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Fiore V, Rastrelli E, Madeddu G, Ranieri R, De Vito A, Giuliani R, Di Mizio G, Bolcato M, De Matteis G, Ialungo AM, Dell'Isola S, Starnini G, Babudieri S. HCV spread among female incarcerated population and treatment pathways to viral elimination in Italian prison settings: clinical perspectives and medico legal aspects. BMC Infect Dis 2022; 22:601. [PMID: 35799126 PMCID: PMC9264562 DOI: 10.1186/s12879-022-07565-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 06/23/2022] [Indexed: 11/22/2022] Open
Abstract
Background Hepatitis C virus (HCV) infection is more frequent among incarcerated people than in general population. In the DAAs era, the short schedules and the low risk of adverse reactions, increased the number of HCV treatments. However, the most part of literature reports lack of incarcerated women inclusion in studies on field. Our aim is to assess the screening execution, HCV prevalence, and DAAs treatment among incarcerated women. A focused insight on quick vs standard diagnosis and staging approach will be also provided.
Methods Incarcerated women from 4 Italian regions’ penitentiary institutes were included. HCV screening was executed with HCV saliva test (QuickOral Test®) or phlebotomy. Stage of liver fibrosis was evaluated with FIB-4 value or fibroscan®, based on physicians’ decision. Treatment prescription followed national protocols. Results We included 156 women, 89 (57%) were Italian, mean age was 41 ± 10 years, and 28 (17.9%) were people who inject drugs (PWIDs). Overall, the HCV seroprevalence was 20.5%. Being PWID and on opioid substitution therapy (OST) were significantly associated with serological status (p-value < 0.001). Of them, the 75.5% of patients had active infection, the most frequent genotype was 3a (50%). Among them, 4 (16.6%) and 6 (25%) had psychosis or alcohol abuse history. The 62.5%, 25% and 12.5% had low, intermediate, and advanced fibrosis, respectively. Out of the 24 HCV-RNA positive patients, the 75% underwent to DAAs treatment. The sustained virological response (SVR12) was achieved in 88.8% of cases. When evaluating the influence of quick diagnosis and staging methods vs standard phlebotomy and fibroscan® on SVR12, FIB-4 use showed higher performance for retainment in treatment during prison staying (p = 0.015), while the use of quick saliva test had no influence on the outcome (p = 0.22). Conclusion HCV seroprevalence and active infections are very high among incarcerated women. More tailored interventions should be focused on HCV diagnosis and treatment in female prison population. The use of quick staging methods (FIB-4) is useful to increase SVR12 achievement without delays caused by the fibroscan® awaiting.
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Affiliation(s)
- Vito Fiore
- Infectious and Tropical Disease Clinic, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Viale San Pietro 35/b, 07100, Sassari, Italy.
| | - Elena Rastrelli
- Medicina Protetta-Unit of Infectious Diseases, Belcolle Hospital, Viterbo, Italy
| | - Giordano Madeddu
- Infectious and Tropical Disease Clinic, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Viale San Pietro 35/b, 07100, Sassari, Italy
| | - Roberto Ranieri
- Penitentiary Infectious Diseases Unit, A.O. Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Andrea De Vito
- Infectious and Tropical Disease Clinic, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Viale San Pietro 35/b, 07100, Sassari, Italy
| | - Ruggero Giuliani
- Penitentiary Infectious Diseases Unit, A.O. Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Giulio Di Mizio
- Forensic Medicine, Department of Law, Magna Graecia, University of Catanzaro, Catanzaro, Italy
| | - Matteo Bolcato
- Legal Medicine, University of Padua, 35121, Padova, Italy
| | - Giuseppe De Matteis
- Health Protection for Adults and Youth Unit, Penitentiary Institute, Salerno, Italy
| | - Anna Maria Ialungo
- Medicina Protetta-Unit of Infectious Diseases, Belcolle Hospital, Viterbo, Italy
| | - Serena Dell'Isola
- Medicina Protetta-Unit of Infectious Diseases, Belcolle Hospital, Viterbo, Italy
| | - Giulio Starnini
