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Ding X, Zhang Z, Li C, Song H, Ding S, Zhou Y, Ren X, Hou F, Wen X, Li C, Wang L, Ma J, Zhang L, Wang Y, Wang S, Geng C, Wu S, Gu J, Tian X, Lu Q. Changes in the prevalence of hepatitis B virus and its related factors in Inner Mongolia between 2006 and 2020. Front Public Health 2025; 13:1533938. [PMID: 40265061 PMCID: PMC12011829 DOI: 10.3389/fpubh.2025.1533938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2024] [Accepted: 03/11/2025] [Indexed: 04/24/2025] Open
Abstract
Objective This study aimed to compare the prevalence of serum hepatitis B virus (HBV) markers in Inner Mongolia between 2006 and 2020. Methods The same sampling process was used in investigations conducted in 2006 and 2020. A multi-stage stratified random sampling method was used to select subjects aged 1-60 years old from 12 cities in Inner Mongolia. Blood samples were collected to detect serological HBV markers including hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (HBsAb), and hepatitis B core antibody (HBcAb). The prevalence of serum biomarkers of hepatitis B, standardized by age and sex, was analyzed and compared between 2006 and 2020. Results There were 6,304 subjects in 2006 and 6,500 in 2020. The prevalence of HBsAg was higher in 2006 than in 2020 (standardized 4.11% vs. 2.75%, p < 0.001). The results were observed for the serum biomarkers of HBsAb (standardized 41.40% vs. 42.14%, p = 0.39) between 2006 and 2020, as well as HBcAb (standardized 22.91% vs. 20.15%, p < 0.001). The hepatitis B vaccine (Hep B vaccine) provides protection against HBV infection. In 2006, the proportions of timely birth dose (TBD) and 3-dose Hep B vaccine coverage for individuals aged 1-14 years were 80.57 and 89.35%, respectively. By 2020, these proportions increased to 97.43 and 96.97%, respectively. Conclusion The prevalence of HBsAg decreased significantly from 2006 to 2020 in Inner Mongolia, suggesting that the Hep B vaccine has made remarkable progress in safeguarding the population against hepatitis B infection.
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Affiliation(s)
- Xuejie Ding
- School of Public Health, Inner Mongolia Medical University, Hohhot, China
| | - Zhongbing Zhang
- Inner Mongolia Center for Disease Control and Prevention, Hohhot, China
| | - Cheng Li
- Inner Mongolia Center for Disease Control and Prevention, Hohhot, China
| | - Hui Song
- North China University of Science and Technology Affiliated Hospital, Tangshan, China
| | - Shuna Ding
- School of Public Health, BaoTou Medical College, Baotou, China
| | - Yu Zhou
- School of Public Health, Inner Mongolia Medical University, Hohhot, China
| | - Xianyun Ren
- Center for Disease Control and Prevention of Hohhot, Hohhot, China
| | - Fei Hou
- Center for Disease Control and Prevention of Baotou, Baotou, China
| | - Xia Wen
- Center for Disease Control and Prevention of Hulunbeier, Hulunbeier, China
| | - Chunyan Li
- Center for Disease Control and Prevention of Hinggan League, Hinggan League, China
| | - Libo Wang
- Center for Disease Control and Prevention of Tongliao, Tongliao, China
| | - Junqing Ma
- Center for Disease Control and Prevention of Chifeng, Chifeng, China
| | - Liwei Zhang
- Center for Disease Control and Prevention of Xilingol League, Xilingol League, China
| | - Yan Wang
- Center for Disease Control and Prevention of Erdos, Erdos, China
| | - Shuling Wang
- Center for Disease Control and Prevention of Wuhai, Wuhai, China
| | - Chunmei Geng
- Center for Disease Control and Prevention of Bayannur, Bayannur, China
| | - Shan Wu
- Center for Disease Control and Prevention of Alxa, Alxa, China
| | - Junmei Gu
- Center for Disease Control and Prevention of Ulanqab, Ulanqab, China
| | - Xiaoling Tian
- Inner Mongolia Center for Disease Control and Prevention, Hohhot, China
| | - Qingbin Lu
- Laboratory Science and Technology, School of Public Health, Peking University, Beijing, China
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Wegener M, Sims K, Brooks R, Nichols L, Sideleau R, McKay S, Villanueva M. Understanding Users' Engagement in a Provider-Created Mobile App for Training to Advance Hepatitis C Care: Knowledge Assessment Survey Study. JMIR Form Res 2024; 8:e52729. [PMID: 39486023 PMCID: PMC11568402 DOI: 10.2196/52729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 08/02/2024] [Accepted: 09/16/2024] [Indexed: 11/03/2024] Open
Abstract
BACKGROUND The World Health Organization and the Centers for Disease Control and Prevention have set ambitious hepatitis C virus (HCV) elimination targets for 2030. Current estimates show that the United States is not on pace to meet elimination targets due to multiple patient, clinic, institutional, and societal level barriers that contribute to HCV testing and treatment gaps. Among these barriers are unawareness of testing and treatment needs, misinformation concerning adverse treatment reactions, need for substance use sobriety, and treatment efficacy. Strategies to improve viral hepatitis education are needed. OBJECTIVE We aim to provide a high-quality HCV educational app for patients and health care workers, particularly nonprescriber staff. The app was vetted by health care providers and designed to guide users through the HCV testing and treatment stages in a self-exploratory way to promote engagement and knowledge retention. The app is comprised of five learning modules: (1) Testing for Hep C (hepatitis C), (2) Tests for Hep C Positive Patients, (3) Treatments Available to You, (4) What to Expect During Treatment, and (5) What to Expect After Treatment. METHODS An HCV knowledge assessment survey was administered to providers and patients at the Yale School of Medicine and 11 Connecticut HIV clinics as part of a grant-funded activity. The survey findings and pilot testing feedback guided the app's design and content development. Data on app usage from November 2019 to November 2022 were analyzed, focusing on user demographics, engagement metrics, and module usage patterns. RESULTS There were 561 app users; 216 (38.5%) accessed the training modules of which 151 (69.9%) used the app for up to 60 minutes. Of them, 65 (30.1%) users used it for >60 minutes with a median time spent of 5 (IQR 2-8) minutes; the median time between initial accession and last use was 39 (IQR 18-60) days. Users accessed one or more modules and followed a nonsequential pattern of use: module 1: 163 (75.4%) users; module 4: 82 (38%); module 5: 67 (31%); module 3: 49 (22.7%); module 2: 41 (19%). CONCLUSIONS This app, created in an academic setting, is one of a few available in English and Spanish that provides content-vetted HCV education for patients and health care supportive staff. It offers the convenience of on-demand education, allowing users to access crucial information about HCV management and treatment in a self-directed fashion that acknowledges and promotes variable preferences in learning approaches. While app uptake was relatively limited, we propose that future efforts should focus on combined promotion efforts with marketing strategies experts aligned with academic experts. Incorporating ongoing user feedback and integrating personalized reminders and quizzes, will further enhance engagement, supporting the broader public health HCV elimination goals.
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Affiliation(s)
- Maximilian Wegener
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Katarzyna Sims
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Ralph Brooks
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Lisa Nichols
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Robert Sideleau
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Sharen McKay
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Merceditas Villanueva
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, Yale University, New Haven, CT, United States
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Kim TV, Pham TND, Phan P, Le MHN, Le Q, Nguyen PT, Nguyen HT, Nguyen DX, Trang B, Cao C, Gurakar A, Hoffmann CJ, Dao DY. Effectiveness and implementation of decentralized, community- and primary care-based strategies in promoting hepatitis B testing uptake: a systematic review and meta-analysis. EClinicalMedicine 2024; 76:102818. [PMID: 39309722 PMCID: PMC11416547 DOI: 10.1016/j.eclinm.2024.102818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2024] [Revised: 08/20/2024] [Accepted: 08/21/2024] [Indexed: 09/25/2024] Open
Abstract
Background Expanding chronic hepatitis B (CHB) testing through effective implementation strategies in primary- and community-care setting is crucial for elimination. Our study aimed to determine the effectiveness of all available strategies in the literature and evaluate their specifications and implementation outcomes, thereby informing future programming and policymaking. Methods We conducted a systematic review and meta-analysis (PROSPERO CRD42023455781), searching Scopus, Embase, PubMed, and CINAHL databases up to June 05, 2024, for randomized controlled trials investigating primary- and community-care-based implementation strategies to promote CHB testing. Studies were screened against a priori eligibility criteria, and their data were extracted using a standardized protocol if included. ROB-2 was used to assess the risk of bias. Implementation strategies' components were characterized using the Behavior Change Wheel (BCW) framework. Random-effect models were applied to pool the effectiveness estimate by strategy. Mixed-effect meta-regression was employed to investigate if effectiveness varied by the number of strategy's BCW components. Findings 7146 unique records were identified. 25 studies were eligible for the review, contributing 130,598 participants. 19 studies were included in the meta-analysis. No studies were conducted in low-and-middle-income countries. Implementation outcomes were reported in only ten studies (40%). Community-based strategies included lay health workers-led education (Pooled Risk Difference = 27.9% [95% Confidence Interval = 3.4-52.4], I2 = 99.3%) or crowdsourced education on social media (3.1% [-2.2 to 8.4], 0.0%). Primary care-based strategies consisted of electronic alert system (8.4% [3.7-13.1], 95.0%) and healthcare providers-led education (HCPs, 62.5% [53.1-71.9], 27.5%). The number of BCW-framework-driven strategy components showed a significant dose-response relationship with effectiveness. Interpretation HCPs-led education stands out, and more enriched multicomponent strategies had better effectiveness. Future implementation strategies should consider critical contextual factors and policies to achieve a sustainable impact towards hepatitis B elimination targets. Funding Tran Dolch Post-Doctoral Fellowship in Hepatology, Johns Hopkins University School of Medicine, Baltimore MD, USA.
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Affiliation(s)
- Thanh Van Kim
- Center of Excellence for Liver Disease in Viet Nam, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Pham Ngoc Thach University of Medicine, Viet Nam
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Trang Ngoc Doan Pham
- Center of Excellence for Liver Disease in Viet Nam, Johns Hopkins School of Medicine, Baltimore, MD, USA
- School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Paul Phan
- Center of Excellence for Liver Disease in Viet Nam, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Minh Huu Nhat Le
- Center of Excellence for Liver Disease in Viet Nam, Johns Hopkins School of Medicine, Baltimore, MD, USA
- International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Research Center for Artificial Intelligence in Medicine, Taipei Medical University, Taipei, Taiwan
| | - Quan Le
- Center of Excellence for Liver Disease in Viet Nam, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Phuong Thi Nguyen
- University of Health Sciences, Vietnam National University Ho Chi Minh City (VNUHCM-UHS), Binh Duong, Viet Nam
| | - Ha Thi Nguyen
- University of Health Sciences, Vietnam National University Ho Chi Minh City (VNUHCM-UHS), Binh Duong, Viet Nam
| | - Dan Xuan Nguyen
- Center of Excellence for Liver Disease in Viet Nam, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Boston University School of Public Health, Boston, MA, USA
| | - Binh Trang
- Center of Excellence for Liver Disease in Viet Nam, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Chelsea Cao
- Center of Excellence for Liver Disease in Viet Nam, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ahmet Gurakar
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Christopher J. Hoffmann
- Center of Excellence for Liver Disease in Viet Nam, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Doan Y Dao
- Center of Excellence for Liver Disease in Viet Nam, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Sheehan Y, Lafferty L, Tedla N, Byrne M, Dawson O, Stewart S, Leber B, Habraken N, Lloyd AR. Development of an evidence-based hepatitis C education program to enhance public health literacy in the Australian prison sector: The Hepatitis in Prisons Education program (HepPEd). THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 129:104461. [PMID: 38971019 DOI: 10.1016/j.drugpo.2024.104461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 04/17/2024] [Accepted: 05/14/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND Australia's prisons have a high chronic hepatitis C (HCV) prevalence (8 %). Antiviral therapies and prison-based hepatitis services are available, but only a minority of those eligible are being treated. Improving the HCV public health literacy of the prison sector via targeted education may overcome key barriers to scale-up treatment. This paper describes the: i) HCV public health literacy of the prison setting; ii) barriers and solutions for HCV education and service engagement; iii) HCV education program co-design and development processes; and iv) HepPEd resources. METHODS A national needs assessment was conducted to analyse the HCV public health literacy of the target audience groups in the prisons (healthcare providers; custodial officers; people in prison) to inform development of a prison-specific HCV education program (HepPEd). Structured interviews were conducted with key informants (n = 40). Three National Steering Committees, one for each target group, were convened to co-design and develop HepPEd. RESULTS Only healthcare providers involved with hepatitis care were considered to have 'good' to 'very good' HCV health literacy (including knowledge, attitudes, and capabilities), with all other groups considered less favourably. Key barriers identified included being time poor (healthcare providers), poor motivation (custodial officers) and stigma (people in prison). Peer education delivery was considered a key facilitator for custodial officers and people in prison. A suite of multi-modal resources addressing the perceived gaps in HCV health literacy was developed, with a broad theme of 'Let's talk about hep C'. Delivery of HepPEd was designed to overcome key barriers and utilise facilitators for each group. CONCLUSIONS Significant gaps in HCV health literacy were perceived amongst the target audience groups. The comprehensive co-design and development processes utilised in HepPEd suggest the program will be well-placed to improve the HCV public health literacy of the prison sector and thereby enhance HCV testing and treatment rates amongst people in prison.
