Global prevalence of viraemic hepatitis C virus (HCV) stands at 71 million (95% CI, 63-79) with only 40% being diagnosed. WHO has set up a target of eradicating HCV infection as a major public health threat by 2030, which looks achievable with implementation of highly successful therapy with direct-acting antivirals (DAA). Although number of patients treated has doubled between 2013 and 2015, achieving WHO target would require a further increase of up to 25%.
DAA therapy is usually administered by specialists across Europe, but non-specialists have been prescribing DAAs since 2016 in Australia. Short duration regimens and low rates of adverse events make it suitable for administering in community setting. However, caution is required in patients with advanced liver disease. A recent report published in the Journal of Hepatology indicates efficient screening programmes with liver stiffness measurements (LSM) in community setting could be useful for detecting patients at risk for liver cirrhosis and decompensation.
A recent study confirmed utility of LSM for fibrosis assessment in patients with chronic hepatitis C in the community setting. 780 patients with chronic hepatitis C, across 21 primary care centres in Australia were compared with a cohort of hospital-referred patients. Patients in community vs hospital-referred cohort identified at risk for advanced fibrosis (LSM ≥12.5 kPa) were similar (P=.2). LSM detected at-risk patients who otherwise could have been missed, as 17.3% of at-risk patients had no clinical signals of advanced disease. Another screening study reported LSM
Following the Australian example, the authors emphasise on new public health strategies in Europe including non-specialists as prescribers and involving community-based screening resources. They comment: “Involving community-based resources would maximize the delivery of state-of-the-art diagnostic tools and treatment options to reduce the burden and costs from chronic liver disease.”