- Medicina Protetta-Unit of Infectious Diseases, Belcolle Hospital, Viterbo, Italy
| | - Sergio Babudieri
- Infectious and Tropical Disease Clinic, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Viale San Pietro 35/b, 07100, Sassari, Italy
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Milestones to reach Hepatitis C Virus (HCV) elimination in Italy: From free-of-charge screening to regional roadmaps for an HCV-free nation. Dig Liver Dis 2022; 54:237-242. [PMID: 33926816 DOI: 10.1016/j.dld.2021.03.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/23/2021] [Accepted: 03/25/2021] [Indexed: 12/11/2022]
Abstract
Although Italy has been on track for Hepatitis C Virus (HCV) elimination since 2019, it fell off track due to the decrease in the number of treated patients. HCV elimination in Italy will be possible if immediate action is taken. A health policy was implemented beginning in 2021, consisting of screening among key populations and birth cohorts (1969-1989), estimated to have a high prevalence of undiagnosed individuals. The active screening requires regional governance that manages the processes' complexity integrating a well-organized network between territory assistance and hospital to achieve an effective HCV care cascade. This document aims to support the regional decision-making process by defining paths for screening and linkage-to-care. Implementing active screening strategies beyond a risk-based approach is required as a General Practitioners' task. Simplified paths must be drawn for the key populations screening. The infrastructure built for COVID-19 vaccination could be used also for HCV screening. According to a multidisciplinary care delivery, screening should be supplemented with rapid linkage-to-care and treatment of newly diagnosed patients. The realization of the proactive screening during the first two years is vital because it will define the tracks for the whole HCV cost-effective screening of 1948-1988 birth cohorts in Italy.
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Supanan R, Han WM, Harnpariphan W, Ueaphongsukkit T, Ubolyam S, Sophonphan J, Tangkijvanich P, Thanprasertsuk S, Avihingsanon A. Brief Report: HCV Universal Test-and-Treat With Direct Acting Antivirals for Prisoners With or Without HIV: A Prison Health Care Workers-Led Model for HCV Microelimination in Thailand. J Acquir Immune Defic Syndr 2021; 88:465-469. [PMID: 34757974 DOI: 10.1097/qai.0000000000002801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 08/23/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND This study investigated the sustained virologic responses (SVRs) among prisoners with hepatitis C virus (HCV) using universal test-and-treat approach by prison health care workers in a central male prison in Thailand. METHODS A universal HCV screening was conducted in a maximum-security central prison (Klong Prem Central Prison) in Thailand. HCV RNA-confirmed prisoners were treated with generic sofosbuvir/velpatasvir by prison health care workers, regardless of their HCV genotypes and duration of prison sentences. We evaluated the SVR rates at 12 weeks after completing direct acting antivirals (DAA) treatment. RESULTS A total of 68 prisoners with detectable HCV RNA received DAA treatment. The median age and duration of prison sentences were 44 years (interquartile range, 41-53) and 25 (interquartile range, 19-33) years, respectively. Twenty-five percentage of the participants was coinfected with HIV, and 6% of the participants was coinfected with hepatitis B virus. Among all prisoners who received DAA treatment, 20 (29%) had genotype (GT)-1a, 3 (4%) had GT-1b, 22 (32%) had GT-3a, 3 (4%) had GT-3b, and 7 (10%) had GT-6. Overall, improvements in liver biomarkers were seen after HCV treatment, and SVR was achieved in 97% of the participants with per-protocol analysis and in 90% of the participants with intention-to-treat analysis. CONCLUSIONS HCV treatment using DAA among prisoners through universal test-and-treat approach led by prison health care workers is highly effective and safe, and such model can potentially help to facilitate the goals of HCV microelimination among prisoners in Thailand.
