Hepatitis C elimination in Sweden: Progress, challenges and opportunities for growth in the time of COVID‐19

Abstract

Background & Aims In 2014, the burden of hepatitis C virus (HCV) in Sweden was evaluated, to establish a baseline and inform public health interventions. Considering the changing landscape of HCV treatment, prevention, and care, and in light of the COVID‐19 pandemic, this analysis seeks to evaluate Sweden’s progress toward the WHO elimination targets and identify remaining barriers. Methods The data used for modeling HCV transmission and disease burden in Sweden were obtained through literature review, unpublished sources, and expert input. A dynamic Markov model was employed to forecast population sizes and incidence of HCV through 2030. Two scenarios (“2019 Base” and “WHO Targets”) were developed to evaluate Sweden’s progress toward HCV elimination. Results At the beginning of 2019, there were 29,700 (95% UI: 19,300 – 33,700) viremic infections in Sweden. Under the base scenario, Sweden would achieve and exceed the WHO targets for diagnosis, treatment, and liver‐related death. However, new infections would decrease by less than 10%, relative to 2015. Achieving all WHO targets by 2030 would require 1) expanding harm reduction programs to reach more than 90% of PWID and 2) treating 90% of HCV+ PWID engaged in harm reduction programs and ≥7% of PWID not involved in harm reduction programs, annually by 2025. Conclusions It is of utmost importance that Sweden, and all countries, find sustainability in HCV programs by broadening the setting and base of providers to provide stability and continuity of care during turbulent times.

Antimicrobial use in Sweden during the COVID-19 pandemic: prescription fill and inpatient care requisition patterns

“…The decline in prescription fills could be explained by the impact of the pandemic on healthcare services, social and economic disruptions that affected case detection and linkage to care. For chronic hepatitis C virus (HCV) infection, the number of patients diagnosed and initiated on treatment between January and October 2020 reduced by 27% and 55%, respectively, compared to the same period in 2019 [ 37 , 38 ]. Further, reduced transmission of chronic viral infections and subsequent decreased demand for prescribed antiviral drugs could also have been influenced by the decreased physical contact, travel to and immigration from endemic countries in relation to COVID-19 mandated restrictions.…”

Real-world hepatitis C treatment outcomes and reinfections among people who inject drugs at a needle and syringe program in Stockholm, Sweden

“…Lastly, the COVID-19 pandemic has resulted in delayed HCV treatments worldwide, which may result in increased HCV-related morbidity and mortality [ 70 ]. In Sweden, an overall 55% decrease in treatment initiations was noted during the first ten months of the pandemic [ 71 ]. A 30% decrease of HCV treatment initiations was also noted at the Stockholm NSP during the same period [ 72 ].…”

“…A recent modeling study, also taking the COVID-19 effects into account, concluded that Sweden is on-track to achieve three of the four WHO targets for HCV elimination. However, to reduce new infections, an increased access to harm reduction programs and a scale-up of HCV treatment among PWID is needed [ 71 ].…”

Hepatitis C time trends in reported cases and estimates of the hidden population born before 1965, Denmark and Sweden, 1990 to 2020

“…Hepatitis C treatment is free of charge and DAA use has been unrestricted since 2018. In both countries, nearly all hepatitis C patients attending clinical care have been treated and cured [ 20 , 22 ].…”