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Arif A, Hasnain A, Chaudhry A, Asim M, Shafqat MN, Altaf A, Saba N, Kemos P, Ansari MA, Barnes E, Metcalfe C, Vickerman P, Qureshi H, Hamid S, Choudhry AA, Niaz SK, Foster GR, Choudhry N. HepFREEPak: protocol for a multi-centre, prospective observational study examining efficacy and impact of current therapies for the treatment of hepatitis C in Pakistan and reporting resistance to antiviral drugs: study protocol. BMC Public Health 2023; 23:2529. [PMID: 38110885 PMCID: PMC10726502 DOI: 10.1186/s12889-023-17290-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 11/22/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Pakistan has one of the highest burdens of Hepatitis C virus (HCV) infection globally. To achieve the World Health Organization's goals for HCV elimination, there is a need for substantial scale-up in testing, treatment, and a reduction in new infections. Data on the population impact of scaling up treatment is not available in Pakistan, nor is there reliable data on the incidence of infection/reinfection. This project will fill this gap by providing important empirical data on the incidence of infection (primary and reinfection) in Pakistan. Then, by using this data in epidemic models, the study will determine whether response rates achieved with affordable therapies (sofosbuvir plus daclatasvir) will be sufficient to eliminate HCV in Pakistan. METHODS This prospective multi-centre cohort study will screen 25,000 individuals for HCV antibody (Ab) and RNA (if Ab-positive) at various centers in Pakistan- Karachi (Sindh) and Punjab, providing estimates of the disease prevalence. HCV positive patients will be treated with sofosbuvir and daclatasvir for 12-weeks, (extended to 24-weeks in those with cirrhosis) and the proportion responding to this first-line treatment estimated. Patients who test HCV Ab negative will be recalled 12 months later to test for new HCV infections, providing estimates of the incidence rate. Patients diagnosed with HCV (~ 4,000) will be treated and tested for Sustained Virological Response (SVR). Questionnaires to assess risk factors, productivity, health care usage and quality of life will be completed at both the initial screening and at 12-month follow-up, allowing mathematical modelling and economic analysis to assess the current treatment strategies. Viral resistance will be analysed and patients who have successfully completed treatment will be retested 12 months later to estimate the rate of re-infection. CONCLUSION The HepFREEPak study will provide evidence on the efficacy of available and widely used treatment options in Pakistan. It will also provide data on the incidence rate of primary infections and re-infections. Data on incidence risk factors will allow us to model and incorporate heterogeneity of risk and how that affects screening and treatment strategies. These data will identify any gaps in current test-and-treat programs to achieve HCV elimination in Pakistan. STUDY REGISTRATION This study was registered on clinicaltrials.gov (NCT04943588) on June 29, 2021.
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Affiliation(s)
- Ambreen Arif
- Doctor's Plaza, Khayaban E Iqbal Block 9 DO Talwar, Karachi, Clifton, 75600, Pakistan.
| | - Aliya Hasnain
- Department of Medicine, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Auj Chaudhry
- Gut & Liver Center, Chaudhry Hospital and PARSA Trust Liver Clinic, Gujranwala, Pakistan
| | - Muhammad Asim
- Dow University of Health Sciences, Karachi, Pakistan
| | | | - Abeer Altaf
- Dow University of Health Sciences, Karachi, Pakistan
| | - Noor Saba
- Department of Medicine, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Polychronis Kemos
- Centre for Immunobiology, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - M Azim Ansari
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Eleanor Barnes
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Chris Metcalfe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Huma Qureshi
- Doctor's Plaza, Khayaban E Iqbal Block 9 DO Talwar, Karachi, Clifton, 75600, Pakistan
| | - Saeed Hamid
- Department of Medicine, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Asad Ali Choudhry
- Gut & Liver Center, Chaudhry Hospital and PARSA Trust Liver Clinic, Gujranwala, Pakistan
| | | | - Graham R Foster
- Centre for Immunobiology, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Naheed Choudhry
- Centre for Immunobiology, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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