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Original article

Vol. 152 No. 4950 (2022)

HCV elimination in a Swiss opioid agonist therapy programme – a cohort study

  • Andrea Bregenzer
  • Cornelia Krismer
  • Stefanie Wendel
  • Patrik Roser
  • Christoph A. Fux
DOI
https://doi.org/10.57187/smw.2022.40009
Cite this as:
Swiss Med Wkly. 2022;152:40009
Published
09.12.2022

Summary

BACKGROUND: In opioid agonist therapy (OAT) programmes, chronic hepatitis C is highly prevalent and directly observed therapy guarantees optimal adherence. Since 2017, all patients with chronic hepatitis C in Switzerland can be treated with pangenotypic direct-acting antivirals irrespective of liver fibrosis stage. Until the end of 2021, however, prescription was restricted to infectious disease specialists, gastroenterologists and certain addiction specialists. Difficult venous access after long-term intravenous drug use and, in the case of referral to a specialist, difficulties keeping appointments are barriers to HCV diagnosis and treatment.

AIMS: To assess whether minimally invasive point-of-care tests and a “test-and-treat / vaccinate on-site” approach can improve human immunodeficiency virus (HIV) / hepatitis C virus (HCV) screening, HCV treatment uptake and immunity against hepatitis A/B.

METHODS: Since September 2018, an infectious disease specialist and a study nurse performed 4-weekly visits in the OAT programme “HAG” (heroin dispensation of the canton Aargau), offering HIV/HCV antibody rapid testing (20 min) and HCV RNA quantification (GeneXpert®, 60 min) from capillary blood, noninvasive liver fibrosis assessment (Fibroscan®, 5–10 min) and HCV treatment prescription on-site. Recommended venous blood draws for HAV/HBV serology and HAV/HBV vaccinations were performed by the staff of the “HAG”. Project performance was assessed by annual cross-sectional chart review.

RESULTS: Of the 128 patients registered in April 2018, 79 (62%) were still present in May 2021. With 72 newly registered, a total of 200 patients could be assessed, of whom 129 (65%) were still present in May 2021. Between April 2018 and May 2021, the proportion ever tested for HIV antibodies increased from 79% (101/128) to 91% (117/129), the proportion ever tested for HCV antibodies from 83% (106/128) to 93% (120/129) and the proportion of those HCV antibody positive ever tested for HCV RNA tested from 89% (47/53) to 98% (56/57). The proportion with adequate HCV management (last HCV antibody test ≤1 year ago, if HCV antibody negative or last HCV RNA test ≤1 year ago, if HCV antibody-positive and RNA-negative) improved from 23% ([15 + 15]/128) to 80% ([55 + 48]/129). Overall, HCV treatment uptake increased from 60% (21/35) to 92% (55/60) and HCV RNA prevalence among the HCV antibody positives decreased from 38% (18/47) to 7% (6/84). Between 2018 and 2021, 19 non-cirrhotic chronic hepatitis C patients were successfully treated on-site (18 sustained virological responses [SVR] 12, 1 SVR4), with excellent adherence (≥93%) and, so far, no reinfection. The proportion with known HAV/HBV serostatus increased from 38%/51% to 64%/76%. Immunity against HAV/HBV improved from 19%/23% to 50%/57%.

CONCLUSION: Capillary blood point-of-care tests and a “test-and-treat / vaccinate on-site” approach remove crucial barriers to diagnosis and treatment, making hepatitis elimination in OAT programmes achievable. A high fluctuation rate requires HIV/HCV/HAV/HBV testing at admission, but also allows more patients to be screened.

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 Apr;148:w14619.29698546
  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 Oct;47(7):931–4. https://doi.org/10.1086/591699 18764772 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 Aug;128(2):234–7. https://doi.org/10.1097/AOG.0000000000001507 27400008 DOI: https://doi.org/10.1097/AOG.0000000000001507
  4. Bihl F, Bruggmann P, Castro Batänjer E, Dufour JF, Lavanchy D, Müllhaupt B, et al. HCV disease burden and population segments in Switzerland. Liver Int. 2022 Feb;42(2):330–9. https://doi.org/10.1111/liv.15111 34839578 DOI: https://doi.org/10.1111/liv.15111
  5. BAG-Bulletin 45/2019 (4.11.2019). Hepatitis C in der Schweiz, epidemiologische Situation 2015-2018. Available from: https://www.bag.admin.ch/dam/bag/de/dokumente/mt/infektionskrankheiten/hepatitis-c/hepatitis-c-epidemiologie-2015-18.pdf (Accessed: 9 June 2022)
