Global HCV elimination requires changes in prescribing, access, policy
AMSTERDAM — Achieving global elimination of hepatitis C requires actionable plans and changes on many levels of society from allowance of non-specialist prescribing to universal access, a group of experts explained at the International Liver Congress.
“Eliminating HCV really does require a national plan,” Jeffery V. Lazarus, MD, senior researcher at the Centre for Health and Infectious Disease Research and WHO Collaborating Centre on HIV and Viral Hepatitis at Rigshospitalet, the University of Copenhagen, said during his presentation. “Having a plan at the national level also represents the kind of commitment we need to eliminate HCV.... A shift is required from individual management for HCV to population management.”
INHSU, ELPA studies
Lazarus presented two studies to be presented as posters at the Congress. The first, conducted by the International Network for Hepatitis in Substance Users (INHSU), looked at restrictions to reimbursement of DAAs to review the availability of interferon-free DAA therapy in EU countries and Switzerland.
Of the 35 countries reviewed, 34 reimbursed for DAAs, Lazarus said. “That doesn’t mean there was universal access.”
Fibrosis stage was a minimum requirement (F2 or higher) in 62% of the countries while 76% of the countries had no alcohol or drug use restrictions and 94% had no additional restrictions for coinfection. Yet, 94% of countries required specialists to prescribe DAA therapy.
“The findings from our studies highlighted considerable variability in DAA therapy restrictions in Europe, particularly with respect to fibrosis stage and injecting drug status,” Lazarus said.
In the second study, Hep CORE, the researchers surveyed the European Liver Patient Association (ELPA) members and looked at national policies as well as awareness, engagement, testing and treatment from the patient perspective.
In 64% of the countries surveyed, the groups reported access to major DAAs, but 16% of groups reported no access to DAAs. The other 20% reported varying availability, Lazarus said.
Even in areas of access, 88% of patient groups reported some restriction of access to DAAs in their countries: 72% reported some fibrosis level requirement; half reported some restriction on basis of drug/alcohol use; and 24% of patient groups reported that non-specialists could prescribe.
Specifically looking at prison populations, 68% of ELPA groups reported DAAs were unavailable in prisons.
“Even where there is availability [in prisons], it doesn’t mean that many people are getting that treatment even if prisoners are a great target for micro-elimination of HCV,” Lazarus said.
The ELPA survey also showed that 80% reported HCV treatment is unavailable anywhere outside of the hospital setting.
Next steps to eradicating HCV
“Restricting DAA prescribing to specialists is a considerable barrier to broad access. Access to HCV treatment outside of hospital settings is key to reaching, in particular, people who inject drugs,” Lazarus said. “If we are going to eliminate HCV in people who inject drug population, we are going to have to meet them on their terms. It doesn’t necessarily mean providing treatment on the street, but it means going to addiction centers, harm reduction centers, drug and alcohol centers and making the treatments available there.”
Lazarus believes global eradication of HCV is possible, but that national plans are a necessity.
“We are in a very exciting and historic moment with the first-ever WHO health sector strategy on viral hepatitis,” Lazarus said. “When I hear that countries haven’t adopted elimination strategies, don’t have plans in place, I would encourage you to direct those countries, those policy-makers, those decision-makers to the WHO global strategy.”– by Katrina Altersitz
Lazarus JV. EASL/INSHU Joint Workshop. Presented at: International Liver Congress; April 19-24, 2017; Amsterdam.
Lazarus JV. FRI-464. Presented at: International Liver Congress; April 19-24, 2017; Amsterdam.
Marshall AD. LBP-505. Presented at: International Liver Congress; April 19-24, 2017; Amsterdam.
Disclosures: Lazarus reports receiving grants from AbbVie and Gilead Sciences, acting as a consultant for Gilead Sciences and MSD and delivering sponsored lectures for AbbVie, Gilead Sciences and MSD.