The TraP Hep C in Iceland

The Trap Hep C programme in Iceland is a pioneering project established in 2016 as a collaborative initiative between the Icelandic Ministry of Health and Gilead with one simple aim: to achieve the elimination of hepatitis C in Iceland as a major health threat – for the benefit of Icelanders and to provide a model to enable other countries and regions to follow their lead.1-3

At the start of the project in 2016 it was estimated that there were 800 people living with the virus on the island (diagnosed and undiagnosed) with a large proportion of HCV sufferers being those at high risk of transmission, including PWID 4-6 Three years later, around 80% of those living with HCV in Iceland have been cured.4  

As a result of the TraP Hep C programme, elimination of hepatitis C as a major health threat in Iceland looks possible.8

It is estimated that there are 800–1,000 hepatitis C virus (HCV)-infected individuals in Iceland, which has a total population of approximately 330,000.4 Data suggest that 80% have received a diagnosis,while 40–70 new cases are diagnosed each year.1

Iceland represents a unique setting to pilot a nationwide HCV elimination programme:7

A “closed system” with little immigration or emigration

A national healthcare system that tracks all new HCV cases, which allows for long-term monitoring of clinical outcomes and burden of disease

TraP project conclusions (so far)

The programme has resulted in a reduction in HCV prevalence and incidence among PWID.6

Figure 3: Prevalence of HCV viraemia in PWID in the TraP Hep C Study by the end of 2018.6

Adapted from Gottfredsson M, 2018

Treatment as prevention is a successful approach in the prevention of transmission of HCV among PWID. With these efforts, Iceland is anticipated to achieve the WHO HCV elimination goals well before 20301

DAA, direct-acting antiviral; HCV, hepatitis C virus,IV, intravenous; PWID, people who inject drugs; TraP Hep C, Treatment as Prevention for Hepatitis C; WHO, World Health Organisation.

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. Olafsson S, et al. Treatment as Prevention for Hepatitis C (TraP Hep C) – a nationwide elimination programme in Iceland using direct-acting antiviral agents. J Intern Med 2018;283:500–507.
  2. Olafsson S. Trap Hep C (Treatment as prevention for hepatitis C in Iceland): An update. Poster presented at Stockholm Liver Week 2017, Stockholm, Sweden.
  3. Olafsson S. Implementation of a successful treatment program for hepatitis C presented at the HIV and Hepatitis Nordic Conference 2018, Stockholm, Sweden.
  4. Rockstroh J. Summary from EASL 2018 for Hepatitis C (HCV).HCV in 2018: Success stories and remaining challenges? Available at http://www.natap.org/2018/EASL/EASL_93.htm (accessed May 2020).
  5. Love A and Stanzeti B. Hepatitis C virus infection in Iceland: a recently introduced bloodborne disease. Epidemiol Infect 1994;113:529–536.
  6. Gottfredsson M. Preliminary results from the Treatment as Prevention for Hepatitis C (TraP HepC ) program in Iceland. Presented at the HIV and Hepatitis Nordic Conference 2018, Stockholm, Sweden.
  7. Sajed N, et al. Support of global efforts toward elimination of hepatitis C virus. Poster #28 presented at the International Viral Hepatitis Elimination Meeting (IVHEM 2017), Amsterdam, The Netherlands. Available at: gilead.com/-/media/files/pdfs/other/hcv%20infographic.pdf?la=en (accessed May 2020).
  8. Olafson, S et al. Iceland may already have reached the WHO 2030 targets for diagnosis and treatment of hepatitis C virus infection. Results from the Treatment as Prevention for Hepatitis C (TrapHepC) program. Available at http://www.natap.org/2019/EASL/EASL_116.htm

The Liver Disease Free Arkhangai project in Mongolia7

Mongolia is one of the most sparsely populated countries in the world: it has a population of approximately 3.03 million at a density of 1.9 people/km2. The low population density and harsh climate make communication, transport and economic development challenging, thereby complicating health service provision.1 Arkanghai Province is a remote agricultural area in the middle of the country with no scheduled flights to its main airport.

The burden of hepatitis C in Mongolia

Hepatitis B and C viruses (HBV and HCV) are the second highest causes of death in Mongolia, after cardiovascular disease. According to a 2003–2005 survey, the prevalence of HCV in Mongolia was 10–15%.2  As a result, Mongolia has the world’s highest rate of liver cancer mortality – at nearly eight times the global average.3

Gilead is proud to support elimination in countries with limited access to resources. By providing life-saving direct-acting antiviral (DAA) therapy, Gilead is actively supporting the efforts of the Government to end HCV in Arkhangai Province, Mongolia, through proactive screening and treatment. Together we’re supporting elimination in Mongolia to help make HCV history.3-6

Aims of the project:

  • In 2016 Gilead partnered with the Mongolian Government and Arkanghai Province Health Department to eliminate HBV and HCV in the region7
  • The National Hepatitis Programme was modified in May 2017 to include the goal of eliminating HCV by 20208

DAA, direct-acting antiviral; HBV, hepatitis B virus; HCV, hepatitis C virus; RNA, ribonucleic acid.

