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EASL 2023 HCV Elimination Updates
HCV Elimination Efforts: Updates From EASL 2023

Released: July 13, 2023

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Key Takeaways
  • Major themes on HCV implementation science presented at EASL 2023 include the development of approaches that target difficult-to-reach patient populations for HCV linkage to care, microelimination projects in high-prevalence populations such as prisons, and countrywide approaches to HCV elimination in Georgia and Germany. 

The WHO has set ambitious goals to eliminate viral hepatitis as a public threat globally by the year 2030, and it was exciting to see multiple research presentations at EASL 2023 describing both global and microelimination strategies working toward hepatitis C virus (HCV) elimination. It was equally exciting to see innovative strategies that optimize engagement in HCV management and cure. Major themes of abstracts presented included the development of approaches that target difficult-to-reach patient populations for HCV linkage to care, as well as outcomes from elimination programs implemented around the world in the past 5-10 years.

Reengagement of Patients With Chronic HCV Infection

An abstract I would like to highlight was presented by Professor Velez from King’s College Hospital in a select abstract poster tour on Thursday, June 22. His work focused on reengaging previously diagnosed but unlinked patients with chronic HCV infection with the goal of initiating treatment in these individuals. The researchers identified more than 1000 positive HCV RNA tests in their national and local hospital HCV registries, and they reached out to the approximately 40% of individuals who had not completed their HCV cascade of care to reengage them in follow-up and treatment. The authors were able to improve adherence in the subsequent cascade of care, but they also pointed to the difficulty in engaging patients. For example, fewer than one half of patients were reachable, and even fewer agreed to participate in linkage to care.

Presented by Chen and colleagues, other novel approaches to identify difficult-to-engage populations included using machine learning methods to identify both clinical attributes and social determinants of health to improve linkage to HCV care.

In addition, Abstract OS-004-YI described a program that implemented community-dispensed HCV treatment for “hard-to-reach” individuals participating in an opiate substitution treatment service in Dublin, Ireland.

Microelimination in Distinct Populations

In addition to reengagement, there was a clear spotlight on microelimination projects that focused on distinct patient populations for whom HCV prevalence is high, such as the prison population.

For example, an abstract presented by Royal and colleagues focused on achieving HCV elimination in 4 female prisons through a nurse-led test-and-treat approach. Other abstracts showed that these types of efforts are paying off: Johnson and colleagues looked at the impact of testing for HCV in the prison system in Northeast England from 2017-2022, discovering that although the proportion of individuals who were HCV antibody positive increased, the proportion who were HCV RNA positive decreased, demonstrating that programs addressing HCV in the prison system are curing more HCV in the population as a whole.

Xia and colleagues also described initial successes of their microelimination program in Zhuhai, China, coined the “Lucky Star Program,” with a rise in HCV screening rates and increase in treatment rates from 32% to 88% after implementation.

Large Efforts to Achieve HCV Elimination

Results of larger-scale efforts for HCV elimination also were presented. Tsertsvadze and colleagues presented an update on achieving HCV elimination on a countrywide scale in Georgia. This program, which began in 2015, is one of the main examples of a nationwide approach to HCV elimination. More than 65% of patients with current HCV infection have been diagnosed in Georgia, and most have initiated treatment and experienced high cure rates regardless of fibrosis status. However, the authors shared that some challenges still remain in identifying persons with current HCV infection and linking them to care.

In addition, results of the countrywide “Check-up 35+” program in the German primary care setting were presented 1 year after implementation by the federal joint committee. In response to the WHO organization goals, Germany implemented a countrywide program to check all individuals aged 35 years and older for HCV, resulting in a large number of HCV tests in the first year after implementation. Of note, they identified 0.78% HCV antibody positivity and 0.13% prevalence of HCV viremia among the general population.

Exciting new data presented at EASL 2023 highlighted both the achievements and challenges in programs that have been implemented globally to work toward HCV elimination. Having this opportunity to learn about distinct approaches from investigators around the world will hopefully bring us closer to our overarching goal of achieving HCV elimination globally.

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