Global change in hepatitis C virus prevalence and cascade of care between 2015 and 2020: a modelling study

Sarah Blach, Norah A Terrault, Frank Tacke, Ivane Gamkrelidze, Antonio Craxi, Junko Tanaka, Imam Waked, Gregory J Dore, Zaigham Abbas, Ayat R Abdallah, Maheeba Abdulla, Alessio Aghemo, Inka Aho, Ulus S Akarca, Abduljaleel M Alalwan, Marianne Alanko Blomé, Said A Al-Busafi, Soo Aleman, Abdullah S Alghamdi, Waleed K Al-Hamoudi, Abdulrahman A Aljumah, Khalid Al-Naamani, Yousif M Al Serkal, Ibrahim H Altraif, Anil C Anand, Motswedi Anderson, Monique I Andersson, Kostas Athanasakis, Oidov Baatarkhuu, Shokhista R Bakieva, Ziv Ben-Ari, Fernando Bessone, Mia J Biondi, Abdul Rahman N Bizri, Carlos E Brandão-Mello, Krestina Brigida, Kimberly A Brown, Robert S Brown, Jr, Philip Bruggmann, Maurizia R Brunetto, Dana Busschots, Maria Buti, Maia Butsashvili, Joaquin Cabezas, Chungman Chae, Viktorija Chaloska Ivanova, Henry Lik Yuen Chan, Hugo Cheinquer, Kent Jason Cheng, Myeong-Eun Cheon, Cheng-Hung Chien, Rong-Nan Chien, Gourdas Choudhuri, Peer Brehm Christensen, Wan-Long Chuang, Vladimir Chulanov, Laura E Cisneros, Barbara Coco, Fernando A Contreras, Markus Cornberg, Matthew E Cramp, Javier Crespo, Fuqiang Cui, Chris W Cunningham, Lucy Dagher Abou, Olav Dalgard, Doan Y Dao, Victor De Ledinghen, Moutaz F Derbala, Keshab Deuba, Karan Dhindsa, Samsuridjal Djauzi, Sylvia Drazilova, Ann-Sofi Duberg, Mohammed Elbadri, Manal H El-Sayed, Gamal Esmat, Chris Estes, Sameera Ezzat, Martti A Färkkilä, Laurent Ferradini, Maria Lucia G Ferraz, Paulo R A Ferreira, Tajana Filipec Kanizaj, Robert Flisiak, Sona Frankova, James Fung, Amiran Gamkrelidze, Edward Gane, Virginia Garcia, Javier García-Samaniego, Manik Gemilyan, Jordan Genov, Liliana S Gheorghe, Pierre M Gholam, Adrian Goldis, Magnus Gottfredsson, Richard T Gray, Jason Grebely, Michael Gschwantler, Behzad Hajarizadeh, Saeed S Hamid, Waseem Hamoudi, Angelos Hatzakis, Margaret E Hellard, Sayed Himatt, Harald Hofer, Irena Hrstic, Bela Hunyady, Petr Husa, Azra Husic-Selimovic, Wasim S M Jafri, Martin Janicko, Naveed Janjua, Peter Jarcuska, Jerzy Jaroszewicz, Anna Jerkeman, Agita Jeruma, Jidong Jia, Jon G Jonasson, Martin Kåberg, Kelly D E Kaita, Kulpash S Kaliaskarova, Jia-Horng Kao, Omor T Kasymov, Angela Kelly-Hanku, Faryal Khamis, Jawad Khamis, Aamir G Khan, Lekey Khandu, Ibtissam Khoudri, Knut B Kielland, Do Young Kim, Nicolas Kodjoh, Loreta A Kondili, Mel Krajden, Henrik Bygum Krarup, Pavol Kristian, Jisoo A Kwon, Martin Lagging, Wim Laleman, Wai Cheung Lao, Daniel Lavanchy, Pablo Lázaro, Jeffrey V Lazarus, Alice U Lee, Mei-Hsuan Lee, Michael K K Li, Valentina Liakina, Young-Suk Lim, Arthur Löve, Boris Lukšić, Shepherd Mufudzi Machekera, Abraham O Malu, Rui T Marinho, Mojca Maticic, Hailemichael D Mekonnen, Maria Cássia Mendes-Correa, Nahum Mendez-Sanchez, Shahin Merat, Berhane Redae Meshesha, Håvard Midgard, Mike Mills, Rosmawati Mohamed, Ellen Mooneyhan, Christophe Moreno, David H Muljono, Beat Müllhaupt, Erkin Musabaev, Gaëtan Muyldermans, Yvonne Ayerki Nartey, Marcelo C M Naveira, Francesco Negro, Alexander V Nersesov, Richard Njouom, Rénovat Ntagirabiri, Zuridin S Nurmatov, Solomon A Obekpa, Stephen Oguche, Sigurdur Olafsson, Janus P Ong, Ohene K Opare-Sem, Mauricio Orrego, Anne L Øvrehus, Calvin Q Pan, George V Papatheodoridis, Markus Peck-Radosavljevic, Mário G Pessoa, Richard O Phillips, Nikolay Pimenov, Dijana Plaseska-Karanfilska, Nishi N Prabdial-Sing, Pankaj Puri, Huma Qureshi, Aninda Rahman, Alnoor Ramji, Devin M Razavi-Shearer, Kathryn Razavi-Shearer, Ezequiel Ridruejo, Cielo Y Ríos-Hincapié, S M Shahriar Rizvi, Geert K M M Robaeys, Lewis R Roberts, Stuart K Roberts, Stephen D Ryder, Shakhlo Sadirova, Umar Saeed, Rifaat Safadi, Olga Sagalova, Sanaa S Said, Riina Salupere, Faisal M Sanai, Juan F Sanchez-Avila, Vivek A Saraswat, Christoph Sarrazin, Gulya Sarybayeva, Carole Seguin-Devaux, Ala I Sharara, Mahdi Sheikh, Abate B Shewaye, William Sievert, Kaarlo Simojoki, Marieta Y Simonova, Mark W Sonderup, C Wendy Spearman, Jan Sperl, Rudolf E Stauber, Catherine A M Stedman, Tung-Hung Su, Anita Suleiman, Vana Sypsa, Natalia Tamayo Antabak, Soek-Siam Tan, Tammo L Tergast, Prem H Thurairajah, Ieva Tolmane, Krzysztof Tomasiewicz, Maia Tsereteli, Benjamin S C Uzochukwu, David A M C Van De Vijver, Daniela K Van Santen, Hans Van Vlierberghe, Berend Van Welzen, Thomas Vanwolleghem, Patricia Vélez-Möller, Federico Villamil, Adriana Vince, Yasir Waheed, Nina Weis, Vincent W-S Wong, Cesar G Yaghi, Kakharman Yesmembetov, Ayman Yosry, Man-Fung Yuen, Evy Yunihastuti, Stefan Zeuzem, Eli Zuckerman, Homie A Razavi, Global change in hepatitis C virus prevalence and cascade of care between 2015 and 2020: a modelling study, The Lancet Gastroenterology & Hepatology, 2022, ISSN 2468-1253, https://doi.org/10.1016/S2468-1253(21)00472-6.

