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SDG 3: hepatitis

Abstract

Background

Hepatitis C virus (HCV) infection is targeted for elimination as a public health threat by 2030. The World Health Organization goal for treatment uptake is ≥ 80% among cases diagnosed with an active HCV infection (RNA- or core antigen-positive), maintained for 2 years.

Aim

To calculate treatment uptake, time from diagnosis to treatment start and complete treatment dispensation among notified cases of HCV infection in Norway.

Method

We linked national data on notified cases diagnosed from 1990–2022 to dispensed prescriptions for HCV treatment from January 2004–February 2023 and data on residence status at the end of 2022. We described treatment uptake by demographic and epidemiological characteristics. We calculated the median number of months from diagnosis to treatment start by year. For direct-acting antiviral treatment periods, complete dispensation was based on the treatment and number of defined daily doses.

Results

Among 12,178 notified cases that had an active infection at diagnosis and were still resident, 10,091 (83%) had received treatment. Uptake among resident cases was > 80% in 2021 and 2022. The median number of months from diagnosis to treatment decreased over time to 3 (interquartile range: 1–5) among cases diagnosed in 2021 and 2022. From 2015–22, 89–93% of direct-acting antiviral treatment periods annually had complete treatment dispensed.

Conclusion

Norway has achieved the elimination goal for treatment uptake among notified cases diagnosed with an active HCV infection. This highlights the benefit of a strategy that includes unrestricted, simplified and integrated treatment options.

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2024-11-14
2024-12-19
/content/10.2807/1560-7917.ES.2024.29.46.2400180
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References

