“Waiting for DAAs”: A retrospective chart review of patients with untreated hepatitis C in Rwanda

Abstract

BackgroundAccess to treatment for hepatitis C virus (HCV) in sub-Saharan Africa is extremely limited. With the advent of direct acting antivirals (DAAs), highly effective and easy-to-deliver oral regimens are now available on the global market. This study was conducted to understand the background and characteristics of a national cohort of patients with HCV infection enrolled in care and awaiting therapy with DAAs.Methods and findingsWe conducted a retrospective chart review of all adult patients with confirmed HCV infection who were currently enrolled in care and treatment at the four existing hepatitis referral centers in Rwanda. Patient charts at these centers were reviewed, and routinely collected data were recorded and analyzed. Overall, 253 patients were identified; median age was 56 years (IQR: 43, 65), and 149 (58.9%) were female. Median viral load was 688,736 IU/ml and 96.7% were HCV genotype 4. As classified by FIB-4 score, 64.8% of the patients had moderate to severe fibrosis. Fibrosis stage was associated with age (OR 1.12, CI 1.09–1.17), but not with time since diagnosis, gender, treatment center, or type of insurance. There was a low frequency of documented co-morbid conditions, including hypertension, diabetes, HIV, and hepatitis B virus.ConclusionsCompared to an estimated 55,000 patients eligible for HCV treatment in Rwanda, this study identified only 253 patients currently diagnosed and engaged in care, highlighting an immense treatment gap in HCV, likely due to the lack of accessible and affordable screening, diagnostic, and treatment modalities. The patients that were enrolled in care had a disproportionately advanced fibrosis stage, possibly indicating late presentation to care or lack of treatment options. In the context of newly available and effective treatment options, this study supports the overall need to accelerate access to HCV screening, diagnostics, and care and treatment services in resource-limited settings in sub-Saharan Africa.

Accelerating the elimination of viral hepatitis: a Lancet Gastroenterology & Hepatology Commission

“…The Rwandan comprehensive community health system offers near universal (>90%) health insurance coverage, and government partnerships have enabled access to subsidised therapy for HCV and HBV. By the end of 2017, over 2000 people had started curative HCV treatment using a simplified DAA regimen approach 292 . In 2017, the Rwandan Biomedical Centre embarked on a campaign of vaccination, screening and confirmation, identifying an estimated 9,000 HCV-infected individuals and 722 HBV-infected individuals that needed to be linked to care and treatment.…”

Controlling hepatitis C in Rwanda: a framework for a national response

“…Using current systems for HIV viral load testing, blood samples for HCV testing are collected at local health centres and district hospitals and delivered to one of the testing sites via a centrally organized transport system, which also delivers results back to the health facilities. Given the predominance of HCV genotypes 1 and 4 in Rwanda, 18 genotyping is not currently recommended before starting patients on direct-acting antiviral drugs according to Rwanda’s guidelines. In 2016, the health ministry conducted a nationwide testing campaign for both HBV and HCV in over 150 000 adults living with HIV.…”

The Cascade of Care for Hepatitis C Treatment in Rwanda: A Retrospective Cohort Study of the 2017–2019 Mass Screening and Treatment Campaign

“…In 2019, only 21% of people living with HCV infection globally knew their status [ 6 ], and approximately 62% among those diagnosed had access to treatment. Access to HCV diagnosis and treatment is particularly challenging in sub-Saharan Africa (SSA) [ 14 ], despite the region accounting for 20% of global infections [ 15 ].…”