Decentralized telemedicine achieves high HCV cure rates in rural India
Decentralized treatment of hepatitis C using telemedicine clinics achieved a sustained virologic response rate of more than 90% regardless of genotype or presence of cirrhosis, according to a published study conducted in India.
“Our strategy in Punjab is aligned with the WHO strategy on viral hepatitis elimination defined as a 90% reduction in incidence and a 65% reduction in mortality from existing levels,” Radha K. Dhiman, MD, DM, FAMS, from the Postgraduate Institute of Medical Education and Research in India, and colleagues wrote. “In addition to expanding prevention services, achieving these targets requires scaling up hepatitis treatment such that 80% of persons with chronic [hepatitis B] and HCV infection are treated.”
As part of the initiative to eliminate HCV in India, the Mukh-Mantri Punjab Hepatitis C Relief Fund program provides free medical treatment for patients with chronic HCV in Punjab.
“The Punjab Model is an innovative interactive model of decentralized services using telementoring and algorithm-based treatment with generic drugs,” the researchers explained. “The Punjab Model trains and supports primary care providers (PCPs) to learn emerging treatment options, adverse effects and treatment adherence for managing CHC using the existing health care infrastructure.”
Dhiman and colleagues enrolled 48,088 patients with chronic HCV from 25 sites, 80.5% of whom lived in rural communities. Patients were treated with Harvoni (sofosbuvir/ledipasvir, Gilead Sciences) or combination Sovaldi (sofosbuvir, Gilead Sciences) and Daklinza (daclatasvir, Bristol-Myers Squibb).
The overall SVR was 91.6% from those who completed treatment and were available for analysis. While intention to treat SVR was 67.6% due to a number of patients with treatment interruption, the modified intention to treat analysis including those whose treatment was successful regardless of interruption revealed an SVR of 91.2%.
All regimens were well tolerated in patients without cirrhosis, there was no treatment-related discontinuation or severe adverse events.
“The results demonstrated cure rates of nearly 92% without any significant difference across genotypes, degree of liver fibrosis or high-risk subgroups,” Dhiman and colleagues wrote. “The feasibility, safety and efficacy of decentralized care and treatment of CHC demonstrated in the Punjab Model, have led to the beginning of [the National Viral Hepatitis Control Program] in India.” – by Talitha Bennett
Disclosure: The researchers report no relevant financial disclosures.