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HCV Care Cascade 26% SVR Rate
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June 25, 2023
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A systematic review and meta-analysis were conducted to provide evidence of outcomes attained across the HCV care cascade in the era of direct-acting antivirals (DAAs).
Studies from North America, Europe and Australia (January 2014 through March 2021) reporting on HCV care cascade outcomes (screening to cure) were included.
this meta-analysis showed that outcomes at each step of the HCV care cascade remain low and are still far from achieving the WHO goal of 80%-90% cure by 2030.9
65 studies comprising 7,402,185 individuals were identified. Among individuals with positive HCV RNA test results, 62% (95%CI 55%-70%) attended their first care appointment, 41% (95%CI 37%-45%) initiated treatment, 38% (95%CI 29%-48%) completed treatment, and 29% (95%CI 25%-33%) achieved cure. HCV screening rates were 43% (95%CI 22%-66%) in prisons or jails, and 20% (95%CI 11%-31%) in emergency departments (EDs). Linkage to care rates were 62% (95%CI 46%-75%) for homeless individuals and 26% (95%CI 22%-31%) for individuals diagnosed in EDs.
Cure rates were 51% (95%CI 30%-73%) in individuals with substance use disorder (SUD) and 17% (95%CI 17%-17%) in homeless individuals. Cure rates were lowest in the U.S.
This systematic review and meta-analysis demonstrated persistent gaps across the HCV care cascade, confirming that the availability of effective all-oral DAA therapies does not guarantee medication access by populations most in need. This study's findings also suggest that continued efforts are needed to improve the care cascade for individuals with HCV infection. Increasing the number of people completing each HCV care cascade step, especially among individuals diagnosed with HCV in ED settings, individuals experiencing homelessness, incarcerated individuals and individuals with SUD, may be a strategy to achieve the WHO's goal of curing HCV infection and reducing the incidence of HCV infection.
Abstract
Introduction
The hepatitis C virus (HCV) epidemic remains a public health problem worldwide. A systematic review and meta-analysis were conducted to provide evidence of outcomes attained across the HCV care cascade in the era of direct-acting antivirals (DAAs).
Methods
Studies from North America, Europe and Australia (January 2014 through March 2021) reporting on HCV care cascade outcomes (screening to cure) were included. When calculating the proportions of individuals completing each step, the numerator for steps 1-8 was the number of individuals completing each step; the denominator was the number of individuals completing the previous step for steps 1-3 and step 3 for steps 4-8. In 2022, random effects meta-analyses were conducted to estimate pooled proportions with 95% CIs.
Results
65 studies comprising 7,402,185 individuals were identified.
Among individuals with positive HCV RNA test results, 62% (95%CI 55%-70%) attended their first care appointment, 41% (95%CI 37%-45%) initiated treatment, 38% (95%CI 29%-48%) completed treatment, and 29% (95%CI 25%-33%) achieved cure.
HCV screening rates were 43% (95%CI 22%-66%) in prisons or jails, and 20% (95%CI 11%-31%) in emergency departments (EDs).
Linkage to care rates were 62% (95%CI 46%-75%) for homeless individuals and 26% (95%CI 22%-31%) for individuals diagnosed in EDs.
Cure rates were 51% (95%CI 30%-73%) in individuals with substance use disorder (SUD) and 17% (95%CI 17%-17%) in homeless individuals. Cure rates were lowest in the U.S.
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