Hepatitis C (HCV) care made its way on to the international health agenda two years ago1. The market release of highly efficacious, well-tolerated and short treatment regimens was the main trigger. Scaling up HCV treatment worldwide to the millions of chronically infected is however not a straightforward task and demands, especially for resource-constrained settings, an evidence-based public health approach2. Well-documented pilot projects, with possibility to embed research, are crucial to build, optimize and contextualize this public health approach3. We started such a pilot project for HCV/HIV coinfection care in a large HIV clinic in Cambodia in 2014. As access to hepatitis C screening, diagnosis and treatment was (and is) almost non-existent in Cambodia, we focused our research on knowledge gaps and tools which can inform and tailor the ”initial public health approach for HCV care”4;5. This initial approach should at least prioritize access to HCV diagnosis and treatment for those more urgently in need. This PhD proposal collates the main research questions we address in this project in Cambodia: 1) extent and nature of the HCV/HIV co-epidemic in Cambodia, 2) outcomes/feasibility of interferon-free HCV treatment when integrated in a primary care HIV clinic, 3) performance of simple lab-based markers for fibrosis staging, in times of growing affordability and evidence for “treat all”, but limited resources and capacity, 4) tools for targeted HCV screening among lowrisk HIV populations, and 5) cost-effectiveness of different HCV testing approaches for HIV populations in Cambodia and other endemicity scenarios. Most of the study fieldwork (cross-sectional epidemiological study, treatment cohort study) in Cambodia has been finalized, analysis and documentation is ongoing. One manuscript was published6, a 2nd is currently under review and three others are in progress. The costeffectiveness analysis and a last field study in Ghana (to externally validate the score for targeted HCV screening derived in the Cambodian setting) needs to be started. I estimate being able to finalize the foreseen studies by end of 2018.
|Effective start/end date||26/04/18 → …|
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