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"Waiting for DAAs": A retrospective chart review of patients with untreated hepatitis C in Rwanda
Neil Gupta1,2, Jules Kabahizi3, Constance Mukabatsinda4
1Division of Global Health Equity, Brigham & Women's Hospital, Boston, Massachusetts, United States of America.
Insights
Hepatitis C virus (HCV) treatment access is limited in sub-Saharan Africa, with a significant gap between eligible patients and those in care. Patients in care often present with advanced fibrosis, underscoring the need for improved screening and treatment accessibility.
Area of Science:
- Hepatology
- Infectious Diseases
- Public Health
Background:
- Sub-Saharan Africa faces severe limitations in accessing hepatitis C virus (HCV) treatment.
- Direct-acting antivirals (DAAs) offer highly effective oral regimens now available globally.
- Understanding the characteristics of HCV patients in care is crucial for improving treatment access.
Purpose of the Study:
- To characterize a national cohort of HCV-infected patients in Rwanda enrolled in care and awaiting DAA therapy.
- To identify factors associated with fibrosis stage in this patient population.
- To highlight the treatment gap for HCV in a resource-limited setting.
Main Methods:
- Retrospective chart review of adult patients with confirmed HCV infection at four referral centers in Rwanda.
- Analysis of routinely collected data including demographics, viral load, and fibrosis staging (FIB-4).
- Examination of associations between fibrosis stage and patient characteristics.
Main Results:
- 253 patients were identified, with a median age of 56; 58.9% were female.
- 96.7% had HCV genotype 4, with a median viral load of 688,736 IU/ml.
- 64.8% had moderate to severe fibrosis (FIB-4), associated with age but not other factors.
Conclusions:
- An immense treatment gap exists, with only 253 patients in care compared to an estimated 55,000 eligible in Rwanda.
- Patients in care presented with disproportionately advanced fibrosis, suggesting late presentation or treatment barriers.
- Accelerating HCV screening, diagnostics, and treatment is essential in resource-limited sub-Saharan African settings.
Background:
Access to treatment for hepatitis C virus (HCV) in sub-Saharan Africa is extremely limited. With the advent of direct acting antivirals (DAAs), highly effective and easy-to-deliver oral regimens are now available on the global market. This study was conducted to understand the background and characteristics of a national cohort of patients with HCV infection enrolled in care and awaiting therapy with DAAs.
Methods And Findings:
We conducted a retrospective chart review of all adult patients with confirmed HCV infection who were currently enrolled in care and treatment at the four existing hepatitis referral centers in Rwanda. Patient charts at these centers were reviewed, and routinely collected data were recorded and analyzed. Overall, 253 patients were identified; median age was 56 years (IQR: 43, 65), and 149 (58.9%) were female. Median viral load was 688,736 IU/ml and 96.7% were HCV genotype 4. As classified by FIB-4 score, 64.8% of the patients had moderate to severe fibrosis. Fibrosis stage was associated with age (OR 1.12, CI 1.09-1.17), but not with time since diagnosis, gender, treatment center, or type of insurance. There was a low frequency of documented co-morbid conditions, including hypertension, diabetes, HIV, and hepatitis B virus.
Conclusions:
Compared to an estimated 55,000 patients eligible for HCV treatment in Rwanda, this study identified only 253 patients currently diagnosed and engaged in care, highlighting an immense treatment gap in HCV, likely due to the lack of accessible and affordable screening, diagnostic, and treatment modalities. The patients that were enrolled in care had a disproportionately advanced fibrosis stage, possibly indicating late presentation to care or lack of treatment options. In the context of newly available and effective treatment options, this study supports the overall need to accelerate access to HCV screening, diagnostics, and care and treatment services in resource-limited settings in sub-Saharan Africa.
