Abstract
ObjectivesGiven limited data on factors associated with hepatitis C virus (HCV) treatment discontinuation and failure in low- and middle-income countries, we aimed to describe patient populations treated for HCV in five countries and identify patient groups that may need additional support.DesignRetrospective cohort analysis using routinely collected data.SettingPublic sector HCV treatment programmes in India (Punjab), Indonesia, Myanmar, Nigeria (Nasarawa) and Vietnam.Participants104 957 patients who initiated treatment in 2016–2022 (89% from Punjab).Primary outcomesTreatment completion and cure.ResultsPatient characteristics and factors associated with outcomes varied across countries and facilities. Across all patients, median age was 40 years (IQR: 29–52), 30.6% were female, 7.0% reported a history of injecting drugs, 18.2% were cirrhotic and 4.9% were coinfected with HIV. 79.8% were prescribed sofosbuvir+daclastasvir. Of patients with adequate follow-up, 90.6% (89,551) completed treatment. 77.5% (69,426) of those who completed treatment also completed sustained virological testing at 12 weeks (SVR12), and of those, 92.6% (64 305) were cured. In multivariable-adjusted models, in most countries, significantly lower treatment completion was observed among patients on 24-week regimens (vs 12-week regimens) and those initiated in later years of the programme. In several countries, males, younger patients <20 years and certain groups of cirrhotic patients were less likely to complete treatment or be cured. In Punjab, treatment completion was also lower in those with a family history of HCV and people who inject drugs (PWID); in other countries, outcomes were comparable for PWID.ConclusionHigh proportions of patients completed treatment and were cured across patient groups and countries. SVR12 follow-up could be strengthened. Males, younger people and those with decompensated cirrhosis on longer regimens may require additional support to complete treatment and achieve cure. Adequate programme financing, minimal user fees and implementation of evidence-based policies will be critical to close gaps.
Funder
UK Foreign Commonwealth and Development Office
Reference33 articles.
1. HCV market intelligence report 2021 and preliminary HBV market insights. Clinton health access initiative 2021, 2021. Available: https://chai19.wpenginepowered.com/wp-content/uploads/2021/08/Hepatitis-C-Market-Report_2021-FINAL-1.pdf
2. Initial success from a public health approach to hepatitis C testing, treatment and cure in seven countries: the road to elimination
3. Global progress report on HIV . Viral hepatitis and sexually transmitted infections, 2021. Geneva: World Health Organization, 2021.
4. Loss to follow‐up in the hepatitis C care cascade: A substantial problem but opportunity for micro‐elimination
5. Hepatitis C among blood donors: cascade of care and predictors of loss to follow-up;Machado;Rev Saude Publica,2017
Cited by
1 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献