The evolving hepatitis C care cascade in a real-world setting: results for the period 2003-2017 from Free Clinic Antwerp

Author: Van der Mussele S, Windelinckx T, Maertens G, Matheï C

Theme: Epidemiology & Public Health Research Year: 2019

Successful hepatitis C (HCV)management requires a care cascade with effective strategies to address
barriers impeding people to move through all the steps of the cascade. Twenty years ago, the drug
treatment center Free Clinic developed its first HCV plan. Since then, a lot has been achieved in
terms of screening, diagnosis and treatment, development of care models and access to care for
people who inject drugs (PWID). In this study we aimed to investigate how these accomplishments
impacted in our centers care continuum.
We performed a retrospective analysis collecting data on screening uptake for HCV antibody and
HCV RNA, treatment initiation and treatment outcome for the period 2003-2017. A cross-sectional
study was performed to calculate the proportion of reinfection by means of the Xpert HCV Viral
Load finger-stick point-of-care RNA test.
Between 2003-2017, 1478 PWID, of whom 21% were women and for whom the median year of
birth was 1972 , attended the center at least once. In this period, HCV antibody screening uptake
increased from 70% to 90% (p<0.001). Amongst HCV antibody positives, the proportion tested for HCV RNA rose from 7% in 2003 to 86% in 2017 (p>0.001). The annual treatment initiation
augmented from 2% to 10% (p<0.001). The overall SVR was 64%. The prevalence of HCV RNA negatives among HCV antibody positives declined from 87% in 2003 to 47% in 2017 (p<0.001). Based on preliminary results the reinfection rate among patients successfully treated for HCV was 3% (final results will be presented at the conference). Conclusions In this study we demonstrate that a sustained and comprehensive hepatitis C management results in a major decline of the micro-environment hepatitis C reservoir. Given the actual annual treatment uptake is maintained, micro-elimination of hepatitis C becomes within reach. Disclosure of interest: Prof Dr Matheï has received funding from MSD and Gilead. No pharmaceutical grants were received in the development of this study.

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