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Affiliation(s)
| | - Win Min Han
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | | | | | - Sasiwimol Ubolyam
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
- Tuberculosis Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Pisit Tangkijvanich
- Department of Biochemistry, Center of Excellence in Hepatitis and Liver Cancer, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; and
| | - Sombat Thanprasertsuk
- Department of Disease Control, Preventive Medicine, Ministry of Public Health, Nonthaburi, Thailand
| | - Anchalee Avihingsanon
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
- Tuberculosis Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Chronic Viral Hepatitis in the Italian Prison Setting: Prevalence, Outcomes, Literature Needs and Perspectives. Healthcare (Basel) 2021; 9:healthcare9091186. [PMID: 34574960 PMCID: PMC8467805 DOI: 10.3390/healthcare9091186] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 08/31/2021] [Accepted: 09/06/2021] [Indexed: 01/13/2023] Open
Abstract
Compared with the general population, incarcerated people have a higher prevalence of several communicable diseases, including viral hepatitis. Nevertheless, there is still a lack of literature in field. Our review aims to shed the actual knowledge on viral hepatitis among incarcerated people in Italy. We performed a comprehensive literature search, through key electronic databases (Scopus, Pubmed–MEDLINE) and search engines (Google Scholar), of peer-reviewed publications (articles and reviews), grey literature on viral hepatitis prevalence, and models proposed for active case finding and control strategies in prison settings. We found that viral hepatitis epidemiology drastically changed in the last five years, particularly on hepatitis C virus (HCV), reporting an HCV antibody (HCV-Ab) prevalence decrease from up to 38% to ˂20% in penitentiary institutes, as well as an even more important reduction in active infections. Probably, the availability of direct-acting antivirals is contributing to this scenario. However, there is a lack of data available regarding incarcerated women. For this reason, more tailored interventions are needed for this sub-population. Judiciary and regulatory bodies should be prompted to discuss and define specific regulations to optimize case active finding strategies, guarantee wide access to effective preventive and treatment options for viral hepatitis and enhance treatment management.
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An intervention to increase hepatitis C virus diagnosis and treatment uptake among people in custody in Iran. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 95:103269. [PMID: 33991887 DOI: 10.1016/j.drugpo.2021.103269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 04/01/2021] [Accepted: 04/14/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Iran is among countries with high opioid agonist therapy (OAT) coverage in prisons, which provides an infrastructure to increase feasibility of HCV programs. We aimed to evaluate the impact of an intervention to improve HCV screening, diagnosis, and treatment, including alongside the provision of OAT, in an Iranian prison. METHODS During July-December 2018, in the Gorgan prison, all incarcerated adults (>18 years) received HCV antibody rapid testing and, if positive, provided a venepuncture sample for HCV RNA testing. Participants with positive RNA received direct-acting antiviral (DAA) therapy [(Sofosbuvir/Daclatasvir) for 24 or 12 weeks, respectively, for those with and without cirrhosis]. Response to treatment was measured by the sustained virological response at 12 weeks post-treatment (SVR12). RESULTS Among 2015 incarcerated people with a median age of 35 years (IQR:29-41), the majority were male (97%), had not finished high school (68%), and had a history of drug use (71%), of whom 15% had ever injected drugs. A third of participants were receiving OAT, including 54% of those who had ever injected. HCV antibody prevalence was 6.7%, and RNA was detected in 4.6% of all participants; this prevalence was 32.6% and 24.7% among those with a history of injection, respectively. Treatment uptake was 82% (75/92) and was similar among people on OAT and those with a history of injection (81%). The majority completed treatment in prison and were available for SVR12 assessment (71%, 53/75). Achieved SVR12 was 100% (53/53) based on the available case analysis; those who did not have available SVR12 were released either prior to treatment initiation or completion (n = 39). CONCLUSION The availability of OAT infrastructure should be considered as an opportunity for enhancing HCV care in prisons. Where resources are limited, the prison harm reduction network could be used to design targeted HCV programs among people who are at higher risk of infection.
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Gaspar R, Liberal R, Tavares J, Morgado R, Macedo G. HIPPOCRATES ® project: A proof of concept of a collaborative program for hepatitis C virus micro-elimination in a prison setting. World J Hepatol 2020; 12:1314-1325. [PMID: 33442457 PMCID: PMC7772731 DOI: 10.4254/wjh.v12.i12.1314] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 09/29/2020] [Accepted: 11/05/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In the last few years we have witnessed a revolution in the treatment of hepatitis C virus (HCV) infection. With the introduction of direct-acting antiviral agents (DAAs), sustained virological response (SVR) is achieved in more than 95% of the patients. The focus is now being turned to the global targets set by the World Health Organization, with the aim of achieving HCV elimination by 2030. Prison inmates constitute one of the high-risk groups, and receive treatment less frequently due to several barriers in access to health care.
AIM To describe the management and follow-up of a cohort of HCV monoinfected patients treated with DAA in the prison setting, where tertial referral liver center specialists locally provide, on-site assessment and treatment for the prisoners.
METHODS A prospective observational study was conducted from April 2017 to March 2020, which included all HCV monoinfected prison inmates in the largest Northern Portugal prison. Demographic, clinical, and laboratory data, as well as transient elastography measurements, were collected onsite by the medical team and prospectively recorded. Patients were treated with DAA according to international guidelines. The primary endpoint was SVR at post-treatment week 12.
