Treatment outcomes and costs of a simplified antiviral treatment strategy for hepatitis C among monoinfected and HIV and/or hepatitis B virus‐co‐infected patients in Myanmar

Abstract

Access to hepatitis C virus (HCV) testing and treatment is limited in Myanmar. We assessed an integrated HIV and viral hepatitis testing and HCV treatment strategy. Sofosbuvir/velpatasvir (SOF/VEL) ± weight‐based ribavirin for 12 weeks was provided at three treatment sites in Myanmar and sustained virologic response (SVR) assessed at 12 weeks after treatment. Participants co‐infected with HBV were treated concurrently with tenofovir. Cost estimates in 2018 USD were made at Yangon and Mandalay using standard micro‐costing methods. 803 participants initiated SOF/VEL; 4.8% were lost to follow‐up. SVR was achieved in 680/803 (84.6%) by intention‐to‐treat analysis. SVR amongst people who inject drugs (PWID) was 79.7% (381/497), but 92.5% among PWID on opioid substitution therapy (OST) (74/80), and 97.4% among non‐PWID (298/306). Utilizing data from 492 participants, of whom 93% achieved SVR, the estimated average cost of treatment per patient initiated was $1030 (of which 54% were medication costs), with a production cost per successful outcome (SVR) of $1109 and real‐world estimate of $1250. High SVR rates were achieved for non‐PWID and PWID on OST. However, the estimated average cost of the intervention (under the assumption of no genotype testing and reduced real‐world effectiveness) of $1250/patient is unaffordable for a national elimination strategy. Reductions in the cost of antivirals and linkage to social and behavioural health services including substance use disorder treatment to increase retention and adherence to treatment are critical to HCV elimination in this population.

Real-world observational experience with direct-acting antivirals for hepatitis C virus: a multicenter retrospective cohort study of treatment outcomes, mortality, and loss-to-follow up in Eritrea

“…Low proportions of LTFUs were also reported by workers in other countries [44,45]. At present, we have to concede that the observed results were largely unexpected because treatment in these facilities is offered for free.…”

Hepatitis C treatment outcomes among people who inject drugs accessing harm reduction settings in Kenya

“…While lower than other cohorts in SSA, the rate of SVR among our participants is comparable to cohorts of PWID in other LMICs. PWID in an HCV treatment cohort in Myanmar achieved an overall SVR rate of 80% 7 . Similarly, 87% of a Bangladeshi HCV treatment cohort of PWID accessing harm services achieved SVR 8 .…”

“…PWID in an HCV treatment cohort in Myanmar achieved an overall SVR rate of 80%. 7 Similarly, 87% of a Bangladeshi HCV treatment cohort of PWID accessing harm services achieved SVR. 8 Furthermore, in an intent-to-treat analysis of HCV treatment services for high-risk groups in Ukraine, 78% of currently injecting PWIDs achieved SVR.…”

Treatment and Cost -outcomes of a simplified antiretroviral treatment strategy for hepatitis C among HCV and HIV co-infected patients in Ukraine

“…While adherence to HCV treatment was not measured, there was minimal loss to follow up; this may have been because of the Community Based Treatment model of care that incorporates a social worker into the clinical management team 18,19 and also provides harm reduction services at a community level. Even among PWID, who typically have high rate of loss to follow up 20 , there were few losses, due perhaps to the Community Based Treatment harm reduction program in Ukraine 19 . Other studies have demonstrated high rates of success with HCV treatment co-located with substance use treatment services and amongst PWID receiving OST 21,22 .…”