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Affiliation(s)
- Yumi Sheehan
- The Kirby Institute, University of New South Wales, Sydney, Australia.
| | - Lise Lafferty
- The Kirby Institute, University of New South Wales, Sydney, Australia; Centre for Social Research in Health, University of New South Wales, Sydney, Australia
| | - Nicodemus Tedla
- School of Biomedical Sciences, University of New South Wales, Sydney, Australia
| | - Marianne Byrne
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | | | | | | | | | - Andrew R Lloyd
- The Kirby Institute, University of New South Wales, Sydney, Australia
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Kim TV, Pham TND, Do B, Dao DVB, Nguyen DX, Lee W, Gish R, Mize G, Trang A, Le A, Phan LTB, Ngo TTD, Phan HT, Nguyen BT, Tang HK, Dao DY. Low HBV knowledge is associated with low HBV vaccination uptake in general adult population despite incentivization of HBV vaccination. BMC Infect Dis 2024; 24:470. [PMID: 38702614 PMCID: PMC11067299 DOI: 10.1186/s12879-024-09326-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 04/15/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Hepatitis B virus (HBV) vaccination in Vietnamese adults remains low and unequally distributed. We conducted a study on HBV-naïve adults living in Ho Chi Minh City, Viet Nam, to determine barriers associated with HBV vaccination uptake after removing the financial barrier by providing free coupons for HBV vaccination. METHODS After being screened for HBsAg, anti-HBs, and anti-HBc, 284 HBV-naïve study participants aged 18 and over (i.e., negative for HBsAg, anti-HBs, and anti-HBc total) were provided free 3-dose HBV vaccine coupons. Next, study participants' receipt of 1st, 2nd, and 3rd doses of HBV vaccine was documented at a pre-specified study healthcare facility, where HBV vaccines were distributed at no cost to the participants. Upon study entry, participants answered questionnaires on sociodemographics, knowledge of HBV and HBV vaccination, and related social and behavioral factors. The proportions of three doses of HBV vaccine uptake and their confidence intervals were analyzed. Associations of HBV vaccine initiation with exposures at study entry were evaluated using modified Poisson regression. RESULTS 98.9% (281 of 284) of study participants had complete data and were included in the analysis. The proportion of participants obtaining the 1st, 2nd, and 3rd doses of HBV vaccine was 11.7% (95% Confidence Interval [95% CI] 8.0-15.5%), 10.7% (95%CI 7.1-14.3%), and 8.9% (95%CI 5.6-12.2%), respectively. On the other hand, participants were more likely to initiate the 1st dose if they had adequate knowledge of transmission (adjusted relative risk [aRR] = 2.58, 95% CI 1.12-5.92), adequate knowledge of severity (aRR = 6.75, 95%CI 3.38-13.48), and annual health-checking seeking behavior (aRR = 2.04, 95%CI 1.07-3.87). CONCLUSION We documented a low HBV vaccination uptake despite incentivization. However, increased vaccine initiation was associated with better HBV knowledge and annual health check-up adherence. When considering expanding HBV vaccination to the general adult population, we should appreciate that HBV knowledge is an independent predictor of vaccine uptake.
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Affiliation(s)
- Thanh Van Kim
- Department of Epidemiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Viet Nam
- Center of Excellence for Liver Disease in Viet Nam, Ross Research Building, Room 908, Johns Hopkins University School of Medicine, 720 Rutland Avenue, Baltimore, MD, 21205, USA
| | - Trang Ngoc Doan Pham
- Viet Nam Viral Hepatitis Alliance, Reston, VA, USA
- Department of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Brian Do
- University of California, La Jolla, San Diego, USA
| | | | - Dan Xuan Nguyen
- Department of Epidemiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Viet Nam
| | - William Lee
- Viet Nam Viral Hepatitis Alliance, Reston, VA, USA
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Robert Gish
- Viet Nam Viral Hepatitis Alliance, Reston, VA, USA
- Hepatitis B Foundation, Doylestown, PA, USA
| | - Gary Mize
- Viet Nam Viral Hepatitis Alliance, Reston, VA, USA
| | - Amy Trang
- Viet Nam Viral Hepatitis Alliance, Reston, VA, USA
| | - Anh Le
- Viet Nam Viral Hepatitis Alliance, Reston, VA, USA
| | | | - Thi-Thuy-Dung Ngo
- Department of Epidemiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Viet Nam
| | | | - Binh Tan Nguyen
- Ho Chi Minh City Department of Health, Ho Chi Minh City, Viet Nam
| | - Hong Kim Tang
- Department of Epidemiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Viet Nam
| | - Doan Y Dao
- Viet Nam Viral Hepatitis Alliance, Reston, VA, USA.
- Center of Excellence for Liver Disease in Viet Nam, Ross Research Building, Room 908, Johns Hopkins University School of Medicine, 720 Rutland Avenue, Baltimore, MD, 21205, USA.
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Kandeel A, Fahim M, Abukamar S, BahaaEldin H, Abuelsood H, Samy S, Deghedy O, Sheta A, Naguib A, El Guindy N, Youssef A, Kamel R, Afifi S, El-Kassas M, Abdelghaffar K. Evidence for the elimination of viral hepatitis B and C in Egypt: Results of a nationwide survey in 2022. Liver Int 2024; 44:955-965. [PMID: 38291807 DOI: 10.1111/liv.15843] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 11/15/2023] [Accepted: 01/04/2024] [Indexed: 02/01/2024]
Abstract
INTRODUCTION Viral hepatitis C (HCV) and B (HBV) were at the top of Egypt's most significant public health challenges, with an estimated 14.7% of its population having antibodies to HCV in 2008. Egypt issued an ambitious action plan in 2014 to eliminate viral hepatitis through strengthening infection control and improving patient care. In 2018, an extensive HCV mass screening campaign was conducted for the entire country's population with treating more than 4 million patients with antivirals. This study aimed to evaluate the current prevalence of viral hepatitis in Egypt after all these efforts. METHODS A cross-sectional household cluster survey was conducted in all 27 Egyptian governorates to obtain a representative sample of Egypt's population. Subjects aged 1-70 years were interviewed using a standardised questionnaire that included demographics, viral hepatitis knowledge, previous infection and risk factors data. Laboratory testing was performed for all subjects for anti-HCV and HBsAg using chemiluminescence. Subjects positive for anti-HCV were further tested for HCV-RNA by RT-PCR. Prevalence rates were calculated by demographic groups and compared to the demographic health survey 2015 results. RESULTS Of 20 881 subjects interviewed, 48.8% were males, 20.2% were children <15 years of age, and 53.7% were residents of rural areas. Of all subjects, 92 (0.4%) were HCV-infected, 1577 (7.6%) were anti-HCV positive and 177 (0.8%) were HBV-chronically infected, including one patient who had mixed HBV and HCV current infection. The prevalence of HCV-current and HBV chronic infections decreased by 93% and 20%, respectively, compared to 2015. CONCLUSIONS Egypt achieved the elimination of the viral hepatitis goal. To maintain low rates of viral hepatitis, community health education, in addition to maintaining infection control and blood safety programs, is essential.
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Affiliation(s)
- Amr Kandeel
- Preventive Sector, Ministry of Health and Population, Cairo, Egypt
| | - Manal Fahim
- Preventive Sector, Ministry of Health and Population, Cairo, Egypt
| | - Shimaa Abukamar
- Preventive Sector, Ministry of Health and Population, Cairo, Egypt
| | - Hala BahaaEldin
- Preventive Sector, Ministry of Health and Population, Cairo, Egypt
| | - Hanaa Abuelsood
- Preventive Sector, Ministry of Health and Population, Cairo, Egypt
| | - Sahar Samy
- Preventive Sector, Ministry of Health and Population, Cairo, Egypt
| | - Ola Deghedy
- Preventive Sector, Ministry of Health and Population, Cairo, Egypt
| | - Amany Sheta
- Central Public Health Laboratory, Ministry of Health and Population, Cairo, Egypt
| | - Amel Naguib
- Central Public Health Laboratory, Ministry of Health and Population, Cairo, Egypt
| | - Nancy El Guindy
- Central Public Health Laboratory, Ministry of Health and Population, Cairo, Egypt
| | - Amr Youssef
- Central Administration for Research and Health Development, Ministry of Health and Population, Cairo, Egypt
| | - Reham Kamel
- Preventive Sector, Ministry of Health and Population, Cairo, Egypt
| | - Salma Afifi
- Ministry of Health and Population, Cairo, Egypt
| | - Moahmed El-Kassas
- Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt
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Ahmed S, Méndez RY, Naveed S, Akhter S, Mushtaque I, Malik MA, Ahmad W, Figueroa RN, Younas A. Assessment of hepatitis-related knowledge, attitudes, and practices on quality of life with the moderating role of internalized stigma among hepatitis B-positive patients in Pakistan. Health Psychol Behav Med 2023; 11:2192782. [PMID: 37008419 PMCID: PMC10064821 DOI: 10.1080/21642850.2023.2192782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023] Open
Abstract
Aim This study aimed to assess the Pakistani hepatitis B patients' knowledge, attitudes, and practices towards hepatitis management and the impact of self-management on the quality of life of hepatitis B patients as well as the moderating role of stigmatization. Methods A cross-sectional study design was used, and the data was collected from a total of 432 hepatitis B positive patients through a self-designed questionnaire. The studied subjects consisted of men (n = 205, 47%), women (n = 165, 38%), and transgender (n = 62, 14%). The obtained data were statistically analyzed using SPSS software version 26.0 for Windows. Results The mean age of the study participants was 48. Knowledge has a significant positive relationship with hepatitis self-management and quality of life, whereas knowledge has a negative relationship with stigmatization. Furthermore, multivariate analysis revealed that men were more knowledgeable about the disease than women and transgender people (6.14 ± 2.08 vs. 3.23 ± 1.61 vs. 1.03 ± 0.73, F = 8.2**, p = .000). On the scale of attitude and practice, significant gender differences were found. Women had more experience with hepatitis self-management than men or transgender (4.21 ± 13.0 vs. 2.17 ± 6.02 vs. 0.37 ± 0.31, F = 6.21**, p = .000). The regression analysis showed that self-management has a positive association with quality of life (B = 0.36, p = .001). The moderation analysis revealed that stigmatization negatively moderates the relationship between self-management and quality of life (B = -0.53, p = .001). Conclusion Generally, patients had good knowledge about the disease and its self-management. However, a societal and community-level awareness campaign should be organized on the quality of life and stigmatization of people with chronic illness regarding their human rights, dignity, and physical, mental, and social well-being.
