Eliminating hepc in children; care closer to home

Background

Hepatitis C virus (HCV) infection is a major global health problem in adults & children. Direct Acting Anti-viral therapies (DAA) achieve cure rates of 99% in adults & adolescents and were licensed for children 3–12yrs in 2020. Prescribing & reimbursement for HCV therapy is centralized in England by NHS England (NHSE). To ensure equitable access, safe & convenient supply, a virtual national treatment pathway for children with HCV in England, Wales & Northern Ireland to provide care to children nearer to home, was established in April 2021. We evaluated its feasibility, efficacy & treatment outcomes.

Methods

A paediatric Multidisciplinary Team Operational Delivery Network (pMDT ODN), funded & supported by NHSE, with relevant paediatric & adult specialists provided a single point of contact for referrals. Referral & treatment protocols were agreed for HCV therapy approved by MHRA. On referral the pMDT ODN agreed the most appropriate therapy based on clinical presentation, genotype, ability to swallow tablets & patient preference. Treatment was prescribed in association with the local paediatrician & pharmacist, with no need for families to travel to national centres. All children in England, Wales & Northern Ireland were eligible for NHS reimbursed funded therapy. Referral centres were approved by the pMDT ODN to dispense medication. Demographic, clinical data, treatment outcomes, End of Treatment (EoT); sustained viral response at 12 weeks (SVR12) and 1yr follow-up (12mSVR) were collected. Feedback on feasibility & satisfaction of the pathway was sought from referrers.

Results

97children referred 04/2021 to 05/2023: 89–England; 7–Wales; 1–Northern Ireland; median age: 8.6 yrs; 52 (52%) male; genotypes 3 (46); 1 (44); 2 (3) & 4 (4). Transmission where known was vertical; No child had cirrhosis. Treatment outcome (where time points reached): 82/97 started; EoT – 71/82 cleared virus; 60 – SVR12; 26 – 12mSVR Referrers found the virtual process easy to access, valuing the opportunity to discuss their patient’s therapy with the virtual MDT & many found it educational. Delays in providing granules formulations due to manufacturing issues & pharmacy issues e.g. confusion with adult packaging have been resolved.

Conclusion

The National HCV pMDT ODN delivers high quality treatment & equity of access for children & young people, 3– 18 yrs with HCV in England, Wales & Northern Ireland, enabling care close to home with 100% cure rates, contributing to the goal of eliminating HCV in the UK by 2025