"Waiting for DAAs": A retrospective chart review of patients with untreated hepatitis C in Rwanda.

Neil Gupta,Athanase Kiromera,Emmanuel Musabeyezu,Joia Mukherjee,Constance Mukabatsinda,Jules Kabahizi,Aimable Mbituyumuremyi,Jennifer Ilo Van Nuil,Timothy David Walker,Kevin Steiner,Sabin Nsanzimana,Jason Blackard

doi:10.1371/journal.pone.0174148

Abstract

BackgroundAccess to treatment for hepatitis C virus (HCV) in sub-Saharan Africa is extremely limited. With the advent of direct acting antivirals (DAAs), highly effective and easy-to-deliver oral regimens are now available on the global market. This study was conducted to understand the background and characteristics of a national cohort of patients with HCV infection enrolled in care and awaiting therapy with DAAs.Methods and findingsWe conducted a retrospective chart review of all adult patients with confirmed HCV infection who were currently enrolled in care and treatment at the four existing hepatitis referral centers in Rwanda. Patient charts at these centers were reviewed, and routinely collected data were recorded and analyzed. Overall, 253 patients were identified; median age was 56 years (IQR: 43, 65), and 149 (58.9%) were female. Median viral load was 688,736 IU/ml and 96.7% were HCV genotype 4. As classified by FIB-4 score, 64.8% of the patients had moderate to severe fibrosis. Fibrosis stage was associated with age (OR 1.12, CI 1.09–1.17), but not with time since diagnosis, gender, treatment center, or type of insurance. There was a low frequency of documented co-morbid conditions, including hypertension, diabetes, HIV, and hepatitis B virus.ConclusionsCompared to an estimated 55,000 patients eligible for HCV treatment in Rwanda, this study identified only 253 patients currently diagnosed and engaged in care, highlighting an immense treatment gap in HCV, likely due to the lack of accessible and affordable screening, diagnostic, and treatment modalities. The patients that were enrolled in care had a disproportionately advanced fibrosis stage, possibly indicating late presentation to care or lack of treatment options. In the context of newly available and effective treatment options, this study supports the overall need to accelerate access to HCV screening, diagnostics, and care and treatment services in resource-limited settings in sub-Saharan Africa.

Highlights

Hepatitis C virus (HCV) infection is a global pandemic affecting an estimated 115–185 million individuals, more than 80% of whom remain chronically infected, and accounts for between 300,000 and 700,000 deaths annually [1,2,3]
Compared to an estimated 55,000 patients eligible for hepatitis C virus (HCV) treatment in Rwanda, this study identified only 253 patients currently diagnosed and engaged in care, highlighting an immense treatment gap in HCV, likely due to the lack of accessible and affordable screening, diagnostic, and treatment modalities
20% of these infections are estimated to occur in sub-Saharan Africa (SSA) [4], and this accounts for the second greatest number of infected individuals after the Eastern European region [5]

Summary

Introduction

Hepatitis C virus (HCV) infection is a global pandemic affecting an estimated 115–185 million individuals, more than 80% of whom remain chronically infected, and accounts for between 300,000 and 700,000 deaths annually [1,2,3]. 20% of these infections are estimated to occur in sub-Saharan Africa (SSA) [4], and this accounts for the second greatest number of infected individuals after the Eastern European region [5]. In Rwanda, a country of 11.3 million people in the Great Lakes region of Africa [7], HCV seroprevalence has been estimated between 3.1–4.1% via antenatal care, blood donor and HIV screening programs [8,9,10]. Access to treatment for hepatitis C virus (HCV) in sub-Saharan Africa is extremely limited.

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