Drop in HCV treatments

The number of people commencing direct-acting antiviral (DAA) treatment for hepatitis C virus (HCV) fell to 110 in the first quarter of 2021, a sizeable decline from the same period of 2019 (354) and 2020 (193).

The pandemic has impacted access with just 532 people commencing treatment last year, compared to 1,196 in 2019.

However, there is also concern among community workers about what they describe as the slow roll-out of community-based testing and treatment.

HCV is largely transmitted by injecting drug use. Testing and treatment in the community are widely regarded as key to ensuring difficult-to-reach groups are identified and receive care.

According to the community treatment guidelines of the HSE National Hepatitis C Treatment Programme (NHCTP), community treatment “may be preferred” if patients find it difficult to attend hospital services. Participating GPs must be registered to prescribe methadone.

Ms Nicola Perry, Manager of liver health support organisation, Community Response, said procedural issues were hindering GP participation. While acknowledging the pandemic’s impact, she added there was “minimal” community-based screening and testing at present.

Ms Kristy Hayes, Head of Advocacy at the Hepatitis C Partnership, said there was a lack of available data on the patient care cascade and the targets necessary to meet Ireland’s viral elimination goals.

Asked for an estimated number of people with chronic hepatitis C infection who had not yet been identified for treatment, a HSE spokesperson said: “The NHCTP is currently engaged in a formal epidemiological study to determine the prevalence.” The spokesperson said there are still patients presenting and being treated later in their disease course, but this has been declining.

According to the Department of Health: “The NHCTP is confident that the programme is on target to make hepatitis C a rare disease in Ireland by 2026, and in alignment with the World Health Organisation goal, to fully eliminate the disease in Ireland by 2030.”

See editorial, More action required on HCV – Medical Independent