Abstract
SummaryBackgroundDespite the availability of effective and well-tolerated direct acting antivirals (DAAs) against hepatitis C virus (HCV) infection, a substantial number of HCV patients remain untreated. Novel strategies targeting HCV patients with poor adherence are urgently needed to enable HCV elimination.MethodsWe implemented a physician-operated HCV hotline (HCV-Phone) that was promoted within the patient community and referral networks. Previously diagnosed HCV patients were contacted via the HCV-Phone and offered low-barrier access to DAA therapy. Patients/referring physicians could directly call or send messages to the HCV-Phone. The HCV-Phone related and unrelated visits as well as DAA treatment initiations throughout 2019 were documented. Patients were followed until October 2020. This study analyzed treatment initiation, adherence to scheduled visits and outcomes in patients in whom management was assisted by the HCV-Phone.ResultsOut of 98 patient contacts via the HCV-Phone 74 attended treatment assessment at our clinic. While 15 (20%) patients were HCV-RNA negative and 1 (1%) patient did not initiate therapy, 58 patients were recruited for DAA therapy via the HCV-Phone. A total of 21 additional patients who started DAAs without HCV-Phone assistance required the use of the HCV-Phone infrastructure later on during treatment, resulting in a total of 79 HCV-Phone related DAA therapies. The poor adherence of patients previously diagnosed with HCV at our clinic is underlined by the long duration from HCV diagnosis to DAA therapy of median 37.0 months (IQR 2.7–181.1 months). A total of 55 (70%) HCV patients achieved a sustained virological response (SVR), 5 (6%) discontinued therapy, 1 (1%) had a reinfection, while 10 (13%) and 8 (10%) patients were lost during DAA therapy or follow-up, respectively.ConclusionThe implementation of a physician-operated phone hotline for patients with HCV infection facilitated treatment initiation in an HCV population with poor adherence. Mainly due to losses to follow-up, the SVR rate remained suboptimal with 70%.
Highlights
With an estimated global prevalence of 71.1 million people affected, chronic hepatitis C virus (HCV) infection remains one of the leading causes of cirrhosis, liver-related death and hepatocellular carcinoma worldwide [1]
In Europe and the USA the vast majority of HCV infections are observed in people who inject drugs (PWID) and HIV positive men who have sex with men (MSM) engaging in high-risk sexual practices [2, 3]
The initiation of treatment in PWID has reportedly increased since the introduction of direct acting antivirals (DAAs)-based therapies, especially people with ongoing drug abuse still show low rates of treatment initiation and suboptimal compliance [12]
Summary
With an estimated global prevalence of 71.1 million people affected, chronic hepatitis C virus (HCV) infection remains one of the leading causes of cirrhosis, liver-related death and hepatocellular carcinoma worldwide [1]. In Europe and the USA the vast majority of HCV infections are observed in people who inject drugs (PWID) and HIV positive men who have sex with men (MSM) engaging in high-risk sexual practices [2, 3]. In 2016, the World Health Organization (WHO) defined targets for reducing the disease burden, with the goal of eliminating HCV until 2030 [4] This requires improved screening strategies for HCV infection, facilitated access to medication by better linkage to care as well as patient education for prevention of reinfections [5]. Among Viennese HIV positive PWID, the prevalence of HCV infections remained stable over the last years, while it increased in HIV positive MSM [13] due to high-risk sex practices [14]. It is of great importance to provide low barrier access to HCV counselling for patients at high risk of viral infection and transmission in order to improve early screening for HCV infection and facilitate access to DAA therapy
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