Geographic populations - Iceland
It is estimated that there are 800–1,000 hepatitis C virus (HCV)-infected individuals in Iceland, which has a total population of approximately 330,000.1 Data suggest that 80% have received a diagnosis,1 while 40–70 new cases are diagnosed each year.2
The burden of hepatitis C in Iceland
In 1994 an Icelandic study reported that HCV was “a recently introduced bloodborne disease” in Iceland, and demonstrated a very high prevalence of HCV among Icelandic intravenous (IV) drug users. Of 152 identified IV drug users, 95 (63%) were shown to have antibodies to HCV.3
Figure 1: Yearly number of cases and incidence of HCV by year of diagnosis in Iceland from 1991 to 20152
Iceland represents a unique setting to pilot a nationwide HCV elimination programme:4
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
Gilead is proud to support elimination on a national scale. Gilead is actively supporting the efforts of the Government, who have prioritised the testing and treatment of HCV. Together we’re supporting elimination in Iceland to help make HCV history.2,4–7
The TraP Hep C Study – Treatment as Prevention for Hepatitis C: a nationwide elimination programme2
Aims of the TraP Hep C Study:
- To initiate HCV treatment for every person in need in Iceland within three years of commencement of the study2,7,8
- To reduce the domestic incidence of HCV in the population by 80% prior to the WHO target of HCV elimination by the year 20302
TraP project details:
The TraP Hep C project is a nationwide programme – a collaboration between the Icelandic Ministry of Health and Gilead for the treatment of all people infected with HCV in Iceland, by providing universal access to direct-acting antivirals (DAAs)2
Figure 2: Phases of the TraP Hep C Study
The programme also offers education and follow-up to people diagnosed with the virus2
A key feature is the early detection of cases and prompt treatment of those at high risk of transmission or disease progression, such as people who inject drugs (PWID), those with advanced liver disease, and prisoners2
The study tracks new cases of HCV and monitors short- and long-term clinical outcomes, burden of disease and long-term healthcare costs2
The first participant entered the programme in January 2016 and all participants were treated by the end of 20185
Through this initiative, Iceland is anticipated to achieve the WHO HCV elimination target well before 20302,7
TraP project conclusions (so far)
The TraP Hep C project has been well received by people living with HCV and the community. Experience in Iceland indicates that by implementing a well-organised nationwide approach, a relatively large proportion of infected individuals, including PWID, can be initiated on treatment within a short period of time.5,6
The programme has resulted in a reduction in HCV prevalence and incidence among PWID.5
Figure 3: Prevalence of HCV viraemia in PWID in the TraP Hep C Study by the end of 20185
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 20302
Information on innovative elimination efforts in Australia, focusing on reaching marginalised populations
Information on elimination efforts in Arkhangai Province, Mongolia
- 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 March 2019).
- 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.
- Love A and Stanzeti B. Hepatitis C virus infection in Iceland: a recently introduced bloodborne disease. Epidemiol Infect 1994;113:529–536.
- 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 March 2019).
- 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.
- Olafsson S. Trap HepC (Treatment as prevention for hepatitis C in Iceland): An update. Poster presented at Stockholm Liver Week 2017, Stockholm, Sweden.
- Olafsson S. Implementation of a successful treatment program for hepatitis C presented at the HIV and Hepatitis Nordic Conference 2018, Stockholm, Sweden.
- Olafsson S, et al. Treatment as Prevention for Hepatitis C in Iceland (TraP HepC). Real-world experience from a nationwide elimination program using direct acting antiviral agents. EASL 2017. Available at: http://www.natap.org/2017/EASL/EASL_121.htm (accessed March 2019).
LID/IHQ/18-12//1048h(1) Date of preparation August 2019