4a - Integrating hepatitis C screening and treatment into routine HIV care in Cameroon is feasible

Background : People with human immunodeficiency virus (HIV) and Hepatitis C virus (HCV) are vulnerable to worse clinical outcomes. Yet, HCV prevalence among people with HIV in Cameroon remains unknown, with diagnosis and treatment largely inaccessible. Integration of HCV services into routine HIV care by general practitioners could improve diagnosis and treatment coverage. We aimed to determine HCV screening acceptability, prevalence, and treatment cure rate among people with HIV attending 11 HIV clinics in the Centre Region of Cameroon.

Methods : We offered HCV rapid antibody screening, and, if positive, an RNA test to all attendees of routine HIV counselling and treatment appointments between 20 April 2021 and 31 May 2022. Screening acceptability was measured in a sub-study in 5/11 clinics. HCV-RNA-positive participants received 12 weeks of pangenotypic sofosbuvir/velpatasvir (400/100mg). We calculated the cure rate as the proportion of participants with a sustained virological response 12 weeks after treatment completion (SVR12) among all starting and completing treatment.

Results : We screened 8,266 (29.9%) of 27,606 individuals on HIV antiretroviral therapy known to receive HIV care from participating clinics as of December 2020. In the sub-study, 256/510 (50.2%) accepted screening. 316/8,266 (3.8%, 95%CI=3.4-4.3%) were anti-HCV positive. Among 286 sampled for HCV-RNA, 251 (87.8%) had detectable HCV-RNA. The cure rate was 93.6% (n=162/173, 95%CI=88.9-96.8%) among those enrolled for treatment and 98.2% (n=162/165, 95%CI=94.8-99.6%) among those completing treatment.

Conclusions Our study demonstrates the viability of integrating HCV screening and treatment into routine HIV care in Cameroon, yielding new HCV diagnoses and high cure rates. Cameroon can use this strategy to achieve its HCV elimination goals, although improvements in screening acceptability, diagnosis and treatment access and laboratory capacity are needed.