Anna Tómasdóttir[1], Ragnheiður H. Friðriksdóttir[2], Bergþóra Karlsdóttir[1], Hildigunnur Friðjónsdóttir[2], Kristín Alexíusdóttir[2], Thora Bjornsdottir[4], Bryndis Olafsdottir[4], Asdis M. Finnbogadottir[4], Valgerður Runarsdottir[4], Sigurdur Olafsson[2,3] Magnús Gottfreðsson[1,3]

Affiliates

Affiliates: Department of Infectious Diseases, Landspítali University Hospital[1], Department of Gastroenterology and Hepatology, Landspítali University Hospital, Reykjavík, Iceland[2] , Faculty of Medicine, School of Health Sciences, University of Iceland[3], Vogur Hospital[4]

Abstract

Background: The Treatment as Prevention for Hepatitis C (TraP HepC) program in Iceland was launched in January 2016, offering treatment with DAA´s to all infected individuals with an active treatment phase spanning three years, set to end in January 2019. People who inject drugs (PWID) account for close to 90% of HCV PCR positive individuals in Iceland and almost 100% of new infections; they have traditionally had high drop-out rates from treatment and thus need to be the focus of our elimination efforts.
Methods: Nurses have played a central role in the elimination efforts facilitating case finding, engagement in care, adherence support and re-infection prevention. For the case finding, coordinated databases have been used to recall patients for confirmatory testing. Awareness campaigns have been conducted in the media and financial incentives have been used in select cases. Care of the patient is conducted in a multidisciplinary manner, with nurses and doctors from three specialties and participation within the penitentiary and social welfare system. Patients are allowed to move freely between sites and specialties. Nurses provide counseling and improve adherence by providing advice, pill boxes and phone messages. Patients who drop out or become re-infected following cure are encouraged to initiate retreatment. Harm reduction has been scaled up.
Results: At 24 months 558 patients were scheduled to complete treatment and follow-up, mean age 42 years, 67% males and 33% females. Current injectors (<6months) accounted for 34% of those receiving treatment; in Iceland stimulants are the drug of choice in 85% of PWID and thus only 10% were receiving opiate substitution treatment. Of those who initiated on treatment 90% completed “per protocol”, with a SVR12 rate of 95%. Patients who discontinued nevertheless reached SVR12 in 42% of cases and retreatment was already initiated in 86% of the remaining PCR positive individuals. During the first two years of the program there were 27/558 confirmed re-infections (5%), of which 96% have started re-treatment.
Conclusions: In contrast to earlier care models the flexible multidisciplinary approach used in TraP HepC, with adherence support, rescreening following cure, low threshold to treatment and prompt treatment of reinfections has resulted in high success rates in PWID.