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RESULTS OF HEPATITIS C VIRUS (HCV) TREATMENT PROGRAM AMONG PEOPLE WHO INJECT DRUGS (PWID) WITH HIV/HCV CO-INFECTION

Sergii Filippovych,

Director: Treatment, Procurement

and Supply Management

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Ukraine: Epidemiological Background

Population: 42 590 879 million

❖ WHO estimates 3% of HCV prevalence in Ukraine (1 280 000)

❖ According to official web of the Cabinet of Ministers of Ukraine national epidemiologists estimate HCV

prevalence in Ukraine at around 7-9% of general population (2 980 000-3 830 000 individuals)

❖ According to the Center of Medical Statistics of the Ministry of Health of Ukraine number of HCV patients in

2016 reached 46 883

❖ In 2016 among new cases of HIV-infection (n=14 334) Viral Hepatitis C Markers were detected in 21.5% of

cases (n=3080)

❖ 30 826 persons were HIV/HVC co-infected as of January 1st, 2017

❖ HCV prevalence rate among PWID in Ukraine exceeds overall average, reaching 56% (2015, Alliance bio-

behavioral research)

❖ Estimated number of PWID in Ukraine is 346 900

❖ Estimated number of PLWH 238 000

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Scaling up Accessible and Effective HCV Treatment through Community-Based Treatment Model for Key Populations in Resource Constrained Ukraine

Key populations: PWID, OST patients, CSW, MSM

Enrollment criteria: Fibrosis≥ F2 (priority F3, F4), METAVIR

Implementation of community-supported DAAs-based HCV treatment model for key populations

Access to laboratory diagnostics (treatment monitoring and follow-up)

Operational research “Effectiveness of HCV Treatment Program for MARPs in the Resource Constrained Ukraine”

Project key objectives:

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Scaling up Accessible and Effective HCV Treatment through Community-Based

Treatment Model for Key Populations in Resource Constrained Ukraine

Project period: April 2015 – December 2017

Geographic coverage: starting from 8 healthcare facilities in 7 regions of Ukraine the Project has expanded for

25 medical settings in 19 oblasts of Ukraine

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0 200 400 600 800 1000 1200 1400 1600 1800 2000

Treatment completion,PWID (n=1512)

PWID (n=1512)

Of them on ART

Of them HCV/HIVco-infected

Enrolled on treatment,by GT (n=1884)

Enrolled on treatment,by Fibrosis (n=1884)

Completed full treatment course (n=1337)

1348

1352

1392

GT1 (n=1029; 54.3%)

F1 (n=104; 5.5%)

Continue treatment (n=151)

PWID on OST (n=164)

GT2 (n=79; 4.2%)

F2 (b=881; 46.8%)

Terminated treatment

(n=24; 1.6%)

GT3 (n=759; 40.6%)

F3 (n=493; 26.2%)

GT4 (n=9; 0.5%)

F4 (n=406; 21.5%)

GT mixed or untypable

(n=8; 0.4%)

Number of patients

74.4%

97.1%80.2%

HCV Treatment Project: Deliverables as of Aug, 1st, 2017

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HCV Treatment Project: PWID Cohort Data*

Cohort Date (n=937), patients (%)

Male 750 (80.0%)

Median age, years 39

HIV co-infection 748 (79.8%)

• out of them receive ART 728 (97.3%)

HBV co-infection 96 (10.2%)

PWID on OST 88 (9.4%)

Treatment Regimens among PWID, patients

SOF+Peg-IFN+RBV 12W 687

SOF+RBV 12W 39

SOF+RBV 16W 4

SOF+RBV 24W 176

SOF+DCV 12-24W 30

SOF/LDV 12W 1

* Cohort includes only PWID patients who received HCV VL evaluation at W12 after finishing full treatment course or terminated treatment.