  1. Westbrook RH, Dusheiko G. Natural history of hepatitis C. J Hepatol. 2014;61(1) Suppl;S58-68.  https://doi.org/10.1016/j.jhep.2014.07.012  PMID: 25443346 
  2. World Health Organisation (WHO). Implementing the global health sector strategies on HIV, viral hepatitis and sexually transmitted infections, 2022-2030: report on progress and gaps 2024. Geneva: WHO; 2024. Available from: https://www.who.int/publications/i/item/9789240094925
  3. Manns MP, Maasoumy B. Breakthroughs in hepatitis C research: from discovery to cure. Nat Rev Gastroenterol Hepatol. 2022;19(8):533-50.  https://doi.org/10.1038/s41575-022-00608-8  PMID: 35595834 
  4. World Health Organisation (WHO). Guidance for country validation of viral hepatitis elimination and path to elimination. Geneva: WHO; 2023. Available from: https://iris.who.int/bitstream/handle/10665/373186/9789240078635-eng.pdf?sequence=1
  5. Polaris Observatory. Countries/Territories — CDA Foundation. [Accessed: 28 Oct 2024]. Available from: https://cdafound.org/polaris-countries-maps
  6. The Norwegian Institute of Public Health (FHI). Statusrapport om eliminasjon av hepatitt B og C som folkehelseproblem i Norge: Oppfølging av den nasjonale strategien mot virale hepatitter. [Status report on the elimination of hepatitis B and C as a public health problem in Norway: Follow-up of the national strategy against viral hepatitis]. Oslo: FHI; 2023. Norwegian. Available from: https://www.fhi.no/publ/2023/statusrapport-om-eliminasjon-av--hepatitt-b-og-c-som--folkehelseproblem-i-n
  7. Thomadakis C, Gountas I, Duffell E, Gountas K, Bluemel B, Seyler T, et al. Prevalence of chronic HCV infection in EU/EEA countries in 2019 using multiparameter evidence synthesis. Lancet Reg Health Eur. 2023;36:100792.  https://doi.org/10.1016/j.lanepe.2023.100792  PMID: 38188273 
  8. Dalgard O, Konopski Z, Bosse FJ, Nordstrand B, Sandvei P, Karlsen L, et al. Hepatitt C – utredning og behandling. Tidsskr Nor Legeforen. [Hepatitis C – follow-up and treatment]. 2011. Norwegian. Available from:  https://doi.org/10.4045/tidsskr.10.02401 
  9. Norwegian Medical Association. Faglig veileder for utredning og behandling av hepatitt C. [National guidelines for the follow-up and treatment of hepatitis C]. Oslo: Norwegian Medical Association; 2014. Norwegian. Available from: https://gastroenterologen.no/2014/10/faglig-veileder-for-utredning-og-behandling-av-hepatitt-c
  10. Norwegian Medical Association. Faglig veileder for utredning og behandling av hepatitt C. [National guidelines for the follow-up and treatment of hepatitis C]. Oslo: Norwegian Medical Association; 2015. Norwegian. Available from: https://gastroenterologen.no/filer/Veileder-Revisjon-mars-2015.pdf
  11. Norwegian Medical Association. Faglig veileder for utredning og behandling av hepatitt C hos voksne. [National guidelines for the follow-up and treatment of hepatitis C among adults]. Oslo: Norwegian Medical Association; 2017. Norwegian. Available from: https://www.legeforeningen.no/contentassets/69820f918014482a8003801d26adced3/hcv-v7-2017.pdf
  12. Norwegian Medical Association. Faglig veileder for utredning og behandling av hepatitt C hos voksne. [National guidelines for the follow-up and treatment of hepatitis C among adults]. Oslo: Norwegian Medical Association; 2019. Norwegian. Available from: https://www.legeforeningen.no/contentassets/be28359cd11745a8bbc090e93d9b9c90/veileder-revisjon-hcv.pdf
  13. Norwegian Medical Association. Faglig veileder for utredning og behandling av hepatitt C. [National guidelines for the follow-up and treatment of hepatitis C]. Oslo: Norwegian Medical Association; 2022. Norwegian. Available from: https://www.legeforeningen.no/contentassets/7e304300c0b5464eaf682fa7b70dd659/veileder-hepatitt-c-2022.pdf
  14. European Union Drugs Agency (EUDA). Viral hepatitis elimination barometer among people who inject drugs in Europe. Lisbon: EUDA; 2023. Available from: https://www.euda.europa.eu/publications/data-factsheet/viral-hepatitis-elimination-barometer-among-people-who-inject-drugs-in-europe_en
  15. van Dijk M, Drenth JPH, HepNed study group. Loss to follow-up in the hepatitis C care cascade: A substantial problem but opportunity for micro-elimination. J Viral Hepat. 2020;27(12):1270-83.  https://doi.org/10.1111/jvh.13399  PMID: 32964615 
  16. Fadnes LT, Aas CF, Vold JH, Leiva RA, Ohldieck C, Chalabianloo F, et al. Integrated treatment of hepatitis C virus infection among people who inject drugs: A multicenter randomized controlled trial (INTRO-HCV). PLoS Med. 2021;18(6):e1003653.  https://doi.org/10.1371/journal.pmed.1003653  PMID: 34061883 
  17. Midgard H, Ulstein K, Backe Ø, Foshaug T, Sørli H, Vennesland K, et al. Hepatitis C treatment and reinfection surveillance among people who inject drugs in a low-threshold program in Oslo, Norway. Int J Drug Policy. 2021;96:103165.  https://doi.org/10.1016/j.drugpo.2021.103165  PMID: 33642182 
  18. Thingnes G, Midgard H, Dalgard O. Point of care HCV RNA Testing in a mobile low-threshold health service for people who inject drugs. Conference of the international network on health and hepatitis in substance users. 13 – 15 October 2021. Virtual conference. Available from: https://az659834.vo.msecnd.net/eventsairaueprod/production-ashm-public/86cbb694975246bbaba18c495ff87d34
  19. Midgard H, Bjørnestad R, Egeland M, Dahl E, Finbråten AK, Kielland KB, et al. Peer support in small towns: A decentralized mobile Hepatitis C virus clinic for people who inject drugs. Liver Int. 2022;42(6):1268-77.  https://doi.org/10.1111/liv.15266  PMID: 35362660 
  20. Malme KB, Ulstein K, Finbråten AK, Wüsthoff LEC, Kielland KB, Hauge J, et al. Hepatitis C treatment uptake among people who inject drugs in Oslo, Norway: A registry-based study. Int J Drug Policy. 2023;116:104044.  https://doi.org/10.1016/j.drugpo.2023.104044  PMID: 37149914 
