Establishment of an outreach, grouping healthcare system to achieve microelimination of HCV for uremic patients in haemodialysis centres (ERASE-C)

Abstract

ObjectiveHCV prevails in uremic haemodialysis patients. The current study aimed to achieve HCV microelimination in haemodialysis centres through a comprehensive outreach programme.DesignThe ERASE-C Campaign is an outreach programme for the screening, diagnosis and group treatment of HCV encompassing 2323 uremic patients and 353 medical staff members from 18 haemodialysis centres. HCV-viremic subjects were linked to care for directly acting antiviral therapy or received on-site sofosbuvir/velpatasvir therapy. The objectives were HCV microelimination (>80% reduction of the HCV-viremic rate 24 weeks after the end of the campaign in centres with ≥90% of the HCV-viremic patients treated) and ‘No-C HD’ (no HCV-viremic subjects at the end of follow-up).ResultsAt the preinterventional screening, 178 (7.7%) uremic patients and 2 (0.6%) staff members were HCV-viremic. Among them, 146 (83.9%) uremic patients received anti-HCV therapy (41 link-to-care; 105 on-site sofosbuvir/velpatasvir). The rates of sustained virological response (SVR12, undetectable HCV RNA 12 weeks after the end of treatment) in the full analysis set and per-protocol population were 89.5% (94/105) and 100% (86/86), respectively, in the on-site treatment group, which were comparable with the rates of 92.7% (38/41) and 100% (38/38), respectively, in the link-to-care group. Eventually, the HCV-viremic rate decreased to 0.9% (18/1,953), yielding an 88.3% reduction from baseline. HCV microelimination and ‘No-C HD’ were achieved in 92.3% (12/13) and 38.9% (7/18) of the haemodialysis centres, respectively.ConclusionOutreach strategies with mass screenings and on-site group treatment greatly facilitated HCV microelimination in the haemodialysis population.ClinicalTrials.gov identifierNCT03803410 and NCT03891550

Sofosbuvir plus velpatasvir combination for the treatment of chronic hepatitis C in patients with end stage renal disease on renal replacement therapy: A systematic review and meta‐analysis

“…A total of seven studies satisfied our pre-defined selection criteria and were included in the meta-analysis. 4,[17][18][19][20][21][22] The flow diagram for the search strategy is shown in Figure 1.…”

“…The seven studies that were finally incorporated in the meta-analysis included four single-centre studies (3 from India and 1 from Bangladesh) and three multicentric studies. 4,[17][18][19][20][21][22] One of the multicentric studies was conducted across 22 centres in Europe, North America and Australia, another was conducted in 18 haemodialysis centres of 3 Taiwanese cities, and the third study was conducted in 15 academic centres of Taiwan. 4,21,22 Five of the studies were prospective while the studies by Gaur et al and Liu et al were retrospective.…”

Long‐term risk of end‐stage renal diseases with maintenance dialysis among chronic hepatitis C patients after antiviral therapy in Taiwan

“…32 The other studies showed no clinically relevant change in renal function among the majority of CHC patients received both sofosbuvir-based or sofosbuvir-free regimens, even until 24 months of post-treatment 33 or among patients with existing CKD, 34 and is safe and effective for ESRD HCV patients under maintenance hemodialysis. 35 However, long-term effects of direct acting antiviral on renal outcome remains unclear. 36 The limitation of this study is the period of follow-up.…”

Towards a safe hospital: hepatitis C in-hospital micro-elimination program (HCV-HELP study)

“…The treatment rate significantly improved for patients from non-hepatology departments, increasing the in-hospital HCV treatment uptake from 6.4 to 73.9% with the strategy [ 7 ]. We successfully implemented a diagnostic cascade for special patient groups such as those undergoing dialysis and prisoners [ 10 , 23 ]. This study further extended the care cascade to vulnerable cancer patients using an entry-based therapeutic control system before initiating chemotherapy.…”

“…Along with many achievements in managing HCV, several measurements have been vigorously implemented over the past decade to achieve the ultimate goal of eliminating HCV. These efforts include amelioration of the epidemic in hyperendemic areas and treatment programs for high-risk groups such as CHC patients undergoing dialysis, people who inject drugs, and prisoners [ 9 , 10 ].…”