Hepatitis C virus elimination in Swiss opioid agonist therapy programmes – the SAMMSU cohort

Bregenzer, Andrea; Bruggmann, Philip; Castro, Erika; Moriggia, Alberto; Rothen, Madeleine; Thurnheer, Maria Christine; Vernazza, Pietro; Scheidegger, Claude

doi:10.4414/smw.2021.20460

Cited by 11 publications

(30 citation statements)

References 52 publications

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“…Within the Swiss Association for the Medical Management in Substance Users (SAMMSU) cohort; the HCV‐RNA prevalence was 13.8%, with a higher HCV prevalence and lower HCV‐treatment uptake seen HIV‐positive patients (26.7%). 19 …”

Section: Methodsmentioning

confidence: 99%

HCV disease burden and population segments in Switzerland

Bihl

Bruggmann

Batänjer³

et al. 2021

Liver International

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Background Switzerland has made strides towards hepatitis C virus elimination, but as of 2019, elimination was not guaranteed. However, political interest in viral hepatitis has been increasing. We sought to develop a better understanding of Switzerland's progress towards HCV elimination and the profile of remaining HCV‐RNA‐positive patients. Methods A previously described Markov model was updated with recent diagnosis and treatment data and run to generate new forecasts for HCV disease burden. Two scenarios were developed to evaluate HCV morbidity and mortality under the status quo and a scenario that achieves the Swiss Hepatitis Strategy Elimination targets. Next, an analysis was conducted to identify population segments bearing a high burden of disease, where future elimination efforts could be directed. Results At the beginning of 2020, an estimated 32 100 viremic infections remained in Switzerland (0.37% viremic prevalence). Adult (≥18 years of age) permanent residents born abroad represented the largest subpopulation, accounting for 56% of HCV infections. Thirteen countries accounted for ≥60% of viremic infections amongst permanent residents born abroad, with most people currently residing in Zurich, Vaud, Geneva, Bern, Aargau and Ticino. Amongst Swiss‐born HCV‐RNA‐positive persons, two‐thirds had a history of IDU, corresponding to 33% of total infections. Conclusions In Switzerland, extra efforts for diagnosis and linkage to care are warranted in foreign‐born populations and people with a history of drug use. Population‐level measures (eg increasing the number of providers, increase screening) can identify patients who may have otherwise fallen through the gaps or avoided care because of stigma.

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Section: Methodsmentioning

confidence: 99%

HCV disease burden and population segments in Switzerland

Bihl

Bruggmann

Batänjer³

et al. 2021

Liver International

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“…Patients were enrolled into the Argovian OAT cohort study "Management of hepatitis C in drug substitution programmes -canton Aargau", approved by the cantonal ethics committee (AG/SO 2012/091; PB_2016-02058) [44], and the Swiss Association for the Medical Management in Substance Users (SAMMSU) cohort, approved by the ethics committees of all participating centres (leading ethics committee: St Gallen, EKSG 13/144) [33]. All participants gave written informed consent.…”

Section: Ethical Considerationsmentioning

confidence: 99%

“…In Scotland, 68% of the patients treated in the era of direct-acting antivirals (2015-2018) were tested for HCV RNA within the first year post-SVR, but only 30% in the second year, suggesting that an estimated 200 reinfections (54% of the estimated total) remained undiagnosed [82]. Even in the Swiss-wide SAMMSU cohort study, yearly HCV antibody and HCV RNA screening is not achieved [33].…”

Section: Yearly Hiv/hcv Screening Adequate Hcv Managementmentioning

confidence: 99%

“…Before (1998-2018), 11-15-year-old adolescents were the primary target group [101]. Thus, it was not very surprising that in our OAT patients with a median age of 42 years (IQR [33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48] in April 2018(born in 1976, IQR 1970-1985, documented HBV immunity was low (<25%) and mainly attributable to past infection. Vaccination uptake was high, with only a few individuals refusing the recommended HAV/HBV vaccinations.…”

Section: Original Articlementioning

confidence: 99%

“…However, harm reduction programmes including OAT and needle and syringe programmes, which have been established in Switzerland since the early 1990s [22,23], reduce the risk of HCV and HIV infection [24][25][26][27][28]. Besides, since 2012, guidelines recommend antiretroviral treatment (ART) irrespective of CD4 count [29], lowering the community viral load and contributing to reduced HIV transmission (treatment as prevention) [30][31][32][33]. For HCV, a mathematical model has shown that OAT and needle and syringe programmes alone are insufficient to substantially reduce HCV RNA prevalence in people who inject drugs, but HCV therapy is required [34].…”

Section: Introductionmentioning

confidence: 99%

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HCV elimination in a Swiss opioid agonist therapy programme – a cohort study

