Reaching hepatitis C virus elimination targets requires health system interventions to enhance the care cascade

Scott, Nick; Doyle, Joseph S; Wilson, David; Wade, Amanda; Howell, Jess; Pedrana, Alisa; Thompson, Alexander; Hellard, Margaret

doi:10.1016/j.drugpo.2017.07.006

Cited by 119 publications

(116 citation statements)

References 46 publications

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“…In addition, modelling studies have pointed to several key additional elements which are required for achieving elimination among PWID: One Australian study highlighted the need for enhanced HCV screening among PWID in order to sustain HCV treatment rates required for elimination, a situation which is likely applicable to many global settings . In addition, a modelling study in the rural U.S. emphasized the importance of retreatment of reinfection in achieving elimination targets .…”

Section: Resultsmentioning

confidence: 99%

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Is hepatitis C virus elimination possible among people living with HIV and what will it take to achieve it?

et al. 2018

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IntroductionThe World Health Organization targets for hepatitis C virus (HCV) elimination include a 90% reduction in new infections by 2030. Our objective is to review the modelling evidence and cost data surrounding feasibility of HCV elimination among people living with HIV (PLWH), and identify likely components for elimination. We also discuss the real‐world experience of HCV direct acting antiviral (DAA) scale‐up and elimination efforts in the Netherlands.MethodsWe review modelling evidence of what intervention scale‐up is required to achieve WHO HCV elimination targets among HIV‐infected (HIV+) people who inject drugs (PWID) and men who have sex with men (MSM), review cost‐effectiveness of HCV therapy among PLWH and discuss economic implications of elimination. We additionally use the real‐world experience of DAA scale‐up in the Netherlands to illustrate the promise and potential challenges of HCV elimination strategies in MSM. Finally, we summarize key components of the HCV elimination response among PWLH.Results and discussionModelling indicates HCV elimination among HIV+ MSM and PWID is potentially achievable but requires combination treatment and either harm reduction or behavioural risk reductions. Preliminary modelling indicates elimination among HIV+ PWID will require elimination efforts among PWID more broadly. Treatment for PLWH and high‐risk populations (PWID and MSM) is cost‐effective in high‐income countries, but costs of DAAs remain a barrier to scale‐up worldwide despite the potential low production price ($50 per 12 week course). In the Netherlands, universal DAA availability led to rapid uptake among HIV+ MSM in 2015/16, and a 50% reduction in acute HCV incidence among HIV+ MSM from 2014 to 2016 was observed. In addition to HCV treatment, elimination among PLWH globally also likely requires regular HCV testing, development of low‐cost accurate HCV diagnostics, reduced costs of DAA therapy, broad treatment access without restrictions, close monitoring for HCV reinfection and retreatment, and harm reduction and/or behavioural interventions.ConclusionsAchieving WHO HCV Elimination targets is potentially achievable among HIV‐infected populations. Among HIV+ PWID, it likely requires HCV treatment scale‐up combined with harm reduction for both HIV+ and HIV‐ populations. Among HIV+ MSM, elimination likely requires both HCV treatment and behaviour risk reduction among the HIV+ MSM population, the latter of which to date has not been observed. Lower HCV diagnostic and treatment costs will be key to ensuring scale‐up of HCV testing and treatment without restriction, enabling elimination.

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Section: Resultsmentioning

confidence: 99%

“…In addition, a modelling study in the rural U.S. emphasized the importance of retreatment of reinfection in achieving elimination targets [21]. As such, elimination strategies likely require regular testing [22], HCV treatment [13,[15][16][17][18][19][20], harm reduction [13,16,21] and retreatment of reinfections [21].…”

Section: Hiv-infected Pwidmentioning

confidence: 99%

Is hepatitis C virus elimination possible among people living with HIV and what will it take to achieve it?

et al. 2018

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“…Obtaining CD4 counts at the point of care in HIV have been shown to engage individuals in care earlier, and point of care Hepatitis C RNA tests are an essential part of improving the cascade of care and reaching elimination targets for Hepatitis C . However, there is limited data on the effect of POCTs on hepatitis B care cascade.…”

Section: Discussionmentioning

confidence: 99%

Point of care and oral fluid hepatitis B testing in remote Indigenous communities of northern Australia

Sullivan

Davies

Binks

et al. 2019

Journal of Viral Hepatitis

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Many Indigenous Australians in northern Australia living with chronic hepatitis B are unaware of their diagnosis due to low screening rates. A venous blood point of care test (POCT) or oral fluid laboratory test could improve testing uptake in this region. The purpose of this study was to assess the field performance of venous blood POCT and laboratory performance of an oral fluid hepatitis B surface antigen (HBsAg) test in Indigenous individuals living in remote northern Australian communities. The study was conducted with four very remote communities in the tropical north of Australia's Northern Territory. Community research workers collected venous blood and oral fluid samples. We performed the venous blood POCT for HBsAg in the field. We assessed the venous blood and oral fluid specimens for the presence of HBsAg using standard laboratory assays. We calculated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the POCT and oral fluid test, using serum laboratory detection of HBsAg as the gold standard. From 215 enrolled participants, 155 POCT and 197 oral fluid tests had corresponding serum HBsAg results. The POCT had a sensitivity of 91.7% and specificity of 100%. Based on a population prevalence of 6%, the PPV was 100% and NPV was 99.5%. The oral fluid test had a sensitivity of 56.8%, specificity of 98.1%, PPV of 97.3% and NPV of 65.9%. The venous blood POCT has excellent test characteristics and could be used to identify individuals with chronic HBV infection in high prevalence communities with limited access to health care. Oral fluid performance was suboptimal.

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“…The global lessonfrom such data is that public health and WHO strategies to eliminate HCV cannot rely on treatment roll-out alone to lead to elimination. Expanded efforts will be required to maintain continued and high levels of HCV treatment uptake [36].…”

Section: Discussionmentioning

confidence: 99%

Heterogeneity in hepatitis C virus treatment prescribing and uptake in Australia: a geospatial analysis of a year of unrestricted treatment access

Scott¹,

Hainsworth²,

Sacks‐Davis³

et al. 2018

Journal of Hepatology

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Reaching hepatitis C virus elimination targets requires health system interventions to enhance the care cascade

Cited by 119 publications

References 46 publications

Is hepatitis C virus elimination possible among people living with HIV and what will it take to achieve it?

Is hepatitis C virus elimination possible among people living with HIV and what will it take to achieve it?

Point of care and oral fluid hepatitis B testing in remote Indigenous communities of northern Australia

Heterogeneity in hepatitis C virus treatment prescribing and uptake in Australia: a geospatial analysis of a year of unrestricted treatment access

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