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Sigmon SC, Peck KR, Batchelder SR, Badger GJ, Heil SH, Higgins ST. Technology-Assisted Buprenorphine Treatment in Rural and Nonrural Settings: Two Randomized Clinical Trials. JAMA Netw Open 2023; 6:e2331910. [PMID: 37755833 PMCID: PMC10534272 DOI: 10.1001/jamanetworkopen.2023.31910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/27/2023] [Indexed: 09/28/2023] Open
Abstract
Importance Expansion of opioid use disorder treatment is needed, particularly in rural communities. Objective To evaluate technology-assisted buprenorphine (TAB) efficacy (1) over a longer period than previously examined, (2) with the addition of overdose education, and (3) among individuals residing in rural communities. Design, Setting, and Participants Two parallel, 24-week randomized clinical trials were conducted at the University of Vermont between February 1, 2018, and June 30, 2022. Participants were adults with untreated opioid use disorder from nonrural (trial 1) or rural (trial 2) communities. These trials are part of a programmatic effort to develop TAB protocols to improve treatment availability in underserved areas. Interventions Within each trial, 50 participants were randomized to TAB or control conditions. Participants in the TAB group completed bimonthly visits to ingest medication and receive take-home doses via a computerized device. They received nightly calls via an interactive voice response (IVR) system, IVR-generated random call-backs, and iPad-delivered HIV, hepatitis C virus (HCV), and overdose education. Control participants received community resource guides and assistance with contacting resources. All participants received harm reduction supplies and completed monthly assessments. Main Outcomes and Measures The primary outcome was biochemically verified illicit opioid abstinence across monthly assessments. Secondary outcomes included self-reported opioid use in both groups and abstinence at bimonthly and random call-back visits, treatment adherence, satisfaction, and changes in HIV, HCV, and overdose knowledge among TAB participants. Results Fifty individuals (mean [SD] age, 40.6 [13.1] years; 28 [56.0%] male) participated in trial 1, and 50 (mean [SD] age, 40.3 [10.8] years; 30 [60.0%] male) participated in trial 2. Participants in the TAB group achieved significantly greater illicit opioid abstinence vs controls at all time points in both trial 1 (85.3% [128 of 150]; 95% CI, 70.7%-93.3%; vs 24.0% [36 of 150]; 95% CI, 13.6%-38.8%) and trial 2 (88.0% [132 of 150]; 95% CI, 72.1%-95.4%; vs 21.3% [32 of 150]; 95% CI, 11.4%-36.5%). High abstinence rates were also observed at TAB participants' bimonthly dosing visits (83.0% [95% CI, 67.0%-92.0%] for trial 1 and 88.0% [95% CI, 71.0%-95.0%] for trial 2). Treatment adherence was favorable and similar between trials (with rates of approximately 99% for buprenorphine administration, 93% for daily IVR calls, and 92% for random call-backs), and 183 of 187 urine samples (97.9%) tested negative for illicit opioids at random call-backs. iPad-delivered education was associated with significant and sustained increases in HIV, HCV, and overdose knowledge. Conclusions and Relevance In these randomized clinical trials of TAB treatment, demonstration of efficacy was extended to a longer duration than previously examined and to patients residing in rural communities. Trial Registration ClinicalTrials.gov Identifier: NCT03420313.
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Affiliation(s)
- Stacey C. Sigmon
- Vermont Center on Behavior and Health, University of Vermont, Burlington
- Department of Psychiatry, University of Vermont, Burlington
- Department of Psychological Science, University of Vermont, Burlington
| | - Kelly R. Peck
- Vermont Center on Behavior and Health, University of Vermont, Burlington
- Department of Psychiatry, University of Vermont, Burlington
- Department of Psychological Science, University of Vermont, Burlington
| | - Sydney R. Batchelder
- Vermont Center on Behavior and Health, University of Vermont, Burlington
- Department of Psychiatry, University of Vermont, Burlington
| | - Gary J. Badger
- Department of Medical Biostatistics, University of Vermont, Burlington
| | - Sarah H. Heil
- Vermont Center on Behavior and Health, University of Vermont, Burlington
- Department of Psychiatry, University of Vermont, Burlington
- Department of Psychological Science, University of Vermont, Burlington
| | - Stephen T. Higgins
- Vermont Center on Behavior and Health, University of Vermont, Burlington
- Department of Psychiatry, University of Vermont, Burlington
- Department of Psychological Science, University of Vermont, Burlington
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Winter RJ, Sheehan Y, Papaluca T, Macdonald GA, Rowland J, Colman A, Stoove M, Lloyd AR, Thompson AJ. Consensus recommendations on the management of hepatitis C in Australia's prisons. Med J Aust 2023; 218:231-237. [PMID: 36871200 DOI: 10.5694/mja2.51854] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 01/04/2023] [Indexed: 03/06/2023]
Abstract
INTRODUCTION Prison settings represent the highest concentration of prevalent hepatitis C cases in Australia due to the high rates of incarceration among people who inject drugs. Highly effective direct-acting antiviral (DAA) therapies for hepatitis C virus (HCV) infection are available to people incarcerated in Australian prisons. However, multiple challenges to health care implementation in the prison sector present barriers to people in prison reliably accessing hepatitis C testing, treatment, and prevention measures. MAIN RECOMMENDATIONS This Consensus statement highlights important considerations for the management of hepatitis C in Australian prisons. High coverage testing, scale-up of streamlined DAA treatment pathways, improved coverage of opioid agonist therapy, and implementation and evaluation of regulated provision of prison needle and syringe programs to reduce HCV infection and reinfection are needed. CHANGES IN MANAGEMENT AS A RESULT OF THIS STATEMENT The recommendations set current best practice standards in hepatitis C diagnosis, treatment and prevention in the Australian prison sector based on available evidence. Prison-based health services should strive to simplify and improve efficiency in the provision of the hepatitis C care cascade, including strategies such as universal opt-out testing, point-of-care testing, simplified assessment protocols, and earlier confirmation of cure. Optimising hepatitis C management in prisons is essential to prevent long term adverse outcomes for a marginalised population living with HCV. Scale-up of testing and treatment in prisons will make a major contribution towards Australia's efforts to eliminate hepatitis C as a public health threat by 2030.
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Affiliation(s)
- Rebecca J Winter
- Monash University, Melbourne, VIC
- Burnet Institute, Melbourne, VIC
- St Vincent's Hospital, Melbourne, VIC
| | - Yumi Sheehan
- Kirby Institute, University of New South Wales, Sydney, NSW
| | - Timothy Papaluca
- St Vincent's Hospital, Melbourne, VIC
- University of Melbourne, Melbourne, VIC
| | - Graeme A Macdonald
- University of Queensland, Brisbane, QLD
- Princess Alexandra Hospital, Brisbane, QLD
| | - Joy Rowland
- Department of Justice, Government of Western Australia, Perth, WA
| | | | - Mark Stoove
- Monash University, Melbourne, VIC
- Burnet Institute, Melbourne, VIC
| | - Andrew R Lloyd
- Kirby Institute, University of New South Wales, Sydney, NSW
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Venkatesh V, Pati GK, Uthansingh K, Mallick P, Narayan J, Mishra D, Sahu MK. Knowledge, Awareness and Prevalence of Hepatitis B Among Urban Slum Dwellers and Residents of Social Welfare Home: A Cross sectional Study From Eastern India. J Clin Exp Hepatol 2023; 13:31-36. [PMID: 36647417 PMCID: PMC9840071 DOI: 10.1016/j.jceh.2022.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/02/2022] [Indexed: 11/06/2022] Open
Abstract
Background/aims In view of limited data on the knowledge and awareness of hepatitis B virus (HBV) and the available preventive strategies at the community level, it was aimed to analyse the knowledge and awareness of HBV in the community. Methods A cross-sectional questionnaire-based survey was conducted among residents of an urban slum and a social welfare home in Bhubaneswar, Odisha, from October 2019 to April 2021. The prevalence of HBV infection was also measured by testing the serum positivity for hepatitis B surface antigen using rapid point-of-care test kits. The statistical analysis was done by using the software SPSS version 20. Results A total of 370 individuals (mean age 38.7 ± 14.9 years, males: 55.1%) were assessed. Although 18.1% (67) had good knowledge, only 16.7% (62) had good awareness about HBV. Approximately 14.8% (55) knew that a vaccine is available in the country for HBV, and 6.2% (23) identified themselves as being vaccinated. Educational status was a significant independent predictor of knowledge and awareness such that people with education level of matriculation and above had odds of 11.05 (95% confidence interval: 5.3-22.7) and 14.7 (95% confidence interval: 6.5-33.1) for having good knowledge and awareness regarding HBV, respectively. A total of 10 participants tested positive for hepatitis B surface antigen contributing to a point prevalence rate of 2.7%. The proportion of individuals with an education status of matriculation and above was higher in the slum area when compared with the welfare home (67% vs 33%; P < 0.001), the knowledge (71.6% vs 28.4%; P < 0.001) and so was the awareness (71% vs 29%; P < 0.001) about HBV as well. Conclusion The relatively low figures of knowledge and awareness identified in our study undermine the need for intensification of health education and promotion activities regarding the prevalence of hepatitis B infection on a large scale at the community level.
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Affiliation(s)
- Vybhav Venkatesh
- Department of Gastroenterology and Hepatobiliary Sciences, IMS and SUM Hospital, Siksha 'O' Anusandhan University, Bhubaneswar, Odisha, India
| | - Girish K Pati
- Department of Gastroenterology and Hepatobiliary Sciences, IMS and SUM Hospital, Siksha 'O' Anusandhan University, Bhubaneswar, Odisha, India
| | - Kanishka Uthansingh
- Department of Gastroenterology and Hepatobiliary Sciences, IMS and SUM Hospital, Siksha 'O' Anusandhan University, Bhubaneswar, Odisha, India
| | - Pradeep Mallick
- Department of Gastroenterology and Hepatobiliary Sciences, IMS and SUM Hospital, Siksha 'O' Anusandhan University, Bhubaneswar, Odisha, India
| | - Jimmy Narayan
- Department of Gastroenterology and Hepatobiliary Sciences, IMS and SUM Hospital, Siksha 'O' Anusandhan University, Bhubaneswar, Odisha, India
| | - Debakanta Mishra
- Department of Gastroenterology and Hepatobiliary Sciences, IMS and SUM Hospital, Siksha 'O' Anusandhan University, Bhubaneswar, Odisha, India
| | - Manoj K Sahu
- Department of Gastroenterology and Hepatobiliary Sciences, IMS and SUM Hospital, Siksha 'O' Anusandhan University, Bhubaneswar, Odisha, India
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Hepatitis B, C and human immunodeficiency virus knowledge among the general greek population: results from the Hprolipsis nationwide survey. BMC Public Health 2022; 22:2026. [PMCID: PMC9637311 DOI: 10.1186/s12889-022-14353-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 09/09/2022] [Indexed: 11/08/2022] Open
Abstract
Abstract
Background
Although several studies on hepatitis B (HBV), C (HCV) and human immunodeficiency virus (HIV) infection have been conducted in Greece, little is known on the knowledge level of the Greek population towards these three infections. Our aim was to assess the knowledge level of the adult Greek general population about the HBV, HCV and HIV.
