Direct-acting antiviral therapy for hepatitis C: The initial experience of the University of Cape Town/Groote Schuur Hospital Liver Clinic, South Africa

Sonderup, Mark; Gogela, Neliswa; Nordien, R; Smuts, Heidi; Korsman, Stephen N.J.; Hardie, Diana; Spearman, C Wendy

doi:10.7196/samj.2020.v110i2.14195

Cited by 7 publications

(6 citation statements)

References 24 publications

(26 reference statements)

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“…[20] Of the many sub-genotypes of GT1, GT1a and GT1b are most frequently observed in SA, with GT1b representing 38 -70% of GT1 sub-genotypes, suggesting that the GT1b sub-genotype in our cohort is in keeping with local patterns. [9,20] GT5a has also not been detected in any key population studies to date -here GT1 and GT3a are prevalent. [5] Reviewing the patients' self-reported histories suggests a shared mode of HCV transmission.…”

Section: Researchmentioning

confidence: 75%

“…Firstly, the median age of 64 years is much older than recently reported heterogeneous SA HCV patient cohorts, of 52 and 47 years, respectively. [9,17] Also, knowing the natural history of chronic HCV infection with a progression time to cirrhosis of ~20 -40 years, infection in this cohort is likely to have occurred many years before, given that 42% had advanced fibrosis or cirrhosis. [18] It must, however, be noted that co-factors such as alcohol use and HIV co-infection influence the natural history of HCV.…”

Section: Discussionmentioning

confidence: 97%

“…through traditional or unsafe medical practices, as a likely means of transmission. [9] Rwandan data also identified that, in This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.…”

mentioning

confidence: 98%

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Expanding the epidemiological understanding of hepatitis C in South Africa: Perspectives from a patient cohort in a rural town

et al. 2021

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Globally, ~71 million people are viraemic for hepatitis C virus (HCV) infection, with 10.2 million (14%) residing in sub-Saharan Africa. [1] The prevalence of HCV in South Africa (SA) is <1%, with modelled data suggesting ~600 000 infected. [2] Despite typical HCV transmission risks being present in SA, such as people who inject drugs (PWID), pre-1992 blood or blood products (before universal HCV screening was introduced into blood services), parenteral injuries in healthcare workers and traditional practices such as scarification, HCV epidemiology is incompletely characterised. Historically, blood transfusion service HCV incidence, as a marker of the general population in SA, is low at 0.03 -0.1%. [3,4] Unsurprisingly, recent data from key populations in SA demonstrate a high prevalence of HCV and HIV-HCV co-infection. [5] HCV prevalence studies in men who have sex with men (MSM) have demonstrated rates of 6%, with genotype (GT) 1a and 3a the predominant genotypes identified. [6] Interestingly, to date no GT5a, an HCV genotype unique to SA, has been identified in any of the key population studies in SA. Local key population data align with global epidemiology as the current major drivers of ongoing HCV infection. [7] Key population patients tend to be younger, the median age being 29 years in SA, whereas the other HCV prevalence peak comprised people invariably >50 years of age. [5,6,8] In recent data from Cape Town looking at a general HCV patient cohort accessing treatment, 26% of patients had no identifiable risk factor, possibly pointing towards other parenteral exposure, e.g. through traditional or unsafe medical practices, as a likely means of transmission. [9] Rwandan data also identified that, in This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

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Section: Researchmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 97%

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Expanding the epidemiological understanding of hepatitis C in South Africa: Perspectives from a patient cohort in a rural town

et al. 2021

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“…These specialist clinics do not specifically cater for the needs of PWID as a vulnerable and challenging population. PWID care is inadequate because of low referral rates [ 11 ], socio-structural barriers, homelessness [ 12 ] and limited access to harm reduction interventions [ 13 ]. Previous local PWID population screening serosurveys did not include significant successful linkage to care [ 10 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

A simplified point-of-service model for hepatitis C in people who inject drugs in South Africa

