Luxembourg is on the path towards eliminating Hepatitis C

• Infection and Immunotherapy Reseach Group

Carole Seguin-Devaux from the LIH Department of Infection and Immunity (DII), as President of the National Surveillance Committee on AIDS, hepatitis and sexually transmitted diseases, supports the monitoring of HIV and Hepatitis in order to eliminate the diseases in Luxembourg . The results of a study evaluating the impact of a comprehensive program for Hepatitis C (HCV) service continuity on HCV serology and HCV RNA from 2010 to 2021 was presented orally at the Fast-Track Cities conference 2024 on the 14^th of October in Paris.

The data showed that providing HCV treatment within and outside of prison among drug users, combined with continued monitoring and prevention services are effective approaches for reducing HCV infection in Luxembourg.

The Fast-Track Cities initiative is a global partnership between cities and municipalities around the world and four core partners – the International Association of Providers of AIDS Care (IAPAC), the Joint United Nations Programme on HIV/AIDS (UNAIDS), the United Nations Human Settlements Programme (UN-Habitat), and the City of Paris. Mayors and other city/municipal officials designate their cities as Fast-Track Cities by signing the Paris Declaration on Fast-Track Cities, which outlines a set of commitments to achieve zero new HIV infections and zero AIDS-related deaths as well as the WHO HCV elimination objectives.

The city of Luxembourg belongs to the network of Fast-Track cities since 2021, and was selected in this global partnership for its expertise in harm reduction services to prevent the transmission of blood-borne viruses. The Fast-Track Cities 2024 conference was the fifth in-person gathering of the Fast-Track Cities network. More than 600 delegates attended the conference, which took place between 13-15 October 2024 in Paris.

The study presented at the conference was conducted by Dr Pierre Braquet, coordinator of the national action program against hepatitis at the National Service of Infectious Diseases at the CHL, and Dr Carole Seguin-Devaux with the support of the service of infectious diseases of the Schrassig prison and the harm reduction and drug treatment services of Luxembourg. The results were presented by Dr Yolanda Alfonso Pires, coordinator of the national action program against HIV at the Direction de la Santé.

A comprehensive program has been established in Luxembourg to address blood-borne viruses among incarcerated individuals and drug users through outreach interventions. Direct Acting Antivirals (DAA) are provided by healthcare services in prisons since 2013 and in harm reduction centers for drug users since 2015. The study was performed by the National Service of Infectious Diseases which evaluated the impact of HCV service continuity on HCV serology and HCV RNA upon prison entry from 2010 to 2021. 9142 screenings for infectious diseases were analyzed among 6572 individuals incarcerated between 2010 and 2021. While the trend of prevalence for HAV (26%), HBsAg (3%), HIV (2%), Quantiferon Tb (27%) and active syphilis (<1%) remains stable from 2010 to 2021, HCV serology and HCV-RNA decreased significantly from 19% to 10% (p<0.001), and from 11% to 3% (p<0.001), respectively at entrance screening.

Decreased HCV serology and HCV-RNA were also observed at the National Service of Infectious Diseases in CHL since 2015 and among drug users during the HCV-UD study performed among drug users between 2015 and 2020. The data could be therefore explained by the establishment of a comprehensive program in prison and outside of prison to test and treat infectious diseases among drug users. Since 2015, on site-testing and linkage to care are proposed by the National Service of Infectious Diseases at two drug consumption facilities and three harm reduction sites delivering opioid substitution treatment. Furthermore, one needle exchange program, safe tattooing services, annual follow-ups, free condom provision, and hepatitis A and B vaccinations have contributed to reducing the spread of infectious diseases among the incarcerated population.

Providing HCV treatment within and outside of prison, combined with continued monitoring and prevention services, are effective approaches to reduce HCV infection in Luxembourg. HCV-RNA among drug users is a good indicator to ascertain elimination of HCV and its strong decreased prevalence demonstrated that Luxembourg is well on the path to HCV elimination.  Reinforcing these services for individuals after prison release is now necessary for moving towards HCV elimination by 2030. The global hepatitis elimination goals are: 90% reduction in new cases of chronic viral hepatitis B and C infections by 2020, and 65% reduction in viral hepatitis B and C deaths by 2030.

The Infection and Immunotherapy Group, led by Dr. Carole Seguin-Devaux, focuses on the micro-elimination of HCV among drug users, which are the main population affected by the disease. She is a Drug Related Infectious Diseases expert for EUDA and ECDC and the President of the National Surveillance Committee of AIDS, hepatitis and sexually transmitted diseases since 2017. The program offered in prison in Luxembourg has been selected as a best practice by the WHO in the compendium of good practices in the health sector response to HIV and hepatitis in 2020. The outreach program HCV-UD in harm reduction services was selected as best practice by the European Union Drugs Agency in the Hepatitis C: models of care for drug services in Europe in 2019.

Control and prevention of infectious diseases in prison and among drug users: the path to HCV elimination in Luxembourg. P. Braquet, P. Hoffmann, D Célet, J. Meyers, V. Klein, F. Mathy, P. Poos, Y Pires-Afonso, T. Staub, V. Arendt, C. Seguin-Devaux