Benchmarking of an Intervention Aiming at the Micro-Elimination of Hepatitis C in Vulnerable Populations in Perpignan, France, to Inform Scale-Up and Elimination on the French Territory

Abstract

Hepatitis C virus (HCV) is an important cause of chronic liver disease. Among at-risk populations, access to care is challenging. The French Ministry of Health has supported a seek-and-treat pilot intervention aiming at micro-elimination in Perpignan, France, to inform scale-up of elimination efforts across the whole territory. University College Dublin (UCD) led a successful EU funded project, called HepCare, focusing on the micro-elimination of HCV. UCD was contracted to evaluate and benchmark the Perpignan results against results from HepCare. Using mixed-method approaches including qualitative interviews with patients, a focus group with healthcare professionals, and quantitative analyses of the cascade of care against results obtained at other European sites, we analyse the acceptability, reproducibility, replicability, and effectiveness of the Perpignan intervention. A total of 960 participants were recruited in the Perpignan area. HCV antibody test results were obtained for 928 (96.6%), of which 150 (15.6%) were antibody-positive. Of the antibody-positive participants, 68 (45.3%) tested positive for HCV-RNA, 141 (94%) were linked to care, and of the HCV-RNA-positive participants, 60 (88%) started treatment. Of those who underwent treatment, 34 (56.7%) completed treatment and achieved a sustained viral response (SVR) at dataset closure, 18 (30%) were still in treatment, 5 (8.3%) defaulted from treatment, and 3 (5%) had a virologic failure or died. The intervention in Perpignan was acceptable to patients, but had limitations in effectiveness, as shown in comparisons with HepCare results. To engage harder-to-reach cohorts in France, future models of care in the territory should incorporate peer support.

Keywords

• hepatitis C
• vulnerable populations
• people who inject drugs
• PWID
• integrated care
• systems of care