Treatment as Prevention for Hepatitis C (TraP Hep C) – a nationwide elimination programme in Iceland using direct‐acting antiviral agents

Ólafsson, Sigurđur; Tyrfingsson, Þorarinn; Rúnarsdóttir, Valgerður; Bergmann, Ottar M.; Hansdóttir, Ingunn; Bjõrnsson, Einar; Johannsson, Birgir; Sigurðardóttir, Bryndís; Fridriksdottir, Ragnheidur H.; Löve, Arthur; Hellard, Margaret; Löve, Thorvarður Jón; Guðnason, Þórólfur; Heimisdóttir, María; Gottfreðsson, Magnús

doi:10.1111/joim.12740

Cited by 70 publications

(71 citation statements)

References 18 publications

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“…2,3 Iceland may be the first to reach this goal, probably by 2020. 4 This is not surprising because Iceland is a well-defined geographic area with devoted staff, excellent infrastructure, access to decentralized treatment for all and a relatively low number of infected persons. In Europe, however, there are wide variations in what has already been achieved and what remains to be done to reach the WHO target.…”

Section: Different Countrie S'/reg Ions' Achie Vements So Farmentioning

confidence: 99%

“…This demands effective linkage to care with methods that are adapted to the different parts of the world. These challenges are easier to overcome in industrialized Western countries such as Iceland with small populations and a small number of infected individuals 4 while they are more difficult in developing regions, eg parts of Eastern Europe, Asia, South America and Africa, where there are more individuals with undiagnosed HCV. 5 One limitation to having a clear view of the progress being made in the worldwide elimination of HCV is suboptimal and lack of standardized reporting in many countries and regions, especially in low-income areas.…”

Section: Introductionmentioning

confidence: 99%

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Hepatitis C elimination – Macro‐elimination

Kåberg

Weiland

2020

Liver International

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In 2016 the WHO set a goal to obtain an 80% reduction in new chronic HCV cases, requiring a level of diagnosis of 90%, treatment coverage of 80% and resulting in a 65% reduction in HCV‐related deaths by 2030. This goal is easier to reach in specific populations such as people who inject drugs (PWID), men who have sex with men (MSM) or blood‐transfusion recipients before screening for HCV became mandatory and in high‐income regions. It is much more difficult to achieve macro‐elimination throughout the population especially in low‐income areas with underdeveloped infrastructures, a high prevalence of HCV and limited economic resources. To achieve the WHO goals by 2030, awareness of HCV must increase and the cascade of care must be improved and implemented. Diagnostic procedures and treatment should be affordable and universally available. At the end of 2017 fewer than 15 countries were on track to reach these goals by 2030.

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Section: Different Countrie S'/reg Ions' Achie Vements So Farmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hepatitis C elimination – Macro‐elimination

Kåberg

Weiland

2020

Liver International

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“…[96,97] Secondly, women's parenting obligations also mean that they may not be able to access services during xed operating hours or at xed intervals, underlining the importance of exible services in providing for women's participation. [100,101] Thirdly, mothers who use drugs report that they are reluctant to access health and harm reduction services because of the risk of losing custody of children based on drug use. [81,[102][103][104] A consistent concern about women's access to harm reduction services in Europe and globally, is that women are often required to navigate multiple separate health and referral systems to address an interrelated health and social concerns.…”

Section: Female-centred Servicesmentioning

confidence: 99%

Women and Barriers to Harm Reduction Services: A Literature Review and Initial Findings From a Qualitative Study in Barcelona, Spain

Shirley-Beavan

Forteza²,

Burke-Shyne

et al. 2020

Preprint

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Background There are an estimated 3.2 million women who inject drugs worldwide, constituting 20% of all people who inject drugs. The limited data that is available suggests that women who inject drugs are at greater risk of HIV and viral hepatitis acquisition than men who inject drugs. This increased vulnerability is a product of a range of environmental, social and individual factors affecting women, which also affect their ability to engage in health promoting services such as harm reduction. Methods The researchers undertook a narrative literature review examining access to harm reduction services for women who use drugs in Europe, and conducted semi-structured focus groups with women who use drugs and harm reduction and prison health workers in Barcelona, Spain. Results Women who use drugs face multiple barriers to accessing harm reduction services. These include: stigma, both in society in general and from health and harm reduction workers in prisons and in the community; gender-based violence and a lack of services that are equipped to address the interaction between drug use and experiences of violence; criminalisation in the form of legal barriers to access, arrest and harassment from law enforcement, and incarceration; a lack of services focused on the specific needs of women, notably sexual and reproductive health services and childcare. In Barcelona, participants reported experiencing all these barriers, and that their engagement with the Metzineres harm reduction centre had to some extent mitigated them. However, women continued to experience structural barriers to harm reduction service access. Conclusions Women and gender non-conforming people who use drugs face unique barriers to accessing harm reduction services. While services such as Metzineres can be life-changing and life-affirming for its members, it is incumbent on states to act to address the structural barriers to health faced by women who use drugs.

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“…An interim analysis reported lower SVR in current PWID but an overall SVR of 90%. Similarly, there was a 53% decrease in incident HCV infection and a 72% decrease in viremia among PWID at the addiction hospital from 2015 to 2017 …”

mentioning

confidence: 95%

“…In the Aids Therapy Evaluation in the Netherlands (ATHENA) cohort, lifting of restrictions on DAA access in MSM with HIV and HCV infections was followed by a 51% decrease in incident HCV infection . Iceland initiated a nationwide elimination program in 2016 with scale‐up of DAA (Treatment as Prevention for Hepatitis C [TraP HepC]) . Due to the high risk for transmission, treatment of PWID is a point of emphasis for this program along with harm reduction efforts and educational campaigns.…”

mentioning

confidence: 99%