Theme: Epidemiology & Public Health Research Year: 2018
Background:
For national elimination of HCV, the Netherlands has a favorable epidemiology with low HCV
prevalence and incidence, and high access to care and treatment. The Dutch national
hepatitis plan focuses on micro-elimination initiatives as a pragmatic and efficient approach.
Although people who use drugs (PWUD) make up only 15% of the estimated total of 23,000
individuals chronically infected with HCV, they are seen as an important target.
Description of model of care/intervention:
The Dutch national hepatitis plan defines 5 steps in the HCV healthcare cascade:
(1) Awareness and prevention: in 2009/2010, a large nationwide HCV awareness campaign
targeted, among others, individuals attending methadone clinics. It was found cost-effective
(ICER €9,056 (95% CI: €6,043–€13,523)).
(2) Case finding is performed through a combination of identifying undiagnosed HCVpositive PWUD (screening) and tracing previously diagnosed patients who are no longer in
clinical care (retrieval). The notorious Dutch Health Council stated that addiction care
institutions are responsible for actively offering HCV testing to PWUD.
(3) Linkage to care is improved in two implementation projects (“Breakthrough Projects”), in
which stakeholders from addiction care and the (nearby) hepatitis treatment centre closely
collaborate, with the main goal to develop local sustainable HCV referral cascades.
(4) Access to medication: all available DAAs are reimbursed by basic healthcare insurance,
irrespective of fibrosis stage or route of transmission.
(5) Monitoring and evaluation: pilots on a registry for hepatitis B & C mono-infections are
ongoing.
Effectiveness:
A study modelling the future HCV burden of disease in the Netherlands estimated an overall
85% reduction in chronic HCV infections by the year 2030, if treatment rate can be scaled up
adequately.
Conclusion and next steps:
HCV elimination in PWUD is feasible if linkage to care is further improved by reducing
treatment thresholds, e.g., by allowing addiction care physicians to prescribe DAA’s.
Disclosure of Interest Statement:
The authors declare that they have no competing interests. This research received no
specific grant from any funding agency in the public, commercial or not-for-profit sectors.