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

References

  1. Chaabna Kand Abu-Raddad LJ. Hepatitis C infection epidemiology in Mongolia: protocol of a systematic review and meta-analysis. Systematic Reviews 2017;6:1- 5.
  2. World HealthOrganisation. Hepatitis: a crisis in Mongolia. July 2017. Available at: https://www.who.int/westernpacific/news/feature-stories/detail/hepatitis-a-crisis-in-mongolia (assessed May 2020)
  3. Stanford University. Hepatitis Prevention, Control, and Elimination Program in Mongolia. Executive Summary. Available at: https://medicinex.stanford.edu/wp-content/uploads/conference/HPCE%20Program%20-%20Executive%20Summary.pdf (accessed May 2020).
  4. Sajed N, et al. Support of global efforts toward elimination of hepatitis C virus. Poster #28 presented at the International Viral Hepatitis Elimination Meeting (IVHEM 2017), Amsterdam, The Netherlands. Available at: gilead.com/-/media/files/pdfs/other/hcv%20infographic.pdf?la=en (accessed May 2020).
  5. World HealthOrganizaiton. Viral hepatitis in Mongolia: situation and response 2015. Available at https://apps.who.int/iris/handle/10665/208324 (accessed May 2020).
  6. Dashtseren B, et al. First results from the general population hepatitis screening in Mongolia. Poster THU-104 presented at the International Liver Congress 2018, Paris, France.
  7. Asia-Pacific Biotech News. Viral hepatitis in Arkhangai: How Asia’s first micro-treatmentprogram’s successes can be leveraged to treat a “silent killer”. Available from: asiabiotech.com/22/ 2207/22070 026x.html. (accessed May 2020).
  8. World Health Organisation. Progress report on access to hepatitis c treatment focus on overcoming barriers in low­ and middle-income countries, 2018. Available at: https://www.who.int/hepatitis/publications/hep-c-access-report-2018/en/ (accessed May 2020).

HCV initiatives in Australia

Hepatitis C virus (HCV) affects 1.4% of the Australian population. Recent estimates suggest that 226,700 people are living with HCV in Australia, of whom 85% have been diagnosed. Approximately 10,000 new infections are reported each year in Australia: 95% of cases can be attributed to injecting drug use. In Australia, HCV-related liver disease is the most common indication for liver transplant.1

Unrestricted access to direct-acting antiviral (DAA) therapy and a diverse range of HCV models of care – including broad prescribing involvement and high coverage of harm reduction strategies for people who inject drugs (PWID) – have had a positive impact on HCV prevalence. Between 2015 and 2016, Australia witnessed a 12% fall in the prevalence of HCV – from 45% to 33% –  among 2,500 PWID included in the annual Australian Needle and Syringe Programme Survey.2

A combination of micro and macro elimination projects in Australia have demonstrated that universal access to DAAs, combined with expanded screening programmes, can increase uptake of treatment and reduced the prevalence of HCV, thereby paving the way for its elimination.3–6

Gilead is proud to support elimination efforts in marginalised populations. Gilead is working with healthcare professionals to prevent HCV among PWID and those in prisons through screening support and universal access to DAAs.2–4,7

Together we’re supporting elimination in Australia to help make HCV history.2–4,7

DAA, direct-acting antiviral; HCV, hepatitis C virus; PWID, people who inject drugs.

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. Holmes, J. Hepatitis C: An update. Available at: https://www.racgp.org.au/download/Documents/AFP/2013/Ju1y/201307h p  df  (accessed March 2019).
  2. DoreGJ and HajarizadehB. Elimination of Hepatitis C Virus in Australia: Laying the Foundation. Infect Dis Clin N Am 2018;32:269 – 279.
  3. Sajed N, et al. Support of Global Efforts Toward Eli mination of Hepatiti s C Virus. Poster #28 presented at the International Viral Hepatitis Elimination Meeting (IVHEM2017). Amsterdam, The Netherlands. Available at: gilead.com/-/media/files/dpfs/other/hcv%20infographic.dpf?la=en (accessed March 2019).
  4. Hajarizadeh B, et al. Poster THU-134. Presented at the International liver Congress 2018, Paris, France.
  5. University of New South Wales. Kirby Institut e. Press release: Control and Elimination within Australia of Hepatiti s C from people living with HIV (CEASE), 2018.Available at: https://kirby.unsw.edu.au/project/control-and-elimination­ within-australia-hepatitis-c-people-Jiving-hiv-cease(accessed March 2019).
  6. Martinello M, et al. Poster THU-404. Presented at the International li ver Congress 2018,Paris, France.
  7. KwonJA, et al. Australia on track to achieve WHO HCV elimination targets following rapid initial DAA treatment uptake: A modelling study.J Viral Hepat 2018. [Epub ahead of print].