Methods
Data were derived from the first general population health survey, Hprolipsis. The sample was selected by multistage stratified random sampling. A standardized questionnaire was administered by trained interviewers during home visits. A knowledge score was constructed based on responses to 17 per infection selected items and categorized in three levels; high (12–17 correct replies) medium (6–11) and low (0–5). Among 8,341 eligible individuals, 6,006 were recruited (response rate: 72%) and 5,878 adults (≥ 18 years) were included in the analysis. The statistical analysis accounted for the study design.
Results
Only 30.4%, 21.6%, and 29.6% of the participants had a high overall knowledge level of HBV, HCV and HIV, respectively. These low percentages were mainly attributed to the high levels of misconception about transmission modes (65.9%, 67.2%, and 67.9%, respectively). Results showed that increasing age and living out of the big metropolitan cities were associated with decreased odds of having higher knowledge. Female gender, higher education level, higher monthly family income, higher medical risk score, history of testing and being born in Greece or Cyprus, were associated with increased odds of having higher knowledge.
Conclusions
There are significant knowledge gaps in the Greek general population regarding modes of transmission, preventive measures and treatment availability for HBV, HCV and HIV. There is an urgent need for large scale but also localized awareness activities targeted to less privileged populations, to fill the gaps in knowledge and increase population engagement in preventive measures.
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Uzair Khalid M, Khan S, Koerber D, Ashok Shah H. Educational interventions to improve hepatitis C testing or treatment in South Asian communities: A systematic review. CANADIAN LIVER JOURNAL 2022; 5:513-529. [PMID: 38144401 PMCID: PMC10735205 DOI: 10.3138/canlivj-2022-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 06/02/2022] [Accepted: 06/05/2022] [Indexed: 12/26/2023]
Abstract
BACKGROUND: Hepatitis C (HCV) places a disproportionately higher burden on the South Asian community in comparison to the general population, despite the availability of effective antiviral therapies. This study seeks to characterize the effectiveness of health promotion initiatives aimed at South Asians to improve HCV prevention, education, screening, and treatment adherence. METHODS: A systematic review (PROSPERO: CRD42021253796) was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Ovid MEDLINE, CINAHL Plus, Web of Science, ERIC, Ovid Embase, Cochrane Library, and PsycINFO were searched from inception to 15 April 2022 for original studies that reported on any health promotion initiative directed at improving HCV outcomes in the South Asian community. Risk of bias was assessed via a quality score. RESULTS: A total of 15 studies (6 uncontrolled interventional, 3 before-after interventional, 3 randomized controlled, 2 prospective cohort, and 1 historically controlled interventional study designs) involving 69,958 participants were included. The most studied interventions were formal HCV teaching (n = 12), community outreach (n = 6), and coupling screening/testing with existing programs (n = 3). Ninety-two percent (14/15) of interventions were concluded to be successful, and 71% (10/14) of those were concluded to be feasible and/or cost-effective. CONCLUSIONS: Interventions that aim to improve HCV education and accessibility to screening/treatment can substantially reduce barriers to care in South Asian communities. Further research, of higher quality RCT evidence, is needed to study the long-term reduction in HCV prevalence from these proposed interventions, and their associated feasibility profiles.
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Affiliation(s)
- Muhammad Uzair Khalid
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Shawn Khan
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Koerber
- Department of Internal Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Hemant Ashok Shah
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Gastroenterology and Hepatology, University Health Network, Toronto, Ontario, Canada
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Innovations in education: A prospective study of storytelling narratives to enhance hepatitis C virus knowledge among substance users. World J Hepatol 2022. [DOI: 10.4254/wjh.v14.i5.973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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14
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Talal AH, Ding YX, Markatou M. Innovations in education: A prospective study of storytelling narratives to enhance hepatitis C virus knowledge among substance users. World J Hepatol 2022; 14:972-983. [PMID: 35721284 PMCID: PMC9157714 DOI: 10.4254/wjh.v14.i5.972] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/21/2022] [Accepted: 04/21/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Even though substance users have the highest hepatitis C virus (HCV) burden, many lack knowledge about the infection. Lack of knowledge is an important obstacle to pursuing HCV care. Although printed materials are conventionally utilized to disseminate HCV-related knowledge, narrative story-telling videos may be an alternative. Data are extremely limited, however, in the ability of storytelling videos to increase HCV knowledge among substance users. In this study, we hypothesized that a story-telling narrative video would increase substance user’s immediate and 1-month HCV-related knowledge compared to a printed format.
AIM To assess immediate and 1-month HCV-related knowledge retention among substance users comparing education delivered via a storytelling narrative video compared to a printed format.
METHODS We conducted a prospective matched, case-control study among substance users actively prescribed buprenorphine enrolled from two sites. The intervention site received the video and the control site, the brochure. Participants (n = 176) were matched on age, gender, and race. We obtained extensive patient and stakeholder input on the video’s design, validated the video’s content, and developed a recruitment plan to guide participant enrollment. Knowledge was assessed by administration of a 25-item instrument immediately before, immediately after, or one month after the intervention. Data were analyzed using nonparametric and generalized linear mixed-effects models.
RESULTS We recruited a total of 176 substance users, 90 and 86 individuals, from each site, respectively. One-month follow up occurred in 92% and 94% of enrollees in the control and intervention groups, respectively. In comparison with the pre-intervention scores, immediate knowledge recall increased significantly for both the intervention (P < 0.0001) and control (P < 0.0001) groups. Multivariate modeling revealed a significant improvement in HCV-related knowledge and retention (P = 0.033) among participants who viewed the storytelling video.
CONCLUSION Storytelling narratives emphasizing HCV education appear to be an effective method to increase HCV-related knowledge among substance users. They should become an educational cornerstone to promote HCV management among this population.
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Affiliation(s)
- Andrew H Talal
- Department of Medicine, University at Buffalo, State University of New York, Buffalo, NY 14203, United States
| | - Yu-Xin Ding
- Department of Biostatistics, University at Buffalo, State University of New York, Buffalo, NY 14214, United States
| | - Marianthi Markatou
- Department of Biostatistics, University at Buffalo, State University of New York, Buffalo, NY 14214, United States
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Low Rates of Hepatitis B Virus Treatment Among Treatment-Eligible Patients in Safety-Net Health Systems. J Clin Gastroenterol 2022; 56:360-368. [PMID: 33780210 DOI: 10.1097/mcg.0000000000001530] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 02/10/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Timely initiation of antiviral therapy in chronic hepatitis B virus (CHB) reduces risk of disease progression. We evaluate overall treatment rates and predictors of treatment among treatment-eligible safety-net CHB patients. METHODS We retrospectively evaluated adults with CHB from 2010 to 2018 across 4 large safety-net health systems in the United States. CHB was identified with ICD-9/10 diagnosis coding and confirmed with laboratory data. Treatment eligibility was determined using American Association for the Study of Liver Diseases (AASLD) guidelines. Comparison of CHB treatment rates among treatment-eligible patients were performed using χ2 testing, Kaplan Meier methods and log-rank testing. Adjusted multivariate Cox proportional hazards models evaluated independent predictors of receiving treatment among eligible patients. RESULTS Among 5157 CHB patients (54.7% male, 34.6% African American, 22.3% Asian), 46.8% were treatment-eligible during the study period. CHB treatment rates were 48.4% overall and 37.3% among CHB patients without human immunodeficiency virus. Significantly lower odds of treatment were observed in females versus males (odds ratio: 0.40, 95% confidence interval: 0.33-0.49, P<0.001) and patients age 65 years or above versus age below 45 years (odds ratio: 0.68, 95% confidence interval: 0.51-0.92, P=0.012). Conversely, significantly greater odds of treatment were observed in African American and Asians versus non-Hispanic whites, CHB patients with indigent care versus commercially insured patients, and non-English speaking versus English speaking patients. CONCLUSION Among a large multicentered, safety-net cohort of CHB patients, 46.8% of treatment-eligible CHB patients overall and 37.3% of treatment-eligible CHB patients without human immunodeficiency virus received antiviral therapy. Improving CHB treatment rates among treatment-eligible patients represents "low hanging fruit," given the clear benefits of antiviral therapy in mitigating disease progression.
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Saine ME, Szymczak JE, Moore TM, Bamford LP, Barg FK, Forde KA, Schnittker J, Holmes JH, Mitra N, Lo Re V. The impact of disease-related knowledge on perceptions of stigma among patients with Hepatitis C Virus (HCV) infection. PLoS One 2021; 16:e0258143. [PMID: 34610030 PMCID: PMC8491913 DOI: 10.1371/journal.pone.0258143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 09/19/2021] [Indexed: 12/12/2022] Open
Abstract
Most patients with hepatitis C virus (HCV) infection perceive some degree of disease-related stigma. Misunderstandings about diseases may contribute to disease-related stigma. The objective of this study was to evaluate patient-level knowledge about HCV infection transmission and natural history and its association with HCV-related stigma among HCV-infected patients. We conducted a cross-sectional survey study among 265 patients with HCV in Philadelphia using the HCV Stigma Scale and the National Health and Nutrition Examination Survey (NHANES) Hepatitis C Follow-up Survey (2001-2008). The association between HCV knowledge and HCV-related stigma was evaluated via linear regression. Overall knowledge about HCV transmission and natural history was high, with >80% of participants answering ≥9 of 11 items correctly (median number of correct responses, 9 [82%]), HCV-related knowledge was similar between HIV/HCV-coinfected and HCV-monoinfected participants (p = 0.30). A higher level of HCV-related knowledge was associated with greater perceived HCV-related stigma (β, 2.34 ([95% CI, 0.51-4.17]; p = 0.013). Results were similar after adjusting for age, race, ethnicity, HIV status, education level, stage of HCV management, time since diagnosis, and history of injection drug use. In this study, increased HCV-related knowledge was associated with greater perceptions of HCV stigma. Clinicians may consider allotting time to address common misconceptions about HCV when educating patients about HCV infection, which may counterbalance the stigmatizing impact of greater HCV-related knowledge.
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Affiliation(s)
- M. Elle Saine
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Julia E. Szymczak
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Tyler M. Moore
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Laura P. Bamford
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego School of Medicine, San Diego, California, United States of America
| | - Frances K. Barg
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States of America
| | - Kimberly A. Forde
- Section of Hepatology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States of America
| | - Jason Schnittker
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States of America
- Department of Sociology, University of Pennsylvania, Philadelphia, PA, United States of America
| | - John H. Holmes
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Nandita Mitra
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Vincent Lo Re
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
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Çelik F, Bektaş H. Preventive and Treatment Interventions for Abdominal Ascites of Patients with Liver Cirrhosis: A Systematic Review of Randomized Controlled Trials. Florence Nightingale Hemsire Derg 2021; 29:250-262. [PMID: 34263244 PMCID: PMC8245014 DOI: 10.5152/fnjn.2021.19171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 11/12/2020] [Indexed: 12/16/2022] Open
Abstract
AIM This systematic review aimed to evaluate the efficacy of preventive and therapeutic approaches used in the management of ascites in liver cirrhosis. METHOD Literature review was done in “Scopus, Web of Science, CINAHL, ScienceDirect, PubMed MEDLINE, Ulakbim National Database, and Cochrane Library” databases using the keywords, “ascites, refractory ascites, liver cirrhosis, intervention, prophylaxis, treatment, nursing management, prevention, ascites management, randomized controlled trials,” and 2,447 articles were obtained. The studies with low bias risk were included. This systematic review was planned by following the recommendations of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) 2015 statement. RESULTS A total of 11 randomized controlled trials were included. When the included studies were examined, ascites treatment approaches were evaluated in all of the studies; however, preventive approaches were not evaluated. It was found that mannitol, a diuretic drug, helps ascites management by contributing to weight loss, decrease in abdominal circumference, and urinary sodium excretion. The automatic low-flow ascites pump also reduced the need for large-volume paracentesis. There was a decrease in weight and abdominal circumference measurements when band compression was applied to the umbilicus. CONCLUSION Therapeutic approaches were found to be effective. It was thought that the lack of nursing practices and the prevention of ascites formation in the abdomen was an important deficiency. Randomized controlled trials were recommended for the prevention of abdominal ascites formation and the side effects of treatment on the patient.
