Eliminating viral hepatitis C in Belgium: the micro-elimination approach

Abstract

Background: Hepatitis C virus is one of the leading causes of chronic liver disease and liver-related deaths worldwide. The estimated prevalence of chronic hepatitis C viral infection among the general Belgian population was 0.57% (n = 64,000) in 2015. Although Belgium has had a 'Hepatitis C Plan' since 2014, elimination efforts are unclear. This study employs the best available data and modelling estimates to define the burden of hepatitis C viral infection among key subgroups in Belgium, identify information gaps and propose potential approaches to screening, linkage to care and treatment, and cure. Methods: We examined the peer-reviewed and grey literature since 2012 for data on the prevalence of hepatitis C viral infection in Belgium in key subgroups identified by national experts and in the literature. Ultimately, this research is primarily based on data provided by the key stakeholders themselves due to a lack of reliable data in the literature. Based on this, we modelled the treatment rates required to reach elimination of hepatitis C in several subgroups. Results: Eleven potential subgroups were identified. There were no data available for two subgroups: generational cohorts and men who have sex with men. In six subgroups, fewer than 3000 people were reported or estimated to have hepatitis C infection. Migrants and people who inject drugs were the most affected subgroups, and children were the least affected subgroup. Only two subgroups are on target to achieve elimination by 2030: patients living with haemophilia and transplant recipients. Conclusions: Removing Belgian treatment reimbursement restrictions in January 2019 was a big step towards eliminating HCV. In addition, increasing surveillance, including with a national registry, treatment prescription by other health-care providers and availability of treatment in local pharmacies are central to improving the current situation and getting on track to reach the 2030 WHO hepatitis C elimination targets in Belgium.

Allocating treatment resources for hepatitis C in the UK: a constrained optimization modelling approach

“…Demarteau et al [32] developed a linear allocation model alongside the Markov model to identify the mix of cervical cancer prevention strategies so that the cancer cases were minimized, given a fixed budget. In line with our results of ICER-based scenario analysis, Demarteau et al reported that when only considering budget constraints, the resource [47] developed a constrained optimization modelling in Excel to demonstrate the number of HCV patient need to treat per year to reach the WHO targets for HCV elimination in Belgium, given the constraints of the number of known HCV patients, annual HCV incidence and the number of years until the year 2030 is reached. However, no specific treatment or prevention interventions were incorporated in the model.…”

“…Linear programming was applied based on one critical condition that a linear incremental change in the independent variable, namely decision variable, and constraint, results in a linear incremental change in the dependent output, namely objective function [38,45]. The programming was developed in Microsoft Excel Solver [32,39,46,47]. In the absence of comparative data on clinical and cost outcomes between PWID/MSM and the general population from long-term follow-up studies to populate the programming, a core Markov model [-48-50] widely used with many local adaptations [51][52][53][54][55][56][57][58][59][60][61] for evaluating the chronic progression and treatment of CHC was further adapted to compare clinical and cost outcomes of CHC treatment among different populations in the UK setting.…”

The Prevalence of HCV Infection and Risk Factors in a Hospital- Based Population Screening, a First Step to the Micro-Elimination of HCV Infection in Medical Institutions from Romania - Results of the HepC ALERT Study

“…Success of this ambitious goal, at least in countries such as ours, is possible only by fragmentation in various strategies/ campaigns of micro-elimination (at national, institutional level, different target populations). However, this approach is used also in wealthy countries with very low prevalence such as Belgium or the Netherlands [16][17][18]. This concept targets specific population subgroups : children (under the age of 15 years), HCV/HIV-coinfected persons, birth cohorts, haemodialysis patients, those diagnosed with haemophilia, men who have sex with men, migrants, people with advanced liver disease, people who inject drugs, prisoners, and transplant recipients [7,15,19,20].…”

“…Removing HCV treatment reimbursement restrictions in many countries was a big step forward to HCV elimination. In Romania this happened only this year, but in other countries in Europe it occurred much earlier [6,18,27]. Another challenge is access to DAAs therapy, especially for people from rural areas.…”

Treatment Coverage and Drug Expenditure in Hepatitis C Patients From 2013 to 2019: A Journey of Improving Treatment Accessibility in Malaysia Through Government-led Initiatives

“…As attention has been disproportionately devoted to patients seeking care from health institutions since DAAs were made available in Malaysia, efforts should also be made to step up the screening and treatment activities at the community level, particularly by extending the services to more public and private primary care centers. Another strategy that could be adopted by the MOH is the micro-elimination approach through systematically screening and treating HCV-infected subpopulations, including patients with advanced liver diseases, prisoners, PWID, PLHIV, hemodialysis patients, and migrants (15)(16)(17). As the first step to make micro-elimination possible, the MOH has recently collaborated with the Ministry of Home Affairs, introducing the hepatitis C program in prisons and drug rehabilitation centers throughout the country.…”