Targeted HCV micro-elimination enhances case finding and treatment

A hepatitis C virus (HCV) micro-elimination programme targeting high-risk groups can enhance the effectiveness of screening and significantly shorten the time to starting direct-acting antiviral (DAA) therapy without compromising treatment outcomes, researchers at the University of Hong Kong (HKU) have reported.

The Conquering Hepatitis via Micro-Elimination (CHIME) programme, started by HKU’s Division of Gastroenterology and Hepatology in collaboration with nongovernmental organizations (NGOs), provides targeted HCV screening for people who inject drugs (PWIDs) and are undergoing rehabilitation. Following point-of-care testing for antibody to HCV at the NGOs’ halfway houses or drug rehabilitation centres, participants with positive results are provided confirmatory blood tests for HCV RNA. Those with confirmed HCV infection are contacted to attend a linkage to care (LTC) clinic for counselling, risk stratification, and evaluation for eligibility for DAA treatment. [Mak LYL, et al, European Association for the Study of the Liver International Liver Congress 2021 (EASL 2021), poster PO-1871]

From the third quarter of 2019 to February 2021, a total of 140 individuals had undergone HCV screening through the programme. Of these, 117 (83.6 percent) were found to be HCV RNA–positive.

“The HCV RNA–positivity rate of 83.6 percent is double the expected rate of 46.2 percent based on viral hepatitis surveillance data in 2017 from the Centre for Health Protection,” said investigator Dr Loey Lung-Yi Mak. “This indicates the effectiveness of the micro-elimination approach in identifying hidden hepatitis C patients in the community.”

Among the 117 HCV RNA–positive individuals, 52 had attended the LTC clinic. “The time from site visit to first LTC clinic visit was 188 days in the CHIME programme, compared with 204 days for non-CHIME patients receiving standard of care [SoC] [p=0.048],” reported Mak.

“Notably, the waiting time for treatment was significantly shortened by 68 percent in the CHIME programme vs SoC. DAA therapy was started 56 days after first clinic visit in the CHIME programme, compared with 175 days for SoC [p<0.001],” she highlighted. “The shortened waiting time can enhance patients’ intention to receive treatment and their compliance with therapy.”

“Among 32 participants who received DAA treatment, sustained virological response [SVR] rate was 90.6 percent, in line with the SVR rate of 95.3 percent with SoC [p=0.226],” she continued.

Most of the CHIME participants had HCV genotype (GT) 6 infection (63.5 percent). No significant differences in SVR rates were observed between GTs (GT1, 94.2 percent [n=146/155]; GT2, 100 percent [n=9/9]; GT3, 93.8 percent [n=15/16]; GT6, 96.8 percent [n=91/94]; p=0.909).

“The CHIME programme is ongoing, with targeted screening expanded to former prison inmates and former drug addicts,” said Mak. “As of August 2021, a total of 213 individuals had received screening, and 74 patients had received treatment.”

The researchers aim to recruit a total of 480 high-risk individuals by the end of December 2021. Those interested in the programme may contact the research team by WhatsApp at 5333 2482.