1. Hepatitis C antibody and RNA prevalence among opiate substituted patients in Germany: Results from the nationwide ECHO-Study
Bernd Schulte1, Moritz Rosenkranz1, Christiane Schmidt1,
Uwe Verthein1, Jens Reimer1,2
1 Zentrum für Interdisziplinäre Suchtforschung (ZIS), Universität Hamburg
2 Gesundheit Nord, Bremen

2. The ECHO Study was financially supported by Janssen-Cilag GmbH Germany

3. Opioid dependent PWID in Germany
approx. 150,000 opioid-dependent persons, mainly PWID, 50% in OST
High regional variability in HCV prevalence rates (Wenz et al. 2016)
HCV AB 42.3–75.0%; HCV RNA 23.1–54.0 %
OST = therapeutic standard
First line medical setting for the provision of antiviral HCV treatment
HCV recommendations available
DAA medications available
..., but lack of data on HCV prevalence
Number of patients registered in OST

4. The ECHO-Study Study design Inclusion criteria Nationwide sample
Non-interventional, prospective study
POM: HCV prevalence among OST patients (Ab, RNA) on the basis of routine care data
SOM: e.g. HCV incidence
Inclusion criteria
OST patient
Nationwide sample
2467 patients from 63 OST units
Study duration
Patient: 12 m; Study: 27 m

5. Patient characteristics
Gender
(n = 2465)
male
72.8 %
Age in years
42.0 (SD 9.0), range: 18-77
Age at onset of opioid dependence
(n = 2429)
21.4 (SD 5.8)
Living situation
(n = 2141)
Own apartment (rent)
83.0%
Relationship
(n = 2139)
Single
54.9 %
Working situation
(n = 2147)
Full/ part time (regularly)
34.1 %
Migration background
24.3 %

6. Opioid substitution treatment data
Opioid substitution treatment (OST)
First time in OST
(n = 2353)
24.3 %
Average duration of OST at this physician/practice
(n = 2413)
6.4 years (SD 5.2), range: 0-27
Substitution medication
(n = 2456)
Percentage
Dosage in mg
(mean, SD, range)
D-/L- Methadone
(liquid or tablets)
76.1%
97.0 (50.5)
Buprenorphine
23.0%
9.8 (6.2) <1 - 32
Other
(Slow-release morphine, codeine)
0.9% --

7. HCV antibody prevalence rates
Anti-HCV prevalence
(N = 2386)
Anti-HCV -
(n = 983)
41.2%
Anti-HCV+
(n = 1403)
58.8%
(95% CI: 56.8% %)
HIER solle rechts ein Balkendiagramm incl CI rein

8. HCV antibody and RNA prevalence rates
Anti-HCV prevalence
(N = 2386)
Anti-HCV -
(n = 983)
41.2%
Anti-HCV+
(n = 1403)
58.8%
(95% CI: 56.8% %)
HCV RNA prevalence
(N = 2260)
HCV-RNA-
(n = 1643)
72.7%
HCV-RNA+
(n = 617)
27.3%
(95% CI: 25.5% %)

9. Estimated number of CHC infected OST patients in Germany
78500
Anti-HCV+
58.8%
HCV-RNA+
27.3%
Hier den Balken 2016 um die alsoluten Zahlen AB RNA Prävalenz ergänzen. Titel ändere ich noch.

10. HCV incidence
Of 983 anti-HCV negative patients, 451 re-tested between baseline and follow up
Mean time between last negative and first positive HCV-test was 27.2 months (SD 26.4, range months)
Tests results indicate HCV-seroconversions among 22 OST patients (4.9%)
Incidence rate
2.5 cases per 100 person-years (dropouts excluded)
2.1 cases per 100 person-years (dropouts included)
OST patients with a HCV seroconversion
High symptom load according OTI-HSS
Substantial problems with illicit drug use
Substantial social problems

11. Antiviral HCV treatment outcomes
Between baseline and follow-up, 151 patients treated for HCV, 98.5% with DAAs
Treatment outcomes (N=134)
Sustained virological response (SVR)
88.6%
Early virological response (EVR) (no further data available)
6.1%
Relapse
3.1%
Non response
0.8%
Premature termination of treatment

12. Discussion OST patients are a high-risk group for HCV infections
One out of four OST patients is CHC infected
Given the low seroconversion and high SVR rates, more efforts are needed to
to increase number of PWID in OST
to increase HCV treatment uptake in OST
Robust epidemiological data continuously needed
to monitor public health impact of OST
for model projections for HCV treatment as prevention
Limitations are in place
e.g. selection bias: larger OST units slightly overrepresented

13. Thanks for your attention!