Micro-elimination of Hepatitis C virus (HCV) infection in the General Population Cohort in rural Uganda: long-term follow-up to assess feasibility and outcomes of a screening and treatment intervention

Background: The availability of highly effective curative direct acting antiviral (DAA) therapy for hepatitis C virus (HCV) is a cornerstone of elimination strategies. We report on long-term follow-up as part of a programme that delivered HCV screening and treatment in a population cohort in Uganda. Methods: Screening for HCV, HIV and HBV was offered to >7000 participants in the Kyamulibwa General Population Cohort (GPC) in Kalungu District in rural South-West Uganda in 2011. In 2017, DAA treatment was offered to those individuals who had previously tested HCV RNA positive who could still be traced, with fixed dose combination ledipasvir + sofosbuvir (LED/SOF) for 12 weeks, and post-treatment follow-up at 24 weeks. Clinical review and elastography was repeated in 2023, and verbal autopsy data reviewed. Results: 13 individuals tested HCV RNA positive, of whom five had been born in Uganda and eight originated from Rwanda. The median age at HCV diagnosis was 61 (range 48-90) and 10/13 (77%) were male. Six years later, five had died, one had left the area, and seven individuals were traced, all of whom accepted treatment, with confirmed cure (sustained virologic suppression (SVR)). After a further six year interval, four of those treated were followed up. Among those who had died, a high prevalence of liver disease was suggested by verbal autopsies. Conclusion: Among individuals offered DAA treatment, acceptance and cure rate were high. In this setting, HCV infection likely contributed to mortality, and affected older adults and migrants, suggesting these groups might be priorities for future micro-elimination programmes.