Gordana Avramovic1, Maeve Reilly2, Walter Cullen3, Juan Macías4, Geoff McCombe3, Tina McHugh5, Cristiana Oprea6, Alistair Story7, Julian Surey8, Caroline Sabin7, Sandra Bivegete9, Peter Vickerman9, Josephine Walker9, Zoe Ward9, John S Lambert10. 1. Mater Misericordiae University Hospital, Ireland, 44 Eccles St, Dublin 7, Ireland; University College Dublin, Ireland, Catherine Mc Auley Centre, 21 Nelson St, Ireland. 2. University of St Andrews, St Andrews KY16 9AJ, UK. 3. University College Dublin, Ireland, Catherine Mc Auley Centre, 21 Nelson St, Ireland. 4. Hospital Universitario de Valme, Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Virgen de Valme, Avenida Bellavista s/n 41014 Sevilla, Spain. 5. Mater Misericordiae University Hospital, Ireland, 44 Eccles St, Dublin 7, Ireland. 6. Victor Babes Clinical Hospital for Infectious and Tropical Diseases, 281 Mihai Bravu avenue, 030303, sector 3, Bucharest, Romania. 7. Find & Treat, University College London Hospital NHS Trust, UK & Collaborative Centre for Inclusion Health, UCL, 250 Euston Rd, London, UK. 8. Institute of Global Health, University College London, UK & Find & Treat, University College London Hospital NHS Trust, 406a, Mortimer Market Centre, London, UK. 9. Population Health Sciences, University of Bristol, School of Social and Community Medicine Oakfield House, Oakfield Grove, Bristol, UK. 10. Mater Misericordiae University Hospital, Ireland, 44 Eccles St, Dublin 7, Ireland; University College Dublin, Ireland, Catherine Mc Auley Centre, 21 Nelson St, Ireland. Electronic address: jlambert@mater.ie.
Abstract
OBJECTIVES: Hepatitis C Virus (HCV) is a significant cause of chronic liver disease. Among at-risk populations, access to diagnosis and treatment is challenging. We describe an integrated model of care, Hepcare Europe, developed to address this challenge. METHODS: Using a case-study approach, we describe the cascade of care outcomes at all sites. Cost analyses estimated the cost per person screened and linked to care. RESULTS: A total of 2608 participants were recruited across 218 clinical sites. HCV antibody test results were obtained for 2568(98•5%); 1074(41•8%) were antibody-positive, 687(60•5%) tested positive for HCV-RNA, 650(60•5%) were linked to care, and 319(43•5%) started treatment. 196(61•4%) of treatment initiates achieved a Sustained Viral Response (SVR) at dataset closure, 108(33•9%) were still on treatment, eight (2•7%) defaulted from treatment, and seven (2•6%) had virologic failure or died. The cost per person screened varied from €194 to €635, while the cost per person linked to care varied from €364 to €2035. CONCLUSIONS: Hepcare enhanced access to HCV treatment and cure, and costs were affordable in all settings, offering a framework for scale-up and reproducibility.
OBJECTIVES:Hepatitis C Virus (HCV) is a significant cause of chronic liver disease. Among at-risk populations, access to diagnosis and treatment is challenging. We describe an integrated model of care, Hepcare Europe, developed to address this challenge. METHODS: Using a case-study approach, we describe the cascade of care outcomes at all sites. Cost analyses estimated the cost per person screened and linked to care. RESULTS: A total of 2608 participants were recruited across 218 clinical sites. HCV antibody test results were obtained for 2568(98•5%); 1074(41•8%) were antibody-positive, 687(60•5%) tested positive for HCV-RNA, 650(60•5%) were linked to care, and 319(43•5%) started treatment. 196(61•4%) of treatment initiates achieved a Sustained Viral Response (SVR) at dataset closure, 108(33•9%) were still on treatment, eight (2•7%) defaulted from treatment, and seven (2•6%) had virologic failure or died. The cost per person screened varied from €194 to €635, while the cost per person linked to care varied from €364 to €2035. CONCLUSIONS: Hepcare enhanced access to HCV treatment and cure, and costs were affordable in all settings, offering a framework for scale-up and reproducibility.
Authors: Zoe Ward; Nyashadzaishe Mafirakureva; Jack Stone; Mary Keevans; Graham Betts-Symonds; Desmond Crowley; Tina McHugh; Gordana Avramovic; John S Lambert; Peter Vickerman Journal: Int J Drug Policy Date: 2021-08-17