National HCV elimination plan in Belgium

The 5-year national HCV elimination plan of Belgium was first released in August 2014 and included 22 points of action related to 6 strategic axes: prevention, testing, linkage to care and health care pathway, vaccination, scientific research, and epidemiologic follow-up1. Nevertheless, 6 years later, we are still not on track to reach WHO goals in time.  

Source: Razavi et al., 20202

To date, a group of independent Belgian HCV experts has prepared a novel vision document for the Ministry of Health with specific and actionable recommendations around prevention, screening, treatment and follow-up that should allow us to get back on track for elimination by 2030.  A formal presentation of this new hepatitis plan had to be postponed due to the COVID-19 and is expected later in 2020.

What can you as an hepatologist do for HCV elimination ?

Despite an excellent hospital health care system in Belgium, patients remain untreated due to several reasons:

  • Diagnosed patients who were not eligible for treatment due to previous restrictions in reimbursement (before 2019) got lost in the hospital database
  • Patients who were diagnosed prior to the DAA era still have the perception of long, painful and complicated treatment regimens and are therefore reluctant to start a new treatment
  • Patients who are diagnosed with HCV within other hospital departments (e.g. gynaecology, nephrology, etc.) and are not referred to or do not follow-up on referral to the hepatologist
  • Hepatologists are hesitant to actively reach out to patients with high risk of HCV infection outside of the hospital (lack of time, hurdles concerning privacy, etc.). However, patients could be identified through collaboration with MSOCs/MASS, psychiatric hospitals, their GP network, etc.

Projects in Belgian hospitals

CHU Brugmann – Dr. Luc Lasser: How to prevent losing patients diagnosed by other departments in the hospital

UZ Gent – Dr. Xavier Verhelst: How to retrieve the patients lost in the hepatology department

UZ Antwerpen – Dr. Wim Verlinden: Lost to follow up in the hepatology department and other hospital departments

UZ Gent – Prof. Hans Van Vlierberghe: Finding patients in the emergency room or via the general practitioner

Elimination by reaching vulnerable populations

Elimination can only be reached through close collaboration amongst the network of people in the local community of the patient, i.e. hepatologists, addiction GPs, nurses, social workers, psychologists, peer-workers, etc.  
Especially vulnerable populations need to be screened for HCV infection since they are at high risk:

People who use drugs

People with migration background or with ethnic background of high endemic countries

(Ex-)prisoners

Men having sex with men

Psychiatric patients

For more information on risk groups please see this video by Prof. Dr. Geert Robaeys.

Projects in first line to reach vulnerable populations

The concept of “one size fits all solution” is not applicable for each environment. Therefore, several first line organisations have initiated projects reaching vulnerable populations in order to link them to care and HCV treatment.

PWUDs

Sida Sol asbl, Liège – Dr. Aurelie Le Van: Screening and linkage to care at Sida Sol

Sida Sol asbl, Liège – Dr. Ariane Torres : Screening and linkage to care at Sida Sol

U Hasselt – Dana Busschots: outreach to PWUDs in the provinces of Antwerp and Limburg

Psychiatric patients

UZ Antwerpen – Dr. Wim Verlinden: HCV infection in psychiatric patients

Related content

DAA, direct-acting antiviral, HCV, hepatitis C virus; PWUD, people who use drugs. LTFU, lost to follow up; MSOCs, Medisch Sociaal Opvang Centrum; MASS, Maison d’Accueil Socio-Sanitaire.

Disclaimer:

While this information is considered to be true and correct at the date of publication (May 2020), changes in circumstances after the time of publication may impact the accuracy of the information.

This page will be updated regularly.

 

References

  1. Federale Overheidsdienst Volksgezondheid. Veiligheid van de voedselketen en Leefmilieu: Protocolakkoord ‘HCV-plan’. Belgisch staatsblad- Moniteur Belge,. In. Brussels; 2014. p. 57926–40. [C-2014/24267]
  2. Razavi H, Sanchez Gonzalez Y, Yuen C, Cornberg M. Global timing of hepatitis C virus elimination in high-income countries. Liver Int. 2020 Mar;40(3):522-529.