Anticipated timing of elimination of hepatitis C virus in Canada’s four most populous provinces

Feld, Jordan J.; Rahal, Yasmine; Robert, Caroline; Sanchez, Yuri; Razavi, Homie

doi:10.1016/s0168-8278(20)31139-9

Cited by 5 publications

(8 citation statements)

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“…The implementation of a variety of strategies including the expansion harm reduction services, applying treatment as prevention strategies, 59 expanding the use of DBS and POC rapid testing, and increasing OAT clinic and PCP buy‐in to screen and treat HCV could assist Canada getting on track to reach its revised HCV elimination goals that were disrupted by the COVID‐19 pandemic 60 …”

Section: Discussionmentioning

confidence: 99%

Real‐world hepatitis C prevalence and treatment uptake at opioid agonist therapy clinics in Ontario, Canada

Wolfson‐Stofko,

Hirode,

Vanderhoff

et al. 2024

Journal of Viral Hepatitis

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Widespread screening for hepatitis C virus (HCV) is necessary for Canada to meet its HCV elimination goals by 2030. People who currently or previously injected drugs are at high risk for HCV. Opioid agonist therapy (OAT, such as methadone and buprenorphine) has been shown to help stabilize the lives of people who are opioid‐dependent. The distribution of OAT in North America typically requires daily, weekly, or monthly clinic visits and presents an opportunity for engagement, screening and treatment for those at high‐risk of HCV. In this study, HCV screening was conducted by staff at OAT clinics in Ontario from 2016 to 2020 and those with chronic infections were treated on‐site with direct‐acting antivirals. Point‐of‐care or dried blood spot (DBS) testing was used for antibodies, DBS or serum for HCV RNA and serum for HCV RNA at SVR12 (sustained virological response). Clinics screened 1954 people (mean age 40 years ±12, 63% male). Forty‐five percent were antibody positive, of whom 64% were HCV RNA+. Eighty percent of those RNA+ set an appointment in which 99% attended. Ninety‐six percent started treatment with 87% completing treatment. Sixty‐eight percent of people who completed treatment submitted a sample for SVR12 testing of which 97% achieved a virological cure. Results suggest that HCV screening and treatment at OAT clinics is feasible, effective and warrants expansion. Data suggest strong treatment adherence due to high rates of SVR12 comparable with other OAT‐based HCV treatment programs. The lack of SVR12 sampling could be addressed by either on‐site phlebotomy or incentivizing SVR12 sampling.

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Section: Discussionmentioning

confidence: 99%

Real‐world hepatitis C prevalence and treatment uptake at opioid agonist therapy clinics in Ontario, Canada

Wolfson‐Stofko,

Hirode,

Vanderhoff

et al. 2024

Journal of Viral Hepatitis

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“…The COVID-19 pandemic may have affected the HCV infection and disease burden in BC. While HCV transmission may have increased among people who inject drugs due to disruption in access to harm reduction services [2], the reduction in HCV treatment initiation found in our study might also have weakened the potential for treatment to act as prevention, particularly among people who inject drugs [46,47]. Among birth cohorts, people born between 1965 and 1974 were shown to account for the second highest number of infections in BC (after those born 1945 to 1964) [48], and our study shows HCV treatment initiation was more affected by the pandemic for this birth cohort compared to others.…”

Section: Discussionmentioning

confidence: 99%

“…A modelling study suggested that targets related to the WHO campaign to eliminate HCV as a public health threat could be met by 2028 in BC, based on the assumptions of annual diagnosis at the 2017-2018 level and treatment at the 2019 level [2]. The study further estimated that HCV elimination would be delayed to 2040, if there were a 10% reduction in diagnosis and treatment from assumed values.…”

Section: Discussionmentioning

confidence: 99%

“…Chronic hepatitis C virus (HCV) infection affects approximately 58 million people worldwide and may result in serious morbidity and death if untreated [1]. In 2016, Canada joined the World Health Organization (WHO) campaign to eliminate HCV as a public health threat, through an 80% reduction in the incidence of chronic HCV infections, increases to a 90% coverage of diagnosis and an 80% coverage of treatment, and a 65% reduction in related mortality by 2030 [2,3]. While direct-acting antivirals (DAAs) represent a highly effective treatment that can cure chronic HCV infection in most cases [4], the COVID-19 pandemic has added to the challenges [5] faced by Canada and other countries in meeting targets for diagnosis and treatment.…”

