Population-based hepatitis C screening and elimination program in Lithuania: 26-month results

Abstract

Background and aims: The Lithuanian HCV screening programme started in May 2022. General practitioners (GPs) received special promoting fee for serological HCV antibody testing: 1. For people born between 1945 and 1994 (once in a lifetime) and 2. For people who inject drugs (PWID) or HIV-positive people (annual HCV testing). This initiative is the first in Central and Eastern Europe. The aim of this study was to assess the results of the first 26 months of the programme and the different scenarios for achieving the WHO 2030 targets. Method: GPs invited people to perform a serum blood test for HCV antibodies. Anti-HCV positive patients were referred to a gastroenterologist or infectologist for HCV RNA testing, and if result was positive, direct-acting antiviral (DAA) therapy was prescribed. Information about patients was obtained from the database of the National Health Insurance Fund. The Markov disease progression model elaborated by the CDA Foundation was used to assess HCV elimination progress. The data from the 2022–2023 screening were used as inputs Three scenarios were developed: the ‘Base’ scenario - return to pre-screening program level in 2023 and 2 scenarios with different extents of treatment. Results: At the beginning of 2022, about 1.8 million people born in 1945–1994 lived in Lithuania. Between May 5, 2022 and June 30, 2024 from this population 1264527 people (69.7%) were tested for HCV antibodies. Positive test results were found in 1.25% of cases. In the risk group, 10670 PWID and HIV+ people were screened, of whom 29.6% were seropositive. Seropositive patients were referred to specialists and viremia was detected in 58,6%. During 26-month (May 2022–June 2024) period 3 times more HCV patients were treated with DAA than during the same period (Aug 2020–April 2022) before starting of the program (5881 vs 1921). Treatment delay for 48.9% of HCV patients was related to organizational problems (fibrosis limitations for treatment were canceled only on April, 2024; delay for patients’ referral from GP to specialists). The Markov disease progression model to assess HCV elimination progress showed the following scenarios: Scenario 1: if the same number of patients are treated as before the screening, the WHO targets will not be reached. Scenario 2: treating 70% of infected patients will meet most but not all WHO targets. Scenario 3: by treating all infected patients by 2030, the WHO target will be met by saving 150 lives and preventing 90 new cases of decompensated cirrhosis and 120 cases of hepatocellular carcinoma. Conclusion: Our data show that in European country with moderate HCV seroprevalence, a population-based screening program can be feasible, screening near 70% (more than 1,2 million) of the population born between 1945 and 1994 during the first 26 months of the program. With no restrictions on DAA treatment, we hope that the WHO 2030 targets can be achieved in Lithuania, but it is essential to ensure that all seropositive patients who have been screened by a GP are consulted and treated by specialists.