HEPCARE EUROPE- A case study of a service innovation project aiming at improving the elimination of HCV in vulnerable populations in four European cities

Abstract

Objectives: Hepatitis C Virus (HCV) is a significant cause of chronic liver disease. Among at-risk populations, access to diagnosis and treatment is challenging. We describe an integrated model of care, Hepcare Europe, developed to address this challenge. Methods: Using a case-study approach, we describe the cascade of care outcomes at all sites. Cost analyses estimated the cost per person screened and linked to care. Results: A total of 2608 participants were recruited across 218 clinical sites. HCV antibody test results were obtained for 2568(985%); 1074(418%) were antibody-positive, 687(605%) tested positive for HCV-RNA, 650(605%) were linked to care, and 319(435%) started treatment. 196(614%) of treatment initiates achieved a Sustained Viral Response (SVR) at dataset closure, 108(339%) were still on treatment, eight (27%) defaulted from treatment, and seven (26%) had virologic failure or died. The cost per person screened varied from s194 to s635, while the cost per person linked to care varied from s364 to s2035. Conclusions: Hepcare enhanced access to HCV treatment and cure, and costs were affordable in all settings, offering a framework for scale-up and reproducibility.

A modelling analysis of financial incentives for hepatitis C testing and treatment uptake delivered through a community‐based testing campaign

“…As such, the campaign was able to target individuals who do not regularly attend other health services (such as drug treatment centres). This may have contributed to the approximately higher costs accumulated during the campaign compared to some other international studies (€558–2670 [~AUD$884–4231] in 28 and £600–682 [~AUD$1110–1261] in 27 ). However, as Australia moves towards the final stages of elimination (and the backlog of ‘willing and waiting’ people receive treatment 10 ), finding and treating individuals who are disengaged from care will be crucial to ensure elimination are actually achieved.…”

“…To our knowledge, our study provides the first published estimate of the cost of finding and diagnosing people with hepatitis C infection in Australia (~A$3215 per RNA‐positive person), and one of only a few studies internationally to estimate the cost of case finding since the introduction of DAA treatment 27–30 . Therefore, our study provides an important estimate for comparing the cost‐effectiveness of other programs aiming to find and diagnose people with hepatitis C infection.…”

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

“…This was the case in our study. In HepCare Europe—a large project addressing the various steps of the cascade of care in community addiction, homeless, and penitentiary services (ie, targeting not only PWUD) in 4 European cities—60.5% of 1074 participants (mainly PWUD) with a positive serology were infected with HCV (versus the 27.1% observed in our study) [ 28 ]. The ultimate challenge for HCV elimination consists of reaching and treating at least half of the remaining 40% of untreated PWUD (to attain a proportion of 80% of PWUD being treated), who are considered to be the most difficult to reach and engage in care in this especially high-risk community.…”

“…As a result, the cost per person screened using our strategy (161€) was substantially lower compared to those reported by the HepCare project (from 194€ testing prisoners to 635€ in medication-assisted treatment clinics) [ 28 ]. Our findings confirm the high SVR12 success rates among PWUD initiating DAA as reported from other settings [ 14 , 35 ].…”

“…Although this strategy resulted in modest improvement in engagement in HCV care, no participant achieved SVR12 [ 29 ]. In the HepCare project, the acceptance rate for testing was 75% [ 28 ]. Only 43.5% of those with detectable HCV RNA were initiated on a treatment regimen.…”