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Affiliation(s)
- Ferya Çelik
- Department of Internal Medicine Nursing, Akdeniz University Faculty of Nursing, Antalya, Turkey
| | - Hicran Bektaş
- Department of Internal Medicine Nursing, Akdeniz University Faculty of Nursing, Antalya, Turkey
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Ahmed MM, O Shaarawy H, Anwar I, Sarhan MD. Barriers to Completing Therapy for Hepatitis C with Direct-Acting Antivirals: A Real-Life Experience from a Single Treatment Center in Egypt. J Prim Care Community Health 2021; 12:21501327211008051. [PMID: 33813925 PMCID: PMC8020227 DOI: 10.1177/21501327211008051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Interferon-based therapies against the hepatitis C virus had a poor adherence
profile. On the other hand, new direct-acting antivirals (DAAs) are orally
administered medications, show high efficacy against the hepatitis C virus
in addition to a high safety profile. Therefore, adherence to this treatment
is expected to improve. Assessment for treatment adherence is mandatory to
assess the feasibility of achieving viral hepatitis elimination. Aim The study aims to assess the adherence rate and causes of non-adherence in
Egyptian hepatitis C patients who received interferon-free treatment
regimens. Methods Retrospective data analysis for 668 hepatitis C patient’s records from August
2014 to October 2019 was done. Assessment of treatment adherence was done by
revising the records and phone calls. However, 172 patients were excluded
due to the absence of contact data. Rest of patients (n = 496) was
categorized into 2 groups: Adherent (n = 432) and non-adherent (n = 64). For
whom comparative analysis was done. Results The adherent group (87%) achieved 100 % sustained virological response after
12 weeks (SVR 12). Non-adherence was reported in 12.9% of patients. Low
awareness was the main cause of non-adherence (43.75%). BMI was the only
significant risk factor for poor adherence
(P = .04). Other Patient demographics,
clinical, and laboratory data didn’t show any significant differences
between both groups. Conclusion Interferon-free regimens are tolerable. Raising awareness is mandatory for
proper treatment adherence and, subsequently, good clinical outcomes.
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Affiliation(s)
| | | | - Ismail Anwar
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mai D Sarhan
- Faculty of Medicine, Cairo University, Cairo, Egypt
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Mazurak N, Stengel A. Psychogastroenterologie. PSYCHOTHERAPEUT 2021. [DOI: 10.1007/s00278-021-00509-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Oleskowicz TN, Ochalek TA, Peck KR, Badger GJ, Sigmon SC. Within-subject evaluation of interim buprenorphine treatment during waitlist delays. Drug Alcohol Depend 2021; 220:108532. [PMID: 33508690 PMCID: PMC8148627 DOI: 10.1016/j.drugalcdep.2021.108532] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/16/2020] [Accepted: 12/18/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND The effectiveness of opioid agonist treatment for opioid use disorder (OUD) is well established, and delays to treatment are still common, particularly in rural geographic areas. In a randomized 12-week pilot study, we demonstrated initial efficacy of a technology-assisted Interim Buprenorphine Treatment (IBT) vs. continued waitlist control (WLC) for reducing illicit opioid use and other risk behaviors during waitlist delays. Upon completion of that parent trial, WLC participants were given the opportunity to receive 12 weeks of IBT, permitting an additional within-subject examination of IBT effects. METHODS Sixteen WLC participants crossed over to receive IBT, involving buprenorphine maintenance with bi-monthly visits, medication administration at home via a computerized device, daily monitoring calls using an Interactive Voice Response (IVR) phone system, and IVR-generated random call-backs. Biochemically-verified illicit opioid abstinence, changes in psychosocial functioning, and HIV + HCV knowledge were examined among participants originally randomized to the WLC phase and who subsequently crossed over to IBT (IBTc). RESULTS Participants submitted a higher percentage of illicit opioid negative specimens at Weeks 4, 8, and 12 during IBT (75 %, 63 %, and 50 %) vs. WLC (0%, 0%, and 0%), respectively (p's<.01). Participants also demonstrated improvements in anxiety, depression, and HIV and HCV knowledge (p's<.01). Medication administration, daily IVR call and random call-back adherence and treatment satisfaction were also favorable. CONCLUSIONS This within-subject evaluation provides additional support for interim buprenorphine's efficacy in reducing illicit opioid use and improving health outcomes during waitlist delays for more comprehensive treatment.
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Affiliation(s)
- Tatum N Oleskowicz
- Vermont Center on Behavior and Health, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA; Department of Psychological Science, University of Vermont, 2 Colchester Ave., Burlington, VT, 05401, USA
| | - Taylor A Ochalek
- Vermont Center on Behavior and Health, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA; Department of Psychological Science, University of Vermont, 2 Colchester Ave., Burlington, VT, 05401, USA
| | - Kelly R Peck
- Vermont Center on Behavior and Health, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA; Department of Psychological Science, University of Vermont, 2 Colchester Ave., Burlington, VT, 05401, USA; Department of Psychiatry, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA
| | - Gary J Badger
- Vermont Center on Behavior and Health, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA; Department of Medical Biostatistics, University of Vermont, 27 Hills Building, Burlington, VT, 05401, USA
| | - Stacey C Sigmon
- Vermont Center on Behavior and Health, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA; Department of Psychological Science, University of Vermont, 2 Colchester Ave., Burlington, VT, 05401, USA; Department of Psychiatry, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA.
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Robaeys G, Bielen R. Management of Hepatitis C Viral Infection in People Who Inject Drugs. HEPATITIS C: CARE AND TREATMENT 2021:191-211. [DOI: 10.1007/978-3-030-67762-6_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Hayward KL, Weersink RA. Improving Medication-Related Outcomes in Chronic Liver Disease. Hepatol Commun 2020; 4:1562-1577. [PMID: 33163829 PMCID: PMC7603526 DOI: 10.1002/hep4.1612] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/20/2020] [Accepted: 09/08/2020] [Indexed: 12/17/2022] Open
Abstract
Patients with chronic liver disease (CLD) are becoming increasingly complex due to the rising prevalence of multimorbidity and polypharmacy. Medications are often essential to manage the underlying liver disease, complications of cirrhosis and portal hypertension, and comorbidities. However, medication-related problems (MRPs) have been associated with adverse patient outcomes, including hospitalization and mortality. Factors that can contribute to MRPs in people with CLD are variable and often entwined. This narrative literature review discusses key barriers and opportunities to modify risk factors and improve medication-related outcomes for people with CLD.
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Affiliation(s)
- Kelly L Hayward
- Centre for Liver Disease Research, Faculty of Medicine The University of Queensland, Translational Research Institute Brisbane QLD Australia.,Department of Gastroenterology and Hepatology Princess Alexandra Hospital Brisbane QLD Australia
| | - Rianne A Weersink
- Department of Clinical Pharmacy Deventer Hospital Deventer The Netherlands
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Pollio DE, North CS, Sims OT, Hong BA. HEPATITIS C PSYCHOEDUCATION CURRICULUM TOPICS GENERATED BY GROUP MEMBERS. SOCIAL WORK WITH GROUPS 2020; 44:83-90. [PMID: 38274393 PMCID: PMC10810246 DOI: 10.1080/01609513.2020.1815631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/13/2020] [Accepted: 07/13/2020] [Indexed: 01/27/2024]
Affiliation(s)
- David E Pollio
- The University of Alabama at Birmingham, Department of Social Work, College of Arts and Sciences, Birmingham, AL, USA
| | - Carol S North
- The University of Texas Southwestern Medical Center, Departments of Psychiatry and Emergency Medicine, Dallas, TX, USA
| | - Omar T Sims
- The University of Alabama at Birmingham, Department of Social Work, College of Arts and Sciences, Birmingham, AL, USA
| | - Barry A Hong
- Washington University School of Medicine, Department of Psychiatry, St. Louis, MO, USA
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A Patient-Centered Hepatitis B Virus (HBV) Educational Intervention Improves HBV Care Among Underserved Safety-Net Populations. J Clin Gastroenterol 2020; 54:642-647. [PMID: 31688365 PMCID: PMC7744280 DOI: 10.1097/mcg.0000000000001276] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
GOALS To evaluate the impact of a prospective patient-centered hepatitis B virus (HBV) educational intervention on improving HBV care. BACKGROUND Improving patients' HBV knowledge has the potential to improve adherence to HBV monitoring and management, particularly among underserved safety-net populations. METHODS Consecutive chronic HBV adults at a single-center safety-net liver clinic were recruited from July 2017 to July 2018 to evaluate the impact of an in-person, language concordant formal HBV educational intervention on improvements in HBV knowledge and HBV management: appropriate HBV clinic follow-up (≥1 visit/year), HBV laboratory monitoring (≥1 HBV viral load and alanine aminotransferase test/year), hepatocellular carcinoma surveillance (≥1 liver imaging test/year among eligible patients), and HBV treatment among treatment eligible patients. HBV knowledge and management were assessed before and after the intervention and compared with age-matched and sex-matched HBV controls who did not receive an education. RESULTS Among 102 patients with chronic HBV (54.9% men; mean age, 52.0±13.8), HBV education improved HBV knowledge scores by 25% (P<0.001), HBV clinic follow-up from 25.5% to 81.4% (P<0.001), HBV laboratory monitoring from 62.8% to 77.5% (P=0.02), and appropriate HBV treatment from 71.5% to 98.5% (P<0.001). Compared with 102 HBV controls, receiving HBV education was associated with higher rates of HBV clinic follow-up (81.4% vs. 39.2%; odds ratio, 7.02; 95% confidence interval, 3.64-13.56; P<0.001) and appropriate HBV laboratory monitoring (77.5% vs. 42.2%; odds ratio, 4.94, 95% confidence interval, 2.64-9.24; P<0.001). CONCLUSION A formal, in-person, language concordant educational intervention leads to significant improvements in HBV knowledge, resulting in improved HBV monitoring and appropriate HBV treatment.
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Touloumi G, Karakosta A, Sypsa V, Petraki I, Anagnostou O, Terzidis A, Voudouri NM, Gavana M, Vantarakis A, Rachiotis G, Kantzanou M, Rosenberg T, Papatheodoridis G, Hatzakis A. Design and Development of a Viral Hepatitis and HIV Infection Screening Program (Hprolipsis) for the General, Greek Roma, and Migrant Populations of Greece: Protocol for Three Cross-Sectional Health Examination Surveys. JMIR Res Protoc 2020; 9:e13578. [PMID: 32004142 PMCID: PMC7055811 DOI: 10.2196/13578] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 06/25/2019] [Accepted: 07/19/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Although infectious diseases are globally on the decline, they remain a major global public health problem. Among them, the hepatitis B virus (HBV) or hepatitis C virus (HCV) and HIV infection are of primary interest. Valid prevalence data on these infections are sparse in Greece, especially for vulnerable populations. OBJECTIVE This study aimed to present the design and methods of Hprolipsis, an integrated viral hepatitis and HIV screening program administered to adults (≥18 years) from the general, Greek Roma, and migrant populations. Its aims were to estimate the prevalence of HBV, HCV, and HIV; assess infectious disease knowledge level; design, implement, and assess population-specific awareness actions; and offer individual counseling and referral when indicated and HBV vaccination to susceptible Roma and migrants. METHODS Multistage, stratified, random sampling based on the 2011 Census was applied to select the general population sample, and nonprobability multistage quota sampling was used for Roma and migrant sample selection. Trained personnel made home (general population) or community (Roma and migrants) visits. Collected blood samples were tested for Hepatitis B surface Antigen, Hepatitis B core Antibody, Hepatitis B surface Antibody, Hepatitis C Antibody, and HIV 1,2 Antibody. The surveys were conducted during May 2013 and June 2016. To estimate an HCV prevalence of 1.5% with 0.3 precision, the required general population sample size was estimated to be 6000. As migrants constitute 10% of the whole Greek population, the migrant sample size was set to 600. A feasible sample size of 500 Greek Roma was set. RESULTS In total, 6006 individuals from the general population (response rate 72%), 534 Greek Roma, and 612 migrants were recruited. Blood test results are available for 4245 individuals from the general population, 523 Roma, and 537 migrants. CONCLUSIONS Hprolipsis is the first nationwide survey on HBV, HCV, and HIV. Its results will enhance our understanding of the health needs and disease burden of these diseases in the 3 studied populations. Its implementation provided useful recommendations for future studies, particularly in vulnerable populations. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/13578.
