A systematic PCR record-based re-call of HCV-RNA-positive people enables re-linkage to care and HCV elimination in Austria - The ELIMINATE project.
DAA
WHO
elimination
hepatitis C
Journal
Liver international : official journal of the International Association for the Study of the Liver
ISSN: 1478-3231
Titre abrégé: Liver Int
Pays: United States
ID NLM: 101160857
Informations de publication
Date de publication:
01 Oct 2024
01 Oct 2024
Historique:
revised:
14
07
2024
received:
27
04
2024
accepted:
07
08
2024
medline:
1
10
2024
pubmed:
1
10
2024
entrez:
1
10
2024
Statut:
aheadofprint
Résumé
Identification of people living with hepatitis C virus (HCV) via readily available laboratory records could be a key strategy for macro-elimination, aligning with the WHO elimination goal. Therefore, the ELIMINATE(ELIMINation of HCV in AusTria East) project aimed to systematically re-link people with a 'last-positive' HCV-RNA PCR record to care. In 10 major liver centres in Eastern Austria, a systematic readout of 'last-positive' HCV-RNA PCR test records obtained between 2008 and 2020 were conducted and linked to available patient contact data. Between 2020 and 2023, individuals were contacted first by phone, then by letter, to inform them about the availability of effective direct-acting antiviral (DAA) treatment and invite them for pre-treatment evaluation. The overall cohort of last-positive HCV+ individuals included 5695 subjects (62.5% males, mean age 57.3 ± 17.3 years); of note, 1931 (34%) of them had died and 759 (13%) individuals had no valid contact information. Of the remaining 3005 individuals, 1171 (40.0%) had already achieved sustained virological response (SVR) at the time of re-call. We successfully reached 617 (20.5%), of whom 417 (67.6%) attended their pre-treatment visit, and 397 (64.3%) commenced DAA-therapy. HCV cure has been confirmed in 326 individuals, corresponding to an SVR rate of 82.1%. The ELIMINATE project identified 5695 people living with HCV who were 'lost to care' despite documented HCV viraemia. While invalid contact data were an evident barrier to HCV elimination, premature deaths among the cohort underscored the severity of untreated HCV. The implementation of a systematic HCV-RNA PCR recorded-based re-call workflow represents an effective strategy supporting the WHO goal of HCV elimination.
Sections du résumé
BACKGROUND AND AIMS
OBJECTIVE
Identification of people living with hepatitis C virus (HCV) via readily available laboratory records could be a key strategy for macro-elimination, aligning with the WHO elimination goal. Therefore, the ELIMINATE(ELIMINation of HCV in AusTria East) project aimed to systematically re-link people with a 'last-positive' HCV-RNA PCR record to care.
METHODS
METHODS
In 10 major liver centres in Eastern Austria, a systematic readout of 'last-positive' HCV-RNA PCR test records obtained between 2008 and 2020 were conducted and linked to available patient contact data. Between 2020 and 2023, individuals were contacted first by phone, then by letter, to inform them about the availability of effective direct-acting antiviral (DAA) treatment and invite them for pre-treatment evaluation.
RESULTS
RESULTS
The overall cohort of last-positive HCV+ individuals included 5695 subjects (62.5% males, mean age 57.3 ± 17.3 years); of note, 1931 (34%) of them had died and 759 (13%) individuals had no valid contact information. Of the remaining 3005 individuals, 1171 (40.0%) had already achieved sustained virological response (SVR) at the time of re-call. We successfully reached 617 (20.5%), of whom 417 (67.6%) attended their pre-treatment visit, and 397 (64.3%) commenced DAA-therapy. HCV cure has been confirmed in 326 individuals, corresponding to an SVR rate of 82.1%.
CONCLUSION
CONCLUSIONS
The ELIMINATE project identified 5695 people living with HCV who were 'lost to care' despite documented HCV viraemia. While invalid contact data were an evident barrier to HCV elimination, premature deaths among the cohort underscored the severity of untreated HCV. The implementation of a systematic HCV-RNA PCR recorded-based re-call workflow represents an effective strategy supporting the WHO goal of HCV elimination.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Gilead Sciences
Informations de copyright
© 2024 The Author(s). Liver International published by John Wiley & Sons Ltd.
Références
EASL recommendations on treatment of hepatitis C: final update of the series. J Hepatol. 2020;73(5):1170‐1218.
Westbrook RH, Dusheiko G. Natural history of hepatitis C. J Hepatol. 2014;61(1 Suppl):S58‐S68.
