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Original article

Vol. 151 No. 0910 (2021)

Hepatitis C virus elimination in Swiss opioid agonist therapy programmes – the SAMMSU cohort

DOI
https://doi.org/10.4414/smw.2021.20460
Cite this as:
Swiss Med Wkly. 2021;151:w20460
Published
04.03.2021

Summary

BACKGROUND

Hepatitis C virus (HCV) infections in Switzerland are mainly related to intravenous drug use. Since 2017, all patients with chronic hepatitis C can be treated with direct-acting antivirals (DAAs) irrespective of fibrosis stage. In March 2019, the Federal Office of Public Health (FOPH) published guidelines for HCV management in people who use drugs. To achieve HCV elimination by 2030, 80% treatment uptake is necessary.

AIM

To evaluate the benefit of interferon-based and interferon-free HCV treatment in patients on opioid agonist therapy (OAT) and monitor HCV elimination, a 2-year study commissioned by the FOPH and conducted within the Swiss Association for the Medical Management in Substance Users (SAMMSU) cohort was performed.

METHODS

Since 2014, the SAMMSU cohort has recruited OAT patients from eight different centres throughout Switzerland. In addition to yearly follow up, cross-sectional data were collected at the time-points 1 May 2017, 1 May 2018 and 1 May 2019. HCV treatment uptake, adherence and success, as well as reinfection rates, the effect of early versus late treatment and the efficacy of the “treatment-as-prevention” approach were analysed.

RESULTS

Between 1 May 2017 and 1 May 2019, the number of patients enrolled into the SAMMSU cohort increased from 623 to 900: 78% were male, the median age was 45 years, 81% had ever used intravenous drugs, 13% were human immunodeficiency virus (HIV) positive and 66% were HCV antibody positive. HCV treatment up to 2012 was exclusively interferon based (maximum 21 patients/year) and since 2016 exclusively interferon free (102 patients in 2017). Treatment success increased from 57% (112/198; interferon based) to 97% (261/268; interferon free) irrespective of cirrhosis or prior non-response to interferon. Simultaneously, treatments became shorter and better tolerated in the interferon-free era, resulting in fewer preterm stops (17% vs 1%) and adherence problems (9% vs 2%). Between 2015 and 2018, the proportion of patients with no/mild fibrosis (F0/F1) at first HCV treatment increased from 0% to 61%. Earlier treatment reduced the duration of infectiousness. Between 1 May 2017 and 1 May 2019, the proportion of chronic hepatitis C patients ever treated increased from 62% (198/321) to 80% (391/490). In parallel, the HCV-RNA prevalence among HCV antibody-positive patients declined from 36% (139/385) to 19% (113/593). The reinfection rate after successful treatment was 2.7/100 person-years. The number of HCV first diagnoses per year decreased from >20 up to 2015 to <10 in 2017 and 2018.

CONCLUSION

With nearly 100% DAA treatment success and a low reinfection rate, treatment uptake directly translates into a reduction of HCV-RNA prevalence. Eighty percent treatment uptake is feasible in OAT patients, and adherence and treatment success are not worse than in other populations. Duration of infectiousness and thus HCV transmission can be reduced by early detection and treatment of chronic hepatitis C.