Bregenzer¹,

Krismer²,

Wendel³

et al. 2022

Swiss Med Wkly

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BACKG ROUND: In opioid agonist therapy (OAT) programmes, chronic hepatitis C is highly prevalent and directly observed therapy guarantees optimal adherence. Since 2017, all patients with chronic hepatitis C in Switzerland can be treated with pangenotypic direct-acting antivirals irrespective of liver fibrosis stage. Until the end of 2021, however, prescription was restricted to infectious disease specialists, gastroenterologists and certain addiction specialists. Difficult venous access after long-term intravenous drug use and, in the case of referral to a specialist, difficulties keeping appointments are barriers to HCV diagnosis and treatment. AIMS: To assess whether minimally invasive point-of-care tests and a "test-and-treat / vaccinate on-site" approach can improve human immunodeficiency virus (HIV) / hepatitis C virus (HCV) screening, HCV treatment uptake and immunity against hepatitis A/B. METHODS: Since September 2018, an infectious disease specialist and a study nurse performed 4-weekly visits in the OAT programme "HAG " (heroin dispensation of the canton Aargau), offering HIV/HCV antibody rapid testing (20 min) and HCV RNA quantification (G eneXpert ® , 60 min) from capillary blood, noninvasive liver fibrosis assessment (Fibroscan ® , 5-10 min) and HCV treatment prescription on-site. Recommended venous blood draws for HAV/HBV serology and HAV/HBV vaccinations were performed by the staff of the "HAG". Project performance was assessed by annual cross-sectional chart review. RESULTS: Of the 128 patients registered in April 2018, 79 (62%) were still present in May 2021. With 72 newly registered, a total of 200 patients could be assessed, of whom 129 (65%) were still present in May 2021. Between April 2018 and May 2021, the proportion ever tested for HIV antibodies increased from 79% (101/128) to 91% (117/129), the proportion ever tested for HCV antibodies from 83% (106/128) to 93% (120/129) and the proportion of those HCV antibody positive ever tested for HCV RNA tested from 89% (47/53) to 98% (56/57). The proportion with adequate HCV management (last HCV antibody test ≤1 year ago, if HCV antibody negative or last HCV RNA test ≤1 year ago, if HCV antibody-positive and RNA-negative) improved from 23% ([15 + 15]/128) to 80% ([55 + 48]/129). Overall, HCV treatment uptake in-creased from 60% (21/35) to 92% (55/60) and HCV RNA prevalence among the HCV antibody positives decreased from 38% (18/47) to 7% (6/84). Between 2018 and 2021, 19 non-cirrhotic chronic hepatitis C patients were successfully treated on-site (18 sustained virological responses [SVR] 12, 1 SVR4), with excellent adherence (≥93%) and, so far, no reinfection. The proportion with known HAV/ HBV serostatus increased from 38%/51% to 64%/76%. Immunity against HAV/HBV improved from 19%/23% to 50%/57%. CONCLUSION: Capillary blood point-of-care tests and a "test-and-treat / vaccinate on-site" approach remove crucial barriers to diagnosis and treatment, making hepatitis elimination in OAT programmes achievable. A high fluctuation rate requires HIV/HCV/HA...

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Initiation of oral hepatitis C virus treatment: Which barriers are pertinent for ambulatory individuals with a history of illicit substance use? A qualitative interview study

Barbati,

Strasser,

Allemann

et al. 2024

Health Science Reports

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Background and AimsThe World Health Organization has set a goal to eradicate hepatitis C virus (HCV) by the year 2030. Nonadherence to HCV treatment has substantial economic implications due to high treatment costs, among others. Barriers to start HCV treatment may be critical. The aim of this study was to assess pertinent barriers to HCV treatment in ambulatory patients with a history of illicit substance use and to compare them to the literature.MethodsBarriers to HCV treatment mentioned by the key risk group (i.e., people who inject drugs) were retrieved from literature through a pragmatic literature search. From 34 published articles, we identified 80 modifiable barriers that were bundled in 23 items within the four topics “Personal difficulties and barriers to treatment,” “Personal motivation to be treated,” “Knowledge about the disease,” and “Received information about the medicine.” In‐depth semistructured interviews were performed face‐to‐face with ambulatory patients from the University Psychiatric Clinics in Basel, Switzerland. Transcripts were coded inductively.ResultsInterviews were performed with seven individuals (mean age: 48.3 years; range: 38–63 years; one woman) treated with oral direct‐acting antivirals between 2014 and 2022. Thirteen barriers to start HCV treatment were mentioned that corresponded to the five categories: information, attitudes, swallowing difficulties, social environment, and unfavorable lifestyle. The barrier “swallowing difficulties” emerged exclusively from the statements provided by the interviewees.ConclusionBarriers to the initiation of HCV treatment indicated by our interviewees clearly differed from the literature. Notably, the challenge of swallowing medicines may be particularly relevant for physicians prescribing and pharmacists dispensing HCV medication.

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Hepatitis C virus elimination in Swiss opioid agonist therapy programmes – the SAMMSU cohort

Cited by 11 publications

References 52 publications

HCV disease burden and population segments in Switzerland

HCV disease burden and population segments in Switzerland

HCV elimination in a Swiss opioid agonist therapy programme – a cohort study

Initiation of oral hepatitis C virus treatment: Which barriers are pertinent for ambulatory individuals with a history of illicit substance use? A qualitative interview study

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