Martinello M, Solomon SS, Terrault NA, Dore GJ. Hepatitis C. Lancet. 2023;402(10407):1085‐1096.
Manns MP, Wedemeyer H, Cornberg M. Treating viral hepatitis C: efficacy, side effects, and complications. Gut. 2006;55(9):1350‐1359.
Lawitz E, Mangia A, Wyles D, et al. Sofosbuvir for previously untreated chronic hepatitis C infection. N Engl J Med. 2013;368(20):1878‐1887.
Falade‐Nwulia O, Suarez‐Cuervo C, Nelson DR, Fried MW, Segal JB, Sulkowski MS. Oral direct‐acting agent therapy for hepatitis C virus infection: a systematic review. Ann Intern Med. 2017;166(9):637‐648.
World Health Organization. Global health sector strategy on viral hepatitis 2016–2021 towards ending viral hepatitis 2016.
Heffernan A, Cooke GS, Nayagam S, Thursz M, Hallett TB. Scaling up prevention and treatment towards the elimination of hepatitis C: a global mathematical model. Lancet. 2019;393(10178):1319‐1329.
Viner K, Kuncio D, Newbern EC, Johnson CC. The continuum of hepatitis C testing and care. Hepatology. 2015;61(3):783‐789.
Safreed‐Harmon K, Blach S, Aleman S, et al. The consensus hepatitis C Cascade of care: standardized reporting to monitor progress toward elimination. Clin Infect Dis. 2019;69(12):2218‐2227.
Austrian Federal Ministry of Social Affairs Health Care and Consumer Protection. HIV/AIDS, Hepatitis B and C in Austria. 2019.
European Centre for Disease Prevention and Control. Hepatitis C Annual Epidemiological Report for 2020. ECDC. 2022.
Schmidbauer C, Schubert R, Schütz A, et al. Directly observed therapy for HCV with glecaprevir/pibrentasvir alongside opioid substitution in people who inject drugs‐first real world data from Austria. PLoS One. 2020;15(3):e0229239.
Schwarz M, Schwarz C, Schütz A, et al. Combining treatment for chronic hepatitis C with opioid agonist therapy is an effective microelimination strategy for people who inject drugs with high risk of non‐adherence to direct‐acting antiviral therapy. J Virus Erad. 2023;9(1):100319.
Schmidbauer C, Schwarz M, Schütz A, et al. Directly observed therapy at opioid substitution facilities using sofosbuvir/velpatasvir results in excellent SVR12 rates in PWIDs at high risk for non‐adherence to DAA therapy. PLoS One. 2021;16(6):e0252274.
Jachs M, Binter T, Chromy D, et al. Outcomes of an HCV elimination program targeting the Viennese MSM population. Wien Klin Wochenschr. 2021;133(13–14):635‐640.
Schwarz M, Gremmel S, Wurz M, et al. “Let's end hepatitis C in Vienna”—the first HCV elimination program targeting homeless and people without medical insurance in Vienna. Z Gastroenterol. 2020;58(5):P61.
Silbernagl M, Slamanig R, Fischer G, Brandt L. Hepatitis C infection and psychiatric burden in two imprisoned cohorts: young offenders and opioid‐maintained prisoners. Health Policy. 2018;122(12):1392‐1402.
Lazarus JV, Wiktor S, Colombo M, Thursz M, EASL International Liver Foundation. Micro‐elimination—a path to global elimination of hepatitis C. J Hepatol. 2017;67(4):665‐666.
Thomas DL, Longo DL. Global elimination of chronic hepatitis. N Engl J Med. 2019;380(21):2041‐2050.
Mangia A, Cotugno R, Cocomazzi G, Squillante MM, Piazzolla V. Hepatitis C virus micro‐elimination: where do we stand? World J Gastroenterol. 2021;27(16):1728‐1737.
Cunningham EB, Wheeler A, Hajarizadeh B, et al. Interventions to enhance testing, linkage to care, and treatment initiation for hepatitis C virus infection: a systematic review and meta‐analysis. Lancet Gastroenterol Hepatol. 2022;7(5):426‐445.
Huang CF, Chen GJ, Hung CC, Yu ML. HCV microelimination for high‐risk special populations. J Infect Dis. 2023;228(Suppl 3):S168‐S179.
Taha G, Ezra L, Abu‐Freha N. Hepatitis C elimination: opportunities and challenges in 2023. Viruses. 2023;15(7):1413.