References

  1. Richard JL, Schaetti C, Basler S, Mäusezahl M. The epidemiology of hepatitis C in Switzerland: trends in notifications, 1988-2015. Swiss Med Wkly. 2018;148:w14619.
  2. Aaron S, McMahon JM, Milano D, Torres L, Clatts M, Tortu S, et al. Intranasal transmission of hepatitis C virus: virological and clinical evidence. Clin Infect Dis. 2008;47(7):931–4. doi:.https://doi.org/10.1086/591699
  3. Fernandez N, Towers CV, Wolfe L, Hennessy MD, Weitz B, Porter S. Sharing of Snorting Straws and Hepatitis C Virus Infection in Pregnant Women. Obstet Gynecol. 2016;128(2):234–7. doi:.https://doi.org/10.1097/AOG.0000000000001507
  4. Grebely J, Page K, Sacks-Davis R, van der Loeff MS, Rice TM, Bruneau J, et al.; InC3 Study Group. The effects of female sex, viral genotype, and IL28B genotype on spontaneous clearance of acute hepatitis C virus infection. Hepatology. 2014;59(1):109–20. doi:.https://doi.org/10.1002/hep.26639
  5. Edlin BR. Perspective: test and treat this silent killer. Nature. 2011;474(7350):S18–9. doi:.https://doi.org/10.1038/474S18a
  6. Thein HH, Yi Q, Dore GJ, Krahn MD. Estimation of stage-specific fibrosis progression rates in chronic hepatitis C virus infection: a meta-analysis and meta-regression. Hepatology. 2008;48(2):418–31. doi:.https://doi.org/10.1002/hep.22375
  7. Westbrook RH, Dusheiko G. Natural history of hepatitis C. J Hepatol. 2014;61(1, Suppl):S58–68. doi:.https://doi.org/10.1016/j.jhep.2014.07.012
  8. Backus LI, Belperio PS, Shahoumian TA, Mole LA. Direct-acting antiviral sustained virologic response: Impact on mortality in patients without advanced liver disease. Hepatology. 2018;68(3):827–38. doi:.https://doi.org/10.1002/hep.29811
  9. Degenhardt L, Peacock A, Colledge S, Leung J, Grebely J, Vickerman P, 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(12):e1192–207. doi:.https://doi.org/10.1016/S2214-109X(17)30375-3
  10. Zahnd C, Brezzi M, Bertisch B, Giudici F, Keiser O. Analyse de Situation des Hépatites B et C en Suisse. Available from: https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&ved=2ahUKEwiC_KLc0YLnAhXDb1AKHWdQAW0QFjABegQIBxAC&url=https%3A%2F%2Fwww.bag.admin.ch%2Fdam%2Fbag%2Fde%2Fdokumente%2Fmt%2Fforschungsberichte%2Fsituationsanalyse-hepatitis-bericht.pdf.download.pdf%2Fsituationsanalyse-hepatitis-bericht-de.pdf&usg=AOvVaw03m8hsizPqQkqZgnEfZfY_
  11. Cominetti F, Simonson T, Dubois-Arber F, Gervasoni JP, Schaub M, Monnat M. Analyse der Hepatitis-C-Situation bei den drogenkonsumierenden Personen in der Schweiz. Lausanne: Institut universitaire de médecine sociale et préventive; 2015. (Raisons de santé 234b) Available from: https://www.iumsp.ch/Publications/pdf/rds234b_de.pdf
  12. Bundesamt für Gesundheit (BAG). Substitutionsgestützte Behandlungen bei Opioidabhängigkeit. Revision July 2013. Available from: https://www.bag.admin.ch/dam/bag/de/dokumente/npp/drogen/sucht/hegebe/substitutionsgestuetzte-behandlungen-bei-opioid-abhaengigkeit.pdf.download.pdf/BAG_Brosch_SGB_d(5)_def.pdf [accessed: 2020 March 15].
  13. Bundesamt für Gesundheit (BAG). Substitutionsgestützte Behandlungen bei Opioidabhängigkeit (1 July 2019). Available from: https://www.bag.admin.ch/bag/de/home/gesund-leben/sucht-und-gesundheit/suchtberatung-therapie/substitutionsgestuetzte-behandlung.html
  14. Bruggmann P, Blach S, Deltenre P, Fehr J, Kouyos R, Lavanchy D, et al. Hepatitis C virus dynamics among intravenous drug users suggest that an annual treatment uptake above 10% would eliminate the disease by 2030. Swiss Med Wkly. 2017;147:w14543.
  15. Lee R, Kottilil S, Wilson E. Sofosbuvir/velpatasvir: a pangenotypic drug to simplify HCV therapy. Hepatol Int. 2017;11(2):161–70. doi:.https://doi.org/10.1007/s12072-016-9776-8