RESULTS There were 98 monoinfected HCV male inmates (mean age, 42.7 ± 8.6 years) included in the analysis. Injecting drugs or tattooing were reported in 74.5%, with 38.8% of the latter being done in prison. Alcohol consumption of more than 30 g/d was referred in 69.4%. The most prevalent genotype was 1a (54.1%), followed by 3 (27.6%), 4 (9.2%) and 1b (6.1%). Pretreatment fibrosis degree was mild-to-moderate (F0-F2) in 77.6% and severe in 22.4% (F3-F4). Treatment regimens chosen were: 45.9% elbasvir/grazoprevir, 29.6% sofosbuvir/velpatasvir, and 12.2% sofosbuvir/ledispavir and glecaprevir/pibrentasvir. No major adverse events were observed. SVR at post-treatment week 12 was 99%.
CONCLUSION In a population considered to be both hard-to-access and a cornerstone for HCV elimination, the onsite evaluation and treatment of HCV-infected prisoners, achieved an exceptional highly effective success rate. This type of collaborative program should be considered to be expanded, to support hepatitis C elimination efforts.
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Affiliation(s)
- Rui Gaspar
- Department of Gastroenterology, Centro Hospitalar de São João, Porto 4200, Portugal
| | - Rodrigo Liberal
- Department of Gastroenterology and Hepatology, Centro Hospitalar de São João, Porto 4200, Portugal
| | - Jorge Tavares
- Estabelecimento Prisional do Porto, Porto 4200, Portugal
| | - Rui Morgado
- Estabelecimento Prisional do Porto, Porto 4200, Portugal
| | - Guilherme Macedo
- Department of Gastroenterology, Centro Hospitalar de São João, Porto 4200, Portugal
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Hariri S, Sharafi H, Sheikh M, Merat S, Hashemi F, Azimian F, Tamadoni B, Ramazani R, Gouya MM, Abbasi B, Tashakorian M, Alasvand R, Alavian SM, Poustchi H, Malekzadeh R. Continuum of hepatitis C care cascade in prison and following release in the direct-acting antivirals era. Harm Reduct J 2020; 17:80. [PMID: 33081794 PMCID: PMC7576794 DOI: 10.1186/s12954-020-00431-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/13/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND People with criminal justice involvement contribute remarkably to the rising hepatitis C virus (HCV) burden; however, the continuum of care is a major barrier to prison-based programs. We aimed to evaluate a comprehensive HCV care model in an Iranian provincial prison. METHODS Between 2017-2018, in the Karaj Central Prison, newly admitted male inmates received HCV antibody testing and venipuncture for RNA testing (antibody-positive only). Participants with positive RNA underwent direct-acting antiviral (DAA) therapy (Sofosbuvir/Daclatasvir). Sustained virological response was evaluated at 12 weeks post-treatment (SVR12). RESULTS Overall, from 3485 participants, 182 (5.2%) and 117 (3.4%) tested positive for HCV antibody and RNA, respectively. Among 116 patients who were eligible for treatment, 24% (n = 28) were released before treatment and 72% (n = 83) initiated DAA therapy, of whom 81% (n = 67/83) completed treatment in prison, and the rest were released. Of total released patients, 68% (n = 30/44) were linked to care in community, and 70% (n = 21/30) completed treatment, including 60% (n = 12/20) and 90% (n = 9/10) among those who were released before and during treatment, respectively. The overall HCV treatment uptake and completion were 89% (n = 103/116) and 85% (n = 88/103), respectively. From people who completed treatment, 43% (n = 38/88) attended for response assessment and all were cured (SVR12 = 100%). CONCLUSIONS Integrated HCV care models are highly effective and can be significantly strengthened by post-release interventions. The close collaboration of community and prison healthcare systems is crucial to promote high levels of treatment adherence. Future studies should investigate the predictors of engagement with HCV care following release.
