O5. TRAP HEP C – Treatment as Prevention for Hepatitis C in Iceland. A nationwide elimination program using direct acting antiviral agents

Magnus Gottfredsson1,2, Óttar Már Bergmann1, Thórarinn Tyrfingsson3, Valgerdur Rúnarsdóttir3, Einar S. Björnsson1,2, Birgir Jóhannsson1, Bryndís Sigurdardóttir1, Ragnheidur Hulda Fridriksdóttir1, María Heimisdóttir1,2, and Sigurdur Ólafsson1,2 for the TRAP HEP C study group.
Affiliates: Landspitali University Hospital, Reykjavik, Iceland1; Faculty of Medicine, School of Health Sciences, University of Iceland2; Vogur addiction treatment centre3, Reykjavik, Iceland.

Background
Hepatitis C virus (HCV) infection is associated with significant morbidity and mortality world-wide. In Iceland, it is estimated that 800-1000 have chronic HCV infection; thus the seroprevalence within the population is estimated at 0,3%. The most common genotypes are 1 (45%) and 3a (50%). The current rate of antiviral treatment uptake will have limited effect on prevalence and long term burden of disease.The availability of highly effective new direct-acting antiviral agents (DAAs) has made treatment on a larger scale feasible. Large-scale treatment may reduce spread and near-eliminate HCV in communities, making a positive impact on morbidity and health care costs in the long term.

Methods
A nationwide treatment effort was launched in Iceland in January 2016, where patients infected with HCV are contacted and offered treatment with DAAs according to the Icelandic national guidelines. All patients undergo hepatic elastography. Individuals with currently active injection drug use (IDU), prisoners and patients with advanced liver disease are prioritized for treatment. Patients are encouraged to bring their friends who may have been exposed to the virus for testing. Active drug users get additional support to facilitate compliance. We aim to treat up to 200 patients every 4 months so that every HCV-infected individual in Iceland will be treated within 36 months (end-2018). The goal of the program is reduction in domestic transmission of HCV (number of new infections).

Results
On July 25th, 373 patients had been contacted and interviewed. Number of patients co-infected with HIV were 34. At the same time, DAA treatment had been initiated in 305 patients, or 31-38% of the HCV-infected population, thereby exceeding our target number.

Conclusions
TRAP HEP C in Iceland has been well received by patients and the community. Our experience indicates that by a well organized nationwide approach a relatively large proportion of infected patients in the community can be initiated on treatment in a short period of time.