Community-based testing and treatment for HIV and hepatitis
C achieved high hepatitis C cure rates in Thailand, results from the Thai
C-FREE study show.
Tanyapom Wansom presented results from the C-FREE cohort
study of community-based HIV and hepatitis C testing and treatment in Thailand,
at the International AIDS Society Conference on HIV Science last month.
The C-FREE study was designed to evaluate the uptake of HIV
and viral hepatitis testing and treatment in people who use drugs and their
sexual partners in Thailand. Testing and treatment were delivered in community
settings offering harm reduction services in four cities in Thailand. The model
of care is designed to eliminate barriers to treatment and provide services in
settings that people who use drugs feel comfortable to visit.
- decompensated cirrhosis
The later stage of
cirrhosis, during which the liver cannot perform some vital functions and
complications occur. See also ‘cirrhosis’ and ‘compensated cirrhosis’.
- intent to treat analysis
All participants in a clinical trial are included in the final analysis, in the groups they were originally assigned to, whether or not they actually completed their course of treatment. Provides a better estimate of the real world effect of a treatment than an ‘on treatment analysis’.
- Partner organisations disseminated information
in the community about the opportunity to be treated for hepatitis C to people
who inject drugs.
and testing for HIV and hepatitis B and C were provided at a local harm
- People with chronic hepatitis C were referred
- 12 weeks after completion of treatment, a
research nurse confirms cure of hepatitis C by doing a rapid viral load test at
the harm reduction drop-in centre.
C-FREE is a prospective cohort study that offers testing for
HIV, hepatitis B and hepatitis C every three months. An open-label treatment
study provides 12 weeks of treatment with the pangenotypic regimen of generic
sofosbuvir/velpatasvir for anyone diagnosed with hepatitis C apart from people
with decompensated cirrhosis or liver cancer.
The C-FREE cohort has enrolled 1322 people since May 2019,
mainly referred by community outreach. Cohort members have a median age of 44
years, 85% are male and 12.5% are gay or bisexual men. Thirty-five per cent are
currently injecting drugs and 38% have injected drugs in the past.
Almost 40% of the study cohort are living with
HIV, most diagnosed prior to joining the cohort, and 94% of people with HIV are
on antiretroviral treatment. Seventy-five per cent of people with HIV have fully
suppressed viral load.
Five per cent were diagnosed with chronic hepatitis B and 68%
tested positive for hepatitis C antibodies, of which 83% had chronic hepatitis
C. Nine per cent had cirrhosis. Seventy-one per cent of people with HIV were
co-infected with hepatitis C, while 2% were co-infected with HIV and hepatitis B.
The hepatitis C treatment sub-study enrolled 667 people, of
whom ten died or were lost to follow-up before completing treatment and
follow-up testing. Of the 667 people who started treatment, 549 completed
treatment, 445 were evaluated for sustained virologic response and 424 achieved
a sustained virologic response. As the study is ongoing, not all participants
have completed treatment. Intent to treat analysis, counting all those who have
completed treatment, shows a cure rate of 92.7%.
Hepatitis C treatment was well tolerated with no serious
adverse events related to the study treatment.