We know <scp>DAA</scp>s work, so now what? Simplifying models of care to enhance the hepatitis C cascade

Lazarus, Jeffrey V.; Pericàs, Juan M.; Picchio, Camila A; Cernosa, Jasna; Hoekstra, Misha; Luhmann, Niklas; Matičič, Mojca; Read, Phillip; Robinson, Emma; Dillon, John

doi:10.1111/joim.12972

Cited by 79 publications

(88 citation statements)

References 159 publications

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“…If a micro-elimination approach focuses on patients already in the health system, screening, treatment and prevention interventions can often be provided more easily, without additional burden on the health system. Furthermore, as in other parts of the world, models of care that tailor to the needs of sub-populations should be considered whenever possible [32], if elimination is to be achieved.…”

Section: Discussionmentioning

confidence: 99%

A micro-elimination approach to addressing hepatitis C in Turkey

İdilman

Razavi

Robbins-Scott

et al. 2020

BMC Health Serv Res

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Background: In 2016, WHO passed the Global Health Sector Strategy on Viral Hepatitis (GHSS), calling for its elimination by 2030. Two years later, Turkey approved a strategy to reach the WHO targets. This study reports new national prevalence data, breaks it down by subpopulation, and models scenarios to reach HCV elimination. Methods: Literature was reviewed for estimates of HCV disease burden in Turkey. They were discussed with stakeholders and used as inputs to develop a disease burden model. The infected population was estimated by sequelae for the years 2015-2030. Three scenarios were developed to evaluate the disease burden in Turkey: a Base 2017 scenario, representing the current standard of care in Turkey; an increased treatment scenario, representing the impact of improved access to DAAs; and a WHO targets scenario, which meet the WHO GHSS viral hepatitis targets of a 65% reduction in mortality and 90% diagnosis rate of the infected population by 2030. Results: At the beginning of 2017, 271,000 viremic infections were estimated. Of these, 58,400 were diagnosed and 10,200 treated. Modelling results showed that, with the current treatment paradigm in Turkey, by 2030 the total number of viremic HCV infections would decline by 35%, while liver-related deaths, hepatocellular carcinoma (HCC), and decompensated cirrhosis would decrease by 10-25%. In the increased treatment scenario, by 2030 viremic HCV infections would decrease by 50%; liver-related deaths, HCC and decompensated cirrhosis would decrease by 45-70%. In the WHO targets scenario, HCV infections would decrease by 80%; sequelae would decrease by 80-85%. Data on disease burden in micro-elimination target subpopulations are largely unavailable. Conclusions: To meet the WHO Global Health Sector Strategy targets for the elimination of HCV, Turkey needs to increase treatment. Better data are needed as well as countrywide access to DAAs.

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Section: Discussionmentioning

confidence: 99%

A micro-elimination approach to addressing hepatitis C in Turkey

İdilman

Razavi

Robbins-Scott

et al. 2020

BMC Health Serv Res

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“…[3] Achieving global elimination of HCV need major increase in service all populations along the entire cascade of care, including testing, linkage to care, retention in care, treatment, chronic care and prevention of primary infection and reinfection. [4] In 2017, Indonesian government started free direct acting antiviral (DAA) program for HCV, mainly sofosbuvir and daclatasvir combination. [5,6] This 12 weeks combination for non-cirrhotic patients and 24 weeks for cirrhotic-patients shown similar success rate for both HIV/HCV co-infected patients and HCV mono-infected patients.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Performance of APRI and FIB-4 for Confirming Cirrhosis in Indonesian HIV/HCV Co-infected Patients

Yunihastuti

Wicaksana

Wiraguna

et al. 2020

Preprint

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BackgroundAfter successful of antiretroviral therapy, highly effective direct acting antiviral (DAA) make HCV elimination reasonable in HIV/HCV co-infected patients. However, in achieving this target, there are still barriers to start DAA treatment, particularly in the area of liver fibrosis assessment that determine the duration of therapy. We aimed to assess the diagnostic performance of APRI and FIB-4 for diagnosing cirrhosis in HIV/HCV co-infected patients using hepatic transient elastography (TE) as gold standard.MethodThis is an retrospective study on HIV/HCV co-infected patients who concomitantly performed hepatic TE measurement, APRI, and FIB-4 evaluation before HCV treatment initiation at a tertiary hospital in Jakarta from 2014 to 2019. Sensitivity, specificity and diagnostic accuracy of indirect biomarkers for liver stiffness measurement (LSM) ≥ 12.5 kPa was determined by receiver operator characteristics curves. Results233 HIV/HCV co-infected patients on stable antiretroviral therapy were included, of whom 91.5% were male with mean age of 37 (SD 5) years. Only 28.7% of patients were classified as cirrhosis (F4). Using TE as gold standard (≥12.5 kPa), the low threshold of APRI (1) had specificity 95%, sensitivity 48.4%, correctly classified 81.6% of patients, with moderate performance, AUROC at 0.72 (95% CI 0.63-0.80). The optimal cut-off of FIB-4 was 1.66 [specificity 92.5%, sensitivity 53.1%, AUROC at 0.73 (95% CI 0.65-0.81)] and correctly classified 81.1% of the patients.ConclusionAPRI score > 1 and FIB-4 score > 1.66 had moderate performance with high specificity in diagnosing cirrhosis. These biochemical markers could be used while TE is not available.

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“…In , the following errors were published in Table and supporting information, Table S1. In Table 2 on page 511‐512, Saludes V et al should have been removed from Migrants section. Table S1 has been corrected and replaced in the online version of the article. …”

Section: Populations Addressed In the Models Of Care Selectedmentioning

confidence: 99%

Corrigendum

2020

J Intern Med

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We know DAAs work, so now what? Simplifying models of care to enhance the hepatitis C cascade

Abstract: Lazarus JV, Peric as JM, Picchio C, Cernosa

Cited by 79 publications

References 159 publications

A micro-elimination approach to addressing hepatitis C in Turkey

A micro-elimination approach to addressing hepatitis C in Turkey

Diagnostic Performance of APRI and FIB-4 for Confirming Cirrhosis in Indonesian HIV/HCV Co-infected Patients

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