Effectiveness of implementing a decentralized delivery of hepatitis C virus treatment with direct-acting antivirals: A systematic review with meta-analysis

Castro, Rodolfo; Perazzo, Hugo; Araujo, Letícia Artilles Mello Mendonça de; Gutierres, Isabella Gonçalves; Grinsztejn, Beatriz; Veloso, Valdiléa G.

doi:10.1371/journal.pone.0229143

Cited by 20 publications

(22 citation statements)

References 43 publications

(76 reference statements)

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“…In a meta-analysis of studies estimating treatment outcomes of decentralized HCV care, the pooled SVR-12 was 81% on intention-totreat (ITT) analysis. 12 It further affirms this model's utility in providing the standard of care using a decentralized model with the existing public health infrastructure. HCV in India Anand and Shalimar review addition to the government policies and financial allocation for drug availability, testing kits, and operational expenditures, we also require media support for creating awareness among the common public regarding preventive and treatment options for HCV.…”

Section: Decentralized Care Modelsmentioning

confidence: 60%

Hepatitis C virus in India: Challenges and Successes

Anand

Shalimar

2021

Clinical Liver Disease

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The past decade has seen a paradigm shift in the management of hepatitis C virus (HCV) infection with the development of direct-acting antiviral (DAA) drugs. In 2016, the World Health Organization laid out the Global Health Sector Strategy on viral hepatitis, which endorsed the elimination of viral hepatitis by 2030. In a country like India with a large population and diverse socioeconomic status and cultural practices, the path to HCV elimination has indeed thrown up both challenges and success stories. CHallenGes Estimating the Disease BurdenAccording to global estimates, the prevalence rate of HCV viremia in India in 2015 was 0.5%, affecting about 4.7 to 10.9 million people. 1 In a meta-analysis of 327 studies, the prevalence rate of HCV in India, as estimated by the seropositive rates of anti-HCV antibody, was 0.85% in community studies, 0.44% in asymptomatic blood donors, and 0.88% in pregnant women. 2 The community-based prevalence results were available from only three states in the country and were associated with marked heterogeneity; therefore, they may not truly reflect the nationwide prevalence. Similarly, the prevalence rates of anti-HCV positivity among blood donors varied between 0.11% and 1.24% across different states (Fig. 1). Notwithstanding the limitations, in a country with more than 1.3 billion individuals, this suggests a huge burden of disease.

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Section: Decentralized Care Modelsmentioning

confidence: 60%

Hepatitis C virus in India: Challenges and Successes

Anand

Shalimar

2021

Clinical Liver Disease

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“…A further potential advantage of DAAs is that they may allow the possibility of decentralising hepatitis C treatment to primary health care facilities in some settings 42 , which could also bring additional cost savings 43 . This benefit will depend on the local health system and needs further investigation.…”

Section: Discussionmentioning

confidence: 99%

The direct-medical costs associated with interferon-based treatment for Hepatitis C in Vietnam

et al. 2020

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Background: Injectable interferon-based therapies have been used to treat hepatitis C virus (HCV) infection since 1991. International guidelines have now moved away from interferon-based therapy towards direct-acting antiviral (DAA) tablet regimens, because of their superior efficacy, excellent side-effect profiles, and ease of administration. Initially DAA drugs were prohibitively expensive for most healthcare systems. Access is now improving through the procurement of low-cost, generic DAAs acquired through voluntary licenses. However, HCV treatment costs vary widely, and many countries are struggling with DAA treatment scale-up. This is not helped by the limited cost data and economic evaluations from low- and middle-income countries to support HCV policy decisions. We conducted a detailed analysis of the costs of treating chronic HCV infection with interferon-based therapy in Vietnam. Understanding these costs is important for performing necessary economic evaluations of novel treatment strategies. Methods: We conducted an analysis of the direct medical costs of treating HCV infection with interferon alpha (IFN) and pegylated-interferon alpha (Peg-IFN), in combination with ribavirin, from the health sector perspective at the Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam, in 2017. Results: The total cost of the IFN treatment regimen was estimated to range between US$1,120 and US$1,962. The total cost of the Peg-IFN treatment regimen was between US$2,156 and US$5,887. Drug expenses were the biggest contributor to the total treatment cost (54-89%) and were much higher for the Peg-IFN regimen. Conclusions: We found that treating HCV with IFN or Peg-IFN resulted in significant direct medical costs. Of concern, we found that all patients incurred substantial out-of-pocket costs, including those receiving the maximum level of support from the national health insurance programme. This cost data highlights the potential savings and importance of increased access to generic DAAs in low- and middle-income countries and will be useful within future economic evaluations.

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“…A substantial treatment scale up is needed especially in IVDU to control the HCV epidemic [ 18 ]. Scale up based on decentralization of HCV treatment with DAAs prescribed by non-specialized personnel at primary care settings was shown to be effective in terms of SVR12 [ 19 ]. Our network linking OST clinics in distant parts of the country to higher level testing and care in the capital is a model for further initiatives to treat individuals living with HCV in Nepal and may be applied elsewhere to help achieve these goals.…”

Section: Discussionmentioning

confidence: 99%

Hepatitis C (HCV) therapy for HCV mono-infected and HIV-HCV co-infected individuals living in Nepal

Murphy

Dixit

et al. 2020

PLoS Negl Trop Dis

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Background Despite direct-acting antivirals (DAA), aims to “eradicate” viral hepatitis by 2030 remain unlikely. In Nepal, an expert consortium was established to treat HCV through Nepal earthquakes aftermath offering a model for HCV treatment expansion in a resource-poor setting. Methodology/Principal findings In 2015, we established a network of hepatologists, laboratory experts, and community-based leaders at 6 Opioid Substitution Treatment (OST) sites from 4 cities in Nepal screening 838 patients for a treatment cohort of 600 individuals with HCV infection and past or current drug use. During phase 1, patients were treated with interferon-based regimens (n = 46). During phase 2, 135 patients with optimal predictors (HIV controlled, without cirrhosis, low baseline HCV viral load) were treated with DAA-based regimens. During phase 3, IFN-free DAA treatment was expanded, regardless of HCV disease severity, HIV viremia or drug use. Sustained virologic response (SVR) was assessed at 12 weeks. Median age was 37 years and 95.5% were males. HCV genotype was 3 (53.2%) or 1a (40.7%) and 32% had cirrhosis; 42.5% were HIV-HCV coinfected. The intention-to-treat (ITT) SVR rates in phase 2 and 3 were 97% and 81%, respectively. The overall per-protocol and ITT SVR rates were 97% and 85%, respectively. By multivariable analysis, treatment at the Kathmandu site was protective and substance use, treatment during phase 3 were associated with failure to achieve SVR. Conclusions/Significance Very high SVR rates may be achieved in a difficult-to-treat, low-income population whatever the patient’s profile and disease severity. The excellent treatment outcomes observed in this real-life community study should prompt further HCV treatment initiatives in Nepal.

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Effectiveness of implementing a decentralized delivery of hepatitis C virus treatment with direct-acting antivirals: A systematic review with meta-analysis

Cited by 20 publications

References 43 publications

Hepatitis C virus in India: Challenges and Successes

Hepatitis C virus in India: Challenges and Successes

The direct-medical costs associated with interferon-based treatment for Hepatitis C in Vietnam

Hepatitis C (HCV) therapy for HCV mono-infected and HIV-HCV co-infected individuals living in Nepal

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