hepatitis C testing and general practitioner initiated direct-acting antiviral therapy in Yangon, Myanmar (CT2 study)

Draper, Bridget; Yee, Win Lei; Pedrana, Alisa; Howell, Jess; Htay, Hla; Naing, Win; Aung, Khin Sanda; Nwe, Nwe; Shilton, Sonjelle; Markby, Jessica; Kyi, Khin Pyone; Hellard, Margaret

doi:10.1016/s0168-8278(20)30616-4

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“…Follow-up of participants was conducted up to 31 August 2020. Of the 633 participants, 606/633 were HCV antibody positive and reflexively tested for HCV RNA using a GeneXpert HCV RNA test [15] , 535/606 were HCV RNA positive, 489/535 met the study eligibility criteria for treatment (individuals who had previously been treated for HCV, who were co-infected with HIV, hepatitis B or tuberculosis, who had renal impairment or who were pregnant were not eligible for treatment through the study), 4 88/4 89 started treatment, and 4 84/4 88 completed treatment [16] . The CT2 study provides valuable costing data on a possible model of testing and treatment in Myanmar, which can be combined with epidemiological and behavioural data from the cross-sectional seroprevalence survey among the general population (from 2015; 18 sites, n = 55,47 [9] ) and two cross-sectional Integrated Biological and Behavioural Surveillance Survey (IBBS) among PWID (from 2014: 10 sites, n = 3340; [17] and from 2017-2018: 13 sites, n = 6061 [18] ) to assess the affordability and potential economic benefits of scaling up testing and treatment interventions for HCV.…”

Section: Introductionmentioning

confidence: 99%

Hepatitis C elimination in Myanmar: Modelling the impact, cost, cost-effectiveness and economic benefits

Scott

Win²,

Tidhar

et al. 2021

The Lancet Regional Health - Western Pacific

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Background: Myanmar has set national hepatitis C (HCV) targets to achieve 50% of people diagnosed and 50% treated by 2030. The WHO has additional targets of reducing incidence by 80% and mortality by 65% by 2030. We aimed to estimate the impact, cost, cost-effectiveness and net economic benefit of achieving these targets. Methods: Mathematical models of HCV transmission, disease progression and the care cascade were calibrated to 15 administrative regions of Myanmar. Cost data were collected from a community testing and treatment program in Yangon. Three scenarios were projected for 2020-2030: (1) baseline (current levels of testing/treatment); and testing/treatment scaled up sufficiently to reach (2) the national strategy targets; and (3) the WHO targets. Findings: Without treatment scale-up, 333,0 0 0 new HCV infections and 97,0 0 0 HCV-related deaths were estimated to occur in Myanmar 2020-2030, with HCV costing a total $100 million in direct costs (testing, treatment, disease management) and $10.4 billion in lost productivity. In the model, treating 55,0 0 0 people each year was sufficient to reach the national strategy targets and prevented a cumulative 40,0 0 0 new infections (12%) and 25,0 0 0 HCV-related deaths (25%) 2020-2030. This was estimated to cost a total $189 million in direct costs ($243 per DALY averted compared to no treatment scale-up), but only $9.8 billion in lost productivity, making it cost-saving from a societal perspective by 2024 with an estimated net economic benefit of $553 million by 2030. Reaching the WHO targets required further treatment scale-up and additional direct costs but resulted in greater longer-term benefits. Interpretation: Current levels of HCV testing and treatment in Myanmar are insufficient to reach the national strategy targets. Scaling up HCV testing and treatment in Myanmar to reach the national strategy targets is estimated to generate significant health and economic benefits. Funding: Gilead Sciences.

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Section: Introductionmentioning

confidence: 99%