  16. Puoti M, Foster GR, Wang S, Mutimer D, Gane E, Moreno C, et al. High SVR12 with 8-week and 12-week glecaprevir/pibrentasvir therapy: An integrated analysis of HCV genotype 1-6 patients without cirrhosis. J Hepatol. 2018;69(2):293–300. doi:.https://doi.org/10.1016/j.jhep.2018.03.007
  17. Brown RS, Jr, Buti M, Rodrigues L, Chulanov V, Chuang WL, Aguilar H, et al. Glecaprevir/pibrentasvir for 8 weeks in treatment-naïve patients with chronic HCV genotypes 1-6 and compensated cirrhosis: The EXPEDITION-8 trial. J Hepatol. 2020;72(3):441–9. doi:.https://doi.org/10.1016/j.jhep.2019.10.020
  18. Zeuzem S. Hepatitis-C-Therapie: State of the Art 2018 [Treatment of Hepatitis C: State of the Art 2018]. Dtsch Med Wochenschr. 2018;143(24):1784–8. Article in German. doi:.https://doi.org/10.1055/a-0591-5916
  19. Hickman M, De Angelis D, Vickerman P, Hutchinson S, Martin NK. Hepatitis C virus treatment as prevention in people who inject drugs: testing the evidence. Curr Opin Infect Dis. 2015;28(6):576–82. doi:.https://doi.org/10.1097/QCO.0000000000000216
  20. World Health Organization. Combating hepatitis B and C to reach elimination by 2030 - Advocacy brief (May 2016). Available from: http://apps.who.int/iris/bitstream/10665/206453/1/WHO_HIV_2016.04_eng.pdf [accessed: 2020 Jan 14]
  21. Swiss Hepatitis Strategy 2014-2030. Available from: https://www.hepatitis-schweiz.ch/files/Dokumente/PDF/Process_Paper_14_02_2019.pdf [accessed: 2020 Jan 14]
  22. Bundesrat 2015. Nationale Strategie Sucht 2017-2024. https://www.bag.admin.ch/dam/bag/de/dokumente/npp/strategie-sucht/strategiedokumente/stategie-sucht.pdf.download.pdf/Nationale%20Strategie%20Sucht.pdf [accessed: 2020 Mar 15]
  23. Bundesamt für Gesundheit (BAG). BAG erweitert Vergütung von Medikamenten gegen Hepatitis C (27 Apr 17). Available from: https://www.bag.admin.ch/bag/de/home/das-bag/aktuell/medienmitteilungen.msg-id-66508.html
  24. Bundesamt für Gesundheit (BAG). Hepatitis C: Uneingeschränkte Vergütung der neuen Arzneimittel für alle Betroffenen (25 Sept 2017). Available from: https://www.bag.admin.ch/bag/de/home/das-bag/aktuell/medienmitteilungen.msg-id-68158.html
  25. Bregenzer A, Conen A, Knuchel J, Friedl A, Eigenmann F, Näf M, et al. Management of hepatitis C in decentralised versus centralised drug substitution programmes and minimally invasive point-of-care tests to close gaps in the HCV cascade. Swiss Med Wkly. 2017;147:w14544.
  26. Bundesamt für Gesundheit (BAG). Hepatitis C bei Drogenkonsumierenden: Richtlinien mit settingspezifischen Factsheets (Mar 2019). Available from: https://www.bag.admin.ch/dam/bag/de/dokumente/mt/infektionskrankheiten/hepatitis-c/richtlinien-hepatitis-c-drogen.pdf.download.pdf/richtlinien-hepatitis-c-drogen-de.pdf [accessed: 2020 Jan 14]
  27. Bregenzer A, Bruggmann P, Castro E, Moriggia A, Rothen M, Thurnheer MC, et al. Schweizer OAT-Programme auf ihrem Weg zur HCV-Elimination – Die SAMMSU-Kohorte. Suchtmedizin. 2019;21(2):75–90.
  28. Prasad L, Spicher VM, Zwahlen M, Rickenbach M, Helbling B, Negro F ; Swiss Hepatitis C Cohort Study Group. Cohort Profile: the Swiss Hepatitis C Cohort Study (SCCS). Int J Epidemiol. 2007;36(4):731–7. doi:.https://doi.org/10.1093/ije/dym096
  29. Schoeni-Affolter F, Ledergerber B, Rickenbach M, Rudin C, Günthard HF, Telenti A, et al.; Swiss HIV Cohort Study. Cohort profile: the Swiss HIV Cohort study. Int J Epidemiol. 2010;39(5):1179–89. doi:.https://doi.org/10.1093/ije/dyp321
  30. Castéra L, Vergniol J, Foucher J, Le Bail B, Chanteloup E, Haaser M, et al. Prospective comparison of transient elastography, Fibrotest, APRI, and liver biopsy for the assessment of fibrosis in chronic hepatitis C. Gastroenterology. 2005;128(2):343–50. doi:.https://doi.org/10.1053/j.gastro.2004.11.018
