ABSTRACT
Background and Objectives: The WHO has identified HCV infection as a public health threat and set a global target for HCV elimination by 2030, yet currently only 11 countries are on track to achieve HCV elimination targets. Up to 60% of HCV + patients are lost to follow-up and remain untreated and this has likely been further exacerbated by the COVID-19 pandemic, which may have reduced HCV treatment urgency, causing many patients to delay care. To achieve the WHO goal, still many patients need to be screened and linked to care. Gilead has been running Local Elimination Programs Leading to Global Action in HCV (LEGA-C) to support implementation science projects toward HCV elimination. Here, we explore the outcomes of LEGA-C programs for patients with HCV especially in Asia. Method(s): The outcomes and impact were measured through the number of studies and patients to be reached;steps in the care cascade as well as efficacy of each model were assessed along with the presentations and publications from each study. Result(s): In total,[120 studies were supported. Of these, 18 have completed or are ongoing in Asia. Through July 2022, 175,192 persons were screened, 6,287 were HCV + and enrolled in a study, and 3,768 received treatment. A simplified screening and linkage to care/ minimal monitoring model was investigated in 8 studies and demonstrated that linkage to care with minimal monitoring could achieve antiviral response comparable to standard practice.[i] Four test-and-treat studies showed that aggressive screening and on-site treatment promotes HCV microelimination.[ii] Three outreach-andcallback studies showed demonstrated the feasibility of recruiting persons to HCV screening programs in community settings.[iii] Seven studies focused on special populations, and 4 of them described the characteristics of special populations with higher rates of HCV infection. Publications from these studies in Asia include 14 full articles, and these papers were cited a total of 56 times. Conclusion(s): The ongoing LEGA-C initiative is demonstrably contributing to the understanding, treatment, and ultimate elimination of HCV. Innovative ideas, active promotion of HCV testing, disease education, patient navigation, and care coordination in these programs led to increased screening and rates of linkage to care. Adopting and adapting effective strategies from these programs may be a feasible way to increase treatment numbers and improve patient outcomes, thus contributing to meeting the WHO goal of HCV elimination in Asia.
ABSTRACT
Background: Hepatitis C virus (HCV) infection is a major cause of chronic liver disease that can progress to cirrhosis and hepatocellular carcinoma. The WHO has identified HCV infection as a public health threat and set a global target for HCV elimination by 2030. Simple pangenotypic direct-acting antiviral regimens allow most patients to be cured with minimal pretreatment and on-treatment monitoring. To achieve the WHO goal, patients-including previously diagnosed HCV-positive patients who have been lost to follow-up- need to be linked to care. Studies report up to 60% of patients who test positive for HCV antibody are lost to follow-up and not treated. This loss has been further exacerbated by the COVID-19 pandemic, during which there was a reduction in treatment urgency, such that many patients put off receiving care. Here, we explore the effectiveness of care re-engagement programs for patients with HCV. Method(s): We assessed ReLink programs (sponsored by Gilead Sciences, Inc.), designed to identify and re-engage HCV-positive patients with medical care and start/restart HCV treatment. We evaluated these programs by analyzing the number of patients, steps in the care cascade where patients were lost to follow-up, and the efficacy of the engagement program (determined by number relinked and treated). Result(s): Six programs assessed 44,964 patient records, identifying 11,163 patients lost to follow-up and eligible for contact. Several common points in the care cascade were identified where patients were most frequently lost to follow- up, often after diagnosis but before start of treatment. The main reason for loss to follow-up was the inability to contact patients. Overall, 3726 patients were relinked with care, and 701 were treated (Table). Several key points were identified for improving patient engagement with care, including the use of electronic databases to identify patients lost to follow-up, securing reliable contact information for patients, and partnership with medical societies. Conclusion(s): Active case-finding, patient navigation, and care coordination in these programs led to increased engagement and treatment rates. Engaging HCV-positive patients with care is urgent, as many may already have developed more advanced liver disease. Adopting and adapting effective strategies from these programs may be a feasible way to improve patient outcomes and increase treatment numbers, thus contributing to meeting the WHO goal of HCV elimination. (Table Presented).