Saayman¹,

Hechter²,

Kayuni

et al. 2023

Harm Reduct J

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Background Globally, 9% of people who inject drugs (PWID), a key hepatitis C-infected population, reside in sub-Saharan Africa. In South Africa, hepatitis C seroprevalence in PWID is high. It is almost 84% in Pretoria and hepatitis C genotypes 1 and 3 predominate. Access to hepatitis C care for PWID is inadequate given low referral rates, socio-structural barriers, homelessness and limited access to harm reduction. Traditional care models do not address the needs of this population. We piloted a simplified complete point-of-service care model, a first of its kind in the country and sub-continental region. Methods Community-based recruitment from Pretoria’s PWID population occurred over 11 months. Participants were screened with point-of-care rapid diagnostic tests for HBsAg (Alere Determine™), hepatitis C and HIV antibodies (OraQuick®). Qualitative HCV viremia was confirmed on site with Genedrive® (Sysmex), similarly at week 4, end of treatment and to confirm sustained virological response. Viremic hepatitis C participants were initiated on 12 weeks of daily sofosbuvir and daclatasvir. Harm reduction and adherence support, through directly observed therapy, peer support, a stipend and transport, was provided. Results A total of 163 participants were screened for hepatitis C antibody, and 66% were positive with 80 (87%) viremic. An additional 36 confirmed hepatitis C viremic participants were referred. Of those eligible to initiate treatment, 87 (93%) were commenced on sofosbuvir and daclatasvir, with 98% (n = 85) male, 35% (n = 30) HIV co-infected, 1% (n = 1) HBV co-infected and 5% (n = 4) HIV/HBV/HCV triple infected. Some 67% (n = 58) accessed harm reduction packs, 57% (n = 50) opioid substitution therapy and 18% (n = 16) stopped injecting. A per protocol sustained virological response of 90% (n = 51) was achieved with 14% (n = 7) confirmed reinfections following a sustained virological response. HCV RNA qualitative testing performance was acceptable with all sustained virological responses validated against a laboratory assay. Mild adverse effects were reported in 6% (n = 5). Thirty-eight percent (n = 33) of participants were lost to follow-up. Conclusion In our setting, a simplified point-of-service hepatitis C care model for PWID yielded an acceptable sustained virological response rate. Retention in care and follow-up remains both challenging and central to success. We have demonstrated the utility of a model of care for our country and region to utilize this more community acceptable and simplified practice.

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“…This is most likely due to underdiagnosis; in a previous article, researchers estimated that only 5–15% of HCV‐infected children in the United States are identified (15). Additionally, limited drug availability in developing countries is important, since children from countries with a high prevalence of HCV such as Africa cannot have access to new antiviral treatment (16). In view of these important changes in the treatment of HCV infection in children, we aimed to study HCV infection and viremia prevalence in children among the general population.…”

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confidence: 99%

Seroprevalence of Hepatitis C in Children Without Identifiable Risk‐Factors

Melikoki

Kourlaba

Kanavaki

et al. 2021

J. pediatr. gastroenterol. nutr.

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Objectives: Hepatitis C virus (HCV) remains a major public health burden for >30 years since its discovery. It is estimated that >80 million people have been already infected. Direct-acting antiviral (DAA) treatment is now approved for young children over the age of 3 years. Treating children before the development of high-risk behaviors is optimal. Thus, assessing the current epidemiology of HCV in children becomes important and may promote awareness. Methods: Articles describing the prevalence of hepatitis C in children, were systematically reviewed. To assess HCV infection prevalence in the general population, studies discussing high-risk groups alone were excluded. Results: Data from 58 studies were analyzed. National data was scarce. An overall prevalence of HCV in children of 0.87% was found, ranging from 0.34% in Europe to 3.02% in Africa. Prevalence of viremic infection is important and data synthesis from available data indicated that HCV viremia was detected in 56.8% of children. The prevalence of HCV according to sex was described in 25 studies but no difference between sexes was detected. HCV prevalence was significantly higher in children older than 10 years (0.97%) when compared to those ages under 10 years old (0.75%, P < 0.001). Conclusions: Considering probable underdiagnosis of HCV infection in children, this information reveals that prevalence is substantial. One may argue that future strategies aiming towards HCV elimination, may need to include antiviral treatment of pre-adolescent children as well.

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Direct-acting antiviral therapy for hepatitis C: The initial experience of the University of Cape Town/Groote Schuur Hospital Liver Clinic, South Africa

Cited by 7 publications

References 24 publications

Expanding the epidemiological understanding of hepatitis C in South Africa: Perspectives from a patient cohort in a rural town

Expanding the epidemiological understanding of hepatitis C in South Africa: Perspectives from a patient cohort in a rural town

A simplified point-of-service model for hepatitis C in people who inject drugs in South Africa

Seroprevalence of Hepatitis C in Children Without Identifiable Risk‐Factors

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