  31. Castera L, Forns X, Alberti A. Non-invasive evaluation of liver fibrosis using transient elastography. J Hepatol. 2008;48(5):835–47. doi:.https://doi.org/10.1016/j.jhep.2008.02.008
  32. Asher AK, Portillo CJ, Cooper BA, Dawson-Rose C, Vlahov D, Page KA. Clinicians’ Views of Hepatitis C Virus Treatment Candidacy With Direct-Acting Antiviral Regimens for People Who Inject Drugs. Subst Use Misuse. 2016;51(9):1218–23. doi:.https://doi.org/10.3109/10826084.2016.1161054
  33. Backmund M, Meyer K, Von Zielonka M, Eichenlaub D. Treatment of hepatitis C infection in injection drug users. Hepatology. 2001;34(1):188–93. doi:.https://doi.org/10.1053/jhep.2001.25882
  34. Belfiori B, Ciliegi P, Chiodera A, Bacosi D, Tosti A, Baldelli F, et al. Peginterferon plus Ribavirin for chronic hepatitis C in opiate addicts on methadone/buprenorphine maintenance therapy. Dig Liver Dis. 2009;41(4):303–7. doi:.https://doi.org/10.1016/j.dld.2008.08.009
  35. Grebely J, deVlaming S, Duncan F, Viljoen M, Conway B. Current approaches to HCV infection in current and former injection drug users. J Addict Dis. 2008;27(2):25–35. doi:.https://doi.org/10.1300/J069v27n02_04
  36. Bruggmann P, Falcato L, Dober S, Helbling B, Keiser O, Negro F, et al.; Swiss Hepatitis C Cohort Study. Active intravenous drug use during chronic hepatitis C therapy does not reduce sustained virological response rates in adherent patients. J Viral Hepat. 2008;15(10):747–52. doi:.https://doi.org/10.1111/j.1365-2893.2008.01010.x
  37. McDermott CL, Lockhart CM, Devine B. Outpatient directly observed therapy for hepatitis C among people who use drugs: a systematic review and meta-analysis. J Virus Erad. 2018;4(2):118–22. doi:.https://doi.org/10.1016/S2055-6640(20)30255-7
  38. Dore GJ, Altice F, Litwin AH, Dalgard O, Gane EJ, Shibolet O, et al.; C-EDGE CO-STAR Study Group. Elbasvir-Grazoprevir to Treat Hepatitis C Virus Infection in Persons Receiving Opioid Agonist Therapy: A Randomized Trial. Ann Intern Med. 2016;165(9):625–34. doi:.https://doi.org/10.7326/M16-0816
  39. Grebely J, Dalgard O, Conway B, Cunningham EB, Bruggmann P, Hajarizadeh B, et al.; SIMPLIFY Study Group. 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(3):153–61. doi:.https://doi.org/10.1016/S2468-1253(17)30404-1
  40. Cunningham EB, Amin J, Feld JJ, Bruneau J, Dalgard O, Powis J, et al.; SIMPLIFY study group. Adherence to sofosbuvir and velpatasvir among people with chronic HCV infection and recent injection drug use: The SIMPLIFY study. Int J Drug Policy. 2018;62:14–23. doi:.https://doi.org/10.1016/j.drugpo.2018.08.013
  41. Cunningham EB, Hajarizadeh B, Amin J, Litwin AH, Gane E, Cooper C, et al.; SIMPLIFY and D3FEAT study groups. Adherence to Once-daily and Twice-daily Direct-acting Antiviral Therapy for Hepatitis C Infection Among People With Recent Injection Drug Use or Current Opioid Agonist Therapy. Clin Infect Dis. 2020;71(7):e115–24. doi:.https://doi.org/10.1093/cid/ciz1089
  42. Christensen S, Buggisch P, Mauss S, Böker KHW, Schott E, Klinker H, et al. Direct-acting antiviral treatment of chronic HCV-infected patients on opioid substitution therapy: Still a concern in clinical practice? Addiction. 2018;113(5):868–82. doi:.https://doi.org/10.1111/add.14128
  43. Wade AJ, Doyle JS, Gane E, Stedman C, Draper B, Iser D, et al. Outcomes of treatment for hepatitis C in primary care compared to hospital-based care: a randomized controlled trial in people who inject drugs. Clin Infect Dis. 2020;70(9):1900–6. doi:.https://doi.org/10.1093/cid/ciz546