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Affiliation(s)
- Giota Touloumi
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Argiro Karakosta
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vana Sypsa
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioanna Petraki
- International Medicine-Health Crisis Management, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Olga Anagnostou
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Agis Terzidis
- International Medicine-Health Crisis Management, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Niki Maria Voudouri
- Programs of Development, Social Support, and Medical Cooperation (PRAKSIS), Athens, Greece
| | - Magda Gavana
- Department of Primary Health Care, General Practice, and Health Services Research, Medical School of Aristotle University, Thessaloniki, Greece
| | - Apostolos Vantarakis
- Environmental Microbiology Unit of Public Health, Medical School, University of Patras, Patra, Greece
| | - George Rachiotis
- Department of Hygiene and Epidemiology, Medical Faculty, University of Thessaly, Larisa, Greece
| | - Maria Kantzanou
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Theofilos Rosenberg
- International Medicine-Health Crisis Management, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - George Papatheodoridis
- Department of Gastroenterology, Laiko General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Cui Y, Moriyama M, Chayama K, Liu Y, Ya C, Muzembo BA, Rahman MM. Efficacy of a self-management program in patients with chronic viral hepatitis in China. BMC Nurs 2019; 18:44. [PMID: 31548833 PMCID: PMC6749624 DOI: 10.1186/s12912-019-0366-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 08/22/2019] [Indexed: 12/12/2022] Open
Abstract
Background Chronic hepatitis, mainly B or C, increases the risk of hepatocellular carcinoma and remains an emerging issue in the globe. China has high rates of liver cancer incidence and mortality in the world. To address such challenges, adequate management of chronic hepatitis is required. Self-management education is one alternative for improving the hepatitis patients’ knowledge of the disease, mental health, and clinical management. This study aimed to examine the quality of life (QOL), psychological effects, and behavioral changes of a self-management program which allows continuity of care for chronic hepatitis B and C patients. Method In a six-month, randomized controlled trial, we invited 73 chronic hepatitis B/C inpatients to receive (i) two face-to-face education sessions provided by a nurse during hospitalization, and monthly telephone counseling at home after discharge; (ii) or usual care treatment (control group). The primary endpoint (patients’ QOL) and secondary outcomes (including self-efficacy, depression symptoms, perceived cognition of illness and behavioral changes) were assessed. In addition, we conducted qualitative data analysis to facilitate the evaluation of the interventions. Results Sixty (82.2%) out of 73 eligible patients with chronic hepatitis B/C (aged 34.9 ± 8.9 years) participated in the study. The intervention group (n = 30) significantly improved on outcomes including QOL, self-efficacy, perceived cognition of illness, and behavioral changes, whereas the control group significantly decreased their healthy behaviors. In terms of behavioral changes, alcohol avoidance, dietary adherence, and stress management also improved in the intervention group. However, there were no significant improvements in symptoms of depression. Most participants (80%) in the intervention group stated that they benefited from the program. Conclusions This program contributed to patients’ acquisition of self-management skills to cope with their illnesses, and significantly improved their QOL. This program serves as a reminder for nurses who care for patients with chronic viral hepatitis to acquire these skills as it would help them address the daily needs of their patients. Trial registration UMIN000025378. Registered December 23, 2016. Electronic supplementary material The online version of this article (10.1186/s12912-019-0366-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ying'ai Cui
- 1Department of Chronic Care and Family Nursing, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553 Japan
| | - Michiko Moriyama
- 1Department of Chronic Care and Family Nursing, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553 Japan
| | - Kazuaki Chayama
- 2Department of Gastroenterology and Metabolism, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553 Japan
| | - Yanhui Liu
- 3School of Nursing of Tianjin University of Traditional Chinese Medicine, 88 Yuquan Road, Nankai District, Tianjin, People's Republic of China 300193
| | - Chunmei Ya
- Department of Infection Prevention, Tianjin Second People's Hospital, 75 South Causeway Road, Nankai District, Tianjin, People's Republic of China
| | - Basilua Andre Muzembo
- 5Department of Public Health, School of Medicine, International University of Health and Welfare, Narita campus 4-3, Kozunomori, Narita-shi, Chiba-ken 286-8686 Japan
| | - Md Moshiur Rahman
- 6Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553 Japan
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Alshammari TM, Aljofan M, Subaie G, Hussain T. Knowledge, awareness, attitude, and practice of health-care professionals toward hepatitis B disease and vaccination in Saudi Arabia. Hum Vaccin Immunother 2019; 15:2816-2823. [PMID: 31226008 PMCID: PMC6930104 DOI: 10.1080/21645515.2019.1629255] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/16/2019] [Accepted: 06/04/2019] [Indexed: 12/21/2022] Open
Abstract
Objectives: Health-care professionals (HCPs) are at very high risk for accidental exposure to hepatitis B virus (HBV) from infected patients; as such, this study aimed to investigate the knowledge, awareness, attitude, and practice of HCPs toward hepatitis B vaccination.Methods: We conducted a cross-sectional study with a pre-tested, validated questionnaire in seven major cities in Saudi Arabia from January to April 2015. The questionnaire consisted of four sections: demographics, knowledge, awareness of hepatitis B infection, and attitude of HCPs toward HBV. We analyzed the data collected from study participants using SAS® V9.2.Results: Approximately 16.5% of participants reported that they had not received the hepatitis B vaccine; however, the majority of participants believed that hepatitis B is common (73.2%) and that vaccination is an effective strategy to reduce disease incidence (75%). Availability of the vaccine was a major barrier to vaccination (48.7%), together with safety concerns surrounding the vaccine (37%).Approximately 31.2% of non-vaccinated participants believed the hepatitis B vaccine is not safe, while only 8% possessed this belief in the vaccinated group. Additionally, 36.4% of non-vaccinated participants were unsure of the effectiveness of the vaccine, compared to 24.3% in the vaccinated group. Inability to afford the vaccine was reported by 18.2% of the non-vaccinated group compared to only 4% of vaccinated participants.Conclusion: There is notable hepatitis B vaccination coverage among HCPs, but observed levels are below global standards. We believe the hurdles preventing non-vaccinated HCPs from being immunized must be addressed.
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Affiliation(s)
- Thamir M. Alshammari
- Medication Safety Research Chair, King Saud University, Riyadh, Saudi Arabia
- Saudi Food and Drug Authority, Riyadh, Saudi Arabia
| | - Mohamad Aljofan
- Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Astana, Kazakhstan
| | - Gehad Subaie
- Department of Pharmacology, College of Pharmacy, University of Hail, Hail, Saudi Arabia
| | - Talib Hussain
- Department of Pharmacology, College of Pharmacy, University of Hail, Hail, Saudi Arabia
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Stewart SL, Dang JH, Török NJ, Chen MS. Patterns and co-occurrence of risk factors for hepatocellular carcinoma in four Asian American communities: a cross-sectional study. BMJ Open 2019; 9:e026409. [PMID: 31256022 PMCID: PMC6609066 DOI: 10.1136/bmjopen-2018-026409] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To investigate risk factor patterns and the simultaneous occurrence of multiple risk factors in the viral, metabolic and lifestyle domains among Asian Americans, who have had the highest mortality rates from hepatocellular carcinoma (HCC). SETTING Sacramento County, California, USA. PARTICIPANTS Eligible participants were county residents ages 18 and older who had not been screened for chronic hepatitis B virus (HBV) and were born in a CDC-defined endemic area or whose parent was born in that area. Of 1004 enrolled, 917 were foreign-born Chinese (130 women, 94 men), Hmong (133 women, 75 men), Korean (178 women, 90 men) or Vietnamese (136 women, 81 men) with complete risk factor data. PRIMARY AND SECONDARY OUTCOME MEASURES We tested participants for HBV and chronic hepatitis C virus (HCV); measured haemoglobin A1c and waist circumference; and recorded self-reported history of diabetes, hypertension, alcohol use and smoking status. We identified risk factor patterns using cluster analysis and estimated gender-specific age-standardised prevalence rates. RESULTS We identified four patterns: (1) viral (chronic HBV or HCV); (2) lifestyle (current smoker or alcohol user, no viral); (3) metabolic (≥2 metabolic, no lifestyle or viral); and (4) lower risk (≤1 metabolic, no lifestyle or viral). Vietnamese men (16.3%, 95% CI 7.4% to 25.3%) and Hmong women (15.1%, 95% CI 7.8% to 22.5%) had the highest viral pattern prevalence. Hmong women had the highest metabolic (37.8%, 95% CI 29.8% to 45.9%), and Vietnamese men the highest lifestyle (70.4%, 95% CI 59.1% to 81.7%) pattern prevalence. In multiple domains, Hmong men and women were most likely to have viral+metabolic risk factors (men: 14.4%, 95% CI 6.0% to 22.7%; women: 11.9%, 95% CI 5.6% to 18.3%); Vietnamese men were most likely to have lifestyle+viral (10.7%, 95% CI 2.7% to 18.8%), and lifestyle+metabolic but not viral (46.4%, 95% CI 34.4% to 58.5%) risk factors. CONCLUSIONS Efforts to reduce HCC must comprehensively address multiple risk factors. TRIAL REGISTRATION NUMBER NCT02596438.
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Affiliation(s)
- Susan L Stewart
- Public Health Sciences, University of California Davis School of Medicine, Sacramento, California, USA
| | - Julie Ht Dang
- UC Davis Comprehensive Cancer Center, University of California Davis School of Medicine, Sacramento, California, USA
| | - Natalie J Török
- Division of Gastroenterology & Hepatology, Department of Medicine, Stanford University, Stanford, California, USA
| | - Moon S Chen
- UC Davis Comprehensive Cancer Center, University of California Davis School of Medicine, Sacramento, California, USA
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Determinants of hepatitis C antiviral effectiveness awareness among people who inject drugs in the direct-acting antiviral era. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 52:115-122. [PMID: 29414462 DOI: 10.1016/j.drugpo.2017.12.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 12/14/2017] [Accepted: 12/18/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND & AIMS Although people who inject drugs (PWID) are at greatest risk of hepatitis C (HCV), treatment uptake in this population has historically been low. Highly effective direct acting antiviral (DAA) treatments for HCV have recently become available. Our aim was to assess the awareness among PWID of these new therapies and their effectiveness. METHODS A national survey of PWID attending injecting equipment provision sites in Scotland during 2015-2016 included questions to gauge the awareness in this population of antiviral treatment and the high cure rates associated with new therapies (defined here as >80%). RESULTS Among 2623 PWID, 92% had ever been tested for HCV. After excluding those ever treated for HCV (n = 226), 79% were aware of HCV treatment. Awareness was more likely among those who had ever been tested and self-reported either a positive (adjusted odds ratio: 16.04, 95%CI 10.57-24.33) or negative (3.11, 2.30-4.22) test result, compared to those who were never tested. The minority of all respondents (17%) were aware of high cure rates. This awareness was more likely among those who had ever been in HCV specialist care (9.76, 5.13-18.60) and those who had not been in specialist care but had been tested and self-reported either a positive (3.91, 2.20-7.53) or negative (2.55, 1.35-4.81) test result, compared to those who had never been tested. CONCLUSION We found poor awareness of the high cure rates associated with DAAs among PWID in Scotland, despite relatively high rates of HCV testing in this population. Increased effort is needed to ensure population groups with high risk of HCV infection are fully informed of the highly effective antiviral medications now available to treat this chronic disease.
