Delivering Effective Hepatitis C Virus Treatment in an Embedded Primary Care Setting Within a Tertiary Care Hospital in Karachi, Pakistan

Abstract

Hepatitis C virus (HCV) endemic regions require accessible treatment interventions. Effectiveness and costs of a pilot HCV treatment programme were evaluated at an embedded primary care service within a tertiary care centre at Indus Hospital and Health Network in Karachi, Pakistan. Data on patients (n = 1288, median age 40 years) initiating direct-acting antiviral (DAA) treatment (October 2016 to December 2018) were extracted from hospital records. Eligible patients had chronic HCV, were treatment naïve, and without hepatic decompensation. Multivariable logistic regression analysed factors associated with treatment outcomes (not completing treatment, treatment completion without sustained virological response test at 12 weeks (SVR12) visit, and treatment completion with SVR12). Costs (2019 USD) were estimated using micro-costing from financial records and staff interviews. Among 1288 patients (63% women), 93% (1200/1288) completed treatment, and 74% (884/1200) attended SVR12 visit, with 98% (n = 870/884) cured. Compared with 0–29 year-olds, incomplete treatment was lower among 30–49 year-olds (aOR 0.47 [0.26–0.83]) and ≥ 50 year-olds (aOR 0.48 [0.24–0.93]). SVR12 non-attendance was higher for 24-week versus 12-week regimens (aOR: 3.46 [1.51–7.93]), but lower for patients with APRI scores 0.5–1.49 (aOR 0.69 [0.50–0.96]) and ≥ 1.5 (aOR 0.44 [0.24–0.78]) compared to 0–0.49. The mean treatment cost was $370.74 per patient, driven by clinic visits $271.80 (73.3%), labs $68.32 (18.4%), and DAAs $30.62 (8.3%). Overall, a high treatment completion and cure rate were achieved, with a low average cost per patient, indicating that this HCV treatment model can be affordable and may be considered for widescale treatment scale-up in Pakistan.