  6. BAG. 2013. Substitutionsgestützte Behandlung bei Opioidabhängigkeit. Revision 2013. Empfehlungen des Bundesamtes für Gesundheit (BAG), der Schweizerischen Gesellschaft für Suchtmedizin (SSAM), der Vereinigung der Kantonsärztinnen und Kantonsärzte Schweiz (VKS). Available from: https://www.bag.admin.ch/dam/bag/de/dokumente/npp/sucht/hegebe/substitutionsgestuetzte-behandlungen-bei-opioid-abhaengigkeit.pdf.download.pdf/BAG_Brosch_SGB_d(5)_def.pdf (Accessed: 9 June 2022)
  7. Bundesamt für Gesundheit (BAG). Substitutionsgestützte Behandlungen bei Opioidabhängigkeit (9.3.2022). Available from: https://www.bag.admin.ch/bag/de/home/gesund-leben/sucht-und-gesundheit/suchtberatung-therapie/substitutionsgestuetzte-behandlung.html (Accessed: 9 June 2022)
  8. Cominetti F, Simonson T, Dubois-Arber F, Gervasoni JP. IUMSP, Schaub M., ISGF, Monnat M., SSP. Analyse der Hepatitis-C-Situation bei den drogenkonsumierenden Personen in der Schweiz. Lausanne, Institut universitaire de médecine sociale et préventive, 2014. (Raisons de santé 234b) Available from: https://www.aramis.admin.ch/Default?DocumentID=14464&Load=true (Accessed: 9 June 2022)
  9. Zahnd C, Brezzi M, Bertisch B, Giudici F, Keiser O. Analyse de Situation des Hépatites B et C en Suisse (23.3.2017). Available from: https://www.bag.admin.ch/dam/bag/de/dokumente/mt/forschungsberichte/situationsanalyse-hepatitis-bericht.pdf.download.pdf/situationsanalyse-hepatitis-bericht-de.pdf (Accessed: 9 June 2022)
  10. 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 Nov;147:w14543. https://doi.org/10.4414/smw.2017.14543 29120012 1424-3997 DOI: https://doi.org/10.4414/smw.2017.14543
  11. Nationale Substitutionsstatistik. Jährliche Statistik. Schweiz - 2020. Available from: https://www.substitution.ch/de/jahrliche_statistik.html&year=2020&canton=ch (Accessed: 9 June 2022)
  12. Nationale Substitutionsstatistik. Jährliche Statistik. Aargau - 2020. Available from: https://www.substitution.ch/de/jahrliche_statistik.html&year=2020&canton=ag (Accessed: 9 June 2022)
  13. 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 Jan;59(1):109–20. https://doi.org/10.1002/hep.26639 23908124 DOI: https://doi.org/10.1002/hep.26639
  14. 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 Aug;48(2):418–31. https://doi.org/10.1002/hep.22375 18563841 DOI: https://doi.org/10.1002/hep.22375
  15. Westbrook RH, Dusheiko G. Natural history of hepatitis C. J Hepatol. 2014 Nov;61(1 Suppl):S58–68. https://doi.org/10.1016/j.jhep.2014.07.012 25443346 DOI: https://doi.org/10.1016/j.jhep.2014.07.012
  16. WHO. 2021. Fact-sheet Hepatitis C (27 July 2021). Available from: https://www.who.int/news-room/fact-sheets/detail/hepatitis-c (Accessed: 11 June 2022)
  17. Evon DM, Stewart PW, Amador J, Serper M, Lok AS, Sterling RK, et al. A comprehensive assessment of patient reported symptom burden, medical comorbidities, and functional well being in patients initiating direct acting antiviral therapy for chronic hepatitis C: results from a large US multi-center observational study. PLoS One. 2018 Aug;13(8):e0196908. https://doi.org/10.1371/journal.pone.0196908 30067745 DOI: https://doi.org/10.1371/journal.pone.0196908
  18. Edlin BR. Perspective: test and treat this silent killer. Nature. 2011 May;474(7350):S18–9. https://doi.org/10.1038/474S18a 21613999 1476-4687 DOI: https://doi.org/10.1038/474S18a
  19. Page K, Melia MT, Veenhuis RT, Winter M, Rousseau KE, Massaccesi G, et al. Randomized Trial of a Vaccine Regimen to Prevent Chronic HCV Infection. N Engl J Med. 2021 Feb;384(6):541–9. https://doi.org/10.1056/NEJMoa2023345 33567193 DOI: https://doi.org/10.1056/NEJMoa2023345
  20. Hartlage AS, Kapoor A, Hepatitis C. Hepatitis C Virus Vaccine Research: Time to Put Up or Shut Up. Viruses. 2021 Aug;13(8):1596. https://doi.org/10.3390/v13081596 34452460 DOI: https://doi.org/10.3390/v13081596
  21. van Heuvel Y, Schatz S, Rosengarten JF, Stitz J. Infectious RNA: Human Immunodeficiency Virus (HIV) Biology, Therapeutic Intervention, and the Quest for a Vaccine. Toxins (Basel). 2022 Feb;14(2):138. https://doi.org/10.3390/toxins14020138 35202165 DOI: https://doi.org/10.3390/toxins14020138
  22. Herzig M, Wolf M. Inside Switzerland’s Radical Drug Policy Innovation. Stanford Social Innovation Review 2019. Available from: https://doi.org/10.48558/MQWP-3277 (Accessed: 9 June 2022)
  23. Uchtenhagen A. Heroin-assisted treatment in Switzerland: a case study in policy change. Addiction. 2010 Jan;105(1):29–37. https://doi.org/10.1111/j.1360-0443.2009.02741.x 19922519 DOI: https://doi.org/10.1111/j.1360-0443.2009.02741.x
  24. Somaini B, Wang J, Perozo M, Kuhn F, Meili D, Grob P, et al. A continuing concern: HIV and hepatitis testing and prevalence among drug users in substitution programmes in Zurich, Switzerland. AIDS Care. 2000 Aug;12(4):449–60. https://doi.org/10.1080/09540120050123855 11091778 DOI: https://doi.org/10.1080/09540120050123855