  44. Yoshida EM, Sulkowski MS, Gane EJ, Herring RW, Jr, Ratziu V, Ding X, et al. Concordance of sustained virological response 4, 12, and 24 weeks post-treatment with sofosbuvir-containing regimens for hepatitis C virus. Hepatology. 2015;61(1):41–5. doi:.https://doi.org/10.1002/hep.27366
  45. Hajarizadeh B, Cunningham EB, Valerio H, Martinello M, Law M, Janjua NZ, et al. Hepatitis C reinfection after successful antiviral treatment among people who inject drugs: A meta-analysis. J Hepatol. 2020;72(4):643–57. doi:.https://doi.org/10.1016/j.jhep.2019.11.012
  46. Ingiliz P, Wehmeyer MH, Boesecke C, Schulze Zur Wiesch J, Schewe K, Lutz T, et al.; European AIDS Treatment Network (NEAT) Study Group; German Hepatitis C Cohort (GECCO) Study Group. Reinfection With the Hepatitis C Virus in Men Who Have Sex With Men After Successful Treatment With Direct-acting Antivirals in Germany: Current Incidence Rates, Compared With Rates During the Interferon Era. Clin Infect Dis. 2020;71(5):1248–54. doi:.https://doi.org/10.1093/cid/ciz949
  47. Vickerman P, Grebely J, Dore GJ, Sacks-Davis R, Page K, Thomas DL, et al., International Collaboration of Incident HIV and Hepatitis C in Injecting Cohorts (InC3). The more you look, the more you find: effects of hepatitis C virus testing interval on reinfection incidence and clearance and implications for future vaccine study design. J Infect Dis. 2012;205(9):1342–50. doi:.https://doi.org/10.1093/infdis/jis213
  48. Osburn WO, Fisher BE, Dowd KA, Urban G, Liu L, Ray SC, et al. Spontaneous control of primary hepatitis C virus infection and immunity against persistent reinfection. Gastroenterology. 2010;138(1):315–24. doi:.https://doi.org/10.1053/j.gastro.2009.09.017
  49. Vogel M, Page E, Matthews G, et al. The use of Week 4 HCV-RNA after Acute HCV Infection to Predict Chronic HCV (Poster). 17th Conference on Retroviruses and Opportunistic Infections 2010 (CROI)
  50. European AIDS Clinical Society. EACS Guidelines Version 10.0 - November 2019 https://www.eacsociety.org/files/2019_guidelines-10.0_final.pdf
  51. Martinello M, Hajarizadeh B, Grebely J, Dore GJ, Matthews GV. Management of acute HCV infection in the era of direct-acting antiviral therapy. Nat Rev Gastroenterol Hepatol. 2018;15(7):412–24. doi:.https://doi.org/10.1038/s41575-018-0026-5
  52. Artenie AA, Minoyan N, Jacka B, Høj S, Jutras-Aswad D, Roy É, et al. Opioid agonist treatment dosage and patient-perceived dosage adequacy, and risk of hepatitis C infection among people who inject drugs. CMAJ. 2019;191(17):E462–8. doi:.https://doi.org/10.1503/cmaj.181506
  53. Colledge S, Leung J, Larney S, Peacock A, Grebely J, Hickman M, et al. Frequency of injecting among people who inject drugs: A systematic review and meta-analysis. Int J Drug Policy. 2020;76:102619. doi:.https://doi.org/10.1016/j.drugpo.2019.102619
  54. Martin NK, Vickerman P, Grebely J, Hellard M, Hutchinson SJ, Lima VD, et al. Hepatitis C virus treatment for prevention among people who inject drugs: Modeling treatment scale-up in the age of direct-acting antivirals. Hepatology. 2013;58(5):1598–609. doi:.https://doi.org/10.1002/hep.26431
  55. Bundesamt für Gesundheit (BAG). Hepatitis C in der Schweiz, epidemiologische Situation 2015–2018. Bull BAG 2019;45:12–24; Available from: https://www.bag.admin.ch/dam/bag/de/dokumente/mt/infektionskrankheiten/hepatitis-c/hepatitis-c-epidemiologie-2015-18.pdf.download.pdf/hepatitis-c-epidemiologie-2015-18-de.pdf [accessed: 2020 Nov 30]
  56. Saag MS, Benson CA, Gandhi RT, Hoy JF, Landovitz RJ, Mugavero MJ, et al. Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults: 2018 Recommendations of the International Antiviral Society-USA Panel. JAMA. 2018;320(4):379–96. doi:.https://doi.org/10.1001/jama.2018.8431
