Dana Busschots1,2, Samira Toghanian3, Rob Bielen1,2, Stina Salomonsson3, Özgür M Koc1,2,4, Greet Hendrickx5, Michel Jadoul6, Frederik Nevens7, Etienne Sokal8, Christian Brixko9, Kathelijne Peerlinck10, Ludwig Apers11, Geert Robaeys1,2,7, Jeffrey V Lazarus12. 1. Faculty of Health and Life Sciences, Hasselt University, Diepenbeek, Belgium. 2. Department of Gastroenterology and Hepatology, Ziekenhuis Oost-Limburg, Genk, Belgium. 3. MSD, Centre of Observational Real-world Evidence (CORE), Stockholm, Sweden. 4. Medical Microbiology, School of NUTRIM, Maastricht University Medical Centre, Maastricht, the Netherlands. 5. Viral Hepatitis Prevention Board, Centre for the Evaluation of Vaccination, Vaccine & Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium. 6. Service de Néphrologie, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium. 7. Department of Gastroenterology and Hepatology, University Hospitals KU Leuven, Leuven, Belgium. 8. Service Gastroentérologie Hépatologie Pédiatrique, Cliniques Universitaires St. Luc, Université Catholique de Louvain, Brussels, Belgium. 9. Department of Hepato-Gastroenterology and Digestive Oncology, CHR Citadelle, Liège, Belgium. 10. Division of Cardiovascular Disorders, Haemophilia Center, University Hospitals KU Leuven, Leuven, Belgium. 11. Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Antwerp, Belgium. 12. Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain. Jeffrey.lazarus@isglobal.org.
Abstract
BACKGROUND: Hepatitis C virus is one of the leading causes of chronic liver disease and liver-related deaths worldwide. The estimated prevalence of chronic hepatitis C viral infection among the general Belgian population was 0.57% (n = 64,000) in 2015. Although Belgium has had a 'Hepatitis C Plan' since 2014, elimination efforts are unclear. This study employs the best available data and modelling estimates to define the burden of hepatitis C viral infection among key subgroups in Belgium, identify information gaps and propose potential approaches to screening, linkage to care and treatment, and cure. METHODS: We examined the peer-reviewed and grey literature since 2012 for data on the prevalence of hepatitis C viral infection in Belgium in key subgroups identified by national experts and in the literature. Ultimately, this research is primarily based on data provided by the key stakeholders themselves due to a lack of reliable data in the literature. Based on this, we modelled the treatment rates required to reach elimination of hepatitis C in several subgroups. RESULTS: Eleven potential subgroups were identified. There were no data available for two subgroups: generational cohorts and men who have sex with men. In six subgroups, fewer than 3000 people were reported or estimated to have hepatitis C infection. Migrants and people who inject drugs were the most affected subgroups, and children were the least affected subgroup. Only two subgroups are on target to achieve elimination by 2030: patients living with haemophilia and transplant recipients. CONCLUSIONS: Removing Belgian treatment reimbursement restrictions in January 2019 was a big step towards eliminating HCV. In addition, increasing surveillance, including with a national registry, treatment prescription by other health-care providers and availability of treatment in local pharmacies are central to improving the current situation and getting on track to reach the 2030 WHO hepatitis C elimination targets in Belgium.
BACKGROUND:Hepatitis C virus is one of the leading causes of chronic liver disease and liver-related deaths worldwide. The estimated prevalence of chronic hepatitis C viral infection among the general Belgian population was 0.57% (n = 64,000) in 2015. Although Belgium has had a 'Hepatitis C Plan' since 2014, elimination efforts are unclear. This study employs the best available data and modelling estimates to define the burden of hepatitis C viral infection among key subgroups in Belgium, identify information gaps and propose potential approaches to screening, linkage to care and treatment, and cure. METHODS: We examined the peer-reviewed and grey literature since 2012 for data on the prevalence of hepatitis C viral infection in Belgium in key subgroups identified by national experts and in the literature. Ultimately, this research is primarily based on data provided by the key stakeholders themselves due to a lack of reliable data in the literature. Based on this, we modelled the treatment rates required to reach elimination of hepatitis C in several subgroups. RESULTS: Eleven potential subgroups were identified. There were no data available for two subgroups: generational cohorts and men who have sex with men. In six subgroups, fewer than 3000 people were reported or estimated to have hepatitis C infection. Migrants and people who inject drugs were the most affected subgroups, and children were the least affected subgroup. Only two subgroups are on target to achieve elimination by 2030: patients living with haemophilia and transplant recipients. CONCLUSIONS: Removing Belgian treatment reimbursement restrictions in January 2019 was a big step towards eliminating HCV. In addition, increasing surveillance, including with a national registry, treatment prescription by other health-care providers and availability of treatment in local pharmacies are central to improving the current situation and getting on track to reach the 2030 WHO hepatitis C elimination targets in Belgium.
Entities:
Keywords:
Belgium; Disease elimination; Health policy; Hepatitis C; Treatment
Authors: Dana Busschots; Cécile Kremer; Rob Bielen; Özgür M Koc; Leen Heyens; Christian Brixko; Pierre Laukens; Hans Orlent; Pascal Bilaey; Francis De Smet; Geert Hellemans; Gaetan Muyldermans; Luk Van Baelen; Niel Hens; Hans Van Vlierberghe; Geert Robaeys Journal: BMC Infect Dis Date: 2021-07-27 Impact factor: 3.090
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