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Marked reduction in prevalence of hepatitis C viremia among people who inject drugs (PWID) during 2nd year of the Treatment as Prevention (TraPHepC) program in Iceland
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Reported by Jules Levin
EASL 2018 April 11-15 Paris France
Download the PDF here
ThorarinnTyrfingsson1, ValgerdurRunarsdottir1, IngunnHansdottir1,2, OttarM. Bergmann3, EinarS. Bjornsson3,4, BirgirJohannsson5, BryndisSigurdardottir5, RagnheidurH. Fridriksdottir3, Arthur Love4, 6, ThorvardurJ. Love4, 7, Gudrun Sigmundsdottir8UbaldoBenitez Hernandez7 ,Maria Heimisdottir4, 9, Magnus Gottfredsson4,5,7, SigurdurOlafsson3,4and the TRAP HEP C working group
1SAA National Center for Addiction Medicine -Reykjavik Iceland, 2Faculty of Psychology, School of Health Sciences, University of Iceland, 3Department of Gastroenterology and Hepatology, LandspitaliUniversity Hospital , 4Faculty of Medicine, School of Health Sciences, University of Iceland, 5Department of Infectious Diseases, LandspitaliUniversity Hospital, 6Department of Virology, 7Department of Science, LandspitaliUniversity Hospital, 8Chief Epidemiologist, Directorate of Health, 9Department of Finance , LandspitaliUniversity Hospital, Reykavik, Iceland.
published March 2018, J int Med -
Treatment as Prevention for Hepatitis C (TraP Hep C) - a nationwide elimination programme in Iceland using direct-acting antiviral agents
https://onlinelibrary.wiley.com/doi/full/10.1111/joim.12740....The possibility of a nationwide HCV treatment/elimination programme was discussed in November 2014 by physicians managing HCV-infected patients in Iceland and representatives of the pharmaceutical company Gilead. The idea was to offer DAAs to all HCV-positive patients within an entire population within a relatively short time frame and simultaneously initiate an observational study with long-term follow-up. Gilead would, in a study setting, provide DAAs free of charge for the project. ......An important part of the programme is that vast majority of cases will be treated within 36 months from the launch of the project, during 2016-2018. ..... treatment as prevention for HCV may provide an opportunity for preventing onward transmission and reducing the prevalence of the disease and its sequelae. Modelling work has suggested that even by a modest scale-up of treatment uptake amongst PWID, a significant reduction in prevalence can be achieved 6. Consequently, HCV elimination using a treatment as prevention approach combined with harm reduction efforts is considered attainable; WHO has set elimination targets for hepatitis C, including a 65% reduction in HCV-related deaths and 80% reduction in HCV incidence by 2030 8. Some countries - including Georgia, Australia, Egypt, Portugal and Spain - are also currently undertaking national hepatitis C elimination efforts 9. Iceland is an ideal setting to examine the effectiveness of the treatment as prevention approach in a real-world setting. Results from recent mathematical modelling for Iceland suggest that by intensifying harm reduction, as well as diagnostic and treatment efforts, the WHO targets for HCV elimination could be achieved sooner than 2030, in fact even 6-10 years earlier 10. This study describes the approach taken to achieve this goal.....Iceland has a population of 340.000 - covered by national health insurance 11. It is a high-income country with healthcare expenditure amounting to 8.9% of GDP in 2014....Over the past 20 years, 40-70 new cases of HCV have been diagnosed in Iceland every year (Fig. 1)....The most commonly used drug amongst PWIDs in Iceland has been the prescription drug methylphenidate, which is indicated for the treatment of attention deficit disorders 20, 21. However, majority of PWIDs treated at SAA use more than one substance intravenously
pdf attached above
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