More Resources

  1. Foundational papers
  2. Microelimination in practice
  3. Basic research papers
  4. Other interesting papers

Follow us on twitter for occasional posts about new research: @microeliminate
Text colours do not code for content — text colour change is just to help you navigate among the short and long references.

Some of the foundational papers for microelimination:

See a video of Lazarus explaining microelimination, or read a 2017 editorial here. Lazarus published another article with further considerations in 2018.

Lazarus et al. Viral hepatitis: “E” is for equitable elimination. Jnl of Hepatology, October 2018Volume 69, Issue 4, Pages 762–764. Full text

 Editorial: Treatment as Prevention: The Breaking of Taboos Is Required in the Fight Against Hepatitis C Among People Who Inject Drugs, by Philip Bruggmann, Hepatology, 2013. Full text

Research papers on microelimination of HCV

Microelimination in practice

A 2019 nurse-led study in Victoria, British Columbia (by Barnett, et al.) found micro-elimination in supportive housing was an effective approach, concluding “This micro-elimination model of care has dramatically decreased the local burden of HCV in PWID and can be used as a model of care for other nurses and communities.” See slides here.

An educate, test, and treat programme towards elimination of hepatitis C infection in Egypt: a community-based demonstration project (full text)
Authors: Gamal Shiha, Ammal M Metwally, Reham Soliman, Mohamed Elbasiony, Nabiel Mikhail, Philippa Easterbrook

The title says it all (or most). Egypt’s Ministry of Health estimated 7% prevalence in 2015, when this project was carried out; the Polaris group estimates 6.3%. In this village, only 4.3% declined testing. In the village, 3.3% of the population had already been treated. Testing found 7.4% viraemic prevalence among those tested (ages 12 – 80). Add that to the 3.3 already treated, and that is a lot of hepatitis C in a village. If that level of prevalence applies to the people who declined testing, there are about another 20 people in the village who have active hepatitis C infection.

The article is packed with practical and interesting information about how they proceeded, and what they found. They started by forming a partnership with some organisations based in the village and the health facility. The Association of Liver Patients also played a role.

Key figures:
4215 (89%) of 4721 eligible screened for HCV Ab and HBsAg; of these:
530 (13%) were HCV antibody positive; of these:
312 (59%) were HCV-RNA positive (7.4% of people tested); of these:
300 (96%) were given 24 weeks of sofosbuvir and ribavirin.
2·3 weeks median time to initiation (IQR 0·0–3·7) from serological diagnosis
293 (98%) of the treated participants achieved SVR12.
42 (13%) HCV-RNA-+ participants had cirrhosis (by transient elastography)
12 (29%) cirrhosis patients diagnosed with HCC (fetoprotein & ultrasound).
3575 (85%) of 4215 eligible villagers completed the baseline and after educational campaign survey; all showed significant increase in score

Published in The Lancent Gastroenterology & Hepatology 2018,
DOI: 10.1016/S2468-1253(18)30139-0.
Get full text by clicking here or on the title.

 Hepatitis C virus treatment for prevention among people who inject drugs: Modeling treatment scale‐up in the age of direct‐acting antivirals by Martin et al. 2013. Full text.

SomA USBe basic micro-elimination research:: hepatitis C

Basic research papers

Gower et al. have compiled prevalence of anti-HCV, viraemia and, where available, genotype from around the world in this valuable 2014 study. Prevalence of viraemia and the percentage of people ever infected who continue with chronic viraemia are important for calculations in planning microelimination. Genotype is no longer important in determining the treatment regimen in case a pan-genotypic regime is used.

Interesting papers on microelimination HCV

 Interesting papers on hepatitis C

Retrospective modelling of hepatitis C virus introduction to Scotland, Click here for full text of McNaughton et al., Spatiotemporal reconstruction of the introduction of hepatitis C virus into Scotland and its subsequent regional transmission, in the Journal of Virology, in 2015

Modellers reconstruct HCV’s arrival in Scotland using phylogenetics, geographic information science (GIS) and Bayesian analysis. Different genotypes are tracked after they are introduced to Glasgow from the global pool. The peak of incidence appears to have been in the 1980s.

This kind of analysis is important to understand transmission, and what has contributed to interrupting it. For microelimination, it is critical to understand networks of transmission, and the dynamics of links between them. This kind of analysis can also be used to prioritise the discovery and treatment of people with resistant variants. It can to used to most convincingly evaluate the effectiveness of current and future interventions as well. With thorough evaluations, microelimination techniques can be refined and adapted to different circumstances.

The Swiss Cohort study has been following HCV patients since 2000. See their website, or one of their papers.

Modelling shows the cost-effectiveness of needle exchanges in preventing hepatitis C in the UK.