Screening, enhancement of access to care and prioritization of treatment of chronic hepatitis C infection in high-risk population in Hong Kong

Abstract

Background and Aims: In the current era of highly effective direct acting antiviral (DAA) therapy, the one of the remaining obstacles to elimination of chronic HCV infection (CHC) is identification of high-risk groups for micro-elimination. In Hong Kong, people who inject drugs (PWIDs) are one of the targets. We aimed to provide linkage to care (LTC) for PWIDs with CHC who are undergoing drug rehabilitation. Method: Since late 2019, we initiated the Conquering Hepatitis vIa Micro-Elimination (CHIME) program and performed a prospective study by forming an outreach team to conduct site visits to halfway house or drug rehabilitation centers run by non-governmental organizations. We performed point-of-care (POC) test for antibody to HCV (anti-HCV), and blood takings were performed for subjects with positive POC results to check for HCV RNA. Subjects with confirmed active CHC were contacted to attend the LTC clinic for counselling, risk stratification and evaluation for DAA. Results: In this interim analysis, 9 site visits were conducted and 140 PWIDs were screened which identified 117 subjects with CHC (83.6% HCV RNA positive) and 52 already attended the LTC clinic (Figure 1A). Compared to subjects who received standard-of-care (non-CHIME, n = 275, 10.5% PWIDs), PWIDs under the CHIME program were younger (median 61 vs 52, p < 0.001), with more male (56.4% 94.2%, p < 0.001), lower chance to expose to previous CHC treatment (16.4% vs 3.8%, p 0.017), higher RNA viral load (1.2x106 vs 2.4x107 IU/mL, p = 0.006) and lower liver stiffness (11 vs 7.2 kPa, p < 0.001). CHIME patients had predominantly genotype 6 (63.5%) infection, with non-significantly higher prevalence of hepatitis B coinfection [7.8% vs 2.9% (non-CHIME patients), p = 0.1]. The time from site visit to first LTC visit and to starting treatment were shorter for CHIME patients compared to non-CHIME patients (Figure 1A). The rates of sustained virological response (SVR) were 90.6% and 95.3 respectively (p = 0.226). No significant differences in SVR were observed between different genotypes or PWIDs vs non-PWIDs. The treatment uptake rate was affected by COVID-19 (Figure 1B). Conclusion: Micro-elimination is an effective strategy to identify subjects with CHC in places like Hong Kong where the overall prevalence of CHC in background population is low. The CHIME program successfully allowed PWIDs with CHC to be linked to care with significant shortening of waiting time and no compromise to treatment outcome.