STRATEGIES TO DECREASE HEPATITIS C BURDEN AND IMPROVE SAFETY, COST-EFFECTIVELY IN THE HEALTH SYSTEM AMONG PATIENTS ON HEMODIALYSIS: LESSONS FROM LOW RESOURCE SETTINGS

Introduction:

Hepatitis C is an indolent infection that occurs not uncommonly in maintenance hemodialysis patients. It is due to the clustering of risk factors in hemodialysis units which are augmented in low-resource settings. Effective prevention practices, improved screening methods and treatment are essential needs of the hour. We describe the structure and clinical outcome of a provider-driven Hepatitis C management program and the benefits accrued, as part of a pilot to understand the feasibility, cost-effectiveness, and implementation. The program is in the background of centres practicing using dedicated machines for Hepatitis C-positive patients.  

Methods:

A large private dialysis provider in India conducted a pilot study in 11 dialysis centres among patients undergoing maintenance hemodialysis in two states, under a public-private partnership from 2022 to 2024. HCV RNA quantitative testing was used to test HCV IgM ELISA-positive patients. We included patients below 60 years of age, with no major comorbidity, adhering to a frequency of at least 2 dialysis sessions per week for 3 months as they were potential candidates for treatment, paid for by the provider. The HCV RNA-positive patients were treated with a combination of Sofosbuvir and Velpatisivir for 12 weeks. The HCV RNA quantitative testing was repeated after treatment to assess the viral remission.

Results:

In 11 dialysis centres, 114 patients on hemodialysis with positive HCV IgM ELISA were selected. Among them, 94 (82%) patients satisfied the inclusion criteria and 85 (75%) patients consented to participate. Mean age, 45.5 ± SD 11.2 years, range was 18 to 60 years, M: F was 80:20%. 100% on arteriovenous fistula access, hemodialysis frequency was 2.5 per week. Among 85 patients, 37 (44%) were HCV RNA negative and were moved to negative machines and 48 (46%) were HCV RNA positive. Among the 48 patients, 38(79%) completed treatment, and 10 dropped for various reasons. 35(92%) but 2 among those died while 33 were moved to negative machines. The cost for testing and treating per patient was estimated at Rs 21,100 while the cost to the health system was higher by Rs 300 per hemodialysis session for Hepatitis C-positive patients, due to the practice of single-use dialyzers.

Conclusions:

This provider-driven program has demonstrated proactive HCV RNA testing and treatment that will address 1. high false positivity, 2. improper allocation of hemodialysis machines, 3. improve utilization of hemodialysis machines, 4. improve individual prognosis of treated patients, 5. decrease disease burden and 6. significant cost benefit to the health system.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.