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Affiliation(s)
- Sanam Hariri
- Liver and Pancreatobiliary Diseases Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, N. Kargar St., 14117, Tehran, Iran
| | | | - Mahdi Sheikh
- Liver and Pancreatobiliary Diseases Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, N. Kargar St., 14117, Tehran, Iran
- Section of Genetics, International Agency for Research on Cancer, Lyon, France
| | - Shahin Merat
- Liver and Pancreatobiliary Diseases Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, N. Kargar St., 14117, Tehran, Iran
| | - Farnaz Hashemi
- Liver and Pancreatobiliary Diseases Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, N. Kargar St., 14117, Tehran, Iran
| | - Fatemeh Azimian
- Centre for Communicable Diseases Control, Ministry of Health and Medical Education, Tehran, Iran
| | - Babak Tamadoni
- Health and Treatment Directorate of Prisons and Security and Corrective Measures Organization, Tehran, Iran
| | - Rashid Ramazani
- Centre for Communicable Diseases Control, Ministry of Health and Medical Education, Tehran, Iran
| | - Mohammad Mehdi Gouya
- Centre for Communicable Diseases Control, Ministry of Health and Medical Education, Tehran, Iran
| | - Behzad Abbasi
- Liver and Pancreatobiliary Diseases Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, N. Kargar St., 14117, Tehran, Iran
| | - Mehrzad Tashakorian
- Health and Treatment Directorate of Prisons and Security and Corrective Measures Organization, Tehran, Iran
| | - Ramin Alasvand
- Health and Treatment Directorate of Prisons and Security and Corrective Measures Organization, Tehran, Iran
| | | | - Hossein Poustchi
- Liver and Pancreatobiliary Diseases Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, N. Kargar St., 14117, Tehran, Iran.
| | - Reza Malekzadeh
- Liver and Pancreatobiliary Diseases Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, N. Kargar St., 14117, Tehran, Iran
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Kuo YH, Kee KM, Hsu NT, Wang JH, Hsiao CC, Chen Y, Lu SN. Using AST-platelet ratio index and fibrosis 4 index for detecting chronic hepatitis C in a large-scale community screening. PLoS One 2019; 14:e0222196. [PMID: 31639131 PMCID: PMC6805051 DOI: 10.1371/journal.pone.0222196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 08/24/2019] [Indexed: 12/17/2022] Open
Abstract
Background Aspartate transaminase-platelet ratio index (APRI) and fibrosis 4 (FIB-4) are two non-invasive indexes to predict liver fibrosis in liver disease. This study was to use APRI and FIB-4 to detect chronic virus hepatitis in community screenings. Methods From 2004 to 2013, a series of community-based health screenings for residents aged 40 and older were held in Tainan city. APRI and FIB-4 of each participant were calculated and their association further analyzed with hepatitis status. Results We enrolled 180359 participants including 18726 (10.4%) hepatitis B virus (HBV), 13428 (7.4%) hepatitis C virus (HCV), 1337 (0.7%) HBV plus HCV and 146868 (81.5%) Non-HBV Non-HCV. The prevalence of chronic HCV increased with the elevation of APRI cut-offs or FIB-4 cut-offs (13.9%, 28.1%, 38.8%, 45.2%, to 49.9% in APRI≥0.3, 0.5, 0.7, 0.9,1.1, p<0.001 for the linear trend; or 15.8%, 26.4%, 34.4% to 39.7% in FIB-4≥1.75, 2.75, 3.5, 4.25, p<0.001). At the township level, APRI≥ 0.7 and FIB-4≥ 3.5 were highly correlated with HCV infection (r = 0.95, p<0.001 in APRI and r = 0.809, p<0.001 in FIB-4) and hepatocellular carcinoma (HCC) development (r = 0.894, p<0.001 in APRI and r = 0.804, p<0.001 in FIB-4), but not correlated with HBV infection. Conclusions Community screenings derived APRI or FIB-4 can identify patient subsets with increased of underlying HCV infection and risk of incident HCC.
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Affiliation(s)
- Yuan-Hung Kuo
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kwong-Ming Kee
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Nien-Tzu Hsu
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Biostatistics and Bioinformatics Center of Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Jing-Houng Wang
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chang-Chun Hsiao
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yi Chen
- Public Health Bureau, Tainan City Government, Tainan, Taiwan
| | - Sheng-Nan Lu
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Hepatogastroenterology, Department of Internal Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
- * E-mail:
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Mokkarala S, Johnson C, Sarkar S, Rudas RJ. Family Practitioner-Directed Hepatitis C Therapy With Direct-Acting Antivirals Achieves High-Sustained Virologic Response in Prison Population. JOURNAL OF CORRECTIONAL HEALTH CARE 2019; 25:134-142. [PMID: 30866706 DOI: 10.1177/1078345819832875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The burden of hepatitis C virus (HCV) infection is disproportionately high in U.S. federal and state prisons. This offers a unique opportunity for targeted HCV screening and treatment. New, highly effective, oral direct-acting antiviral (DAA) agents have the potential to eliminate many of the hurdles previously imposed by older interferon-based therapies. However, a relative deficit of providers motivated or empowered to treat HCV, along with a lack of treatment data on use of DAAs in prisons, greatly restricts the ability to treat the prison population. Here, we present a retrospective chart review of HCV treatment with DAAs by a family practitioner in a California state prison. Our data demonstrate that focused treatment by a primary care practitioner can achieve high HCV cure rates even in historically difficult to treat populations. Treatment of prison populations per local and national guidelines by family practitioners should be pursued to facilitate the eradication of hepatitis C in the United States.
