Iceland, after adopting a multidisciplinary public health approach for addiction treatment services, is poised to be one of the first countries to meet the World Health Organization (WHO) target of substantially eliminating infections from the hepatitis C virus (HCV). These findings, from a population-based study, were published in Lancet Gastroenterology and Hepatology.
Between 2016 and 2019, all residents of Iceland (N=332,529) were covered by national health insurance. The treatment as prevention for hepatitis C (TraP HepC) program was offered to all individuals with HCV covered by the national health insurance and offered them direct-acting antiviral (DAA) agents, provided free of charge by Gilead Sciences. The program also included needle-syringe programs and offered medication-assisted opioid treatment, as ~90% of HCV cases have historically been associated with intravenous drug use.
At the launch of the program, 1248 patients were antibody positive for HCV, of whom 682 were polymerase chain reaction (PCR) positive. In addition, 86.8% (n=59) of the incarcerated individuals at the Litla Hraun Prison were tested for HCV and 28.8% (n=17) were PCR positive for HCV.
After the launch of the TraP HepC program, HCV testing increased by 81%, resulting in 8.2% of the adult population being tested for the virus. A total of 183 new infections were detected during the program.
The 703 individuals who received HCV treatment through TraP HepC were aged median 45 (interquartile range [IQR], 35-56) years, 67.4% were men, 15.4% did not have stable housing, 84.1% had a history of injecting drugs, 57.6% had HCV genotype 3a, and 35.1% genotype 1a.
HCV treatment was initiated by 96.5% of the program enrollees and 90.2% of those who initiated care were cured.
This study may be limited by the small population size of Iceland and specific sample of individuals who inject drugs in the country. It remains unclear whether a similar program would be effective in larger, more populous countries.
These data indicated that this multidisciplinary public health approach to eliminate HCV infections country-wide was effective and poises Iceland to be one of the first nations to reach the WHO goal of reducing HCV infections by 80% by 2030.
Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.
Olafsson S, Fridriksdottir RH, Love TJ, et al. Cascade of care during the first 36 months of the treatment as prevention for hepatitis C (TraP HepC) programme in Iceland: a population-based study. Lancet Gastroenterol Hepatol. 2021;6(8):628-637. doi:10.1016/S2468-1253(21)00137-0