3 places where HCV micro-elimination efforts are working

In his younger days, the man served in the army. He had the military tattoos to prove it, too. Now in his 50s, with a closer eye on his health, this Estonian man visited his doctor for a checkup. His doctor told him that he could get a hepatitis C test.

The test result was positive, which caught him completely by surprise. Worse still, he also had liver fibrosis, an advanced stage of liver damage his doctors say was caused by the hepatitis C virus (HCV). He’ll never know for sure, but he could only assume that his tattoos from decades ago were the culprit. His HCV test was made possible by AbbVie Estonia, which supported a new HCV screening project called From Micro to Macro.

The project’s goal sounds simple: to understand the true prevalence of HCV in Estonia. But one of the biggest problems facing HCV elimination is finding HCV-positive people so they can be connected to care. The lack of HCV awareness from health care providers in primary care remains the bottleneck of an HCV free Estonia. Many countries around the world wrestle with this problem, too.

In partnership with SYNLAB Estonia, the biggest medical laboratory in the country, general practitioners (GPs) could offer their patients HCV tests through this project. The risk groups were determined by the questionnaire, and an HCV test was automatically ordered for patients whose routine bloodwork showed elevated liver enzymes (ALAT/ASAT).

The screening project has been a resounding success, testing more than 9,000 patients with risk factors, such as blood donors before 1994 (donor blood wasn’t tested for HCV until then) or elevated liver enzymes.

Thanks to the HCV screening project, the army veteran was connected to care.

“Our hope is that From Micro to Macro’s findings could further encourage GPs in Estonia to remember the importance of testing their patients for HCV,” says Dr. Paul Naber, the infectologist working at SYNLAB. “These data are evidence that there’s a tremendous benefit for screening during primary care visits, which is why it was important to find out the true scope of HCV in high risk groups.”
 

At the foot of the green hills that rise above Hiroshima Bay is the industrial city of Kure. Home to more than 200,000 people and the second largest naval dockyard in Japan, Kure has a rich heritage of shipbuilding. The largest battleship ever built, the Yamato, was launched here in 1940.

Today, this historic city has struggled with a high prevalence of HCV infections, higher than the rate in Hiroshima prefecture as a whole.

Well aware of the HCV problem not just in Kure but across the prefecture, the local government in Hiroshima was already eager to eliminate HCV. Fortunately, two nationally recognized hepatologists worked at a local university hospital. AbbVie Japan connected the dots, forming a unique three-party partnership – AbbVie’s first public-private-academic partnership – to tackle HCV in Hiroshima.

The project, called Arcadia Hiroshima, has diagnosed more than 3,000 HCV-positive patients across the entire prefecture.

Nearly 700 patients have been treated for their disease.

“This unique three-party partnership has been a tremendous success,” says Junko Tanaka, Professor at Hiroshima University. “This undertaking of large-scale HCV screening targeted at accelerating elimination is the first of its kind. I strongly believe that it will serve as a model for future collaboration between government, academia, and industry.”

In Kure, more than 1,700 people have been screened so far, with several patients identified and now in the process of being linked to care.

Arcadia Hiroshima hopes to replicate this partnership model on a national level in Japan soon.
 

The methadone clinic in Haifa where people go to rehab for substance abuse disorders didn’t feel like a place someone would go to get well. It was drab and uninspiring. Patients stayed for 30 days to get help kicking their addiction, which for the majority of them was IV drug use. Beyond treating substance abuse disorders, few opportunities existed to better one’s health.

Despite many of the patients being at risk for HCV, few knew anything about the disease, and even fewer knew if they had it, recalls Julio Burman, CEO and founder of ‎HETZ (The Israeli Association for the Health of the Liver). But as he spoke to 30 or so patients gathered that day, he saw a light bulb switch on in their minds.

“They were like, ‘Oh my, do I also have a disease that I didn’t even know about?’” Burman says. “Once I was able to talk to them about HCV, they were very motivated to get tested and learn their status.”

In partnership with AbbVie and the Israeli Ministry of Health, Julio created a project called Road to Recovery. The project aims to help people who use IV drugs get screened, diagnosed and linked to care.

Low treatment levels among IV drug users have been a stubborn barrier to HCV elimination not just in Israel, but around the world.

Many people who inject drugs don’t feel comfortable going to hospitals or doctors’ offices, so they remain undiagnosed and at a high risk of spreading the disease. Even those who may get an initial screen at a rehab clinic often don’t follow up with a GP for additional testing and prescriptions. So how do you diagnose and treat a population of people who don’t go to the doctor?

Road to Recovery’s solution was to set up a one-stop-shop inside a methadone clinic so that patients can go through the whole journey inside the clinic. A social worker invites a small group of patients at the center to meet with nurses and take blood tests. GPs visit the clinic to do any additional follow-ups. Treatment is provided on-site.

“We knew that the people with substance abuse disorders often struggle to make their appointments and stay connected to care, so we decided to bring the care right to them,” Julio says.

The project has had rapid success. Road to Recovery started at one methadone clinic in Haifa in 2018 and has since expanded to 11 rehab centers across Israel.

One patient from Tel Aviv was so motivated by his experience that he’s now stepped into the role of patient advocate, and travels to clinics to help educate other patients about HCV.

“I just want people to have hope,” says one patient from the clinic. “They can beat addiction and come out of rehab ready to move on with life. I’m living proof.”