  25. Van Den Berg C, Smit C, Van Brussel G, Coutinho R, Prins M ; Amsterdam Cohort. Full participation in harm reduction programmes is associated with decreased risk for human immunodeficiency virus and hepatitis C virus: evidence from the Amsterdam Cohort Studies among drug users. Addiction. 2007 Sep;102(9):1454–62. https://doi.org/10.1111/j.1360-0443.2007.01912.x 17697278 DOI: https://doi.org/10.1111/j.1360-0443.2007.01912.x
  26. van Santen DK, Boyd A, Matser A, Maher L, Hickman M, Lodi S, et al. The effect of needle and syringe program and opioid agonist therapy on the risk of HIV, hepatitis B and C virus infection for people who inject drugs in Amsterdam, the Netherlands: findings from an emulated target trial. Addiction. 2021 Nov;116(11):3115–26. https://doi.org/10.1111/add.15503 33788326 DOI: https://doi.org/10.1111/add.15503
  27. Puzhko S, Eisenberg MJ, Filion KB, Windle SB, Hébert-Losier A, Gore G, et al. Effectiveness of Interventions for Prevention of Common Infections Among Opioid Users: A Systematic Review of Systematic Reviews. Front Public Health. 2022 Feb;10:749033. https://doi.org/10.3389/fpubh.2022.749033 35273933 DOI: https://doi.org/10.3389/fpubh.2022.749033
  28. Platt L, Minozzi S, Reed J, Vickerman P, Hagan H, French C, et al. Needle syringe programmes and opioid substitution therapy for preventing hepatitis C transmission in people who inject drugs. Cochrane Database Syst Rev. 2017 Sep;9(9):CD012021. https://doi.org/10.1002/14651858.CD012021.pub2 28922449 DOI: https://doi.org/10.1002/14651858.CD012021.pub2
  29. Thompson MA, Aberg JA, Hoy JF, Telenti A, Benson C, Cahn P, et al. Antiretroviral treatment of adult HIV infection: 2012 recommendations of the International Antiviral Society-USA panel. JAMA. 2012 Jul;308(4):387–402. https://doi.org/10.1001/jama.2012.7961 22820792 DOI: https://doi.org/10.1001/jama.2012.7961
  30. Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al.; HPTN 052 Study Team. Antiretroviral Therapy for the Prevention of HIV-1 Transmission. N Engl J Med. 2016 Sep;375(9):830–9. https://doi.org/10.1056/NEJMoa1600693 27424812 DOI: https://doi.org/10.1056/NEJMoa1600693
  31. Baral S, Rao A, Sullivan P, Phaswana-Mafuya N, Diouf D, Millett G, et al. The disconnect between individual-level and population-level HIV prevention benefits of antiretroviral treatment. Lancet HIV. 2019 Sep;6(9):e632–8. https://doi.org/10.1016/S2352-3018(19)30226-7 31331822 DOI: https://doi.org/10.1016/S2352-3018(19)30226-7
  32. Saag MS, Gandhi RT, Hoy JF, Landovitz RJ, Thompson MA, Sax PE, et al. Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults: 2020 Recommendations of the International Antiviral Society-USA Panel. JAMA. 2020 Oct;324(16):1651–69. https://doi.org/10.1001/jama.2020.17025 33052386 DOI: https://doi.org/10.1001/jama.2020.17025
  33. Bregenzer A, Bruggmann P, Castro E, Moriggia A, Rothen M, Thurnheer MC, et al. Hepatitis C virus elimination in Swiss opioid agonist therapy programmes - the SAMMSU cohort. Swiss Med Wkly. 2021 Mar;151:w20460. https://doi.org/10.4414/smw.2021.20460 33705563 DOI: https://doi.org/10.4414/smw.2021.20460
  34. Martin NK, Hickman M, Hutchinson SJ, Goldberg DJ, Vickerman P. Combination interventions to prevent HCV transmission among people who inject drugs: modeling the impact of antiviral treatment, needle and syringe programs, and opiate substitution therapy. Clin Infect Dis 2013;57 Suppl 2(Suppl 2):S39-45 DOI: https://doi.org/10.1093/cid/cit296
  35. 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 (Accessed: 10 June 2022)
  36. 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 (Accessed: 10 June 2022)
  37. Chahine EB, Sucher AJ, Hemstreet BA. Sofosbuvir/Velpatasvir: The First Pangenotypic Direct-Acting Antiviral Combination for Hepatitis C. Ann Pharmacother. 2017 Jan;51(1):44–53. https://doi.org/10.1177/1060028016668897 27609942 DOI: https://doi.org/10.1177/1060028016668897
  38. 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 Aug;69(2):293–300. https://doi.org/10.1016/j.jhep.2018.03.007 29551706 DOI: https://doi.org/10.1016/j.jhep.2018.03.007
  39. 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 Mar;72(3):441–9. https://doi.org/10.1016/j.jhep.2019.10.020 31682879 DOI: https://doi.org/10.1016/j.jhep.2019.10.020
  40. Aghemo A, Colombo M. Glecaprevir/Pibrentasvir: The Final Piece in the Hepatitis C Virus Treatment Puzzle? Gastroenterology. 2018 Mar;154(4):1195–6. https://doi.org/10.1053/j.gastro.2018.01.035 29406265 DOI: https://doi.org/10.1053/j.gastro.2018.01.035
