Risk factors for viral hepatitis C infection in Rwanda: Results from a Nationwide Screening Program

Makuza, Jean Damascène; Liu, Carol; Ntihabose, Corneille Killy; Dushimiyimana, Donatha; Umuraza, Sabine; Nisingizwe, Marie Paul; Umutesi, Justine; Serumondo, Janvier; Mugeni, Soline Dusabeyesu; Semakula, Muhamed; Gupta, Neil; Hellard, Margaret; Nsanzimana, Sabin

doi:10.21203/rs.2.9671/v1

Cited by 4 publications

(4 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Participants younger than 40 years of age in our study were more likely to have GT4r subtype. This finding was surprising given the significantly lower prevalence of HCV among younger age groups in Rwanda and presumed low level of ongoing transmission in this age group 7 . One possible explanation for this finding may be a higher premature mortality in individuals with GT4r subtype.…”

Section: Discussionmentioning

confidence: 88%

Risk factors for difficult‐to‐treat hepatitis C virus genotype 4r in Rwanda and implications for elimination in sub‐Saharan Africa

Shumbusho¹,

Liu

Kateera³

et al. 2021

Journal of Viral Hepatitis

Self Cite

View full text Add to dashboard Cite

In sub‐Saharan Africa, there exist distinct HCV genotype (GT) subtypes harbouring resistance‐associated substitutions to commonly used non‐structural protein 5A (NS5A) inhibitor–based direct‐acting antiviral (DAA) regimens. In particular, GT4r subtype has demonstrated high rates of treatment failure. In the absence of routine viral sequencing in sub‐Saharan Africa, it is important to identify sociodemographic, epidemiologic, and clinical characteristics that may be associated with GT4r infection. Methods: A secondary analysis was performed on data from 300 adults with HCV GT4 enrolled in a prospective trial assessing the safety and efficacy of sofosbuvir‐ledipasvir in Rwanda in 2017. The association between characteristics at enrolment and GT subtype was assessed by chi‐square analysis and logistic regression. In multivariate analysis, there were a higher proportion of participants with GT4r subtype with age <40 years (OR: 3.6, 95% CI: 1.3–10.5, p = 0.02), previous hospitalization (OR: 2.5, 95% CI: 1.3–5.0, p = 0.006), previous surgery (OR: 2.2, 95% CI: 1.1–4.2, p = 0.03), cirrhosis (OR: 3.2, 95% CI: 1.3–7.5, p = 0.008) and baseline HCV RNA >1 million IU/ml (OR: 3.4, 95% CI: 1.6–6.9, p = 0.001). Rwandan adults with GT4r are more likely to be younger, have a history of hospital admissions and surgeries and have more active or advanced liver disease compared to those with other GT4 subtypes. In the absence of advanced diagnostics to assess GT subtype, patients with these characteristics may warrant closer monitoring for treatment failure or alternative DAA regimens. More treatment experience with diverse DAA regimens is urgently needed for GT subtypes particular to this region.

show abstract

Section: Discussionmentioning

confidence: 88%

Risk factors for difficult‐to‐treat hepatitis C virus genotype 4r in Rwanda and implications for elimination in sub‐Saharan Africa

Shumbusho¹,

Liu

Kateera³

et al. 2021

Journal of Viral Hepatitis

Self Cite

View full text Add to dashboard Cite

show abstract

“…In sub-Saharan Africa, seroprevalence of hepatitis C is estimated at around 3% [8], which is approximately three times higher than estimates from general populations in Europe (0.54-1.5%) [9] and the United States (US) (0.9%) [10]. Rwanda, where hepatitis C prevalence estimates range between 6.8 and 9% among people over 25 years old and above, [11,12] is the first country in sub-Saharan Africa to launch a national hepatitis C elimination plan. This ambitious plan exceeds WHO targets [7] and aims to screen 4 million people and treat at least 90% of identified cases by 2024 [13].…”

Section: Introductionmentioning

confidence: 87%

Initiation of hepatitis C treatment in two rural Rwandan districts: a mobile clinic approach

