Punjab, India: Mass treatment of a population with chronic hepatitis C infection produces high rates of cure

12 April 2018, Paris, France: A large-scale study evaluating the feasibility of decentralized care and the provision of free direct-acting antiviral agents (DAAs) has reported high rates of cure among a population of almost 20,000 individuals completing treatment for hepatitis C virus (HCV) infection. The study conducted in Punjab, India, which was reported today at The International Liver Congress™ 2018 in Paris, France, validated the efficacy and safety of generic all-oral DAA regimens delivered using a decentralized algorithm-based public health model.

'We have shown in our study that it is possible to cure more than 90% of individuals with HCV infection in a highly dispersed population using well-trained teams in government medical colleges and district hospitals, and widely available DAAs', said Professor Radha Krishan Dhiman from the Postgraduate Institute of Medical Education and Research, Chandigarh, India and lead author of the study. 'We believe the Punjab Model could be applied to many different populations with the aim of eliminating HCV'.

Hepatitis C virus (HCV) infection represents a major healthcare burden in India, with an estimated 12-18 million people infected.1 The burden is particularly heavy in the Indian state of Punjab, owing to the high prevalence of risk factors such as unsafe medical practices – including unsafe medical injections, blood transfusions and dental procedures – and intravenous drug use.2,3 Similar to other geographical regions in India, genotype 3 predominates in the state of Punjab.3,4

The study presented today by Prof. Dhiman formed part of a concerted effort in the Punjab region to both decrease the reservoir of HCV by treating established cases and reduce the incidence of new cases,3,5 and was made possible by the foundation in 2016 of the Mukh Mantri Punjab Hepatitis C Relief Fund,6 which provides free treatment to all individuals with chronic HCV infection. The study assessed the feasibility of delivering decentralized HCV care via three government medical colleges and 22 district hospitals, and required the training of approximately 90 medical specialists, pharmacists and data managers. Epidemiological data were managed with support from the Clinton Health Access Initiative.7 A cost-effective treatment algorithm was developed using sofosbuvir-based regimens to treat all patients with HCV infection, with regimens selected based on the presence/absence of cirrhosis and HCV genotype.5 A total of 29,371 patients (61.7% male; mean age 42 years) were enrolled in 1 year, of which 19,646 patients completed treatment with a sustained virological response (SVR) at 12 weeks of 92.5%. Cure rates among individuals with cirrhosis (93.1%) and without cirrhosis (92.4%), and those with genotype 3 (92.6%) and other genotypes (93.1%), were similar. No major adverse events were reported.

'This study is an impressive example of how to upscale the treatment of hepatitis C, which is important to reduce hepatitis C-related complications, particularly the development of hepatocellular carcinoma', said Prof. Markus Cornberg from the Hannover Medical School, Germany, and EASL Governing Board Member.

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About The International Liver Congress™

This annual congress is the biggest event in the EASL calendar, attracting scientific and medical experts from around the world to learn about the latest in liver research. Attending specialists present, share, debate and conclude on the latest science and research in hepatology, working to enhance the treatment and management of liver disease in clinical practice. This year, the congress is expected to attract approximately 10,000 delegates from all corners of the globe. The International Liver Congress™ 2018 will take place from 11¬-15 April 2018 at the Paris Convention Centre, Paris, France.

About The European Association for the Study of the Liver (EASL)

Since its foundation in 1966, this not-for-profit organization has grown to over 4,000 members from all over the world, including many of the leading hepatologists in Europe and beyond. EASL is the leading liver association in Europe, having evolved into a major European association with international influence, and with an impressive track record in promoting research in liver disease, supporting wider education and promoting changes in European liver policy.

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Onsite location reference

Session title: Parallel session: HCV: Striving towards elimination
Time, date and location of session: 13. April 2018, 04:00 PM – 04:15 PM, South 2
Presenter: Radha Krishan Dhiman, India
Abstract: Decentralized care is effective in the management of patients with hepatitis C in a public health care setting: The Punjab Model

Author disclosures

None reported.

References

1. Dhiman RK. Future of therapy for hepatitis c in India: a matter of accessibility and affordability? J Clin Exp Hepatol. 2014;4(2):85-6.

2. Puri P, et al. Consensus Statement of HCV Task Force of the Indian National Association for Study of the Liver (INASL). Part I: Status report of HCV infection in India. J Clin Exp Hepatol. 2014;4(2):106-16.

3. Dhiman RK, et al. Tackling the hepatitis C disease burden in Punjab, India. J Clin Exp Hepatol. 2016;6(3):224-32.

4. Jindal N, et al. Risk factors and genotypes of HCV infected patients attending tertiary care hospital in North India. Indian J Med Microbiol. 2015;33(1):189-90.

5. World Health Organization India. World Hepatitis Day 2016. Punjab initiatives for hepatitis-C treatment. Available from: http://www.searo.who.int/india/mediacentre/events/2016/punjab_initiatives_for_hepatitis_c.pdf?ua=1. Last accessed: February 2018.

6. Department of Health and Family Welfare, Government of Punjab. Mukh Mantri Punjab Hepatitis C Relief Fund (MMPHCRF) June 2016. Available from: http://pbhealth.gov.in/mmphcrf.htm. Last accessed March 2018.

7. Clinton Health Access Initiative. Available from: https://clintonhealthaccess.org/. Last accessed March 2018.

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