  21. European Centre for Disease Prevention and Control. Monitoring of responses to the hepatitis B and C epidemics in EU/EEA countries, 2023. 2024. Available from: https://www.ecdc.europa.eu/en/publications-data/monitoring-responses-hepatitis-b-and-c-epidemics-eueea-countries-2023
  22. Yousafzai MT, Bajis S, Alavi M, Grebely J, Dore GJ, Hajarizadeh B. Global cascade of care for chronic hepatitis C virus infection: A systematic review and meta-analysis. J Viral Hepat. 2021;28(10):1340-54.  https://doi.org/10.1111/jvh.13574  PMID: 34310812 
  23. The Norwegian Institute of Public Health (FHI). Norwegian Surveillance System for Communicable Diseases (MSIS). Oslo: FHI. [Accessed: 15 Mar 2024]. Available from: https://www.fhi.no/en/ou/msis
  24. Helsedata. Data sources. [Accessed: 15 Mar 2024]. Available from: https://helsedata.no/en/data-sources/?page=1&sort=0
  25. WHO Collaborating Centre for Drug Statistics Methodology. ATC/DDD Index 2024. Oslo: Norwegian Institute of Public Health. [Accessed: 15 Mar 2024]. Available from: https://www.whocc.no/atc_ddd_index
  26. The Norwegian Tax Administration. National Population Register. Oslo: The Norwegian Tax Administration. [Accessed: 15 Mar 2024]. Available from: https://www.skatteetaten.no/en/person/national-registry
  27. Isaksen K, Aabakken L, Grimstad T, Karlsen L, Sandvei PK, Dalgard O. Hepatitis C treatment at three Norwegian hospitals 2000-2011. Tidsskr Nor Laegeforen. 2015;135(22):2052-8.  https://doi.org/10.4045/tidsskr.14.1478  PMID: 26627293 
  28. Malme KB, Stene-Johansen K, Klundby I, Backe Ø, Foshaug T, Greve MH, et al. Virologic response and reinfection following HCV treatment among hospitalized people who inject drugs: follow-up data from the OPPORTUNI-C Trial. Viruses. 2024;16(6):858.  https://doi.org/10.3390/v16060858  PMID: 38932151 
  29. Heo M, Norton BL, Pericot-Valverde I, Mehta SH, Tsui JI, Taylor LE, et al. Optimal hepatitis C treatment adherence patterns and sustained virologic response among people who inject drugs: The HERO study. J Hepatol. 2024;80(5):702-13.  https://doi.org/10.1016/j.jhep.2023.12.020  PMID: 38242324 
  30. Whittaker R, Midtbø JE, Kløvstad H. Monitoring progress towards the elimination of hepatitis C as a public health threat in Norway: a modelling study among people who inject drugs and immigrants. J Infect Dis. 2024;230(3):e700-11.  https://doi.org/10.1093/infdis/jiae147  PMID: 38537267 
  31. O’Sullivan M, Jones AM, Mourad A, Haddadin Y, Verma S. Excellent hepatitis C virus cure rates despite increasing complexity of people who use drugs: Integrated-Test-stage Treat study final outcomes. J Viral Hepat. 2023;31(2):66-77.  https://doi.org/10.1111/jvh.13897  PMID: 38018328 
  32. Grebely J, Tran L, Degenhardt L, Dowell-Day A, Santo T Jr, Larney S, et al. Association Between Opioid Agonist Therapy and Testing, Treatment Uptake, and Treatment Outcomes for Hepatitis C Infection Among People Who Inject Drugs: A Systematic Review and Meta-analysis. Clin Infect Dis. 2021;73(1):e107-18.  https://doi.org/10.1093/cid/ciaa612  PMID: 32447375 
  33. Opheim E, Dalgard O, Ulstein K, Sørli H, Backe Ø, Foshaug T, et al. Towards elimination of hepatitis C in Oslo: Cross-sectional prevalence studies among people who inject drugs. Int J Drug Policy. 2024;123:104279.  https://doi.org/10.1016/j.drugpo.2023.104279  PMID: 38061225 
  34. Valerio H, Alavi M, Law M, Tillakeratne S, Amin J, Janjua NZ, et al. High hepatitis C treatment uptake among people with recent drug dependence in New South Wales, Australia. J Hepatol. 2021;74(2):293-302.  https://doi.org/10.1016/j.jhep.2020.08.038  PMID: 32931879 
  35. Oru E, Trickey A, Shirali R, Kanters S, Easterbrook P. Decentralisation, integration, and task-shifting in hepatitis C virus infection testing and treatment: a global systematic review and meta-analysis. Lancet Glob Health. 2021;9(4):e431-45.  https://doi.org/10.1016/S2214-109X(20)30505-2  PMID: 33639097 
  36. Midgard H, Malme KB, Pihl CM, Berg-Pedersen RM, Tanum L, Klundby I, et al. Opportunistic treatment of hepatitis C infection among hospitalized people who inject drugs (OPPORTUNI-C): A stepped wedge cluster randomized trial. Clin Infect Dis. 2023;78(3):582-590.  https://doi.org/10.1093/cid/ciad711  PMID: 37992203 
  37. Trickey A, Fajardo E, Alemu D, Artenie AA, Easterbrook P. Impact of hepatitis C virus point-of-care RNA viral load testing compared with laboratory-based testing on uptake of RNA testing and treatment, and turnaround times: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2023;8(3):253-70.  https://doi.org/10.1016/S2468-1253(22)00346-6  PMID: 36706775 
  38. Isfordink CJ, van Dijk M, Brakenhoff SM, Kracht PAM, Arends JE, de Knegt RJ, et al. Hepatitis C Elimination in the Netherlands (CELINE): How nationwide retrieval of lost to follow-up hepatitis C patients contributes to micro-elimination. Eur J Intern Med. 2022;101:93-7.  https://doi.org/10.1016/j.ejim.2022.04.024  PMID: 35527178 
  39. Dröse S, Hansen JF, Røge BT, Øvrehus ALH, Christensen PB. Retrieval of patients with hepatitis C who were lost to follow-up in Southern Denmark. Infect Dis (Lond). 2023;55(5):361-9.  https://doi.org/10.1080/23744235.2023.2189298  PMID: 36930953 
  40. Nardone A, Nerlander L, Duffell E, Valenciano M, Buti M, Marcos-Fosch C, et al. A pilot sentinel surveillance system to monitor treatment and treatment outcomes of chronic hepatitis B and C infections in clinical centres in three European countries, 2019. Euro Surveill. 2023;28(6):2200184.  https://doi.org/10.2807/1560-7917.ES.2023.28.6.2200184  PMID: 36757314 
  41. The Norwegian Institute of Public Health (FHI). Elektronisk laboratoriemelding til MSIS og laboratoriedatabasen. [Electronic laboratory notification to MSIS and the laboratory database]. Oslo: FHI. [Accessed: 15 Mar 2024]. Norwegian. Available from: https://www.fhi.no/hn/helseregistre-og-registre/msis/elektronisk-laboratoriemelding-til-msis-og-laboratoriedatabasen
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