French hepatitis C care cascade: substantial impact of direct-acting antivirals, but the road to elimination is still long

Abstract

Background Hepatitis C virus (HCV) elimination by 2030, as targeted by the World Health Organization (WHO), requires that 90% of people with chronic infection be diagnosed and 80% treated. We estimated the cascade of care (CoC) for chronic HCV infection in mainland France in 2011 and 2016, before and after the introduction of direct-acting antivirals (DAAs). Methods The numbers of people (1) with chronic HCV infection, (2) aware of their infection, (3) receiving care for HCV and (4) on antiviral treatment, were estimated for 2011 and 2016. Estimates for 1) and 2) were based on modelling studies for 2011 and on a virological sub-study nested in a national cross-sectional survey among the general population for 2016. Estimates for 3) and 4) were made using the National Health Data System. Results Between 2011 and 2016, the number of people with chronic HCV infection decreased by 31%, from 192,700 (95% Credibility interval: 150,900-246,100) to 133,500 (95% Confidence interval: 56,900-312,600). The proportion of people aware of their infection rose from 57.7 to 80.6%. The number of people receiving care for HCV increased by 22.5% (representing 25.7% of those infected in 2016), while the number of people on treatment increased by 24.6% (representing 12.1% of those infected in 2016). Conclusions This study suggests that DAAs substantially impact CoC. However, access to care and treatment for infected people remained insufficient in 2016. Updating CoC estimates will help to assess the impact of new measures implemented since 2016 as part of the goal to eliminate HCV.

Late presentation for HCV care: Time to target people with diabetes and/or hazardous alcohol use (ANRS CO22 HEPATHER cohort)

“…These two findings have the potential to greatly contribute to the WHO’s aim to eliminate HCV by 2030, 28 as they highlight new groups to be added to the existing list of groups which need to be targeted because of their increased risk of HCV infection 29 . In France, even though the objectives towards HCV elimination are more audacious (elimination by 2025) 30 and despite the HCV cascade of care having been greatly improved in the DAA era, 31 there is still the need to strengthen access to care and treatment 31 …”

“…HCV cascade of care having been greatly improved in the DAA era, 31 there is still the need to strengthen access to care and treatment. 31 Previous studies showed the bi-directional association between diabetes and hepatitis C. On the one hand, chronic HCV infection -by altering the metabolism of glucose and leading to insulin resistance -increases the risk of developing diabetes.…”

“…HCV cascade of care having been greatly improved in the DAA era, 31 there is still the need to strengthen access to care and treatment. 31 Previous studies showed the bi-directional association between diabetes and hepatitis C. On the one hand, chronic HCV infection -by altering the metabolism of glucose and leading to insulin resistance -increases the risk of developing diabetes. 32,33 On the other hand, diabetics have a higher prevalence of HCV infection than nondiabetics, and HCV infection is associated with an increased risk of diabetes irrespective of liver fibrosis stage.…”

Comment on review article: Chronic hepatitis C virus infection cascade of care in pediatric patients

“…However, in 2016 the treatment was less accessible for the patients. As for CoC, updated estimates are needed to assess the impact of newly implemented approaches aimed to promote hepatitis C elimination[ 5 ]. Furthermore, improving the linkage to care is lifesaving given the precipitous dropouts occurring in HCV CoC[ 6 ].…”

Reaching Hard-to-Reach People Who Use Drugs: A Community-Based Strategy for the Elimination of Hepatitis C

“…Therefore, many PWUD are left unscreened and untreated [ 14 , 15 ], resulting in an uncontrolled HCV epidemic among PWUD [ 16 ]. Furthermore, in many countries—such as France—the absence of population-based data among PWUD makes it difficult to estimate progress towards HCV elimination in this particularly high-risk group [ 17 ].…”