A global systematic review of efforts to accelerate the elimination of hepatitis C through micro-elimination among PWID and other target populations

Author: Camilia Picchio Chris Byrne Javier Crespo Massimo Colombo Graham Cooke Gregory J Dore Jason Grebely John W Ward John F Dillon Jeffrey V Lazarus

Theme: Epidemiology and Public Health Research Year: 2021

Background: The introduction of new hepatitis C virus (HCV) all-oral direct-acting antiviral therapy in 2013 galvanized WHO to define ambitious targets for eliminating HCV as a public health threat by 2030. Micro-elimination projects help achieve this goal by targeting small-scale, high-risk populations. Through such targeting, micro-elimination reveals effective strategies and partnerships to guide the scale-up of national elimination efforts. The aim of this study was to document and quantify the evidence that exists to support HCV micro-elimination among high-prevalence populations globally. Methods: We systematically searched the literature on PubMed/Medline from 1/1/2014 to 31/12/2020 and relevant scientific conference abstract titles from 2017-19 (AASLD, APASL, ILC, INHSU, IVHEM). Modelling studies were excluded. Results were synthesized and quantified in terms of key micro-elimination components (having a plan, specific targets, multistakeholder process, and monitoring of outcomes). Results: We identified 957 articles, of which 32 full-text manuscripts fit the inclusion criteria in addition to 28 conference abstracts reporting on micro-elimination initiatives. Among the manuscripts, interventions to eliminate HCV mainly focused on people who are incarcerated (9), people who inject drugs (PWID) (7), and people who are HIV/HCV co-infected (5) (Figure 1). Half of the conference abstracts (n=14) were PWID focused. Micro-elimination initiatives were reported predominantly in high-income countries (81.2%; 26/32). Overall, 75% of the manuscripts and conference abstracts reported at least 3 out of 4 of the micro-elimination components. Thirteen manuscripts had documented sustained virologic response (SVR) rates above 90%, 7 had between 89-80%, 6 below 79%, and 4 below 50%. Conclusion: HCV micro-elimination has become increasingly employed to achieve HCV elimination targets for key sub-populations but is not yet widespread. Micro-elimination strategies can achieve high SVR rates and should contribute to reaching national elimination goals. More initiatives should be encouraged and shared, particularly in low and-middle income countries. Disclosure of Interest Statement: No funding for this project was received. Figure 1. List of identified micro-elimination target populations in published articles from 2014-2020 and conference abstracts from 2017-2019 HCV, hepatitis C virus; LTFU, lost to follow-up; MSM, men who have sex with men; PWID, people who inject drugs; PWUD, people who use drugs; US, United States. 9 5 2 2 2 7 5 1 1 1 1 6 2 1 3 1 14 1 2 2 2 1 P E O P L E W H O A R E I N C A R C E R A T E D H I V / H C V C O- I N F E C T E D P E O P L E W I T H B L E E D I N G D I S O R D E R S P E O P L E E X P E R I E N C I N G H O M E L E S S N E S S T H O S E L T F U P W U D O R P W I D G E N E R A L O R A D U L T P O P U L A T I O N I N A D E F I N E D R E G I O N I N C A R C E R A T E D P E R S O S A N D P W I D P E O P L E W I T H S U B S T A N C E U S E D I S O R D E R S P R E G N A N T W O M E N M I G R A N T S , R E F U G E E S , A N D U N D O C U M E N T E D I N D I V I D U A L S M S M L I V I N G W I T H H I V U S V E T E R A N S A M E R I C A N I N D I A N S ( C H E R O K E E ) # OF IDENTIFIED TARGET POPULATIONS TARGET POPULATIONS Manuscripts Conference abstracts

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