HEPCARE EUROPE- A case study of a service innovation project aiming at improving the elimination of HCV in vulnerable populations in four European cities

Objectives: Hepatitis C Virus (HCV) is a significant cause of chronic liver disease. Among at-risk populations, access to diagnosis and treatment is challenging. We describe an integrated model of care, Hepcare Europe, developed to address this challenge. Methods: Using a case-study approach, we describe the cascade of care outcomes at all sites. Cost analyses estimated the cost per person screened and linked to care. Results: A total of 2608 participants were recruited across 218 clinical sites. HCV antibody test results were obtained for 2568(98.5%); 1074(41.8%) were antibody-positive, 687(60.5%) tested positive for HCV-RNA, 650(60.5%) were linked to care, and 319(43.5%) started treatment. 196(61.4%) of treatment initiates achieved a Sustained Viral Response (SVR) at dataset closure, 108(33.9%) were still on treatment, eight (2.7%) defaulted from treatment, and seven (2.6%) had virologic failure or died. The cost per person screened varied from (sic)194 to (sic)635, while the cost per person linked to care varied from (sic)364 to Euro2035. Conclusions: Hepcare enhanced access to HCV treatment and cure, and costs were affordable in all settings, offering a framework for scale-up and reproducibility. (C) 2020 Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.