  41. Moradpour D, Fehr J, Semela D, Rauch A, Müllhaupt B. Treatment of Chronic Hepatitis C - January 2021 Update. Expert Opinion Statement by SASL, SSG and SSI. Available from: https://www.sginf.ch/files/sasl-ssg-ssi_eos_hepc_jan2021_1.pdf (Accessed: 10 June 2022)
  42. Hepatitis Schweiz. News (17.01.2022). Neu können Hepatitis-C-Medikamente auch von Hausärzt:innen verschrieben werden. Available from: https://hepatitis-schweiz.ch/news/neu-koennen-hepatitis-c-medikamente-auch-von-hausaerztinnen-verschrieben-werden (Accessed: 10 June 2022)
  43. Bundesamt für Gesundheit (BAG)→Versicherungen→Krankenversicherung→Leistungen und Tarife→Arzneimittel→Referenzdokumente zur Spezialitätenliste→Liste der Ärzte mit Erfahrung in Suchtmedizin und in der Behandlung von chronischer Hepatitis C (01.12.2021). Available from: https://www.bag.admin.ch/dam/bag/de/dokumente/kuv-leistungen/arzneimittel/liste-der-aerzte-mit-erfahrung-in-suchtmedizin-und-in-der-behandlung-von-chronischer-hepatitis-c.pdf (Accessed: 10 June 2022)
  44. 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 Nov;147:w14544.29185250 DOI: https://doi.org/10.4414/smw.2017.14544
  45. 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 Aug;150:w20317. https://doi.org/10.4414/smw.2020.20317 32799310 DOI: https://doi.org/10.4414/smw.2020.20317
  46. 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 Oct;149:w20137. https://doi.org/10.4414/smw.2019.20137 31656039 DOI: https://doi.org/10.4414/smw.2019.20137
  47. Bregenzer A, Ottiger C, Krismer C, Sager K, Fux CA. HCV RNA quantification in capillary dried blood spots with the Xpert® HCV Viral Load test for diagnosing chronic HCV infection, monitoring treatment and detecting reinfection. Swiss Med Wkly. 2021 Dec;151:w30089.34964589 DOI: https://doi.org/10.4414/SMW.2021.w30089
  48. News NB. (22 February 2011). OraSure Technologies Receives FDA Approval for Its OraQuick(R) HCV Rapid Test Using Fingerstick Whole Blood. Available from: https://www.nbcnews.com/id/wbna41713925 (Accessed: 10 June 2022)
  49. Lee SR, Kardos KW, Schiff E, Berne CA, Mounzer K, Banks AT, et al. Evaluation of a new, rapid test for detecting HCV infection, suitable for use with blood or oral fluid. J Virol Methods. 2011 Mar;172(1-2):27–31. https://doi.org/10.1016/j.jviromet.2010.12.009 21182871 DOI: https://doi.org/10.1016/j.jviromet.2010.12.009
  50. Smookler D, Vanderhoff A, Biondi MJ, Valencia J, Ryan P, Karkada J, et al. Reducing Read Time of Point-of-Care Test Does Not Affect Detection of Hepatitis C Virus and Reduces Need for Reflex RNA. Clin Gastroenterol Hepatol. 2021 Jul;19(7):1451–1458.e4. https://doi.org/10.1016/j.cgh.2020.07.058 32763480 1542-7714 DOI: https://doi.org/10.1016/j.cgh.2020.07.058
  51. Lamoury FM, 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 May;217(12):1889–96. https://doi.org/10.1093/infdis/jiy114 29534185 1537-6613 DOI: https://doi.org/10.1093/infdis/jiy114
  52. Cooper CL. Now Is the Time to Quickly Eliminate Barriers Along the Hepatitis C Cascade of Care. J Infect Dis. 2018 May;217(12):1858–60. https://doi.org/10.1093/infdis/jiy117 29534217 DOI: https://doi.org/10.1093/infdis/jiy117
  53. 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 (Accessed: 10 June 2022)
  54. Bruggmann P, Broers B, Meili D. Hepatitis C-Therapie bei Patienten unter Opioidsusbstitution. Empfehlungen der Schweizerischen Gesellschaft für Suchtmedizin (SSAM). Schweiz Med Forum 2007;7:916-919 DOI: https://doi.org/10.4414/fms.2007.06330
  55. Grebely J, Robaeys G, Bruggmann P, Aghemo A, Backmund M, Bruneau J, et al.; International Network for Hepatitis in Substance Users. Recommendations for the management of hepatitis C virus infection among people who inject drugs. Int J Drug Policy. 2015 Oct;26(10):1028–38. https://doi.org/10.1016/j.drugpo.2015.07.005 26282715 DOI: https://doi.org/10.1016/j.drugpo.2015.07.005
  56. World Health Organization (WHO). 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: 10 June 2022)
  57. Swiss Hepatitis. 2019. Swiss Hepatitis Strategy 2014-2030, Process Paper - A Living Document. January 2019, Version 4. Available from: https://hepatitis-schweiz.ch/data/download/2871/Process_Paper_14_02_2019.pdf (Accessed: 10 June 2022)
  58. European AIDS Clinical Society (EACS) Guidelines Version 11.0, October 2021, Available from: https://www.eacsociety.org/media/final2021eacsguidelinesv11.0_oct2021.pdf (Accessed: 11 June 2022)
  59. Vogel M, Page E, Matthews G, Guiguet M, Dominguez S, Dore G, et al. Use of week 4 HCV RNA after acute HCV infection to predict chronic hcv infection [abstract 640]. In: 17th Conference on Retroviruses and Opportunistic Infections; 16-19 February 2010; San Francisco, California, USA.
