Background:
In Switzerland DAA treatment is reimbursed by universal healthcare insurance and can be prescribed by all medical doctors since 2022. The Hepatitis C Virtual Clinic (HCVC) initiative was launched in 2019 to support primary care providers PCP to diagnose, follow-up and/or prescribe DAA treatment for people living with chronic hepatitis C infection.
Description of intervention:
Our medical practice and the Levant Foundation are home to the HCVC initiative. In 2023 we added the mobile offer to perform onsite screening visits for viral hepatitis and liver stiffness with a portable fibroscan at settings caring for people who use drugs PWUD and migrant population with precarious situation. Onsite visits are designed and performed together with PCP teams.
Effectiveness:
The HCV cascade of care is summarized (figure 1a). Overall, 160 individuals have been screened, average age= 46 ± 8 years, women = 18% (29), men that have sex with men MSM = 16% (26), migrants = 12% (20), PWUD = 71% (114), HCV+ = 51% (82) and HCV RNA += 45% (37/82). Readiness for direct acting antivirals DAA treatment was 86% (32/37), corresponding to 31 chronic hepatitis naive to treatment and 1 reinfection (3.1%). Cure rate was 100% (32).
The rate of hepatitis B core antibodies (anti-HBc) was 80% (16/20) in the migrant group in contrast to 5.2% (6/114) and 3.8% (1/26) in the PWUD and MSM groups, respectively. Additionally, we identified a high proportion of liver fibrosis and steatosis among individuals from the migrant group (figure 1b).
Conclusion and next steps:
We identified different trends of viral hepatitis which need to be further addressed in order to improve care strategies in key populations and achieve local HBV and HCV elimination. Particularly, HCV and HBV care costs need to be covered for migrant population to overcome treatment barriers. |