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Affiliation(s)
- Sameera Mokkarala
- 1 School of Medicine, University of California, Davis, Sacramento, CA, USA.,Current affiliation: Department of Obstetrics and Gynecology, Kaiser Permanente Los Angeles Medical Center
| | - Cole Johnson
- 2 Division of Gastroenterology and Hepatology, University of California, Davis, Sacramento, CA, USA
| | - Souvik Sarkar
- 2 Division of Gastroenterology and Hepatology, University of California, Davis, Sacramento, CA, USA
| | - Robert J Rudas
- 3 Mule Creek State Prison, California Department of Corrections and Rehabilitation, Ione, CA, USA
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Kronfli N, Nitulescu R, Cox J, Moodie EEM, Wong A, Cooper C, Gill J, Walmsley S, Martel‐Laferrière V, Hull MW, Klein MB. Previous incarceration impacts access to hepatitis C virus (HCV) treatment among HIV-HCV co-infected patients in Canada. J Int AIDS Soc 2018; 21:e25197. [PMID: 30460791 PMCID: PMC6246945 DOI: 10.1002/jia2.25197] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 10/02/2018] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION The prevalence of hepatitis C virus (HCV) is far higher in prison settings than in the general population; thus, micro-elimination strategies must target people in prison to eliminate HCV. We aimed to examine incarceration patterns and determine whether incarceration impacts HCV treatment uptake among Canadian HIV-HCV co-infected individuals in the direct-acting antiviral (DAA) era. METHODS The Canadian Co-Infection Cohort prospectively follows HIV-HCV co-infected people from 18 centres. HCV RNA-positive participants with available baseline information on incarceration history were included and followed from 21 November 2013 (when second-generation DAAs were approved by Health Canada) until 30 June 2017. A Cox proportional hazards model was used to assess the effect of time-updated incarceration status on time to treatment uptake, adjusting for patient-level characteristics known to be associated with treatment uptake in the DAA era. RESULTS Overall, 1433 participants (1032/72% men) were included; 67% had a history of incarceration and 39% were re-incarcerated at least once. Compared to those never incarcerated, previously incarcerated participants were more likely to be Indigenous, earn <$1500 CAD/month, report current or past injection drug use and have poorly controlled HIV. There were 339 second-generation DAA treatment initiations during follow-up (18/100 person-years). Overall, 48% of participants never incarcerated were treated (27/100 person-years) compared to only 31% of previously incarcerated participants (15/100 person-years). Sustained virologic response (SVR) rates at 12 weeks were 95% and 92% respectively. After adjusting for other factors, participants with a history of incarceration (adjusted hazard ratio (aHR): 0.7, 95% CI: 0.5 to 0.9) were less likely to initiate treatment, as were those with a monthly income <$1500 (aHR: 0.7, 95% CI: 0.5 to 0.9) or who reported current injection drug use (aHR: 0.7, 95% CI: 0.4 to 1.0). Participants with undetectable HIV RNA (aHR: 2.1, 95% CI: 1.6 to 2.9) or significant fibrosis (aHR: 1.5, 95% CI: 1.2 to 1.9) were more likely to initiate treatment. CONCLUSIONS The majority of HIV-HCV co-infected persons had a history of incarceration. Those previously incarcerated were 30% less likely to access treatment in the DAA era even after accounting for several patient-level characteristics. With SVR rates above 90%, HCV elimination may be possible if treatment is expanded for this vulnerable and neglected group.
