Policy responses to hepatitis C in the Nordic countries: Gaps and discrepant reporting in the Hep-Nordic study

Abstract

Background and aimsIn the Nordic countries (Denmark, Finland, Iceland, Norway, Sweden), the prevalence of chronic hepatitis C virus (HCV) infection is relatively low in the general population, but is much higher among people who inject drugs (PWID). We conducted an exploratory study to investigate the extent to which these countries have policies supporting key elements of the public health response that is necessary to achieve the global goal of eliminating HCV as a public health threat.MethodsFourteen stakeholders representing government agencies, medical societies, and civil society organisations (CSOs) in the Nordic countries completed a cross-sectional online survey that included 21 policy questions related to national coordination, prevention, testing, linkage to care, and treatment. We summarised the findings in a descriptive analysis, and noted discrepant responses from stakeholders within the same country.ResultsStakeholders reported that three of the five study countries have national viral hepatitis strategies, while only Iceland has a national HCV elimination goal. The availability of harm reduction services varies, with opioid substitution therapy provided for the general population throughout all countries, but not needle and syringe programmes. No country has access to anonymous HCV testing in all parts of the country. National HCV treatment guidelines are available in all countries except Finland, and all countries provide publicly funded direct-acting antiviral treatment. Disagreement regarding policies was observed across countries, and CSOs were the stakeholder group that most frequently answered survey questions incorrectly.ConclusionThe Nordic region as a whole has not consistently expressed its commitment to tackling HCV, despite the existence of large HCV epidemics among PWID in these countries. Stakeholder alignment and an established elimination goal with an accompanying strategy and implementation plan should be recognised as the basis for coordinated national public health efforts to achieve HCV elimination in the Nordic region and elsewhere.

Association of fatty liver disease with mortality outcomes in an Eastern Finland male cohort

“…It should be noted also that the hepatitis B and hepatitis C statuses of the subjects were not established at recruitment. Although the prevalence rate of hepatitis B38 and hepatitis C39 have remained low in the Finnish population, routine screening tests for hepatitis B became available since the early 1980s40 shortly before the onset of subject recruitment. Similarly, screening test for hepatitis C was available since 1989,41 around the end of recruitment.…”

Fatty liver index as a predictor of increased risk of cardiometabolic disease: finding from the Kuopio Ischaemic Heart Disease Risk Factor Study Cohort

“…Another limitation of the study is that the hepatitis B and hepatitis C statuses of the subjects were not established at baseline. However, the prevalence rates of hepatitis B46 and hepatitis C47 have remained low in the Finnish population. Also, our study population comprised of men only.…”

Uptake and predictors of direct-acting antiviral treatment for hepatitis C among people receiving opioid agonist therapy in Sweden and Norway: a drug utilization study from 2014 to 2017

“…The coverage of preventive interventions and harm reduction services varies among PWIDs. Although the distribution of needle and syringe programs is relatively poor [12], opioid treatment programs such as OAT has higher coverage in many countries [13]. OAT has shown to reduce the risk of HCV acquisition [14], and despite ongoing illicit drug use, patients on OAT are achieving high SVR rates [15].…”