Barriers To Widespread Hepatitis C Treatment Among People Who Inject Drugs: Data From The Sammsu Cohort

Author: Moriggia A, Bregenzer A, Bruggmann P, Castro E, Rothen M, Rougemont M, Schmid P, Thurnheer C, Scheidegger

Theme: Clinical Research Year: 2017

Global hepatitis C virus (HCV) elimination will require a broad extension of treatment to people who inject drugs (PWID). PWID have historically a low HCV treatment uptake. We examined barriers to HCV treatment in a Swiss national cohort of patients in opioid substitution treatment (OST).
The SAMMSU cohort is an ongoing, prospective, open cohort of OST patients in Switzerland. Data are collected annually since 2014 with a wide list of key parameters including demographical and socio-economical variables, drug and alcohol use, psychiatric and somatic comorbidities and therapies. We examined the cascade of HCV care and the barriers to broad HCV treatment in our population.
As of April 2017, 511 subjects were enrolled in the cohort. HCV-Ab prevalence of 65% (332/509). Of the 332 HCV-Ab positive subjects, 262 (79%) had ever had chronic hepatitis C (CHC), while in 40 (12%) the status was unknown. Among 151 subjects who received treatment for HCV, 112 (74%) met a sustained virological response (SVR), 13 (9%) had treatment failure and for 26 (17%) no outcome was reported. As a result, of 262 CHC subjects, 112 (43%) were cured from HCV, 124 (47%) still had an active disease and for 26 (10%) the status was unknown. Overall, 111 subjects (42%) never received treatment. While the majority (56%) of them had a F0/F1 fibrosis stage (62), 27% (30) had a F2-F4 stage and in 19 subjects (17%) fibrosis was not assessed. The main reasons reported for not treating HCV were reimbursement restrictions, lack of patient’s motivation, uncontrolled substance use and physician’s perception that the treatment was unnecessary.
Despite a good treatment uptake (151/262, 58%) in our population of OST patients, several barriers and gaps remain at different steps of the cascade of HCV care. Efforts should focus on scaling up treatment and developing linkage to care strategies.

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