  60. 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 Jul;15(7):412–24. https://doi.org/10.1038/s41575-018-0026-5 29773899 DOI: https://doi.org/10.1038/s41575-018-0026-5
  61. 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 Jan;61(1):41–5. https://doi.org/10.1002/hep.27366 25314116 DOI: https://doi.org/10.1002/hep.27366
  62. 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 Feb;128(2):343–50. https://doi.org/10.1053/j.gastro.2004.11.018 15685546 DOI: https://doi.org/10.1053/j.gastro.2004.11.018
  63. Castera L, Forns X, Alberti A. Non-invasive evaluation of liver fibrosis using transient elastography. J Hepatol. 2008 May;48(5):835–47. https://doi.org/10.1016/j.jhep.2008.02.008 18334275 DOI: https://doi.org/10.1016/j.jhep.2008.02.008
  64. 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 Sep;46(3):912–21. https://doi.org/10.1002/hep.21835 17705266 DOI: https://doi.org/10.1002/hep.21835
  65. Cunningham EB, Wheeler A, Hajarizadeh B, French CE, Roche R, Marshall AD, et al. Interventions to enhance testing, linkage to care, and treatment initiation for hepatitis C virus infection: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2022 May;7(5):426–45. https://doi.org/10.1016/S2468-1253(21)00471-4 35303490 DOI: https://doi.org/10.1016/S2468-1253(21)00471-4
  66. Oru E, Trickey A, Shirali R, Kanters S, Easterbrook P. Decentralisation, integration, and task-shifting in hepatitis C virus infection testing and treatment: a global systematic review and meta-analysis. Lancet Glob Health. 2021 Apr;9(4):e431–45. https://doi.org/10.1016/S2214-109X(20)30505-2 33639097 DOI: https://doi.org/10.1016/S2214-109X(20)30505-2
  67. 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 Mar;3(3):153–61. https://doi.org/10.1016/S2468-1253(17)30404-1 29310928 DOI: https://doi.org/10.1016/S2468-1253(17)30404-1
  68. 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 Dec;62:14–23. https://doi.org/10.1016/j.drugpo.2018.08.013 30352330 DOI: https://doi.org/10.1016/j.drugpo.2018.08.013
  69. 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 Oct;71(7):e115–24. https://doi.org/10.1093/cid/ciz1089 31677262 DOI: https://doi.org/10.1093/cid/ciz1089
  70. 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 Apr;72(4):643–57. https://doi.org/10.1016/j.jhep.2019.11.012 31785345 DOI: https://doi.org/10.1016/j.jhep.2019.11.012
  71. Akiyama MJ, Lipsey D, Heo M, Agyemang L, Norton BL, Hidalgo J, et al. Low Hepatitis C Reinfection Following Direct-acting Antiviral Therapy Among People Who Inject Drugs on Opioid Agonist Therapy. Clin Infect Dis. 2020 Jun;70(12):2695–702. https://doi.org/10.1093/cid/ciz693 31346609 DOI: https://doi.org/10.1093/cid/ciz693
  72. Falcato L, Bernardini C, Bruggmann P. Hepatitis C reinfection following successful direct-acting antiviral therapy among patients attending a multidisciplinary treatment centre for people who use drugs in Zurich, Switzerland. Int J Drug Policy. 2021 Oct;96:103434. https://doi.org/10.1016/j.drugpo.2021.103434 34511311 DOI: https://doi.org/10.1016/j.drugpo.2021.103434
  73. Cunningham EB, Hajarizadeh B, Amin J, Hellard M, Bruneau J, Feld JJ, et al. Reinfection Following Successful Direct-acting Antiviral Therapy for Hepatitis C Virus Infection Among People Who Inject Drugs. Clin Infect Dis. 2021 Apr;72(8):1392–400. https://doi.org/10.1093/cid/ciaa253 32166305 DOI: https://doi.org/10.1093/cid/ciaa253
  74. Barocas JA. It’s Not Them, It’s Us: Hepatitis C Reinfection Following Successful Treatment Among People Who Inject Drugs. Clin Infect Dis. 2021 Apr;72(8):1401–3. https://doi.org/10.1093/cid/ciaa258 32166311 DOI: https://doi.org/10.1093/cid/ciaa258
  75. Bregenzer A, Scheidegger C. Hepatitis C bei Drogenkonsumierenden im Rahmen der SAMMSU-Kohorte. Abschlussbericht 2022. Im Auftrag des Bundesamtes für Gesundheit (BAG). https://www.aramis.admin.ch/Grunddaten/?ProjectID=45343 (Accessed: 11 June 2022)
  76. 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 Aug;71(5):1248–54. https://doi.org/10.1093/cid/ciz949 31562816 DOI: https://doi.org/10.1093/cid/ciz949