et al. 2021

Self Cite

View full text Add to dashboard Cite

Background To eliminate hepatitis C, Rwanda is conducting national mass screenings and providing to people with chronic hepatitis C free access to Direct Acting Antivirals (DAAs). Until 2020, prescribers trained and authorized to initiate DAA treatment were based at district hospitals, and access to DAAs remains expensive and geographically difficult for rural patients. We implemented a mobile clinic to provide DAA treatment initiation at primary-level health facilities among people with chronic hepatitis C identified through mass screening campaigns in rural Kirehe and Kayonza districts. Methods The mobile clinic team was composed of one clinician authorized to manage hepatitis, one lab technician, and one driver. Eligible patients received same-day clinical consultations, counselling, laboratory tests and DAA initiation. Using clinical databases, registers, and program records, we compared the number of patients who initiated DAA treatment before and during the mobile clinic campaign. We assessed linkage to care during the mobile clinical campaign and assessed predictors of linkage to care. We also estimated the cost per patient of providing mobile services and the reduction in out-of-pocket costs associated with accessing DAA treatment through the mobile clinic rather than the standard of care. Results Prior to the mobile clinic, only 408 patients in Kirehe and Kayonza had been initiated on DAAs over a 25-month period. Between November 2019 and January 2020, out of 661 eligible patients with hepatitis C, 429 (64.9%) were linked to care through the mobile clinic. Having a telephone number and complete address recorded at screening were strongly associated with linkage to care. The cost per patient of the mobile clinic program was 29.36 USD, excluding government-provided DAAs. Providing patients with same-day laboratory tests and clinical consultation at primary-level health facilities reduced out-of-pocket expenses by 9.88 USD. Conclusion The mobile clinic was a feasible strategy for providing rapid treatment initiation among people chronically infected by hepatitis C, identified through a mass screening campaign. Compared to the standard of care, mobile clinics reached more patients in a much shorter time. This low-cost strategy also reduced out-of-pocket expenditures among patients. However, long-term, sustainable care would require decentralization to the primary health-centre level.

show abstract

“…In this context, the World Health Organization (WHO) has developed a campaign to eliminate hepatitis C by 2030 (7) In sub-Saharan Africa, seroprevalence of hepatitis C is estimated at around 3% (8), which is approximately three times higher than estimates from general populations in Europe (0.54-1.5%) (9) and the United states (0.9%) (10). Rwanda, where hepatitis C prevalence estimates range between 6.8% and 9% among people over 25 years old and above, (11,12) is the rst country in sub-Saharan Africa to launch a national Hepatitis C elimination plan. This ambitious plan exceeds WHO targets (7) and aims to screen 4 million people and treat at least 90% of identi ed cases by 2024 (13).…”

Section: Read Full License Introductionmentioning

confidence: 99%

Initiation of Hepatitis C treatment in two rural Rwandan districts: A mobile clinic approach

Kamali

Barnhart

Nyirahabihirwe

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

Background: To eliminate hepatitis C, Rwanda is conducting national mass screenings and providing hepatitis C patients with free access to Direct Acting Antivirals (DAAs). Until 2020, all prescribers trained and authorized to initiate DAA treatment were based at District Hospitals, and access to DAAs remains expensive and geographically difficult for rural patients. We designed and implemented a mobile hepatitis clinic to provide DAA treatment initiation at primary-level health facilities among hepatitis C patients identified through mass screening campaigns in rural Kirehe and Kayonza districts. Methods: The mobile clinic team was composed of one clinician trained and authorized to manage hepatitis, one lab technician, and one driver. Eligible patients received same-day clinical consultations, counselling, laboratory tests and DAA initiation. Using clinical databases, registers, and program records, we compared the number of patients who initiated DAA treatment before and during the mobile clinic campaign. We assessed linkage to care during the mobile clinical campaign and assessed predictors of linkage to care. We also estimated the cost per patient of providing mobile services and the reduction in out-of-pocket costs associated with accessing DAA treatment through the mobile clinic rather than the standard of care.Results: Prior to the mobile clinic, only 408 patients in Kirehe and Kayonza had been initiated on DAAs over a 25-month period. Between November 2019 and January 2020, out of 661 eligible patients with chronic hepatitis C, 429 (64.9%) were linked to care through the mobile clinic. Having a telephone number and complete address recorded at screening were strongly associated with linkage to care. The cost per patient of the mobile clinic program was 29.36 USD, excluding government-provided DAAs. Providing patients with same-day laboratory tests and clinical consultation at primary-level health facilities reduced out-of-pocket expenses by 9.88 USD. Conclusion: The mobile clinic model was a feasible strategy for providing rapid treatment initiation among hepatitis C patients identified through a mass screening campaign. Compared to the standard of care, mobile clinics reached more patients in a much shorter time. This low-cost strategy also reduced out-of-pocket expenditures among patients. However, long-term, sustainable care would require decentralization to the primary health-center level.

show abstract

Risk factors for viral hepatitis C infection in Rwanda: Results from a Nationwide Screening Program

Cited by 4 publications

References 11 publications

Risk factors for difficult‐to‐treat hepatitis C virus genotype 4r in Rwanda and implications for elimination in sub‐Saharan Africa

Risk factors for difficult‐to‐treat hepatitis C virus genotype 4r in Rwanda and implications for elimination in sub‐Saharan Africa

Initiation of hepatitis C treatment in two rural Rwandan districts: a mobile clinic approach

Initiation of Hepatitis C treatment in two rural Rwandan districts: A mobile clinic approach

Contact Info

Product

Resources

About