Decentralised, Task-Shifted Hepatitis C Testing and Treatment Services in Urban Myanmar
Myanmar (population 53 million) is a South-East Asian lower middle-income country with a mixed epidemic of HCV, with 2.7% anti-HCV positivity in the general population and 56% among people who inject drugs, and an estimated million people living with HCV. Access to HCV care is limited by the number of hepatologists (estimated at 25 nationwide) and unaffordability of diagnostics and direct-acting antivirals (DAAs). The national treatment programme has treated approximately 11 000 people living with HCV, but considerable scale-up and expansion is required to reach all affected. Fortunately, general practitioners (GPs) can prescribe DAAs and national guidelines also support simplified pretreatment assessments (no genotyping or FibroScan). Creating and evaluating a simplified clinical pathway and model of care for Myanmar is an important step towards expanding decentralised primary care-based HCV testing and treatment.
A study, published in BMJ Open, assessed the feasibility of a simplified HCV model of care in Myanmar with simplified HCV testing (delivering point-of-care (PoC) serological rapid diagnostic tests and onsite PoC HCV RNA GeneXpert tests for viral load confirmatory diagnosis) and treatment workflows (GP-led prescription of DAAs), and provided 10 recommendations for successful implementation.
Full study results can be accessed here.