Title

Integrating hepatitis C services into ART clinics in low and middle income countries (LMICs) as an approach toward hepatitis C micro-elimination: pilot experience in Nigeria

Presenter

Chukwuemeka Agwuocha

Authors

C. Agwuocha¹, O. Adisa¹, O. Nwobi¹, M.-M. Akanmu¹, C.E. Boeke², I. Ikpeazu¹, A. Azania², I. Adamu³, A.Y. Ahmed³, R. Abade Bello³, J. Kama¹, O. Fernandes², F. Lufadeju¹, O. Wiwa¹

Institutions

¹Clinton Health Access Intiative, Abuja, Nigeria, ²Clinton Health Access Intiative, Boston, United States, ³Nasarawa State Ministry of Health, Lafia, Nigeria

BACKGROUND: Globally, an estimated one in ten people living with HIV (PLHIV) is co-infected with viral hepatitis B or C (HBV, HCV), which increases morbidity and mortality[1]. HCV can be cured with low-cost, well-tolerated direct acting antiviral treatment. Improving outcomes among PLHIV with HCV/HBV co-infection demands strategic service delivery approaches including integrating HCV/HBV services in antiretroviral therapy (ART) clinics. This abstract highlights HCV/HIV service integration outcomes achieved at 4 ART sites in Nasarawa State, Nigeria.

[1] https://pubmed.ncbi.nlm.nih.gov/26922272/

METHODS: A baseline assessment was conducted at ART facilities and community ART engagements including home visits to identify critical points for service integration including HCV screening, viral load (VL) confirmatory testing, and treatment without disruption to existing services. No routine HCV screening for PLHIV was previously available. Relevant healthcare workers were trained on HCV management and data reporting. From July 2020 – December 2022, PLHIV coming for ART visits received HCV screening during triaging and positive patients were linked to care. Patient navigators and ART defaulter trackers identified unscreened PLHIV using facility HCV screening and enrolment data and prompted their return to the facility for HCV services through texts/calls or provided these services in community settings. Positive patients were linked to VL testing and treatment in either the facility or community.
RESULTS: During this integration pilot, a total of 3831 PLHIV were screened of 4042 receiving ART across the sites (94.8%; Male (M)/Female (F) = 29%/71%). 426 (11.1%) were seropositive, 371 received a confirmatory HCV VL (87.1%), 218 were viremic (58.8%), and 175 initiated HCV treatment.

CONCLUSIONS: Despite the effects of the COVID-19 pandemic, and financing barriers necessitating domestic resource mobilization, HIV/HCV service integration at ART clinics and community settings has been a successful strategy to dramatically expand HCV screening and treatment among HIV clients and a critical step to achieving HCV micro-elimination in PLHIVs in LMICs.

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