French hepatitis C care cascade: substantial impact of direct-acting antivirals, but the road to elimination is still long

Cécile Brouard, Josiane Pillonel, Marjorie Boussac, Victor de Lédinghen, Antoine Rachas, Christine Silvain, Nathalie Lydié, Stéphane Chevaliez, Corinne Pioche, Julien Durand, Florence Lot, Elisabeth Delarocque-Astagneau, Cécile Brouard, Josiane Pillonel, Marjorie Boussac, Victor de Lédinghen, Antoine Rachas, Christine Silvain, Nathalie Lydié, Stéphane Chevaliez, Corinne Pioche, Julien Durand, Florence Lot, Elisabeth Delarocque-Astagneau

Abstract

Background: Hepatitis C virus (HCV) elimination by 2030, as targeted by the World Health Organization (WHO), requires that 90% of people with chronic infection be diagnosed and 80% treated. We estimated the cascade of care (CoC) for chronic HCV infection in mainland France in 2011 and 2016, before and after the introduction of direct-acting antivirals (DAAs).

Methods: The numbers of people (1) with chronic HCV infection, (2) aware of their infection, (3) receiving care for HCV and (4) on antiviral treatment, were estimated for 2011 and 2016. Estimates for 1) and 2) were based on modelling studies for 2011 and on a virological sub-study nested in a national cross-sectional survey among the general population for 2016. Estimates for 3) and 4) were made using the National Health Data System.

Results: Between 2011 and 2016, the number of people with chronic HCV infection decreased by 31%, from 192,700 (95% Credibility interval: 150,900-246,100) to 133,500 (95% Confidence interval: 56,900-312,600). The proportion of people aware of their infection rose from 57.7 to 80.6%. The number of people receiving care for HCV increased by 22.5% (representing 25.7% of those infected in 2016), while the number of people on treatment increased by 24.6% (representing 12.1% of those infected in 2016).

Conclusions: This study suggests that DAAs substantially impact CoC. However, access to care and treatment for infected people remained insufficient in 2016. Updating CoC estimates will help to assess the impact of new measures implemented since 2016 as part of the goal to eliminate HCV.

Keywords: Cascade of care; Diagnosis; Direct-acting antivirals; Elimination; France; Hepatitis C; Management; Prevalence; Treatment.

Conflict of interest statement

Stéphane Chevaliez has received research grants from Gilead and has served as an advisor and/or speaker for Abbott, Cepheid, Hologic.

Victor de Lédinghen has received consulting fees from Gilead, AbbVie.

Christine Silvain has served as a speaker for AbbVie, Gilead.

All these grants and fees were independent of the work presented in this article.

None for the other authors.

Figures

Fig. 1
Fig. 1
Schematic overview of the principle of the multi-parameter evidence synthesis method in 2011. Pop. = population; prev. = prevalence
Fig. 2
Fig. 2
Schematic overview of the projection modelling used to estimate the number of people unaware of their infection in 2011. Each year, individuals enter or leave the pool of the chronically-infected undiagnosed population
Fig. 3
Fig. 3
Estimated chronic HCV cascade of care in 2011 and in 2016 in mainland France according to main analysis and analysis with age range adjustment. Note: Percentages are calculated from the estimated numbers of people with chronic HCV infection

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