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Abstract
Hepatitis C virus infection is the most common chronic blood-borne infection in the United States (U.S.). Increasing rates of hepatitis C virus infection among drug users present a significant public health problem in the U.S. and globally. This article describes the effect an educational intervention on hepatitis C virus knowledge. A project was conducted using the Brief Hepatitis C Knowledge Scale to assess pre- and post-test intervention knowledge. An educational intervention consisting of a video (Hepatitis C: Get the Facts) and a written handout, as well as a question-and-answer session, was administered to participants at a local health department. Analysis of the data through use of descriptive statistics to compare percentage change of the mean from the pretest to post-test to 3-week post-test intervention was performed. Results demonstrated the use of an educational intervention to be effective in increasing hepatitis C virus knowledge. An increase in knowledge regarding hepatitis C virus transmission may lead to a decrease in overall hepatitis C virus infection rates as well as risky behaviors.
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Correction to: Hepatology, Medicine and Policy: Articles with DOIs 10.1186/s41124-016-0014-8, 10.1186/s41124-016-0013-9 and 10.1186/s41124-016-0012-x. HEPATOLOGY, MEDICINE AND POLICY 2018. [PMID: 30480669 PMCID: PMC8044667 DOI: 10.1186/s41124-016-0014-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background India has a high burden of disease from hepatitis B virus (HBV), with 3.7 % point-prevalence, as well as from hepatitis C virus (HCV), with 1–1.5 % prevalence. Societal ignorance about HBV and HCV in India limits the potential for prevention and treatment efforts to bring these diseases under control. Since patients’ own knowledge about their health condition may have important health consequences, this study sought to assess knowledge levels among HBV and HCV patients referred to the virology laboratory of the Liver Foundation, West Bengal. Methods Patients who had tested positive for HBsAg or anti-HCV at government specialty clinics were invited to enroll in the study when they presented for follow-up laboratory testing. Study participants completed a survey that contained three multiple-choice questions about viral hepatitis etiology and five multiple-choice questions about the consequences of HBV and HCV infection. Mean knowledge scores for male and female respondents were compared, and comparisons were also made across different places of residence, age groups, education levels and income levels. One-way ANOVA was used to test for significant differences. Results Among 520 study participants, the mean knowledge score was 4.76 on an eight-point scale. Approximately 40 % of the study sample scored less than 4.0. Almost three-quarters of respondents correctly responded to the question, “Which organ of the human body is affected by hepatitis?” while almost two-thirds knew how hepatitis B is transmitted. Regarding consequences of HBV and HCV infection, less than one-third of study participants answered correctly when asked, “What happens when one is infected with hepatitis B or C?” Slightly more than two-thirds of people correctly answered the question about how hepatitis B is prevented. The mean knowledge score varied across age groups (P = 0.0009), education levels (P = 0.0001) and monthly household income levels (P = 0.0001). With higher levels of schooling and higher household income, there were corresponding increases in knowledge scores. Conclusion There is room for improving knowledge of HBV and HCV etiology and consequences among patients as well as healthcare workers in India. More awareness activities should be organized, accompanied by further research to track whether knowledge scores improve over time.
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Koc ÖM, Robaeys G, Yildirim B, Posthouwer D, Hens N, Koek GH. The influence of ethnicity on disease outcome in patients with chronic hepatitis B infection. J Med Virol 2018; 91:623-629. [PMID: 30381836 PMCID: PMC6587848 DOI: 10.1002/jmv.25353] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 10/29/2018] [Indexed: 12/18/2022]
Abstract
Since the cultural diversity in Western Europe is growing, this study assessed whether foreign‐born chronic hepatitis B (CHB) patients have more cirrhosis than Dutch‐ or Belgian‐born patients, with a main focus on the Turkish population. Baseline characteristics (eg, socioeconomic status [SES]), biological characteristics, and disease outcome (eg, cirrhosis) were collected for all patients. Between December 2009 and January 2015, 269 CHB patients participated from the outpatient departments of three hospitals in the Netherlands, Belgium, and Turkey. Out of the 269 CHB patients, 210 were foreign‐born and 59 were Dutch‐ or Belgian‐born. Compared with Dutch‐ or Belgian‐born patients, foreign‐born patients had a higher prevalence of low SES (58% vs 31%; P = 0.001) and cirrhosis (27% vs 10%; P = 0.007). Among the Turkish population, there were no significant differences regarding the prevalence of low SES (73% vs 61%; P = 0.170), alcohol abuse (1% vs 5%; P = 0.120), anti‐hepatitis C virus positivity (4% vs 0%; P = 0.344), anti‐hepatitis D virus positivity (1% vs 6%; P = 0.297), and cirrhosis (37% vs 27%; P = 0.262) between patients (n = 102) living in Turkey (local) and Turkish CHB (n = 38) patients living in the Netherlands or Belgium (immigrant). In multivariate analysis, low SES (odds ratio, 5.7; 95% confidence interval, 2.3‐14.5; P < 0.001) was associated with cirrhosis. In this study, foreign‐born CHB patients were associated with more advanced HBV‐related liver disease with 27% having cirrhosis. However, ethnicity was not associated with cirrhosis when SES was included in the multivariate analysis. The similar prevalence of cirrhosis in local Turkish compared to immigrant Turkish CHB patients is novel and warrants further investigation. Foreign‐born individuals have a higher prevalence of cirrhosis than Dutch‐ or Belgian‐ born individuals There was a lower socioeconomic status in the foreign‐born individuals No difference in the prevalence of cirrhosis was seen between the local and immigrant Turkish population Socioeconomic status and not ethnicity was an independent predictor of cirrhosis
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Affiliation(s)
- Özgür M Koc
- Department of Internal Medicine, Infectious Diseases and Medical Microbiology, Maastricht University Medical Centre, Maastricht, The Netherlands.,School of Nutrition and Translational Research in Metabolism, University Maastricht, Maastricht, The Netherlands.,Department of Gastroenterology and Hepatology, Ziekenhuis Oost-Limburg, Genk, Belgium.,Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Geert Robaeys
- Department of Gastroenterology and Hepatology, Ziekenhuis Oost-Limburg, Genk, Belgium.,Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Department of Hepatology, UZ Leuven, Leuven, Belgium
| | - Beytullah Yildirim
- Department of Gastroenterology, Ondokuz Mayis University, School of Medicine, Samsun, Turkey
| | - Dirk Posthouwer
- Department of Internal Medicine, Infectious Diseases and Medical Microbiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Niel Hens
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Hasselt University, Hasselt, Belgium.,Centre for Health Economic Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Ger H Koek
- School of Nutrition and Translational Research in Metabolism, University Maastricht, Maastricht, The Netherlands.,Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Surgery, University Hospital of the RWTH, Aachen, Germany
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Ochalek TA, Heil SH, Higgins ST, Badger GJ, Sigmon SC. A novel mHealth application for improving HIV and Hepatitis C knowledge in individuals with opioid use disorder: A pilot study. Drug Alcohol Depend 2018; 190:224-228. [PMID: 30056321 PMCID: PMC6446902 DOI: 10.1016/j.drugalcdep.2018.05.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 05/04/2018] [Accepted: 05/06/2018] [Indexed: 12/11/2022]
Abstract
AIMS There is a critical need to reduce infectious disease transmission among individuals with opioid use disorder (OUD). Here we examine the ability of a novel, automated educational intervention, delivered via iPad in a single visit, to improve human immunodeficiency virus (HIV) and Hepatitis C (HCV) knowledge among adults with OUD. METHODS Participants were 25 adults enrolled in a 12-week trial evaluating the efficacy of an Interim Buprenorphine Treatment for reducing illicit opioid use and other risk behaviors during delays to opioid treatment. Participants completed baseline HIV and HCV knowledge assessments with corrective feedback. They then completed an interactive HIV flipbook and HCV video followed by a second administration of the knowledge assessments. The knowledge assessments were repeated at post-intake Weeks 4 and 12. RESULTS At baseline, participants answered 69% and 65% of items correctly on the HIV and HCV assessments, respectively. The educational intervention was associated with significant increases in knowledge (86% and 86% correct on the HIV and HCV assessments, respectively; p's<.001). These improvements persisted throughout the study, with scores at Week 4 and 12 significantly greater than baseline (p's<.001). CONCLUSION This HIV+Hepatitis Education intervention was associated with significant and sustained improvements in knowledge of HIV + HCV transmission and risk behaviors in this vulnerable group of individuals with OUD. Given the continuing opioid epidemic, efforts are urgently needed to reduce HIV and HCV contraction and transmission among individuals with OUD. Mobile health educational interventions may offer a time- and cost-effective approach for addressing these risks.
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Affiliation(s)
- Taylor A Ochalek
- Vermont Center on Behavior and Health, University of Vermont, Rm 1415 UHC, 1 S. Prospect St., Burlington VT 05401, USA; Department of Psychology, University of Vermont, Rm 1415 UHC, 1 S. Prospect St., Burlington VT 05401, USA.
| | - Sarah H Heil
- Vermont Center on Behavior and Health, University of Vermont, Rm 1415 UHC, 1 S. Prospect St., Burlington VT 05401, USA; Department of Psychology, University of Vermont, Rm 1415 UHC, 1 S. Prospect St., Burlington VT 05401, USA; Department of Psychiatry, University of Vermont, Rm 1415 UHC, 1 S. Prospect St., Burlington VT 05401, USA
| | - Stephen T Higgins
- Vermont Center on Behavior and Health, University of Vermont, Rm 1415 UHC, 1 S. Prospect St., Burlington VT 05401, USA; Department of Psychology, University of Vermont, Rm 1415 UHC, 1 S. Prospect St., Burlington VT 05401, USA; Department of Psychiatry, University of Vermont, Rm 1415 UHC, 1 S. Prospect St., Burlington VT 05401, USA
| | - Gary J Badger
- Department of Biostatistics, University of Vermont, Biostatistics Unit, 27 Hills Building, Rm 25D, Burlington, VT 05401, USA
| | - Stacey C Sigmon
- Vermont Center on Behavior and Health, University of Vermont, Rm 1415 UHC, 1 S. Prospect St., Burlington VT 05401, USA; Department of Psychology, University of Vermont, Rm 1415 UHC, 1 S. Prospect St., Burlington VT 05401, USA; Department of Psychiatry, University of Vermont, Rm 1415 UHC, 1 S. Prospect St., Burlington VT 05401, USA
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Aluzaite K, Tewhaiti-Smith J, Fraser M, Johnson S, Glen E, Beck A, Smith B, Dummer J, Schultz M. A liver health hui: hepatitis C knowledge and associated risk factors in New Zealand gang members and their families. ROYAL SOCIETY OPEN SCIENCE 2018; 5:172167. [PMID: 30224989 PMCID: PMC6124044 DOI: 10.1098/rsos.172167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 08/03/2018] [Indexed: 06/08/2023]
Abstract
Hepatitis C virus (HCV) and B virus (HBV) infections are highly prevalent, with a high percentage of undiagnosed cases. Knowledge of HCV and its modes of transmission are essential for disease prevention and management. We studied a high-risk New Zealand gang population on viral hepatitis prevalence, their level of knowledge and the liver health risk factors in a community setting. Participants completed demographic, risk factor and knowledge questionnaires in three health meetings in New Zealand. Participants' blood samples were tested for HBV, HCV, biochemical indicators of liver disease. Liver fibrosis levels were assessed using a Fibroscan® device. We studied 52 adult Mongrel Mob members, affiliates and whānau (extended family) throughout New Zealand. We identified no HCV and two HBV cases, confirmed high-risk factor levels and poor associated knowledge, with a significant association between lack of knowledge and presence of specific risk factors. We successfully conducted a community-focused, high-risk, hard-to-reach gang population study, and found a link between lack of knowledge and risk factors for HCV infection. This study provided first-of-its-kind data on viral hepatitis in a gang population and demonstrated the need for educational screening programmes to aid early HCV detection, prevention and treatment.
