Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 May 27:37:100801.
doi: 10.1016/j.lanwpc.2023.100801. eCollection 2023 Aug.

A community-based strategy to eliminate hepatitis C among people who inject drugs in Vietnam

Nicolas Nagot  1 , Nguyen Thanh Binh  2 , Tran Thi Hong  2 , Vu Hai Vinh  3 , Catherine Quillet  1 , Roselyne Vallo  1 , Duong Thi Huong  2 , Khuat Thi Hai Oanh  4 , Nham Thi Tuyet Thanh  4 , Delphine Rapoud  1 , Bach Thi Nhu Quynh  5 , Duc Quang Nguyen  2 , Jonathan Feelemyer  6 , Laurent Michel  7 , Peter Vickerman  8 , Hannah Fraser  8 , Laurence Weiss  9 , Maud Lemoine  10 , Karine Lacombe  11 , Don Des Jarlais  6 , Pham Minh Khue  2 , Jean Pierre Moles  1 , Didier Laureillard  1   12 ; DRIVE-C study group
Collaborators, Affiliations

A community-based strategy to eliminate hepatitis C among people who inject drugs in Vietnam

Nicolas Nagot et al. Lancet Reg Health West Pac. .

Abstract

Background: Towards hepatitis C elimination among people who inject drugs (PWID), we assessed the effectiveness of a strategy consisting of a community-based respondent-driven sampling (RDS) as wide screening, a simplified and integrated hospital-based care, and prevention of reinfection supported by community-based organisations (CBO), in Hai Phong, Vietnam.

Methods: Adults who injected heroin were enrolled in a RDS survey implemented in two CBO premises. Rapid HIV and HCV tests were done on site, and blood was taken for HCV RNA testing. Those with detectable HCV RNA were referred with CBO support to three public hospitals for 12-week sofosbuvir/daclatasvir, plus ribavirin for patients with cirrhosis. Participants were followed-up 12 weeks post-treatment (SVR12) and 48 weeks after enrolment. The primary endpoint was the rate of undetectable HCV RNA participants at 48 weeks.

Findings: Among the 1444 RDS survey participants, 875 had hepatitis C. Their median age was 41 years (IQR 36-47), 96% were males, 36% were HIV-coinfected. Overall, 686 (78.4%) started sofosbuvir/daclatasvirs, and 629 of the 647 (97.2%) patients tested at SVR12 were cured. At week 48 (581/608) 95.6% had undetectable HCV RNA, representing 66.4% of all PWID identified with hepatitis C. The reinfection rate after SVR12 was 4/100 person-years (95% CI: 2-7).

Interpretation: Our strategy, involving CBO and addressing all steps from wide HCV screening to prevention of reinfection, stands as a promising approach to eliminate HCV among PWID in low and middle-income countries.

Funding: France ANRS|MIE (#ANRS12380). The RDS survey was implemented with grants from the NIDA (#R01DA041978) and ANRS|MIE (#ANRS12353).

Keywords: Community-based organisations; Hepatitis C; People who inject drugs; Respondent-driven sampling.

PubMed Disclaimer

Conflict of interest statement

ML received fees from Cepheid and Gilead US, as well as consultancy fees from Gilead US, outside the submitted work. KL received grants or contracts from MSD, honoraria from Janssen and Gilead, and travel support from Gilead, outside the submitted work. DDJ received grants and contracts from U.S. Centers for Disease Control, outside the submitted work. PV grants and contracts from Gilead medical Sciences outside the submitted work. Other authors declare no competing interest.

Figures

Fig. 1
Fig. 1
Cascade of hepatitis C testing and care among PWID in Hai Phong, Vietnam. The blue bars display the hepatitis C testing cascade. The orange bars display the hepatitis C care cascade.
Fig. 2
Fig. 2
Participants enrolment and follow-up. ∗These participants have missed this visit but have attended at least one later visit.
See this image and copyright information in PMC

References

    1. World Health Organization . World Health Organ; 2016. Combating hepatitis B and C to reach elimination by 2030; pp. 1–16.
    1. Degenhardt L., Peacock A., Colledge S., et al. Global prevalence of injecting drug use and sociodemographic characteristics and prevalence of HIV, HBV, and HCV in people who inject drugs: a multistage systematic review. Lancet Glob Health. 2017;5:e1192–e1207. - PMC - PubMed
    1. Cooke G.S., Andrieux-Meyer I., Applegate T.L., et al. Accelerating the elimination of viral hepatitis: a lancet Gastroenterology & Hepatology commission. Lancet Gastroenterol Hepatol. 2019;4:135–184. - PubMed
    1. Grebely J., Dalgard O., Conway B., et al. Sofosbuvir and velpatasvir for hepatitis C virus infection in people with recent injection drug use (SIMPLIFY): an open-label, single-arm, phase 4, multicentre trial. Lancet Gastroenterol Hepatol. 2018;3:153–161. - PubMed
    1. Martin N.K., Vickerman P., Dore G.J., Hickman M. The hepatitis C virus epidemics in key populations (including people who inject drugs, prisoners and MSM): the use of direct-acting antivirals as treatment for prevention. Curr Opin HIV AIDS. 2015;10:374–380. - PMC - PubMed

LinkOut - more resources