  77. Carson JM, Hajarizadeh B, Hanson J, O’Beirne J, Iser D, Read P, et al.; REACH-C Study Group. Effectiveness of treatment for hepatitis C virus reinfection following direct acting antiviral therapy in the REACH-C cohort. Int J Drug Policy. 2021 Oct;96:103422. https://doi.org/10.1016/j.drugpo.2021.103422 34426040 DOI: https://doi.org/10.1016/j.drugpo.2021.103422
  78. Safreed-Harmon K, Blach S, Aleman S, Bollerup S, Cooke G, Dalgard O, et al. The Consensus Hepatitis C Cascade of Care: Standardized Reporting to Monitor Progress Toward Elimination. Clin Infect Dis. 2019 Nov;69(12):2218–27. https://doi.org/10.1093/cid/ciz714 31352481 DOI: https://doi.org/10.1093/cid/ciz714
  79. Beck T, Bruggmann P, Haemmig R, Caflisch C, Falcato L, Fink A, et al. Medizinische Empfehlungen für Opioidagonistentherapie (OAT) bei Opioidabhängigkeits-Syndrom 2020. Bern: SSAM; 2020. Available from: https://www.ssam-sapp.ch/fachleute/empfehlungen/opioidagonistentherapie-oat (Accessed: 11 June 2022)
  80. Witteck A, Schmid P, Hensel-Koch K, Thurnheer MC, Bruggmann P, Vernazza P ; Swiss Hepatitis C and HIV Cohort Studies. Management of hepatitis C virus (HCV) infection in drug substitution programs. Swiss Med Wkly. 2011 May;141:w13193. https://doi.org/10.4414/smw.2011.13193 21623473 DOI: https://doi.org/10.4414/smw.2011.13193
  81. Iakunchykova O, Meteliuk A, Zelenev A, Mazhnaya A, Tracy M, Altice FL. Hepatitis C virus status awareness and test results confirmation among people who inject drugs in Ukraine. Int J Drug Policy. 2018 Jul;57:11–7. https://doi.org/10.1016/j.drugpo.2018.03.022 29655101 DOI: https://doi.org/10.1016/j.drugpo.2018.03.022
  82. Yeung A, Palmateer NE, Dillon JF, McDonald SA, Smith S, Barclay S, et al. Population-level estimates of hepatitis C reinfection post scale-up of direct-acting antivirals among people who inject drugs. J Hepatol. 2022 Mar;76(3):549–57. https://doi.org/10.1016/j.jhep.2021.09.038 34634387 DOI: https://doi.org/10.1016/j.jhep.2021.09.038
  83. Biotech CT. Home / Product Line / Rapid Tests / Hepatitis / HAV IgG/IgM Rapid Test CE. Available from: https://ctkbiotech.com/product/hav-igg-igm-rapid-test-ce/ (Accessed: 11 June 2022)
  84. Abbott. Determine™ HBsAg 2. Der diagnostische Schnelltest mit der weltweit höchsten Sensitivität zum Nachweis des Hepatitis-B-Oberflächenantigens aus Serum-, Plasma oder Vollblutproben. Available from: https://www.globalpointofcare.abbott/de/product-details/determine-hbsag-2.html (Accessed: 11 June 2022)
  85. Amini A, Varsaneux O, Kelly H, Tang W, Chen W, Boeras DI, et al. Diagnostic accuracy of tests to detect hepatitis B surface antigen: a systematic review of the literature and meta-analysis. BMC Infect Dis. 2017 Nov;17(S1 Suppl 1):698. https://doi.org/10.1186/s12879-017-2772-3 29143619 DOI: https://doi.org/10.1186/s12879-017-2772-3
  86. Poiteau L, Soulier A, Roudot-Thoraval F, Hézode C, Challine D, Pawlotsky JM, et al. Performance of rapid diagnostic tests for the detection of anti-HBs in various patient populations. J Clin Virol. 2017 Nov;96:64–6. https://doi.org/10.1016/j.jcv.2017.09.012 28982043 DOI: https://doi.org/10.1016/j.jcv.2017.09.012
  87. Xiao Y, Thompson AJ, Howell J. Point-of-Care Tests for Hepatitis B: an Overview. Cells. 2020 Oct;9(10):2233. https://doi.org/10.3390/cells9102233 33023265 DOI: https://doi.org/10.3390/cells9102233
  88. El-Ghitany EM, Farghaly AG. Evaluation of commercialized rapid diagnostic testing for some Hepatitis B biomarkers in an area of intermediate endemicity. J Virol Methods. 2013 Dec;194(1-2):190–3. https://doi.org/10.1016/j.jviromet.2013.08.026 24004823 DOI: https://doi.org/10.1016/j.jviromet.2013.08.026
  89. Wu FY, Liao YW, Wu JF, Chen HL, Hsu HY, Chang MH, et al. A Simple and Rapid Test-card Method to Detect Hepatitis B Surface Antigen and Antibody: Potential Application in Young Children and Infants. Pediatr Neonatol. 2016 Jun;57(3):219–24. https://doi.org/10.1016/j.pedneo.2015.07.003 26560182 DOI: https://doi.org/10.1016/j.pedneo.2015.07.003
