A same day ‘test and treat’ model for chronic HCV and HBV infection: Results from two community‐based pilot studies in Egypt

Abstract

Prompt access to confirmatory viral load testing and staging of liver disease are key barriers in uptake of treatment for chronic hepatitis B and C infection. Our objective was to establish the feasibility of a same day ‘test and treat’ model in two distinct community‐based settings in Egypt through use of key point‐of‐care (POC) portable tools for HCV and HBV viral load assessment and staging of liver disease followed by treatment initiation. Community sites were a village in northern Egypt (site 1) and a government office in Cairo (site 2). The following model was adopted: community awareness raising in the week before project initiation; site assessment to ensure optimal placement and calibration of equipment and clinical care set‐up; transfer of key portable laboratory instruments to the sites (four cartridge GeneXpert, FibroScan and abdominal ultrasound); screening using rapid diagnostic tests for HCV‐Ab and HBsAg, with immediate venous or finger‐stick blood sampling for HCV‐RNA and HBV‐DNA assay, FibroScan staging of liver disease and ultrasound screening for liver cancer. At site 1, 475 individuals were screened over a single day, 125 were positive for HCV‐Ab and 4 for HBsAg, 43 of 56 new HCV diagnoses were HCV RNA positive, and 3 of 4 HBsAg positive were HBV DNA positive, 40 initiated HCV treatment, and one HBV treatment . At site 2, 3188 individuals were screened over 3 days, 157 were positive for HCV‐Ab, and 27 for HBsAg; 38 of 76 new HCV diagnoses were HCV RNA positive, and 15 of 18 HBsAg positive were HBV‐DNA positive. Across both sites, 78 patients were counselled and initiated on treatment for HCV and 12 for HBV within 3 and 4 hours, respectively, of initial positive rapid diagnostic test result. We have shown the feasibility of a same day ‘test and treat’ model for chronic HCV and HBV infection in two community‐based settings in Egypt that achieved high levels of linkage to care and initial treatment.

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

“…While some countries such as Egypt and Pakistan are currently on track to reach these goals, most European countries are still working on improving their HCV elimination strategies [ 7 – 10 ]. Targeted screening programs aiming at specific key population groups (e.g.…”

Decentralized, Community-Based Hepatitis C Point-of-Care Testing and Direct-Acting Antiviral Treatment for People Who Inject Drugs and the General Population in Myanmar: Protocol for a Feasibility Study

“…Globally, international and national guidelines support the implementation of decentralized community-based, GP-led models of care for hepatitis C [ 7 , 17 ]. However, few publications document such models of care in detail or their outcomes regarding the completion of the diagnostic pathway and treatment uptake and outcomes [ 12 - 14 , 19 ]. This study allows us to assess the implementation requirements of this clinical pathway, its feasibility, acceptability to both patients and providers, and its cost, along with the effectiveness of providing decentralized testing and treatment to patients in terms of the uptake of treatment and achievement of cure among those diagnosed.…”

“…Previous studies have demonstrated that treating people with hepatitis C infection with DAAs in community settings is feasible and that people achieve similar SVR12 rates to those treated in tertiary settings [ 12 ]; however, there is still little evidence for the feasibility and effectiveness of this model of care in low- and middle-income settings [ 13 , 14 , 19 ]. Decentralizing diagnostic testing and treatment initiation and offering these services at a one-stop shop has the potential to reduce time to DAA initiation, increase retention in care, and provide curative treatment to many people unable to access tertiary hospital services.…”

“…They are sometimes referred to as generalist doctors or primary care physicians in other settings, although it should be noted that in many settings, primary care physicians/GPs often have specialized training. Globally, research trials and programs led by non-government organizations have included decentralized community-based, GP-led models of care [ 12 , 13 ] and, more recently, trials of same-day treatment initiation models [ 12 , 14 ]. However, there is little well-documented evidence of these models of care and their feasibility and effectiveness, particularly in resource-limited settings [ 12 ].…”

“…The National Guidelines for the Simplified Treatment of Hepatitis C Virus Infection allow GPs to prescribe DAA therapy and for the use of the Cepheid GeneXpert hepatitis C RNA PCR test to assess if someone has current hepatitis C infection [ 18 ]. However, to date, there is insufficient data to assess the success of this decentralized approach, including the use of the community-based diagnostic and treatment pathway in Myanmar and other low-and middle-income settings globally [ 12 , 14 , 19 ].…”