Targeted HCV microelimination programme expanded after initial success

The University of Hong Kong’s (HKU) hepatitis C virus (HCV) microelimination programme targeting high-risk populations is expanded recently to eligible persons in custody (PICs) following initial success in individuals with history of illicit drug use, needle sharing or imprisonment undergoing rehabilitation in halfway houses or drug rehabilitation centres.

The CHIME (Conquering Hepatitis via Microelimination) programme, initiated by researchers from HKU’s Division of Gastroenterology and Hepatology, provides rapid point-of-care screening for HCV antibody and reflex HCV RNA testing via venipuncture to targeted high-risk populations in Hong Kong. Participation is on a voluntary basis. Viraemic participants are invited to attend a linkage to care (LTC) clinic for counselling and direct-acting antiviral (DAA) treatment.

Between 2019 and 2021, the researchers conducted 22 site visits to halfway houses and drug rehabilitation centres run by nongovernmental organizations in Hong Kong. A total of 396 individuals with history of illicit drug use, needle sharing or imprisonment underwent HCV screening. More than half (57.8 percent; n=229) of the participants screened positive for antibody to HCV, while 47.2 percent (n=187) were viraemic. [Mak LY, et al, The Liver Meeting 2023, abstract 1818-A]

Among 187 viraemic participants, median age was 50 years, 93 percent were male, all were smokers, and 53.1 percent were heavy drinkers. Additionally, 79.7 percent reported needle sharing, while 54.7 percent had history of tattoos. All viraemic participants were heterosexual, with 74.3 percent having multiple sexual partners and 69.5 percent being unmarried.

HCV genotype 6 was predominant (58.6 percent), followed by genotype 3 (16.4 percent). In addition, 70.3 percent had abnormal alanine aminotransferase (ALT) levels, 16.4 percent were cirrhotic, and 4.7 percent had hepatitis B virus co-infection.

About two-thirds (68.4 percent; n=128) of viraemic participants attended the LTC clinic, while 31.6 percent (n=59) defaulted clinic visits. The median waiting time for LTC clinic appointment was 23.9 weeks. Among those who attended the LTC clinic, only 44.5 percent were aware of their HCV infection prior to the programme.

All viraemic participants who attended the LTC clinic were willing to receive DAA treatment. Among 102 participants who underwent post-treatment blood test, 97.1 percent (n=99) achieved sustained virological response (SVR), while 90 percent achieved ALT normalization. No serious side effects were reported with DAA treatment.

“The CHIME programme successfully identified high-risk populations with HCV infection in Hong Kong,” the researchers noted. “Although these individuals are prone to nonengagement, all of the HCV-infected participants who were successfully linked to the care system showed high intention to receive treatment, which resulted in a high SVR rate.”

In October 2023, the programme was expanded to eligible PICs in Stanley Prison in collaboration with the Correctional Services Department. “The testing process was very smooth [thus far] in this 3-year pilot programme. Eligible PICs diagnosed with HCV infection receive a 2- to 3-month course of DAA therapy,” said Dr Loey Mak of HKU’s Division of Gastroenterology and Hepatology.