Feasible To Treat Hepatitis C At Scale, Study

A decentralized, algorithm-based public health model helped cure over 90 percent of patients with hepatitis C virus infections in Punjab, India.

AsianScientist (Apr. 23, 2018) – A public health initiative developed in India to treat hepatitis C virus (HCV) infections has been shown to be effective in a study presented at The International Liver Congress 2018.

HCV infection represents a major healthcare burden in India, with an estimated 12-18 million people infected. The burden is particularly heavy in the Indian state of Punjab, owing to the high prevalence of risk factors such as unsafe medical practices—including unsafe medical injections, blood transfusions and dental procedures—and intravenous drug use.

In a bid to decrease the reservoir of HCV by treating established cases and reducing the incidence of new cases, a team of researchers led by Professor Radha Krishan Dhiman from the Postgraduate Institute of Medical Education and Research, Chandigarh, India, provided free direct-acting antiviral agents (DAAs) to nearly 20,000 individuals.

Part of a concerted effort in the Punjab region, the study assessed the feasibility of delivering decentralized HCV care via three government medical colleges and 22 district hospitals, and required the training of approximately 90 medical specialists, pharmacists and data managers.

“We have shown in our study that it is possible to cure more than 90 percent of individuals with HCV infection in a highly dispersed population using well-trained teams in government medical colleges and district hospitals, and widely available DAAs,” said Dhiman.

“We believe the Punjab Model could be applied to many different populations with the aim of eliminating HCV.”

A cost-effective treatment algorithm was developed using sofosbuvir-based regimens to treat all patients with HCV infection, with regimens selected based on the presence or absence of cirrhosis and HCV genotype. A total of 29,371 patients (61.7 percent male; mean age 42 years) were enrolled in one year, of which 19,646 patients completed treatment with a sustained virological response (SVR) at 12 weeks of 92.5 percent.

Cure rates among individuals with cirrhosis (93.1 percent) and without cirrhosis (92.4 percent), and those with genotype 3 (92.6 percent) and other genotypes (93.1 percent), were similar. No major adverse events were reported.

“This study is an impressive example of how to upscale the treatment of hepatitis C, which is important to reduce hepatitis C-related complications, particularly the development of hepatocellular carcinoma,” said Professor Markus Cornberg from the Hannover Medical School, Germany, and governing board member of the European Association for the Study of the Liver.


Source: European Association for the Study of the Liver; Photo: Shutterstock.
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