  90. Cruz HM, Scalioni LP, Paula VS, Miguel JC, Ó KM, Milagres FA, et al. Poor sensitivity of rapid tests for the detection of antibodies to the hepatitis B virus: implications for field studies. Mem Inst Oswaldo Cruz. 2017 Mar;112(3):209–13. https://doi.org/10.1590/0074-02760160394 28146158 DOI: https://doi.org/10.1590/0074-02760160394
  91. Bottero J, Boyd A, Gozlan J, Lemoine M, Carrat F, Collignon A, et al. Performance of rapid tests for detection of HBsAg and anti-HBsAb in a large cohort, France. J Hepatol. 2013 Mar;58(3):473–8. https://doi.org/10.1016/j.jhep.2012.11.016 23183527 DOI: https://doi.org/10.1016/j.jhep.2012.11.016
  92. Mag IA. Diagnostics. HBV rapid test for HBsAg, anti-HBc and anti-HBs. Available from: https://www.magia-diagnostics.com/diagnostics/ (Accessed: 11 June 2022)
  93. Murtagh R, Swan D, O’Connor E, McCombe G, Lambert JS, Avramovic G, et al. Hepatitis C Prevalence and Management Among Patients Receiving Opioid Substitution Treatment in General Practice in Ireland: Baseline Data from a Feasibility Study. Interact J Med Res. 2018 Dec;7(2):e10313. https://doi.org/10.2196/10313 30567692 DOI: https://doi.org/10.2196/10313
  94. Felsen UR, Fishbein DA, Litwin AH. Low rates of hepatitis A and B vaccination in patients with chronic hepatitis C at an urban methadone maintenance program. J Addict Dis. 2010 Oct;29(4):461–5. https://doi.org/10.1080/10550887.2010.509281 20924882 DOI: https://doi.org/10.1080/10550887.2010.509281
  95. Kane M. Global programme for control of hepatitis B infection. Vaccine. 1995;13 Suppl 1:S47–9. https://doi.org/10.1016/0264-410X(95)93547-M 7571830 DOI: https://doi.org/10.1016/0264-410X(95)93547-M
  96. BAG-Bulletin 48/2021 (29.11.2021). Sexuell übertragene Infektionen und Hepatitis B/C in der Schweiz im Jahr 2020: eine epidemiologische Übersicht. Available from: https://www.bag.admin.ch/dam/bag/de/dokumente/cc/Kampagnen/Bulletin/2021/bu-48-21.pdf.download.pdf/BU_48_21_DE.pdf (Accessed: 11 June 2022)
  97. BAG-Bulletin 16/2021 (29.04.2021). Durchimpfung von 2-, 8- und 16-jährigen Kindern und Jugendlichen in der Schweiz, 2017–2019. Available from: https://www.bag.admin.ch/dam/bag/de/dokumente/mt/i-und-b/durchimpfung/bu-16-21-durchimpfung-2017-2019.pdf (Accessed: 11 June 2022)
  98. Vernazza PL, Rasi M, Ritzler M, Dost F, Stoffel M, Aebi-Popp K, et al. The Swiss STAR trial - an evaluation of target groups for sexually transmitted infection screening in the sub-sample of women. Swiss Med Wkly. 2020 Dec;150:w20393. https://doi.org/10.4414/smw.2020.20393 33382076 DOI: https://doi.org/10.4414/smw.2020.20393
  99. Schmidt AJ, Rasi M, Esson C, Christinet V, Ritzler M, Lung T, et al. The Swiss STAR trial - an evaluation of target groups for sexually transmitted infection screening in the sub-sample of men. Swiss Med Wkly. 2020 Dec;150:w20392. https://doi.org/10.4414/smw.2020.20392 33382077 DOI: https://doi.org/10.4414/smw.2020.20392
  100. Bundesamt für Gesundheit (BAG), Eidgenössische Kommission für Impffragen (EKIF). Schweizerischer Impfplan 2019. Richtlinien und Empfehlungen. Bern: Bundesamt für Gesundheit, 2019. www.bag.admin.ch/impfplan
  101. Bundesamt für Gesundheit (BAG), Eidgenössische Kommission für Impffragen (EKIF). Schweizerischer Impfplan 2018. Richtlinien und Empfehlungen. Bern: Bundesamt für Gesundheit, 2018. www.bag.admin.ch/impfplan
  102. 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 Oct;10(10):639–44. https://doi.org/10.4254/wjh.v10.i10.639 30386457 DOI: https://doi.org/10.4254/wjh.v10.i10.639
  103. Berzigotti A, Tsochatzis E, Boursier J, Castera L, Cazzagon N, Friedrich-Rust M, et al.; European Association for the Study of the Liver. Electronic address: easloffice@easloffice.eu; Clinical Practice Guideline Panel; Chair; EASL Governing Board representative; Panel members. EASL Clinical Practice Guidelines on non-invasive tests for evaluation of liver disease severity and prognosis - 2021 update. J Hepatol. 2021 Sep;75(3):659–89. https://doi.org/10.1016/j.jhep.2021.05.025 34166721 DOI: https://doi.org/10.1016/j.jhep.2021.05.025
