From individual cure

to HCV elimination

in Romania by 2035

The government’s plans to address and eliminate HCV in Romania

Associate professor Corina Pop

State Secretary MH

Romania

The distribution of HCV infection across the EUViremic prevalence and total infected persons by country (2015)

The European Union HCV Collaborators*. Hepatitis C virus prevalence and level of intervention required to achieve the WHO targets for elimination in the Europena Union by 2030: A modelling study. Lancet Gastroenterol Hepatol 2017. Published on line March 14, 2017 http://dx.doi.org/10.1016/S2468-1253(17)30045-6

Total viremics in the EU: 3,238,000

Romania in the EU landscape of hepatitis CHCV Prevalence and genotype distribution

• Prevalence based on data from 2010* Nationwide study, n = 13,460;

• Anti-HCV prevalence

• Viremic Rate – 85% (expert input during Meeting 2)

• Genotype distribution

* Gheorghe L, Iacob S, Csiki E, et al. Prevalence of hepatitis C in Romania: different from European rates? J Hepatol 2008; 49:658 * Gheorghe L, Csiki IE, Iacob S, Gheorghe C, Smira G, Regep L. The prevalence and risk factors of hepatitis C virus infection in adult population in

Romania: a nationwide survey 2006-2008. J Gastrointestin Liver Dis 2010; 19: 373-9;

G1a G1b G1 Total G2 G3 G4 G5 G6

5.4% 92.6% 98.0% 0% 0.8% 1.2%

** Sultana C, Oprisan G, Szmal C, et al. Molecular epidemiology of hepatitis C virus strains from Romania. J Gastrointestin Liver Dis 2011; 20: 261-6.

Year of estimate anti-HCV Prevalence Total Cases

2008 – adults (18-69) 3.2% 529,000

2008 – all ages 3.3% (2.9% - 3.6%) 693,000 (637,000 – 800,000)

Year of estimate anti-HCV Prevalence Total Cases

2008 – all ages 2.7% (2.5% - 3.1%) 589,000 (541,000 – 680,000)

2016 (projected) – all

ages 2.4% (1.9% - 2.7%) 523,000 (418,000 – 571,000)

HCV diagnosis and treatment proportion

in the EU vs Ro 2015

The European Union HCV Collaborators*. Hepatitis C virus prevalence and level of intervention required to achieve the WHO targets for elimination in the Europena Union by 2030: A modelling study. Lancet Gastroenterol Hepatol 2017. Published on line March 14, 2017 http://dx.doi.org/10.1016/S2468-1253(17)30045-6

41.2%

2.4%

Romania 2016

High viremic prevalence (2.54%)

Diagnosis rate: 87,900; 16% of the viremic

population; 7,500 annualy

Treatment rate: ~1.05% annualy with a cure rate

1.46; overall 90,000→<15% of the viremic

population

Model of Cascade of Care in BC, Canada

The continuum of HCV testing, diagnosis,

link to care and treatment

From lessons to action

2016-2017

Decision have been taken:

✓MH-WHO Conference awareness-raising

✓Advisory board and Steering Committee

✓Action plan

✓National Strategy Document ongoing

✓Screening programme to start soon

✓Enhancing care and treatment ongoing

National Action Plan:

Strategic Directions

1. Evidence-based national planning

• Governing structure

• Communication strategy

2. Optimizing interventions

• Prevention

• Testing & diagnosis

• Link to care & enhancing therapy

• A public health approach

• Optimization of services & continuum of hepatitis services

• Universal health coverage

3. Sufficient allocation of regional/national resources

4. Apply innovations along the entire continuum of prevention,

diagnosis, treatment and care services

Strategic National Plan

Tackling

Hepatitis B, C, and D

National strategy

for prevention, control and management

of chronic viral hepatitis

B,C and D

Hepatitis B, C and D

Regional/National

Screening programme

EU Commission - Directorate General Employment,

Social Affairs & Inclusion

OPHC Operational Programme Human Capital

How to improve the Therapy uptake?

Active screening programme

National HCV Registry

Elimination of restricted access

Diagnosed = treated patient (waiting list?)

Instead of conclusions …

WHO-EU Targets scenario calculation for Romania

• Meeting the WHO Targets would require:

• Scaling up treatment to 32,000 patients annually by 2025

• Scaling up diagnosis of new patients to 33,000 annually by 2025

• Treating all fibrosis stages starting in 2018

• High level of treatment efficiency (>95%)

• Efforts to reduce the number of new infections through harm reduction and

treatment as prevention

2015 2016 2017 2018 2020 2025

Treated 3,400 8,100 12,000 15,000 25,000 32,000

Newly Diagnosed 7,500 7,500 10,000 22,000 25,000 33,000

Fibrosis Stage >= F3 >= F3 >= F2 >= F0 >= F0 >= F0

Treated Age 15-74 15-74 15-74 15-74 15-74 15-74

SVR 69% 89% 95% 95% 95% 95%

Instead of conclusions …

In Romania, by 2030,

number of HCV viremic cases will decline by 20%,

while cases of HCC, cirrhosis and liver-related mortality

are projected to increase by 25%, 30% and 30%, respectively

1900

2400

increase by 25% increase by 30%

2700

3400

increase by 30%

650062,900

7500

66,700

Sibley A, Han KH, Abourached A, … Gheorghe L, et al. The present and future disease burden of hepatitis C virus infections with today’s treatment paradigm. J Viral Hepat 2015; 22 (Dec) (Suppl 4):21-41. doi: 10.1111/jvh.12476

decline by 20%