Population-based hepatitis C screening in country with moderate seroprevalence: 21-month. Results: of the program in Lithuania

Abstract

Background: Lithuanian HCV screening program started on May, 2022. State health authorities pay general practitioners (GPs) a special promoting fee for performing serological tests for HCV antibodies: 1. For the population born in 1945-1994 (once per life) and 2. For people who inject drugs (PWID) or are HIV-infected (annual HCV testing). Such an initiative is the first in Central and Eastern Europe. This study aimed to evaluate results of the first 21-month of the program and different scenarios to achieve WHO 2030 targets. Methods: GPs invited people to perform a serum blood test for HCV antibodies. Anti-HCV (+) 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 January 31, 2024, from this population 1145121 people (63,6%) were tested for HCV antibodies. Positive test results were found in 1.23% of cases. In the risk group, 9604 PWID and HIV+ people were screened, and 30,1% were seropositive. Viremia was detected in 58 %. During 21-month period 4811 patients were treated with DAA. The number of treated patients during 21 months of program increased 2,8 times in comparison to previous 21 month before the program (Aug 2020 - Apr 2022). Treatment delay for 48% of HCV patients was related to organizational problems (consultation waiting line; fibrosis restrictions were removed only on May, 2024). By the end of 2024 we expect to perform HCV antibody testing in 80% of the target population and treatment of 80% of RNA-positive individuals, further aiming to cure most of infected patients by 2030. The Markov disease progression model to assess HCV elimination 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 64 % (more than 1,1 million) of the population born between 1945 and 1994 during the first 21 months of the program. WHO 2030 goals can be achievable in Lithuania.