The Lancet regional health. Western Pacific · 2025
Early performance of a decentralised, primary-care hepatitis C programme in Cambodia: a retrospective programme evaluation, 2024.
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Soputhy Chansovannara, Girond Florian, Keo Samley, Kim Kolveasna, Sagaon-Teyssier Luis, Penicaud Capucine, Ly Sovann, Mosnier Emilie
Аннотация
BACKGROUND: Real-world evidence on decentralised, primary-care delivery for hepatitis C virus (HCV) in the Western Pacific is limited. We evaluated Cambodia's national, primary care-led HCV programme in 2024.
METHODS: We analysed facility-level data from 256 health facilities in 15 operational districts to assess six HCV cascade steps: screening, anti-HCV positivity, RNA testing, viraemia, treatment initiation, and treatment completion. Design-based survey estimators were used to estimate proportions with 95% confidence intervals (CIs). To account for multi-stage design (clustering within operational districts), design-based generalised linear models were utilised to assess the factors associated with viraemia, treatment initiation and completion.
FINDINGS: HCV testing coverage among adults (≥18 years; denominator 2,196,351) was 3·5% (95% CI 2·5-4·4). Of 76,512 adults tested, 3213 (4·2%; 95% CI 3·1-5·6) were anti-HCV-positive; 2628/3213 (81·8%) received RNA testing, and 1446/2628 (55·0%; 95% CI 49·5-60·3) were viraemic (1·9% of all tested). Among RNA-positive individuals, 1345/1446 (93·0%) initiated direct-acting antivirals and 1289/1345 (95·8%) completed treatment. Viraemia was higher among men (adjusted odds ratio [aOR] 1·40; 95% CI 1·05-1·86), varied by province (Takeo aOR 2·79, Kampong Cham aOR 2·11 versus Battambang), and elevated in October-December (Q4; aOR 1·79) versus January-March. Treatment initiation and completion surpassed 90% across facilities. The principal gap was confirmatory testing (18·2% of anti-HCV-positive individuals lacked RNA testing).
INTERPRETATION: A decentralised, primary-care model achieved high linkage and treatment completion in the first year. Closing the confirmatory testing gap (reflex RNA/core antigen from same encounter), prioritising low-coverage/high-burden districts, and establishing patient-level linkage to capture sustained virologic response at week 12 are priorities to accelerate elimination.
FUNDING: ANRS MIE (ANRS0689b).
METHODS: We analysed facility-level data from 256 health facilities in 15 operational districts to assess six HCV cascade steps: screening, anti-HCV positivity, RNA testing, viraemia, treatment initiation, and treatment completion. Design-based survey estimators were used to estimate proportions with 95% confidence intervals (CIs). To account for multi-stage design (clustering within operational districts), design-based generalised linear models were utilised to assess the factors associated with viraemia, treatment initiation and completion.
FINDINGS: HCV testing coverage among adults (≥18 years; denominator 2,196,351) was 3·5% (95% CI 2·5-4·4). Of 76,512 adults tested, 3213 (4·2%; 95% CI 3·1-5·6) were anti-HCV-positive; 2628/3213 (81·8%) received RNA testing, and 1446/2628 (55·0%; 95% CI 49·5-60·3) were viraemic (1·9% of all tested). Among RNA-positive individuals, 1345/1446 (93·0%) initiated direct-acting antivirals and 1289/1345 (95·8%) completed treatment. Viraemia was higher among men (adjusted odds ratio [aOR] 1·40; 95% CI 1·05-1·86), varied by province (Takeo aOR 2·79, Kampong Cham aOR 2·11 versus Battambang), and elevated in October-December (Q4; aOR 1·79) versus January-March. Treatment initiation and completion surpassed 90% across facilities. The principal gap was confirmatory testing (18·2% of anti-HCV-positive individuals lacked RNA testing).
INTERPRETATION: A decentralised, primary-care model achieved high linkage and treatment completion in the first year. Closing the confirmatory testing gap (reflex RNA/core antigen from same encounter), prioritising low-coverage/high-burden districts, and establishing patient-level linkage to capture sustained virologic response at week 12 are priorities to accelerate elimination.
FUNDING: ANRS MIE (ANRS0689b).