  57. UNAIDS. 90–90–90—An ambitious treatment target to help end the AIDS epidemic. 2014. https://www.unaids.org/sites/default/files/media_asset/90-90-90_en.pdf [accessed: 2020 Mar 10]
  58. Coutinho RA. HIV and hepatitis C among injecting drug users. BMJ. 1998;317(7156):424–5. doi:.https://doi.org/10.1136/bmj.317.7156.424
  59. Hellard M, Rolls DA, Sacks-Davis R, Robins G, Pattison P, Higgs P, et al. The impact of injecting networks on hepatitis C transmission and treatment in people who inject drugs. Hepatology. 2014;60(6):1861–70. doi:.https://doi.org/10.1002/hep.27403
  60. Katzman C, Mateu-Gelabert P, Kapadia SN, Eckhardt BJ. Contact tracing for hepatitis C: The case for novel screening strategies as we strive for viral elimination. Int J Drug Policy. 2019;72:33–9. doi:.https://doi.org/10.1016/j.drugpo.2019.04.003
  61. Lamoury FMJ, Bajis S, Hajarizadeh B, Marshall AD, Martinello M, Ivanova E, et al.; LiveRLife Study Group. Evaluation of the Xpert HCV Viral Load Finger-Stick Point-of-Care Assay. J Infect Dis. 2018;217(12):1889–96. doi:.https://doi.org/10.1093/infdis/jiy114
  62. Cooper C. Rapid HCV RNA testing: removing the final obstacle to elimination. Lancet Gastroenterol Hepatol. 2017;2(7):468–9. doi:.https://doi.org/10.1016/S2468-1253(17)30086-9
  63. Bregenzer A, Warmann N, Ottiger C, Fux CA. Rapid point-of-care HCV RNA quantification in capillary whole blood for diagnosing chronic HCV infection, monitoring treatment and detecting reinfection. Swiss Med Wkly. 2019;149:w20137. doi:.https://doi.org/10.4414/smw.2019.20137
  64. Bajis S, Maher L, Treloar C, Hajarizadeh B, Lamoury FMJ, Mowat Y, et al.; LiveRLife Study Group. Acceptability and preferences of point-of-care finger-stick whole-blood and venepuncture hepatitis C virus testing among people who inject drugs in Australia. Int J Drug Policy. 2018;61:23–30. doi:.https://doi.org/10.1016/j.drugpo.2018.08.011
  65. Wlassow M, Poiteau L, Roudot-Thoraval F, Rosa I, Soulier A, Hézode C, et al. The new Xpert HCV viral load real-time PCR assay accurately quantifies hepatitis C virus RNA in serum and whole-blood specimens. J Clin Virol. 2019;117:80–4. doi:.https://doi.org/10.1016/j.jcv.2019.06.007
  66. Shaheen AA, Myers RP. Diagnostic accuracy of the aspartate aminotransferase-to-platelet ratio index for the prediction of hepatitis C-related fibrosis: a systematic review. Hepatology. 2007;46(3):912–21. doi:.https://doi.org/10.1002/hep.21835
  67. The Kirby Institute. Monitoring hepatitis C treatment uptake in Australia (Issue 10). The Kirby Institute, UNSW Sydney, NSW, Australia, June 2019, Available from: https://kirby.unsw.edu.au/report/monitoring-hepatitis-c-treatment-uptake-australia-issue-10-june-2019 [accessed: 2020 Dec 01]
  68. Loustaud-Ratti V, Debette-Gratien M, Carrier P. European Association for the Study of the Liver and French hepatitis C recent guidelines: The paradigm shift. World J Hepatol. 2018;10(10):639–44. doi:.https://doi.org/10.4254/wjh.v10.i10.639
  69. Palmer AY, Wade AJ, Draper B, Howell J, Doyle JS, Petrie D, et al. A cost-effectiveness analysis of primary versus hospital-based specialist care for direct acting antiviral hepatitis C treatment. Int J Drug Policy. 2020;76:102633. doi:.https://doi.org/10.1016/j.drugpo.2019.102633
  70. Bundesamt für Statistik. Hauptsprache der ständigen Wohnbevölkerung 2017; https://www.bfs.admin.ch/bfs/de/home/statistiken/bevoelkerung/sprachen-religionen/sprachen.html (published: 29 Jan 2019)
  71. Schürch S, Fux CA, Dehler S, Conen A, Knuchel J, Friedl A, et al. Management of hepatitis C in opioid agonist therapy patients of the Swiss canton Aargau within and outside the cohort study. Swiss Med Wkly. 2020;150:w20317. doi:.https://doi.org/10.4414/smw.2020.20317

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