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Over 1,500 patients have commenced treatment — national hep C programme

The report, published in the Health Protection Surveillance Centre (HPSC) Epi-Insight e-zine, also states that all patients with haemophilia have been offered treatment, with 90 per cent successfully treated.

The programme also reports that treatment has been extended to people with moderate liver disease, while a model of hepatitis C treatment in the community setting has been developed, with pilot sites having commenced in June.

“Treatment to date has been delivered through seven adult hospital treatment sites under the care of consultant hepatologists and infectious disease physicians,” states the update from Ms Michele Tait, National Hepatitis C Treatment Programme Manager, HSE. “The hospital-based service will continue to provide services to all HCV-infected patients.

“Additionally, the pilot community-based treatment service will facilitate patients who are not linked to care or who have disengaged with care in the hospital system to be provided with treatment in settings which are more accessible to them and thereby maximising the numbers of people being treated under the NHCTP, which is in line with its overall aim of making hepatitis C a rare disease in Ireland by 2030.”

The NHCTP was initiated in 2015 following a recommendation in the 2014 Department of Health report A Public Health Plan for the Pharmaceutical Treatment of Hepatitis C.

Meanwhile, national hepatitis C screening guidelines have been developed in the HPSC by a multi-stakeholder guideline development group. The document makes recommendations on screening for hepatitis C virus infection and the manner in which this should be undertaken. It is understood the guideline will be published shortly, along with an implementation plan and budget impact analysis.

DAA-based eradication of HCV associated with improved glycaemic control

Direct-acting antiviral (DAA)-based eradication of hepatitis C virus (HCV) is associated with improved glycaemic control in patients with diabetes, as evidenced by decreased mean HbA1c and decreased insulin use, according to a recent study published in the journal Diabetes Care.

The US-based researchers identified 2,435 patients with diabetes who underwent interferon-free and ribavirin-free DAA-based antiviral treatment for HCV in the national Veterans Affairs healthcare system. Changes in average haemoglobin A1c (HbA1c) level and use of antidiabetic medications one year before and after antiviral treatment were compared between patients who achieved sustained virologic response (SVR) and those who did not.

According to the study: “Among patients with elevated baseline HbA1c, the drop in HbA1c associated with antiviral treatment was greater in those who achieved SVR (0.98 per cent) than in those who sustained treatment failure (0.65 per cent) (adjusted mean difference 0.34, P=0.02). Use of antidiabetic medications decreased more in patients who achieved SVR than in those who sustained treatment failure, especially for the use of insulin, which dropped significantly from 41.3 per cent to 38 per cent in patients achieving SVR, compared with a slight increase from 49.8 per cent to 51 per cent in those who sustained treatment failure.”

These endocrine benefits of SVR provide additional justification for considering antiviral treatment in all patients with diabetes, according to the authors.

WHO advises on the use of multidisease testing devices for TB, HIV and hepatitis

The World Health Organisation (WHO) recently released a new information note on Considerations for adoption and use of multidisease testing devices in integrated laboratory networks. The document, prepared by the Global TB Programme and the Department of HIV and Global Hepatitis Programme, provides a strategic overview of key implementation considerations for diagnostic integration using testing devices for tuberculosis (TB), HIV and viral hepatitis.

According to the WHO, new laboratory technologies are available or are being developed to allow for testing of different conditions using a common platform for disease-specific tests. For instance, a single device can be used to diagnose TB and HIV infection, and quantitatively measure HIV and hepatitis C viral load.

GeneXpert machines — initially procured by countries for the detection of TB and rifampicin resistance, following an initial WHO recommendation in December 2010 — were subsequently expanded for use in early infant diagnosis of HIV and viral load testing using relevant cartridges in the same GeneXpert device.

“With the power and adaptability of molecular technologies, we are in an era of great advancement for the rapid diagnosis of many diseases using single platforms,” said Dr Mario Raviglione, Director of the WHO’s Global TB Programme. “These platforms offer technical and financial efficiencies to countries in their disease control efforts, while expanding access to care and saving lives.

“We encourage countries to use multidisease platforms for testing of HIV, TB and hepatitis as much as possible and feasible,” said Dr Gottfried Hirnschall, Director of the WHO’s Department of HIV and Global Hepatitis Programme. “Multidisease devices can increase system efficiencies and improve access to testing for patients in need. Such devices can also help overcome specific challenges in diagnosis and treatment, such as HIV early infant diagnosis and viral load monitoring for both HIV and hepatitis.”

The WHO said these devices “bring new opportunities for collaboration and integration, which can provide significant system efficiencies and cost savings; increase patient access; and ultimately improve quality of care”.

The WHO’s information note is primarily intended for use by national laboratory services and TB, HIV and hepatitis programme managers. It may also be of interest to managers of maternal, newborn and child health programmes, and sexual and reproductive health programmes; international and bilateral agencies; and organisations that provide financial and technical support to relevant national health programmes, said the WHO.

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