Spotlight on HCV treatment programs
Studies of hepatitis C virus (HCV) found that patients in Kentucky were less likely to be treated for HCV if they were receiving medication for opioid use disorder, that a mobile free clinic in Alabama successfully treated patients with a single in-person visit, and HCV treatment rates have increased in Israel over the past decade.
Multiple recent studies looked at the effectiveness of efforts to treat hepatitis C virus (HCV).
The first study, which was funded by Bloomberg Philanthropies and published by the Journal of General Internal Medicine on Jan. 21, assessed direct-acting antiviral use among patients with HCV and opioid use disorder who were covered by Kentucky Medicaid in 2020 and 2021. Of the 2,149 patients, 36% (n=780) received antivirals for HCV and 84% (n=1,804) received any medication for opioid use disorder (MOUD), most commonly buprenorphine (n=1,414; 66%). After adjustment, patients who received MOUD were significantly less likely to get HCV medications than those who did not (33% vs. 46%; P<0.0001). Patients taking methadone received antivirals at a particularly low rate (29%). The lower rate of HCV treatment in patients on MOUD was contrary to the study authors' hypothesis, which “assumed that there would be new opportunities for co-treatment, especially in primary care settings.” They called for clinician and patient education about the acceptability of treating HCV and OUD at the same time.
Another study, published by the Journal of General Internal Medicine on Feb. 12, reported on HCV treatment by a free clinic with a mobile unit that provided transitional care to people leaving jails and prisons in Alabama. The clinic used point-of-care diagnostics to condense HCV screening and pretreatment evaluation into a single encounter. In 2023 and 2024, the clinic screened 369 patients, of whom 104 (28.1%) were HCV-antibody positive and 71 (19.2%) were viremic. Seventy patients completed diagnostics, 54 started treatment, and 41 confirmed that they completed treatment. Of the 20 patients who had sustained virologic response tested at 12 weeks, 19 were cured. The median time from diagnosis to treatment initiation was 27 days. “This pilot program demonstrates that it is possible to condense the entire hepatitis C treatment evaluation into a single encounter,” said the study authors, who noted that their program relied on philanthropic support and HCV medication manufacturers providing the drugs through patient assistance programs to those who were uninsured. The pilot was funded by the Equal Justice Initiative, where all of the study authors were employed at least part-time.
The third study, which was conducted and funded by AbbVie and published by Advances in Therapy on Feb. 6, used an Israeli database to assess treatment of HCV. Of 2,809 patients who were antibody-positive for HCV in 2009 to 2020, 2,651 (94.4%) had an HCV polymerase chain reaction (PCR) test done, which was positive in 1,417 (50.4%). The median time from a positive antibody test to HCV treatment was 3.3 years, with 55.5% of patients who were PCR-positive receiving direct-acting antivirals. Of the 416 patients who underwent testing for sustained virologic response at 12 weeks, 413 were cured. The study found that the time for HCV detection to treatment shortened significantly after the development of direct-acting antivirals, although the number of patients receiving HCV care declined during pandemic-related closures. “These improvements are likely the result of specific intervention programs implemented in Israel between 2009 and 2020, aimed at simplification and removal of restrictions on HCV care,” the study authors said. “This study suggests that a concentrated effort to link patients to care is likely to result in improved results in reaching the [World Health Organization]'s elimination target; however, additional efforts are needed to recover from the negative effects of COVID-19.”