Abstract
SummaryThe World Health Organisation has recently called for hepatitis C virus (HCV) elimination and has identified people who inject drugs (PWID) as a key population to scale‐up screening and linkage to care. This study reports the cascade of care for HCV in PWID attending the largest opioid substitution treatment (OST) clinic in Dar‐es‐Salaam, Tanzania. Between February 2011 and March 2016, HCV serology for all PWID registered at the Muhimbili National Hospital OST clinic, Dar‐es‐Salaam were obtained from records. In 2015, consecutive HCV‐seropositive PWID were invited to undergo a clinical evaluation including epidemiological questionnaire, liver stiffness measurement (Fibroscan) and virological analysis (HCV RNA viral load and genotyping). During the study period, 1350 persons registered at the OST clinic: all had a HCV serology including 409 (30%) positive results. Among the HCV‐seropositive individuals, 207 (51%) were active attenders and 153 (37%) were enrolled for clinical assessment: 141 (92%) were male, median age: 38 years (IQR 34‐41), and 65 (44%) were co‐infected with HIV; 116 patients (76%) had detectable HCV RNA, with genotypes 1a (68%) and 4a (32%); 21 (17%) had clinically significant fibrosis (≥F2) and 6 (5%) had cirrhosis (F4). None were offered HCV treatment. Chronic hepatitis C among PWID enrolled in the OST centre in Dar‐es‐Salaam is frequent, but its continuum of care is insufficient; integration of HCV diagnosis and treatment should form a part of OST intervention in PWID in Tanzania.
Highlights
An estimated 71 million people are chronically infected with the hepatitis C virus (HCV) worldwide and each year between 400 000 and 700 000 deaths are attributable to this virus.[1,2]
In its 2016-2021 global hepatitis plan, the World Health Organisation (WHO) defined ambitious strategies to achieve 90% reduction in new HCV cases and 65% decrease in HCV-related mortality by 2030.3 Intravenous drug use is a major driver of HCV spread worldwide and the WHO has clearly identified people who inject drugs (PWID) as a key population to target for HCV screening, prevention and care.[4]
Between February 2011 and March 2016, routine blood borne virus screening (BBV) was offered to all PWID registering at the largest opioid substitution treatment (OST) clinic in Tanzania, located at Muhimbili National Hospital (MNH), Dar-es-Salaam
Summary
An estimated 71 million people are chronically infected with the hepatitis C virus (HCV) worldwide and each year between 400 000 and 700 000 deaths are attributable to this virus.[1,2] The World Health Organisation (WHO) has recently called for HCV elimination.[3]. The WHO 2016 HCV guidelines advocate the use of simple noninvasive scores to stratify liver disease (aspartate transferase [AST] to platelet ratio index [APRI] and Fib-4) in the absence of ready access to liver biopsy or Fibroscan.[4] In Africa, in particular in SSA, there has been limited work done to evaluate the performance of noninvasive scores of fibrosis in patients with HCV. Bonnard et al[14] demonstrated a modest performance of APRI and Fib-4 to predict fibrosis level in HCV genotype 4 infected patients in Egypt, while another study found good performance of gamma-glutamyl transferase to platelet ratio (GPR) in the same population.[15] the severity of liver disease and cascade of care among HCV-infected PWID has been poorly documented in Africa. We determined the proportion of significant liver fibrosis or cirrhosis using liver stiffness measurement (LSM), as measured by ultrasound-based transient elastography, and assessed the diagnostic accuracy of APRI, Fib-4 and GPR using LSM as a reference test
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