Norway is among the first countries in the world to have achieved the global treatment target among people diagnosed with hepatitis C
Research findings
|Published
Over 80% of people diagnosed with an active hepatitis C infection have received treatment for their infection. This is the main finding from a new study by the Norwegian Institute of Public Health (NIPH), published in the journal Eurosurveillance.
Hepatitis C is targeted for elimination as a public health threat
Hepatitis C virus causes a mainly chronic infection that often causes no symptoms, but can lead to liver failure and liver cancer. In 2022 around 250 000 people globally died because of a hepatitis C infection (who.int). Hepatitis C used to be a difficult infection to treat, but since 2014 simple, effective, short-lasting, and well tolerated treatment has been available. In line with the UN sustainability goals, the World Health Organisation (WHO) has therefore set the aim of eliminating hepatitis C as a public health problem (who.int). Elimination is defined according to different target areas, including the proportion of people diagnosed with hepatitis C who have received treatment.
In Norway, the prevalence of hepatitis C is low in the general population. People who have ever injected drugs and immigrants from high prevalence countries are the main risk groups. Hepatitis C treatment has been available free of charge to all people diagnosed with hepatitis C in Norway since February 2018.
Treatment among people diagnosed with hepatitis C in Norway
The study, recently published in Eurosurveillance, is a registry linkage study between the Norwegian Surveillance System for Communicable Diseases, the Norwegian Prescribed Drug Registry and the National Population Register. Among reported cases of hepatitis C diagnosed with an active infection and living in Norway, the proportion treated increased from 28% in 2014 to 80% in 2021 and 82% in 2022. This is above the WHO's target of 80%, maintained for at least two years. Most cases started treatment within a couple of months of diagnosis.
– This is a really pleasing result. So far, few other countries have documented achievement of this goal, says Robert Whittaker, researcher at the NIPH. We also see that most people who start treatment complete the treatment course, he continues.
In addition to the offer of treatment to all those diagnosed, several other measures and initiatives have been implemented in Norway in recent years. This includes simplified treatment pathways outside specialist healthcare (hepatittfag.no) and treatment integrated into various low-threshold and outreach health services for people who have ever injected drugs.
– Our results indicate that the implemented measures and initiatives have had the desired effect, notes Whittaker.
Room for improvement remains
Since the global and national strategies for the elimination of hepatitis C as a public health threat were first launched, Norway has made great progress towards this goal. The prevalence among people who inject drugs has likely decreased by 80 – 90%, and the estimated incidence of new infections and hepatitis C related deaths suggest that Norway has also reached these targets. Only 12 countries are considered to be on track to achieve the elimination goal, including Norway (cdafound.org).
The study also shows that approximately 15% of newly diagnosed cases each year do not start treatment.
– This suggests that the provision of treatment can be further strengthened, Whittaker concludes. In addition to testing at-risk groups, treatment of diagnosed cases is essential to prevent infection, continue to reduce the disease burden, and achieve and maintain elimination.