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Treatment success among PWID*

93.90%95.70%

90.20% 91.30%

98.30%100.00%

50.00%

55.00%

60.00%

65.00%

70.00%

75.00%

80.00%

85.00%

90.00%

95.00%

100.00%

HCV/HIV coinfected HCV monoinfected

SVR12 rates

PWID in remission Active PWID PWID on OST

* Please note, that HCV VL at W12 after treatment was yet tested only at patients, who received SOF+Peg-IFN+RBV 12W or SOF+RBV 12-24W

(depending on HCV GT and Fibrosis stage) treatment regimens, as patients receiving SOF/LED are still on treatment/pending evaluation.

www.aph.org.uaStep 1. Sharing information on

the Project via NGOs,

communities and medical staff;

referrals to HCV diagnostic

Step 2. Case-manager informs

potential patients from key groups

about enrollment criteria and

refers patients to a doctor Step 3. A doctor

conditions a list of

examinations required to

take enrollment decision

Step 5.

Selection of the

treatment

regimen for

enrolled patients

Step 6. Social support

provided by a case

manager;

3 sessions on re-

infection prevention

Step 7.

Laboratory

monitoring of

treatment

END of

TREATMENT

MD

Team

Step 8. Treatment

success evaluation

(HCV VL test at

W12 after end of

treatment) Dia

gnostic

s

Step 4.Multi-disciplinary

team consisting of a

doctor, a nurse and a

social worker takes joint

decision on patients

enrollment (MDT)

Community-based HCV Treatment Model

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Multidisciplinary Approach to Patient Oriented

Integrated Services

Patient

Doctor & Nurse

Consultations

Diagnostics

Administering treatment

Dispensing medicines

Clinical monitoring

Laboratory monitoring

Social Support at the Time of Treatment

Counseling

Scheduling visits to doctors

Prevention of re-infection sessions

Linking ART and OST (if necessary)

Multidisciplinary team

(MDT) consisting of a doctor,

a nurse and social worker takes joint

decision on patients enrollment

Case

Manager

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Interventions of HCV Re-infection Prevention (3 sections)

1. Referral, linkage and access to harm reduction program:

• Needles, Syringes Program (NSP)

• Opioid Substitution Treatment (OST)

• Condoms Distribution (CD)

2. Safe health behavior intervention aimed at raising awareness on HCV risk factors adherence to treatment:

• Informational sessions on HCV transmission

• Breaking myths about HCV treatment

• Filling in HCV awareness gaps 3. Communications with relatives, partners, friends

• Informational sessions on HCV transmission

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Retaining in care among PWID (n=1512)

• Retaining in care level among PWID shown by our Treatment Project is 98.4%

• Only 1.6% (n=24) PWID patients enrolled terminated treatment:• 10 patients suffered serious adverse events (4 were reenrolled on

treatment);

• 8 patients refused to continue treatment (1 was reenrolled on treatment);

• 4 patients died;

• 1 patient on SOF+RBV 24W had detectable HCV VL at W12

• 1 patient discovered cervical cancer, was transferred to oncology center (was reenrolled on treatment)

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HCV Treatment Project Findings

o Treatment of PWID and retaining them on care continues to be a challenge

o Multidisciplinary approach with high attention to social support shows itself as a highly

effective service model of HCV treatment for PWID

o Treatment of PWID with DAAs provided by multidisciplinary teams with enhanced social

support showed

✓ PWID high adherence to HCV treatment

✓ PWID high treatment success rates

✓ similar effectiveness of treatment among PWID-patients with HIV/HCV co-

infection and HCV mono-infection

o HCV treatment scale-up with DAA in Ukraine and other countries in the region will require

substantial price reductions inmedications, governmental commitment and organized efforts of

stakeholders to overcome structural and program barriers

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Thank You5 Dilova st., building 10A, 9th floor

03680 Kyiv, Ukraine

Tel.: (+380 44) 490-5485

Fax: (+380 44) 490-5489

e-mail: filippovych@aph.org.ua

http://aph.org.ua

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