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  • Establishment of an outreach, grouping healthcare system to achieve microelimination of HCV for uremic patients in haemodialysis centres (ERASE-C)

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Hepatology
Original research
Establishment of an outreach, grouping healthcare system to achieve microelimination of HCV for uremic patients in haemodialysis centres (ERASE-C)
  1. Ming-Lung Yu1,2,
  2. Chung-Feng Huang1,2,
  3. Yu-Ju Wei1,3,
  4. Wen-Yi Lin4,
  5. Yi-Hung Lin1,
  6. Po-Yao Hsu1,
  7. Cheng-Ting Hsu1,
  8. Ta Wei Liu3,
  9. Jia-Jung Lee5,
  10. Sheng-Wen Niu5,
  11. Jiun-Chi Huang5,
  12. Tzu-Sui Hung5,
  13. Ming-Lun Yeh1,2,
  14. Ching-I Huang1,2,
  15. Po-Cheng Liang1,
  16. Ming-Yen Hsieh1,3,
  17. Szu-Chia Chen5,
  18. Jee-Fu Huang1,2,3,
  19. Jer-Ming Chang5,
  20. Yi-Wen Chiu5,
  21. Chia-Yen Dai1,2,
  22. Shang-Jyh Hwang5,
  23. Wan-Long Chuang1,2
  24. On behalf of the FORMOSA-LIKE investigators
  1. 1 Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
  2. 2 Faculty of Internal Medicine and Hepatitis Research Center, College of Medicine, and Center for Cohort Study,Kaohsiung Medical University,Kaohsiung,Taiwan
  3. 3 Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital,Kaohsiung Medical University,Kaohsiung,Taiwan
  4. 4 Hepatobiliary Division, Department of Internal Medicine,Kaohsiung Medical University Hospital, Kaohsiung Medical University,Kaohsiung,Taiwan
  5. 5 Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
  1. Correspondence to Professor Ming-Lung Yu, Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Chung Ho Memorial Hospital, Kaohsiung, Taiwan; fish6069{at}gmail.com; Professor Wan-Long Chuang; waloch{at}kmu.edu.tw

Abstract

Objective HCV prevails in uremic haemodialysis patients. The current study aimed to achieve HCV microelimination in haemodialysis centres through a comprehensive outreach programme.

Design The ERASE-C Campaign is an outreach programme for the screening, diagnosis and group treatment of HCV encompassing 2323 uremic patients and 353 medical staff members from 18 haemodialysis centres. HCV-viremic subjects were linked to care for directly acting antiviral therapy or received on-site sofosbuvir/velpatasvir therapy. The objectives were HCV microelimination (>80% reduction of the HCV-viremic rate 24 weeks after the end of the campaign in centres with ≥90% of the HCV-viremic patients treated) and ‘No-C HD’ (no HCV-viremic subjects at the end of follow-up).

Results At the preinterventional screening, 178 (7.7%) uremic patients and 2 (0.6%) staff members were HCV-viremic. Among them, 146 (83.9%) uremic patients received anti-HCV therapy (41 link-to-care; 105 on-site sofosbuvir/velpatasvir). The rates of sustained virological response (SVR12, undetectable HCV RNA 12 weeks after the end of treatment) in the full analysis set and per-protocol population were 89.5% (94/105) and 100% (86/86), respectively, in the on-site treatment group, which were comparable with the rates of 92.7% (38/41) and 100% (38/38), respectively, in the link-to-care group. Eventually, the HCV-viremic rate decreased to 0.9% (18/1,953), yielding an 88.3% reduction from baseline. HCV microelimination and ‘No-C HD’ were achieved in 92.3% (12/13) and 38.9% (7/18) of the haemodialysis centres, respectively.

Conclusion Outreach strategies with mass screenings and on-site group treatment greatly facilitated HCV microelimination in the haemodialysis population.

ClinicalTrials.gov identifier NCT03803410 and NCT03891550

  • HCV
  • antiviral therapy
  • liver
  • infectious disease

Data availability statement

All data relevant to the study are included in the article or uploaded as online supplementary information. The current analysis was retrieved from de-identified participant data. There is no additional information.

https://doi.org/10.1136/gutjnl-2020-323277

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as online supplementary information. The current analysis was retrieved from de-identified participant data. There is no additional information.

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    Footnotes

    • Twitter @davyliu0708

    • M-LY, C-FH and Y-JW contributed equally.

    • Correction notice This article has been corrected since it published Online First. The author's name, Ming-Yen Hsieh, has been corrected.

    • Contributors Conception and design: M-LY. Acquisition of data: C-FH, Y-JW, W-YL, Y-HL, P-YH, C-TH, T-WL, J-JL, S-WN, J-CH, T-SH, M-LY, C-IH, P-CL, M-YH, S-CC, J-FH, J-MC, Y-WC, C-YD, S-JH. Data analysis and interpretation: C-FH and M-LY. Manuscript drafting and critical revision: C-FH and M-LY. Approval of the final version of the manuscript: M-LY and W-LC.

    • Funding This study was supported partly by grants from Kaohsiung Medical University (MOST 108-2314-B-037-066-MY3, MOST 108-2314-B-037-003) and Kaohsiung Medical University Hospital (KMUH108-8R05). This study was also supported in part by research grants from the Investigator-Initiated Studies Program of Merck Sharp & Dohme Corp (MISP#58122) and Gilead Science (IN-TW-342–5567).

    • Disclaimer The funding did not influence how the study was conducted or the approval of the manuscript. The opinions expressed in this paper are those of the authors and do not necessarily represent those of Merck Sharp & Dohme Corp or Gilead Science.

    • Competing interests M-LY: research support from Abbvie, Abbott, BMS, Gilead, Merck and Roche. Consultant for Abbvie, Abbott, Ascletis, BMS, Gilead, J&J, Merck, Novartis, Pharmaessential and Roche. Speaker for Abbvie, Abbott, Ascletis, BMS, Gilead, Merck, Pharmaessential and Roche. C-FH: speaker for Abbvie, BMS, Gilead, Merck and Roche.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.