Section: Introductionmentioning

confidence: 99%

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Impact of the COVID-19 Pandemic on Hepatitis C Treatment Initiation in British Columbia, Canada: An Interrupted Time Series Study

Morrow,

Binka,

et al. 2024

Viruses

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We investigated the impacts of the COVID-19 pandemic on hepatitis C (HCV) treatment initiation, including by birth cohort and injection drug use status, in British Columbia (BC), Canada. Using population data from the BC COVID-19 Cohort, we conducted interrupted time series analyses, estimating changes in HCV treatment initiation following the introduction of pandemic-related policies in March 2020. The study included a pre-policy period (April 2018 to March 2020) and three follow-up periods (April to December 2020, January to December 2021, and January to December 2022). The level of HCV treatment initiation decreased by 26% in April 2020 (rate ratio 0.74, 95% confidence interval [CI] 0.60 to 0.91). Overall, no statistically significant difference in HCV treatment initiation occurred over the 2020 and 2021 post-policy periods, and an increase of 34.4% (95% CI 0.6 to 75.8) occurred in 2022 (equating to 321 additional people initiating treatment), relative to expectation. Decreases in HCV treatment initiation occurred in 2020 for people born between 1965 and 1974 (25.5%) and people who inject drugs (24.5%), relative to expectation. In summary, the pandemic was associated with short-term disruptions in HCV treatment initiation in BC, which were greater for people born 1965 to 1974 and people who inject drugs.

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“…[8,9] Various model-based studies have demonstrated the projection of HCV elimination for different countries. [6,[10][11][12][13] However, most models used have not yet considered the impact of (1) transmission dynamics; (2) COVID-19; and (3) ongoing immigration. Thus, existing models may fail to generate accurate projections necessary to assess the impact of interventions, particularly related to CHC incidence.…”

Section: Introductionmentioning

confidence: 99%

Feasibility of hepatitis C elimination by screening and treatment alone in high-income countries

Tian,

Forouzannia,

Feng

et al. 2024

Hepatology

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Background & Aims: Despite the availability of highly effective direct-acting antiviral therapy, chronic hepatitis C (CHC) continues to cause a major public health burden. In many high-income countries, treatment rates have been declining, which was exacerbated by the impact of the COVID-19 pandemic, threatening the ability to meet the World Health Organization (WHO)’s targets for eliminating hepatitis C virus (HCV) as a public health threat by 2030. We sought to model the impact of CHC in Canada, a resource-rich country with ongoing immigration from HCV-endemic regions; which relies exclusively on risk-based screening for case identification. Approach & Results: We developed an agent-based model to characterize the HCV epidemic in a high-income country with ongoing immigration. Combinations of prevention such as harm-reduction, screening, and treatment strategies were considered. Model parameters were estimated from the literature and calibrated against historical HCV data. Sensitivity analyses were performed to assess uncertainty. Under the current status quo of risk-based screening, we predict the incidence of CHC-induced decompensated cirrhosis, hepatocellular carcinoma, and liver-related deaths would decrease by 79.4%, 76.1%, and 62.1%, respectively, between 2015–2030, but CHC incidence would only decrease by 11.1%. Results were sensitive to HCV transmission rate and annual number of people initiating treatment. Conclusions: Current risk-based screening, and subsequent treatment, will be inadequate to achieve WHO goals. With extensive scale-up in screening, and treatment, the mortality target may be achievable, but the target for preventing new CHC cases is unlikely reachable, highlighting the importance of developing enhanced harm-reduction strategies for HCV elimination.

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Anticipated timing of elimination of hepatitis C virus in Canada’s four most populous provinces

Cited by 5 publications

References 0 publications

Real‐world hepatitis C prevalence and treatment uptake at opioid agonist therapy clinics in Ontario, Canada

Real‐world hepatitis C prevalence and treatment uptake at opioid agonist therapy clinics in Ontario, Canada

Impact of the COVID-19 Pandemic on Hepatitis C Treatment Initiation in British Columbia, Canada: An Interrupted Time Series Study

Feasibility of hepatitis C elimination by screening and treatment alone in high-income countries

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