Since its launch in 2016, a hepatitis C elimination program in Iceland has treated approximately 56% to 70% of the estimated viremic population with direct-acting antivirals, according to a recently published update.
“The idea was to offer DAAs to all HCV-positive patients within an entire population within a relatively short time frame and simultaneously initiate an observational study with long-term follow-up,” Sigurdur Olafsson, MD, FACP, Landspitali University Hospital, and colleagues wrote. “Gilead would, in a study setting, provide DAAs free of charge for the project.”
The Treatment as Prevention for Hepatitis C in Iceland program, or TraP HepC, was designed to treat a majority of Icelanders with HCV, including injection drug users. The concept was initially discussed in 2014 and then put into action in 2016.
“With the TraP Hep C program, Iceland is taking a cohesive, multipronged approach that includes scale-up of prevention, testing and early treatment of hepatitis C in both hospital and community settings,” the researchers wrote. “It includes a multidisciplinary public health model of care and cooperation between government, health services, the penitentiary system and community organizations.”
According to Olafsson and colleagues, Iceland has seen 40 to 70 new cases of HCV each year over the last 20 years with an estimated viremic population of 1,100 (range, 880-1,300) in 2014 for a population prevalence of 0.3% (range, 0.3-0.4). Most individuals with HCV in Iceland also have a history of injection drug use.
During the initial phase from January to October 2016, all patients with HCV received treatment with Harvoni (ledipasvir/sofosbuvir, Gilead Sciences) for 8 weeks to 12 weeks. Patients with genotype 3 also received ribavirin. After November 2016, all patients received Epclusa (sofosbuvir/velpatasvir, Gilead Sciences).