Summary

Background

Since the release of the first global hepatitis elimination targets in 2016, and until the COVID-19 pandemic started in early 2020, many countries and territories were making progress toward hepatitis C virus (HCV) elimination. This study aims to evaluate HCV burden in 2020, and forecast HCV burden by 2030 given current trends.

Methods

This analysis includes a literature review, Delphi process, and mathematical modelling to estimate HCV prevalence (viraemic infection, defined as HCV RNA-positive cases) and the cascade of care among people of all ages (age ≥0 years from birth) for the period between Jan 1, 2015, and Dec 31, 2030. Epidemiological data were collected from published sources and grey literature (including government reports and personal communications) and were validated among country and territory experts. A Markov model was used to forecast disease burden and cascade of care from 1950 to 2050 for countries and territories with data. Model outcomes were extracted from 2015 to 2030 to calculate population-weighted regional averages, which were used for countries or territories without data. Regional and global estimates of HCV prevalence, cascade of care, and disease burden were calculated based on 235 countries and territories.

Findings

Models were built for 110 countries or territories: 83 were approved by local experts and 27 were based on published data alone. Using data from these models, plus population-weighted regional averages for countries and territories without models (n=125), we estimated a global prevalence of viraemic HCV infection of 0·7% (95% UI 0·7–0·9), corresponding to 56·8 million (95% UI 55·2–67·8) infections, on Jan 1, 2020. This number represents a decrease of 6·8 million viraemic infections from a 2015 (beginning of year) prevalence estimate of 63·6 million (61·8–75·8) infections (0·9% [0·8–1·0] prevalence). By the end of 2020, an estimated 12·9 million (12·5–15·4) people were living with a diagnosed viraemic infection. In 2020, an estimated 641 000 (623 000–765 000) patients initiated treatment.

Interpretation

At the beginning of 2020, there were an estimated 56·8 million viraemic HCV infections globally. Although this number represents a decrease from 2015, our forecasts suggest we are not currently on track to achieve global elimination targets by 2030. As countries recover from COVID-19, these findings can help refocus efforts aimed at HCV elimination.

Countries/Territories: Afghanistan, Algeria, Argentina, Armenia, Australia, Austria, Azerbaijan, Bahrain, Belgium, Brazil, Bulgaria, Burkina Faso, Burundi, Cambodia, Cameroon, Canada, Central African Republic, Chad, Chile, China (mainland), Colombia, Croatia, Cuba, Czechia, Democratic Republic of the Congo, Denmark, Dominican Republic, Egypt, El Salvador, Estonia, Ethiopia, Fiji, Finland, France, Gabon, The Gambia, Georgia, Germany, Ghana, Greece, Hong Kong, Hungary, Iceland, India, Indonesia, Iran, Iraq, Ireland, Israel, Italy, Japan, Jordan, Kazakhstan, Kenya, Kyrgyzstan, Latvia, Lebanon, Libya, Lithuania, Luxembourg, Madagascar, Malaysia, Malta, Mexico, Mongolia, Morocco, Mozambique, Netherlands, New Zealand, Nigeria, Norway, Oman, Pakistan, Panama, Papua New Guinea, Peru, Philippines, Poland, Portugal, Puerto Rico, Qatar, Romania, Russia, Rwanda, Saudi Arabia, Slovakia, Slovenia, South Africa, South Korea, Spain, Sweden, Switzerland, Syria, Taiwan, Tajikistan, Tanzania, Thailand, Tunisia, Turkey, Uganda, Ukraine, United Arab Emirates, United Kingdom, USA, Uzbekistan, Venezuela, Vietnam, Yemen