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Putting HBV/HCV Testing and Treatment in
HIV Clinics Has Benefits in Vietnam
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AIDS 2022, July 29-August 2, Montreal
Mark Mascolini
Offering HBV and HCV screening and treatment in community primary health care HIV clinics in Vietnam sped uptake of viral hepatitis testing and linkage to care in people most at risk for HBV and HCV infection, according to findings in Vietnam’s HepLINK project [1].
Vietnam has 7.8 million people with HBV infection and 1 million with HCV. Liver cirrhosis or hepatocellular carcinoma develops in 80,000 Vietnamese people every year, and 40,000 die from hepatocellular carcinoma or decompensated liver cirrhosis. Large majorities of people with HBV (80%) and HCV (90%) in Vietnam do not get diagnosed, and only 1% eligible for HBV or HCV therapy get treated annually. These daunting statistics reflect limited awareness of viral hepatitis in at-risk populations, lack of routinely offered HBV/HCV screening and testing at health facilities, limiting HCV therapy to provincial and central hospitals, and coverage of only 50% of the cost of HCV therapy by health insurance.
To address these problems, from September 2020 to August 2022, the Vietnam Administration of Medical Services/Ministry of Health and PATH launched the HepLINK project, funded by The Hepatitis Fund, in two cities with high viral hepatitis prevalence: Hanoi and Ho Chi Minh City. The project involved a multilayered integration of rapid HBV/HCV testing in existing HIV services. Elements of the program included online and offline demand creation, community-led and facility-based testing, diagnostic confirmation and evaluation for treatment eligibility, and ultimately treatment and follow-up.
From April 2021 to May 2022, comparison of the HBV care cascade in community-based programs and facility-based programs confirmed a numerical advantage for the community approach. Among 11,201 people tested for HBsAg in community programs, 1135 (10.1%) were positive, 472 had HBV treatment eligibility evaluated, 398 were judged eligible for treatment, and 270 began HBV therapy (67.8% of 398). With the facility-based approach, among 8317 people tested for HBsAg, 417 (5.0%) tested positive, 210 had treatment eligibility evaluated, 206 proved eligible for HBV therapy, and 194 began therapy (94.2% of 206).
Proportions of key populations positive for HBsAg among those screened were 14.2% of female sex workers, 10.8% of people who inject drugs, 7.8% of people with HIV, 6.9% of drug users, 5.2% of men who have sex with men (MSM), 3.6% of transgender women, and 4.0% of others. Overall positivity prevalence stood at 8% (1552 of 19,518).
A multivariable models adjusted for age, HIV status, sexually transmitted infection status, antiretroviral use, and other variables determined that people who had community-based testing had almost twice higher odds of HBV infection than did people who had facility-based testing (adjusted odds ratio [aOR] 1.84, 95% confidence interval [CI] 1.59 to 2.14, P < 0.001). Other factors independently associated with HBsAg positivity were age 25 or older, being a drug injector, female sex worker, or MSM, not being vaccinated for HBV, taking antiretroviral therapy, and receiving nonoccupational postexposure prophylaxis.
The HCV care cascade showed an advantage for facility-based testing in the same period-April 2021 to May 2022. Among 8292 people tested for anti-HCV antibodies in a facility-based program, 1500 (18.1%) tested positive, 754 had confirmatory testing, 544 had HCV infection confirmed, and 450 (82.7% of 544) began treatment. With community-based testing, among 11,309 people tested for anti-HCV antibodies, 785 (6.9%) tested positive, 344 had confirmatory testing, 330 had HCV confirmed, and 218 (66.1% of 330) began therapy.
Proportions of key populations testing positive for anti-HCV were 27.6% of people with HIV, 12.9% of people who inject drugs, 5.9% of drug users, 3.8% of female sex workers, 1.4% of MSM, 1.4% of transgender women, and 4.0% of others. Overall, 2285 of 19,601 people (11.7%) tested positive for HCV.
Multivariable analysis determined that community-based testing lowered chances of testing positive for HCV about 84% compared with facility-based testing (aOR 0.16, 95% CI 0.14 to 0.19, P < 0.001). Other variables independently associated with HCV positivity were age 25 or older, being a person who injects drugs, a drug user, or a female sex worker, living with HIV, using HIV PrEP, and testing for HIV.
The researchers concluded that integrating HBV and HCV testing into community primary care HIV clinics hastens access to and uptake of viral hepatitis testing, as well as linkage to care, for at-risk populations. They stressed that “community engagement is essential to boost awareness, trust and use of HBV/HCV testing, treatment and prevention services.” They added that the HBV integrated model “created a tremendous opportunity” for people with HBV to get access to free antiretrovirals and anti-HIV PrEP.
Reference
1. Bao NV, Tuan KD, Khanh AT, Khanh LT, et al. Integration of hepatitis B and C testing into HIV services: an opportunity to achieve dual elimination of viral hepatitis and HIV in Vietnam. AIDS 2022, July 29-August 2, Montreal. Abstract OAE0505.
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