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Affiliation(s)
- Nadine Kronfli
- Division of Infectious Diseases/Chronic Viral Illness ServiceDepartment of MedicineGlen siteMcGill University Health CentreMontrealQCCanada
| | - Roy Nitulescu
- Research Institute of the McGill University Health CentreMontrealQCCanada
| | - Joseph Cox
- Division of Infectious Diseases/Chronic Viral Illness ServiceDepartment of MedicineGlen siteMcGill University Health CentreMontrealQCCanada
- Department of Epidemiology, Biostatistics, and Occupational HealthMcGill UniversityMontrealQCCanada
| | - Erica EM Moodie
- Department of Epidemiology, Biostatistics, and Occupational HealthMcGill UniversityMontrealQCCanada
| | - Alexander Wong
- Department of MedicineUniversity of SaskatchewanReginaSKCanada
| | - Curtis Cooper
- Department of MedicineUniversity of OttawaOttawaONCanada
| | - John Gill
- Department of MedicineUniversity of CalgaryCalgaryABCanada
| | - Sharon Walmsley
- University Health NetworkTorontoONCanada
- CIHR Canadian HIV Trials NetworkVancouverBCCanada
| | | | - Mark W Hull
- Department of MedicineUniversity of British ColumbiaVancouverBCCanada
- British Columbia Centre for Excellence in HIV/AIDSVancouverBCCanada
| | - Marina B Klein
- Division of Infectious Diseases/Chronic Viral Illness ServiceDepartment of MedicineGlen siteMcGill University Health CentreMontrealQCCanada
- CIHR Canadian HIV Trials NetworkVancouverBCCanada
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Bielen R, Stumo SR, Halford R, Werling K, Reic T, Stöver H, Robaeys G, Lazarus JV. Harm reduction and viral hepatitis C in European prisons: a cross-sectional survey of 25 countries. Harm Reduct J 2018; 15:25. [PMID: 29751763 PMCID: PMC5948815 DOI: 10.1186/s12954-018-0230-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 04/17/2018] [Indexed: 12/15/2022] Open
Abstract
Background Current estimates suggest that 15% of all prisoners worldwide are chronically infected with the hepatitis C virus (HCV), and this number is even higher in regions with high rates of injecting drug use. Although harm reduction services such as opioid substitution therapy (OST) and needle and syringe programs (NSPs) are effective in preventing the further spread of HCV and HIV, the extent to which these are available in prisons varies significantly across countries. Methods The Hep-CORE study surveyed liver patient groups from 25 European countries in 2016 and mid-2017 on national policies related to harm reduction, testing/screening, and treatment for HCV in prison settings. Results from the cross-sectional survey were compared to the data from available reports and the peer-reviewed literature to determine the overall degree to which European countries implement evidence-based HCV recommendations in prison settings. Results Patient groups in nine countries (36%) identified prisoners as a high-risk population target for HCV testing/screening. Twenty-one countries (84%) provide HCV treatment in prisons. However, the extent of coverage of these treatment programs varies widely. Two countries (8%) have NSPs officially available in prisons in all parts of the country. Eleven countries (44%) provide OST in prisons in all parts of the country without additional requirements. Conclusion Despite the existence of evidence-based recommendations, infectious disease prevention measures such as harm reduction programs are inadequate in European prison settings. Harm reduction, HCV testing/screening, and treatment should be scaled up in prison settings in order to progress towards eliminating HCV as a public health threat.
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Affiliation(s)
- Rob Bielen
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Department of Gastroenterology and Hepatology, Ziekenhuis Oost Limburg, Genk, Belgium
| | - Samya R Stumo
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Carrer del Roselló, 132, 4th, ES-08036, Barcelona, Spain
| | | | - Klára Werling
- 2nd Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Tatjana Reic
- European Liver Patients' Association (ELPA), Brussels, Belgium
| | - Heino Stöver
- Institute for Addiction Research, Frankfurt University of Applied Sciences, Frankfurt, Germany
| | - Geert Robaeys
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Department of Gastroenterology and Hepatology, Ziekenhuis Oost Limburg, Genk, Belgium.,Department of Gastroenterology and Hepatology, University Hospitals KU Leuven, Leuven, Belgium
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Carrer del Roselló, 132, 4th, ES-08036, Barcelona, Spain. .,CHIP, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
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Hepatitis C Virus Seroprevalence and Associated Risk Factors Among Male Drug Injectors in Kermanshah, Iran. HEPATITIS MONTHLY 2017. [DOI: 10.5812/hepatmon.58739] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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