"Waiting for DAAs": A retrospective chart review of patients with untreated hepatitis C in Rwanda

PLoS One. 2017 Mar 21;12(3):e0174148. doi: 10.1371/journal.pone.0174148. eCollection 2017.

Abstract

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.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Antiviral Agents / economics*
  • Antiviral Agents / therapeutic use
  • Female
  • Health Expenditures
  • Health Services Accessibility*
  • Hepacivirus / classification
  • Hepacivirus / genetics
  • Hepatitis C / epidemiology*
  • Hepatitis C / pathology
  • Hepatitis C / virology
  • Humans
  • Insurance, Health / statistics & numerical data
  • Liver Cirrhosis / epidemiology*
  • Liver Cirrhosis / pathology
  • Liver Cirrhosis / virology
  • Male
  • Middle Aged
  • Retrospective Studies
  • Rwanda / epidemiology
  • Time-to-Treatment / statistics & numerical data*
  • Viral Load
  • Young Adult

Substances

  • Antiviral Agents

Grants and funding

The authors acknowledge the support and contributions of the Rwanda Ministry of Health, Rwanda Biomedical Center, University Teaching Hospital of Kigali, University Teaching Hospital of Butare, Rwanda Military Hospital, and King Faisal Hospital in the establishment of HCV treatment centers and access to registry data. Finally, we are grateful to Partners In Health and Brigham & Women’s Hospital for in-kind support of this study. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.