  104. European Association for Study of Liver Asociacion Latinoamericana para el Estudio del Higado. EASL-ALEH Clinical Practice Guidelines: non-invasive tests for evaluation of liver disease severity and prognosis. J Hepatol. 2015 Jul;63(1):237–64. https://doi.org/10.1016/j.jhep.2015.04.006 25911335 DOI: https://doi.org/10.1016/j.jhep.2015.04.006
  105. WHO guidelines on hepatitis B and C testing. Geneva: World Health Organization; 2017. Available from https://apps.who.int/iris/rest/bitstreams/1080581/retrieve (Accessed: 11 June 2022)
  106. Pawlotsky JM, Negro F, Aghemo A, Berenguer M, Dalgard O, Dusheiko G, et al.; European Association for the Study of the Liver. Electronic address: easloffice@easloffice.eu; Clinical Practice Guidelines Panel: Chair; EASL Governing Board representative; Panel members. EASL recommendations on treatment of hepatitis C: final update of the series. J Hepatol. 2020 Nov;73(5):1170–218. https://doi.org/10.1016/j.jhep.2020.08.018 32956768 DOI: https://doi.org/10.1016/j.jhep.2020.08.018
  107. Ghany MG, Morgan TR ; AASLD-IDSA Hepatitis C Guidance Panel. Hepatitis C Guidance 2019 Update: American Association for the Study of Liver Diseases-Infectious Diseases Society of America Recommendations for Testing, Managing, and Treating Hepatitis C Virus Infection. Hepatology. 2020 Feb;71(2):686–721. https://doi.org/10.1002/hep.31060 31816111 DOI: https://doi.org/10.1002/hep.31060
  108. Bruggmann P, Maeschli B. Hepatitis C micro-elimination among people on opioid agonist therapy is a low-hanging fruit. Swiss Med Wkly. 2020 Sep;150:w20348. https://doi.org/10.4414/smw.2020.20348 33035351 DOI: https://doi.org/10.4414/smw.2020.20348
  109. Wade A, Draper B, Doyle J, Allard N, Grinzi P, Thompson A, et al. A survey of hepatitis C management by Victorian GPs after PBS-listing of direct-acting antiviral therapy. Aust Fam Physician. 2017;46(4):235–40.28376580
  110. Bruggmann P, Maeschli B, Scheideger C. Hepatitis-C-Behandlungen in der hausärztlichen Praxis. Prim Hosp Care Allg Inn Med. 2020;20(02):67–9. DOI: https://doi.org/10.4414/phc-d.2020.10162
  111. Bajis S, Applegate TL, Grebely J, Matthews GV, Dore GJ. Novel Hepatitic C Virus (HCV) Diagnosis and Treatment Delivery Systems: Facilitating HCV Elimination by Thinking Outside the Clinic. J Infect Dis. 2020 Nov;222 Suppl 9:S758–72. https://doi.org/10.1093/infdis/jiaa366 33245354 DOI: https://doi.org/10.1093/infdis/jiaa366
  112. Swiss DR. Fallpauschalenkatalog SwissDRG 11.0 Abrechnungsversion (2022/2022). Anlage 2: Zusatzentgeltkatalog (Zeilen 2349ff (Sofosbuvir und Velpatasvir) und 2678ff (Glecaprevir und Pibrentasvir)). (Genehmigte Version vom 11. Juni 2022, Stand: 06. Dezember 2021) Available from: https://www.swissdrg.org/de/akutsomatik/swissdrg-system-1102022/fallpauschalenkatalog (Accessed: 11 June 2022)
  113. Bundesamt für Gesundheit (BAG). Analysenliste (AL). Gesamtliste der AL. Analysenliste per 1. Februar 2022 in Excel Format (23.12.2021). Available from: https://www.bag.admin.ch/dam/bag/de/dokumente/kuv-leistungen/leistungen-und-tarife/Analysenliste/klva-anhang3-gesamtliste-excel-01022022.xlsx (Accessed: 11 June 2022)
  114. Pharma Suisse. Schweizerischer Apothekerverband. Liste der Impfungen nach Kanton. (Stand: 01.10.2021) Available from: https://www.ihre-apotheke.ch/data/docs/de/48258/Liste-der-Impfungen-nach-Kanton-Stand-1-10-2021.pdf?v=1.0 (Accessed: 11 June 2022)
  115. Bundesamt für Gesundheit (BAG). Spezialitätenliste (SL). SL-Publikationen aktueller Monat. Liste der gestrichenen Packungen seit 01.01.2010. Available from: http://www.xn--spezialittenliste-yqb.ch/File.axd?file=Gestrichene_Packungen_Emballages_radies.xlsx (Accessed: 11 June 2022)
  116. Bundesamt für Gesundheit (BAG), Eidgenössische Kommission für Impffragen (EKIF). Schweizerischer Impfplan 2022. Richtlinien und Empfehlungen. Bern: Bundesamt für Gesundheit, 2022. Available from: https://www.bag.admin.ch/dam/bag/de/dokumente/mt/i-und-b/richtlinien-empfehlungen/allgemeine-empfehlungen/schweizerischer-impfplan.pdf (Accessed: 11 June 2022)