Abstract
BackgroundThe burden of hepatitis C (HCV) infection in Pakistan is among the highest in the world, with a reported national HCV prevalence of 6.7% in 2014. In specific populations, such as in urban communities in Karachi, the prevalence is suspected to be higher. Interferon-free treatment for chronic HCV infection (CHC) could allow scale up, simplification and decentralization of treatment to such communities. We present an interim analysis over the course of February-December 2015 of an interferon-free, decentralised CHC programme in the community clinic in Machar Colony, Karachi, Pakistan.DesignA retrospective analysis of a treatment cohort.ResultsThere were 1,089 patients included in this analysis. Aspartate to platelet ratio index score was used to prioritize patients in terms of treatment initiation, with 242 patients placed in high priority for treatment and 202 starting treatment as scheduled. 169 patients started HCV treatment with Sofosbuvir-Ribavirin regimen according to HCV genotype over the course of 2015: of these, 35% had Hemoglobin reductions below 11.0 g/dl during the treatment course. Among the 153 patients (85%) with genotype 3 HCV infection, 84% of patients achieved sustained virologic response at 12 weeks following treatment completion (SVR 12).ConclusionOutcomes of HCV treatment with all oral combination in an integrated, decentralized model of care for CHC in a primary care setting, using simplified diagnostic and treatment algorithms, are comparable to the outcomes achieved in clinical trial settings for Sofosbuvir-based regimens. Our results suggest the feasibility and the pertinence if including interferon-free treatment regimens in the national programme, at both provincial and national levels.
Highlights
Hepatitis C Virus (HCV) infection is an urgent global health concern
Aspartate to platelet ratio index score was used to prioritize patients in terms of treatment initiation, with 242 patients placed in high priority for treatment and 202 starting treatment as scheduled. 169 patients started HCV treatment with Sofosbuvir-Ribavirin regimen according to HCV genotype over the course of 2015: of these, 35% had Hemoglobin reductions below 11.0 g/dl during the treatment course
Among the 153 patients (85%) with genotype 3 HCV infection, 84% of patients achieved sustained virologic response at 12 weeks following treatment completion (SVR 12)
Summary
Hepatitis C Virus (HCV) infection is an urgent global health concern. The World Health Organization (WHO) estimates that more than 185 million people are infected with HCV. [1] Transmission is blood-borne, occurring through unsafe injection practices, inadequate sterilization of instruments, blood transfusion, sexual transmission, and mother-to-child transmission. [1] Chronic Hepatitis C can develop into cirrhosis and hepatocellular carcinoma, and ~350,000 people are estimated to die from these complications annually. [2] The prevalence of HCV infection varies worldwide: the Middle East and North African regions, including Egypt and Pakistan, register among the highest prevalence of HCV. [3]Pakistan is a lower middle-income country with a population of approximately 180 million. [4] In 2014, an estimated adult HCV seroprevalence of 6.7% was reported in Pakistan. [4,5] The province of Sindh, where Karachi is situated, has a recorded seroprevalence of 5.5% among the general population. [6,7] Most important risk factors for HCV transmission in Pakistan are health system-related, including a documented high frequency of therapeutic injections, [8] reuse of syringes, and unlicensed clinics conducting high volumes of blood transfusions, dental surgeries, etc. [9] Most HCV infections in Pakistan are genotype 3 (69.1%), followed by genotypes 1 (7.1%), 2 (4.2%) and 4 (2.2%). [5,7] Interferon (IFN)-based treatment for HCV is recommended by the Chief Minister’s Programme for Hepatitis B and C, and a 67% end of treatment viral clearance for such regimens has been documented. [10] HCV treatment is conventionally offered through specialized, tertiary care-level governmental hospitals. Available data on CHC treatment in Pakistan describes outcomes of IFN-based therapy, but no published data on programme outcomes of CHC treatment using IFN-free DAA regimens was available as of November 2016 Likewise, performance indicators such as pre-treatment attrition and end of treatment outcomes for HCV care integrated at primary health care level have not often been documented. The burden of hepatitis C (HCV) infection in Pakistan is among the highest in the world, with a reported national HCV prevalence of 6.7% in 2014 In specific populations, such as in urban communities in Karachi, the prevalence is suspected to be higher. We present an interim analysis over the course of February-December 2015 of an interferon-free, decentralised CHC programme in the community clinic in Machar Colony, Karachi, Pakistan
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