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HCV disease burden and population segments in Switzerland
Florian Bihl1,2, Philip Bruggmann3, Erika Castro Batänjer4
1Gastroenterology and Hepatology Department, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.
Insights
Switzerland is working towards hepatitis C virus (HCV) elimination. Key efforts should target foreign-born individuals and those with a history of drug use to identify remaining HCV-RNA-positive patients.
Area of Science:
- Hepatology
- Public Health
- Infectious Disease Epidemiology
Background:
- Switzerland has progressed towards hepatitis C virus (HCV) elimination, but complete elimination was not guaranteed as of 2019.
- Increasing political interest in viral hepatitis necessitates a deeper understanding of Switzerland's HCV elimination progress.
- The study aimed to profile remaining HCV-RNA-positive patients to guide future elimination strategies.
Purpose of the Study:
- To update a Markov model with recent data for forecasting HCV disease burden in Switzerland.
- To evaluate HCV morbidity and mortality under current strategies versus achieving Swiss Hepatitis Strategy Elimination targets.
- To identify high-burden population segments for targeted future elimination efforts.
Main Methods:
- An existing Markov model was updated with current diagnosis and treatment data.
- Two scenarios were simulated: status quo and achievement of elimination targets.
- Analysis focused on identifying population segments with a high burden of HCV disease.
Main Results:
- An estimated 32,100 viremic HCV infections (0.37% prevalence) remained in Switzerland in early 2020.
- Adult permanent residents born abroad constituted the largest subpopulation (56%) of HCV infections.
- Injecting drug use (IDU) history was noted in two-thirds of Swiss-born positive individuals, representing 33% of total infections.
Conclusions:
- Targeted diagnosis and linkage to care are crucial for foreign-born populations and individuals with a history of drug use in Switzerland.
- Population-level interventions, including increased provider numbers and screening, are vital to reach patients missed by current systems.
- Addressing stigma is essential to encourage care-seeking behaviors among vulnerable populations for HCV elimination.
Background:
Switzerland has made strides towards hepatitis C virus elimination, but as of 2019, elimination was not guaranteed. However, political interest in viral hepatitis has been increasing. We sought to develop a better understanding of Switzerland's progress towards HCV elimination and the profile of remaining HCV-RNA-positive patients.
Methods:
A previously described Markov model was updated with recent diagnosis and treatment data and run to generate new forecasts for HCV disease burden. Two scenarios were developed to evaluate HCV morbidity and mortality under the status quo and a scenario that achieves the Swiss Hepatitis Strategy Elimination targets. Next, an analysis was conducted to identify population segments bearing a high burden of disease, where future elimination efforts could be directed.
Results:
At the beginning of 2020, an estimated 32 100 viremic infections remained in Switzerland (0.37% viremic prevalence). Adult (≥18 years of age) permanent residents born abroad represented the largest subpopulation, accounting for 56% of HCV infections. Thirteen countries accounted for ≥60% of viremic infections amongst permanent residents born abroad, with most people currently residing in Zurich, Vaud, Geneva, Bern, Aargau and Ticino. Amongst Swiss-born HCV-RNA-positive persons, two-thirds had a history of IDU, corresponding to 33% of total infections.
Conclusions:
In Switzerland, extra efforts for diagnosis and linkage to care are warranted in foreign-born populations and people with a history of drug use. Population-level measures (eg increasing the number of providers, increase screening) can identify patients who may have otherwise fallen through the gaps or avoided care because of stigma.
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