At-Risk Groups Falling Behind in Global Effort to Eliminate Hepatitis C

Efforts to eliminate new hepatitis C cases by 2030, a goal set by the World Health Organization (WHO), are falling short in high-risk groups, according to a large, pooled analysis of published studies.

High-income regions — especially Western Europe — reported stronger results, while lower-income countries showed major service gaps and limited data.

People living with the HIV, those who inject drugs, men who have sex with men, and incarcerated individuals saw suboptimal screening for the hepatitis C virus (HCV), the cause of hepatitis C, weak linkage to care and treatment uptake, and disparities in treatment adherence.

“Strengthening screening, embedding HCV care within existing service platforms, expanding access, and establishing high-quality data systems, particularly in low-resource settings, will be essential to accelerate progress towards HCV elimination,” the researchers wrote.

The study, “Progressing towards global hepatitis C elimination: a systematic review and meta-analysis of care cascades in key populations,” was published in The Lancet Regional Health – Western Pacific.

Evaluating the ‘care cascade’ around the world

Hepatitis C is caused by a liver infection with HCV, which spreads through contact with contaminated blood. It is most commonly transmitted through shared needles while injecting drugs or contaminated medical equipment. Left untreated, it can lead to chronic liver inflammation, cirrhosis (permanent liver scarring), liver failure, or liver cancer.

Highly effective direct-acting antivirals (DAAs) can cure most patients. In response, the WHO has set a goal to eliminate hepatitis C as a major public health threat by 2030.

The pooled analysis, conducted by researchers in Australia and China, examined how effectively countries move at-risk groups through the “HCV care cascade,” from viral screening and diagnosis to treatment and a confirmed cure.

Data from 219 studies, covering 884,450 people in 46 countries, were included. Evaluated at-risk groups included people living with HIV, those who inject drugs, men who have sex with men, and those imprisoned.

Data from 235,691 people living with HIV across 31 countries/territories, Western Europe led the way in hepatitis C care: 83.3% were screened, 92.3% received confirmatory testing, 69.9% started treatment, and more than 94% completed treatment and were assessed for cure.

However, other regions lagged. About half (51.8%) were screened in Australasia, two-thirds (66.2%) received confirmatory testing in East Asia and the Pacific, and treatment was started in less than half (44.4%) in North America.

High-income countries performed best overall, with around 70% of people screened and more than 90% completing most of the remaining steps in care. Little data were available from middle-income countries, and none from low-income nations.

Among more than 180,500 people who inject drugs across 35 countries/territories, Western Europe again outperformed other regions, including Eastern Europe, which showed lower rates of screening (55.5% vs. 87%) and confirmatory testing (76.6% vs. 95.5%). Linkage to care was strongest in Western Europe (92.2%) but lowest in North America (41.4%). Treatment uptake was also lower in North America than in Eastern Europe (35.2% vs. 71.2%).

While 80%-90% of the patients who started therapy completed it in most regions, North America had lower completion rates (78%), and Australasia had low cure confirmation rates (61%). Lower-income countries consistently showed weaker performance in screening, treatment completion, and cure follow-up.

Disparities in care for men with same-sex partners, incarcerated people

Data from 16 high-income countries/territories regarding 51,491 men who had sex with men demonstrated that HCV screening was lowest in Western Europe (56.2%), and confirmatory testing was lowest in Australasia (45.5%).

North America performed better in early testing steps. Some 71.5% were screened, and 95% underwent confirmatory testing. However, only 16.7% of these people were linked to care, and 26% started treatment.

Treatment uptake was highest in Australasia (80%).

North America had low cure rates (57.5% among those treated), while Western Europe had higher rates (92%).

Barriers for HCV screening in this group of people “include low awareness and perceived susceptibility; concerns about discomfort, confidentiality, and cost; stigma related to same-sex behaviour and substance use; and competing social priorities,” the researchers wrote.

Among more than 416,000 incarcerated individuals across 19 countries, HCV screening remained below 70% across regions, except North America (81.7%). Confirmatory testing ranged from 69.2% in Australasia to 99.6% in East Asia and the Pacific. In North America, about 64.9% of patients were linked to care after diagnosis, leaving many without follow-up.

Treatment access varied widely across regions, with a gap of more than 70% between the highest and lowest. While most regions reported treatment completion rates above 80%, Eastern Europe fell short of that mark. Cure rates among treated patients ranged from 35.5% in Eastern Europe to 78.2% in Western Europe.

Upper-middle-income countries reported lower treatment and cure rates than high-income nations, and no data were available from low-income countries.

“This study reveals critical shortcomings in the global HCV care cascade for key populations, particularly limited screening coverage, fragile care linkage, and treatment gaps, which are exacerbated in lower income settings,” the researchers wrote.

“These findings underscore the urgent need to develop integrated HCV care systems tailored to key populations, embedding systematic screening, diagnosis, and treatment within existing HIV services, harm reduction programmes, prison health systems, and [men who have sex with men-targeted] interventions,” they concluded.

Source: Liver Disease News