INHSU 2018—Enhancing the HCV care cascade


  • Maria Joao Almeida
  • HCV Conference Reports
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Takeaway

  • Reaching the goal of HCV elimination by 2030 implies acting on all steps of the HCV continuum of care – should tasks be shifted?

Why this matters

  • 2018 EASL recommendation is to enhance HIV-HBV and HCV virus screening in at-risk population.[1]
  • It is also a recommendation of the French guidelines to have their population screened for the 3 viruses once in a lifetime.[1]
  • Shifting tasks to people who are in contact with people with HCV makes HCV therapy and cure more widely available, empowering workers, people and peers, and making it easier and more cost-effective.[2]
  • The model of HCV screening should be reviewed as these differ if self-testing, or if one-step or two-step testing are chosen.[1]
  • Epidemics are diverse even in a single country and change over time. Strategies need to consider existing programmes and population needs (community partnerships are vital).[3]

Key results

  • One-step or two-step strategies depend on cost of tests, technologies available, performance, prevalence of infection, uptake rate of screening, and patients lost to follow-up.[1]
  • Still a lot of work to do in self-testing, as there is evidence of tension associated with outcomes – the value of autonomy, the fear of dealing with a positive result, and the fear of finding the right engage to care.[1]
  • Cost-efficacy analysis is essential to drive screening policies.
  • One size does not fit all services for HCV elimination – bin or shift tasks to simplify HCV continuum of care.[2]
  • Integration of HCV testing improves the continuum of care, with a significant impact on community HCV testing and awareness.[3]
  • Features of the social environment shape vulnerabilities to HCV and HIV transmission across ecologic levels in different settings.[4][5]

Limitations

  • The impact on the continuum of care as a whole should be evaluated (from screening to cure) and not only impact of screening rates.
  • For better linkage to care, other strategies (peers, incentives) for HCV treatment are needed.

Expert comment

  • Anne Øvrehus, MD, Staff Specialist of the Odense University Hospital, Denmark concluded that, “I think that one of the very interesting things that came up was the point of doing things as simple as you can, what can you put in the bin to make everything easy and accessible, which is something that we’ve been working for a long time. But another very complex issue I think that was raised was about integrating HCV into HIV and TB, and that raises a whole lot of new concerns about what happens that impacts the patient and the stigma and services. Should we move away from of having vertical programmes and into more integrated ones? I think that is a field that has just begun and there’s a long way ahead, so I think the session very well illustrated the many complex issues about getting hepatitis C all the way out.”

 

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