P0716 - Treating Hepatitis C Infection in a Resource Limited Setting in Pakistan

Fatima Shahid, MD¹, Amer H. Siddiqui, MBBS², Basma Shahid, MD³, Sadia Chiragh, MBBS^4
1University of Rochester Medical Center, Strong Memorial Hospital, Rochester, NY; ²Post Graduate Medical Institute, Lahore, Punjab, Pakistan; ³East Carolina University, Greeneville, NC; ⁴Al-Aleem Medical College Lahore, Lahore, Punjab, Pakistan

Introduction: The World Health Organization (WHO) has estimated that 71 million people have been infected with hepatitis C virus (HCV) globally. Pakistan has the second highest prevalence worldwide (6.2%). In order to reach the WHO goal for hepatitis eradication by 2030, easy access to care including in remote areas with poor infrastructure and efficient allocation of resources is to be made. Here we share our experience in effectively screening and treating patients for hepatitis C in a local village setting with limited resources and access to healthcare.

Methods: Data from a monthly screening and treatment camp held in Nankana, Punjab, Pakistan was collected between April 2017 and December 2019. A team consisting of a general physician, pharmacist and laboratory technician travels 2 hours from the nearest city to visit Nankana village once a month. Patients are screened for HCV antibodies followed by PCR tests for confirmation of infection. Confirmed patients are then called for an initial visit consisting of history, physical exam and blood tests. Sofosbuvir/Daclatasvir or Ribavirin/Sofosbuvir/Daclatasvir is started in patients depending on absence or presence of cirrhosis, respectively, for 12 weeks. PCR levels are checked prior to treatment initiation, at 12 weeks and 36 weeks. If PCR levels at 12 weeks are still positive, patients are treated for another 12 weeks followed by repeat PCR. Local community members help ensure compliance and follow up.

Results: Approximately 1400 patients were screened during the study period. 288 patients were tested positive for HCV exposure out of which 206 had infection. The prevalence of hepatitis C infection was estimated to be 14.6%. 166 patients (75 males and 91 females) received treatment, 18 were lost to follow-up, while 39 declined treatment. Only 1 patient was still positive at the end of 12 weeks and completed another 12 weeks of treatment after which repeat PCR was negative. 71% (146/205) of the HCV infected patients completed treatment.

Discussion: We share our experience in setting up a small scale but successful screening camp to inform efforts in other areas with poor access to health care. By using a simplified guideline catering to our patient population and resources we were able to treat patients locally at a primary care clinic. Barriers include lack of access to healthcare, poor infrastructure, poor health literacy, social stigma and cultural factors that result in noncompliance (e.g. preference to use homeopathic over allopathic treatment).



Disclosures:


Fatima Shahid, MD¹, Amer H. Siddiqui, MBBS², Basma Shahid, MD³, Sadia Chiragh, MBBS⁴. P0716 - Treating Hepatitis C Infection in a Resource Limited Setting in Pakistan, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.