The European Union HCV Collaborators. Hepatitis C virus prevalence and level of intervention required to achieve the WHO targets for elimination in the European Union by 2030: a modelling study. Lancet Gastroenterol Hepatol. 2017;2(5):325‐336.
Aleman S, Soderholm J, Busch K, et al. Frequent loss to follow‐up after diagnosis of hepatitis C virus infection: a barrier towards the elimination of hepatitis C virus. Liver Int. 2020;40(8):1832‐1840.
Stasi C, Silvestri C, Voller F. Update on hepatitis C epidemiology: unaware and untreated infected population could Be the key to elimination. SN Compr Clin Med. 2020;2(12):2808‐2815.
Chen CJ, Huang YH, Hsu CW, et al. Hepatitis C micro‐elimination through the retrieval strategy of patients lost to follow‐up. BMC Gastroenterol. 2023;23(1):40.
Lopes H, Baptista‐Leite R, Franco D, Serra MA, Escudero A, Martín‐Moreno JM. Let's end HepC: modelling public health epidemiological policies applied to hepatitis C in Spain. Front Public Health. 2021;9:735572.
Omran D, Alboraie M, Zayed RA, et al. Towards hepatitis C virus elimination: Egyptian experience, achievements and limitations. World J Gastroenterol. 2018;24(38):4330‐4340.
Schwarz C, Bauer D, Dorn L, et al. ELIMINATE: a PCR record‐based macroelimination project for systematic recall of HCV‐RNA‐positive persons in Austria. Wien Klin Wochenschr. 2023;136:278‐288.
Hartl L, Jachs M, Bauer D, et al. HCV hotline facilitates hepatitis C elimination during the COVID‐19 pandemic. J Viral Hepat. 2022;29(12):1062‐1072.
Steininger L, Chromy D, Bauer D, et al. Direct patient‐physician communication via a hepatitis C hotline facilitates treatment initiation in patients with poor adherence. Wien Klin Wochenschr. 2021;133(9–10):452‐460.
de Franchis R, Bosch J, Garcia‐Tsao G, et al. Baveno VII—renewing consensus in portal hypertension. J Hepatol. 2022;76(4):959‐974.
Castera L, Forns X, Alberti A. Non‐invasive evaluation of liver fibrosis using transient elastography. J Hepatol. 2008;48(5):835‐847.
Wai CT, Greenson JK, Fontana RJ, et al. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology. 2003;38(2):518‐526.
Shah AG, Lydecker A, Murray K, et al. Comparison of noninvasive markers of fibrosis in patients with nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol. 2009;7(10):1104‐1112.
Beekmans N, Klemt‐Kropp M. Re‐evaluation of chronic hepatitis B and hepatitis C patients lost to follow‐up: results of the Northern Holland hepatitis retrieval project. Hepatol Med Policy. 2018;3(1):5.
Kracht PAM, Arends JE, van Erpecum KJ, et al. REtrieval and cure of chronic hepatitis C (REACH): results of micro‐elimination in the Utrecht province. Liver Int. 2019;39(3):455‐462.
Ferraz MLG, de Andrade A, Pereira GHS, et al. Retrieval of HCV patients lost to follow‐up as a strategy for hepatitis C microelimination: results of a Brazilian multicentre study. BMC Infect Dis. 2023;23(1):468.
Hajarizadeh B, Grebely J, Martinello M, Matthews GV, Lloyd AR, Dore GJ. Hepatitis C treatment as prevention: evidence, feasibility, and challenges. Lancet Gastroenterol Hepatol. 2016;1(4):317‐327.
Cartwright EJ, Pierret C, Minassian C, et al. Alcohol use and sustained virologic response to hepatitis C virus direct‐acting antiviral therapy. JAMA Netw Open. 2023;6(9):e2335715.
Alavi M, Janjua NZ, Chong M, et al. The contribution of alcohol use disorder to decompensated cirrhosis among people with hepatitis C: an international study. J Hepatol. 2018;68(3):393‐401.
Schwarz C, Schubert R, Schwarz M, et al. CHIME—a tailored HCV microelimination project in Viennese people who inject drugs at drug centralized substitution centers. J Virus Erad. 2023;9(3):100338.
Polaris Observatory HCVC. Global change in hepatitis C virus prevalence and cascade of care between 2015 and 2020: a modelling study. Lancet Gastroenterol Hepatol. 2022;7(5):396‐415.