Substantial Decline of Hepatitis C Virus Prevalence among PWID in Flanders, Belgium: The Result of a Comprehensive Approach

Author: Cathy Matheï, Anton Van Dijck, Rob Bielen, Stefan Bourgeois, Rita Verrando, Geert Robaeys

Theme: Epidemiology & Public Health Research Year: 2016


Cathy Matheï1,2, Anton Van Dijck1, Rob Bielen3, Stefan Bourgeois4, Rita Verrando5, Geert Robaeys3

1 Free Clinic, Antwerp, Belgium

2 KU Leuven, Leuven, Belgium

3Ziekenhuis Oost Limburg, Genk, Belgium

4 ZNA Campus Stuivenberg, Antwerp, Belgium

5 CAD Limburg, Hasselt, Belgium

Background: In developed countries the majority of transmissions and cases of hepatitis C (HCV) are among people who inject drugs (PWID). Modeling studies suggest that HCV incidence and prevalence can be reduced substantially using opioid agonist therapy (OAT) and needle and syringe exchange programs (NSEP) in combination with treatment. However, empirical evidence is lacking. We studied the impact of an integrated care program (ICP) including education, OAT, NSEP and HCV antiviral treatment on the HCV prevalence among PWID.

Methods: We compared the results of 2 observational studies conducted in 2 outpatient treatment centers in Belgium. The first study preceding the development and implementation of the ICP, was conducted in 1999-2000 and the second in 2013-2015.

Results: In 1999-2000 the total population consisted of 225 PWID with a mean age of 34 y of whom 65% were male. In 2013-15, 500 PWID with a mean age of 42 y of whom 76 % were male, made up the study population. In the first study treatment uptake among anti-HCV positives was 1% while this was 26% in the second study (Fisher exact, p<0.0001). Among anti-HCV positive PWID 94 % and 51 % tested positive for the presence of HCV-RNA in the first and second study respectively (Chi-square, p<0.0001). In one center only prevalence of anti-HCV significantly decreased from 84 % in the first study to 75% in the second (Chi square, p=0.02). Conclusion: These results show a substantial decline in chronic hepatitis C prevalence among PWID attending centers providing ICP in Belgium even with a moderate treatment uptake. The fact that in one center also anti-HCV prevalence decreased suggests a decrease in HCV transmission. Since most were treated in the pre DAA period we expect this trend to continue in the future.