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Affiliation(s)
- Kristina Aluzaite
- Department of Medicine, University of Otago, PO Box 913, Dunedin 9054, New Zealand
| | | | - Margaret Fraser
- Gastroenterology Unit, Southern District Health Board, Dunedin Hospital, Dunedin, New Zealand
| | - Steve Johnson
- Department of Medicine, University of Otago, PO Box 913, Dunedin 9054, New Zealand
- Gastroenterology Unit, Southern District Health Board, Dunedin Hospital, Dunedin, New Zealand
| | - Elizabeth Glen
- Gastroenterology Unit, Southern District Health Board, Dunedin Hospital, Dunedin, New Zealand
| | - Allison Beck
- Otago Hepatitis C Resource Centre, Dunedin, New Zealand
| | - Barbara Smith
- Dunedin Intravenous Organization Needle Exchange, Dunedin, New Zealand
| | - Jack Dummer
- Department of Medicine, University of Otago, PO Box 913, Dunedin 9054, New Zealand
| | - Michael Schultz
- Department of Medicine, University of Otago, PO Box 913, Dunedin 9054, New Zealand
- Gastroenterology Unit, Southern District Health Board, Dunedin Hospital, Dunedin, New Zealand
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Nikoo N, Javidanbardan S, Akm M, Hakobyan S, Nikoo M, Kwan C, Song M, Vogel M, Somers J, Krausz M. Hepatitis C prevalence and associated risk factors among individuals who are homeless and diagnosed with mental illness: At Home/Chez Soi Study, Vancouver, BC. Eur J Public Health 2018; 29:242-247. [DOI: 10.1093/eurpub/cky142] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Nooshin Nikoo
- Centre for Health Evaluation and Outcome Sciences (CHEOS), Institute of Mental Health, University of British Columbia, Canada
- Department of Family Medicine, University of British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Canada
| | - Sanam Javidanbardan
- Centre for Health Evaluation and Outcome Sciences (CHEOS), Institute of Mental Health, University of British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Canada
| | | | - Syune Hakobyan
- Centre for Health Evaluation and Outcome Sciences (CHEOS), Institute of Mental Health, University of British Columbia, Canada
- Vancouver Infectious Diseases Centre, Vancouver, BC, Canada
| | - Mohammadali Nikoo
- Centre for Health Evaluation and Outcome Sciences (CHEOS), Institute of Mental Health, University of British Columbia, Canada
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Canada
| | - Celia Kwan
- Centre for Health Evaluation and Outcome Sciences (CHEOS), Institute of Mental Health, University of British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Canada
| | - Michael Song
- Centre for Health Evaluation and Outcome Sciences (CHEOS), Institute of Mental Health, University of British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Canada
| | - Marc Vogel
- Centre for Health Evaluation and Outcome Sciences (CHEOS), Institute of Mental Health, University of British Columbia, Canada
- Psychiatric University Clinics, Basel, Switzerland
| | | | - Michael Krausz
- Centre for Health Evaluation and Outcome Sciences (CHEOS), Institute of Mental Health, University of British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Canada
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Canada
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Abstract
INTRODUCTION Liver disease forms a global health burden and is a cause of significant morbidity and mortality. Good patient education has proven to be a key tool in disease management, providing significant benefit in knowledge and behavioral modifications. To develop effective educational tools, a good understanding of patient educational needs and preferred learning methods is necessary. Few studies have evaluated the educational needs of patients with liver disease. This study aims to assess the educational needs of patients at a large tertiary liver center. METHOD This study was a questionnaire-based cross-sectional study evaluating patient demographics,perceived and unperceived educational needs (hepatitis B and hepatitis Cknowledge) at a tertiary liver centre. RESULTS A total of 300 patients completed the questionnaire. Most patients stated they were "extremely" or "quite" interested in learning more about their liver condition (84.9%, n=242), in either "moderate" or "a lot of" detail (94.6%, n=202). There was no association between gender, age, level of education, annual income and interest of patients in learning more about their liver condition. There was a significant association between number of clinic visits and interest to learn more (p=0.022), but there was no association between the duration of their follow-up at the clinic and their interest to learn more (p=0.243). CONCLUSIONS Overall, patients showed great interest in learning more about their liver condition, potentially indicating a need for more educational programs. Most patients prefer reading (via internet or pamphlets/brochures) or one-to-one discussions, giving us a good sense of potentially successful educational strategies that will fit the needs of most patients.
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Affiliation(s)
- Sarah S Al Ghamdi
- Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Hemant Shah
- Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto Centre for Liver Disease, University Health Network, Toronto ON, Canada
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Dong N, Chen WT, Bao M, Lu Y, Qian Y, Lu H. Self-Management Behaviors Among Patients With Liver Cirrhosis in Shanghai, China: A Cross-Sectional Study. Clin Nurs Res 2018; 29:448-459. [PMID: 29806496 DOI: 10.1177/1054773818777914] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Effective self-management of liver cirrhosis requires medication adherence and lifestyle modifications. The purpose of this study was to investigate the self-management behaviors of liver cirrhosis patients and how their knowledge of cirrhosis, psychological status, and self-efficacy contributes to self-management practices in Shanghai, China. Subjects were recruited from the hepatology units in an infectious hospital in Shanghai, China. Self-administered questionnaires were collected and medical charts were reviewed by the research staff. A total of 134 subjects were enrolled from November 2016 to March 2017. The results indicate that the self-management behaviors mean score was 2.51 out of 4 and that depression, severity of cirrhosis, and self-efficacy significantly affected self-management behaviors and explained 22.9% of the total variance. The findings also indicate that psychological stress, disease severity, and self-efficacy affected self-management behaviors in liver cirrhosis patients. Interventions focusing on decreasing depression and enhancing self-efficacy according to disease severity should improve self-management behaviors in this population.
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Affiliation(s)
- Ning Dong
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | | | - Meijuan Bao
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Yan Lu
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Yuqian Qian
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Hongzhou Lu
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
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Samji H, Yu A, Kuo M, Alavi M, Woods R, Alvarez M, Dore GJ, Tyndall M, Krajden M, Janjua NZ. Late hepatitis B and C diagnosis in relation to disease decompensation and hepatocellular carcinoma development. J Hepatol 2017; 67:909-917. [PMID: 28684103 DOI: 10.1016/j.jhep.2017.06.025] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 05/27/2017] [Accepted: 06/18/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND & AIMS We measured the timing of hepatitis B virus (HBV) and hepatitis C virus (HCV) diagnoses relative to the detection of decompensated cirrhosis (DC) and hepatocellular carcinoma (HCC) as an indicator of late hepatitis diagnosis. METHODS HBV and HCV diagnoses were defined relative to the diagnosis of DC or HCC such that HBV/HCV diagnoses within two years prior, at the time of or after HCC or DC diagnosis were considered late. We performed multivariable logistic regression to assess factors associated with late HBV/HCV diagnoses among those with DC or HCC. RESULTS From 1990 to 2012, 778/32,664 HBV cases (2.4%) and 3,925/57,866 HCV cases (6.8%) developed DC while 628/32,644 HBV cases (1.9%) and 902/57,866 HCV cases (1.6%) developed HCC. Among HBV and HCV cases with DC, 49% and 40% respectively were late diagnoses, as were 46% and 31% of HBV and HCV cases with HCC, respectively. HBV late diagnosis declined from 100% in 1992 to 11% and 26% in 2011, while HCV late diagnosis declined from 100% in 1992 to 16% and 14% in 2011 for DC and HCC respectively. In multivariable modelling, late HBV diagnosis was associated with mental illness and a fewer number of physician visits in the five years prior to HBV diagnosis. Late HCV diagnosis was also associated with fewer physician visits, while those with illicit drug use were less likely to be diagnosed late. CONCLUSIONS The proportion of late diagnoses has declined over time. People with better engagement with the healthcare system and with risk activities were diagnosed earlier. Lay summary: Late diagnosis of HBV and HCV represents a missed opportunity to reduce the risk of serious liver disease. Our results identify successes in earlier diagnosis over time using risk-based testing as well as groups that are being missed for screening such as those who do not see a physician regularly and those with serious mental illness.
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Affiliation(s)
- Hasina Samji
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, British Columbia V5Z 4R4, Canada; University of British Columbia, 2329 West Mall, Vancouver, British Columbia V6T 1Z4, Canada; Simon Fraser University, 8888 University Dr, Burnaby, British Columbia V5A 1S6, Canada
| | - Amanda Yu
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, British Columbia V5Z 4R4, Canada
| | - Margot Kuo
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, British Columbia V5Z 4R4, Canada
| | - Maryam Alavi
- The Kirby Institute, University of New South Wales, Wallace Wurth Building, High St, Kensington, NSW 2052, Australia
| | - Ryan Woods
- BC Cancer Agency, 600 W 10th Ave, Vancouver, British Columbia V5Z 4E6, Canada
| | - Maria Alvarez
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, British Columbia V5Z 4R4, Canada
| | - Gregory J Dore
- The Kirby Institute, University of New South Wales, Wallace Wurth Building, High St, Kensington, NSW 2052, Australia
| | - Mark Tyndall
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, British Columbia V5Z 4R4, Canada; University of British Columbia, 2329 West Mall, Vancouver, British Columbia V6T 1Z4, Canada
| | - Mel Krajden
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, British Columbia V5Z 4R4, Canada; University of British Columbia, 2329 West Mall, Vancouver, British Columbia V6T 1Z4, Canada
| | - Naveed Z Janjua
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, British Columbia V5Z 4R4, Canada; University of British Columbia, 2329 West Mall, Vancouver, British Columbia V6T 1Z4, Canada.
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Fabrellas N, Carol M, Torrabadella F, de Prada G. Nursing care of patients with chronic liver diseases: Time for action. J Adv Nurs 2017; 74:498-500. [DOI: 10.1111/jan.13350] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Núria Fabrellas
- School of Nursing; Faculty of Medicine and Health Sciences; Universitat de Barcelona; Barcelona Spain
| | - Marta Carol
- School of Nursing; Faculty of Medicine and Health Sciences; Universitat de Barcelona; Barcelona Spain
- Liver unit; Hospital Clinic; Institut d'investigacions biomediques August Pi Sunyer (IDIBAPS); Barcelona Spain
| | - Ferran Torrabadella
- Liver unit; Hospital Clinic; Institut d'investigacions biomediques August Pi Sunyer (IDIBAPS); Barcelona Spain
| | - Gloria de Prada
- Liver unit; Hospital Clinic; Institut d'investigacions biomediques August Pi Sunyer (IDIBAPS); Barcelona Spain
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Gonzalez SA, Fierer DS, Talal AH. Medical and Behavioral Approaches to Engage People Who Inject Drugs Into Care for Hepatitis C Virus Infection. ADDICTIVE DISORDERS & THEIR TREATMENT 2017; 16:S1-S23. [PMID: 28701904 PMCID: PMC5491232 DOI: 10.1097/adt.0000000000000104] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Direct-acting antivirals for hepatitis C virus infection may revolutionize treatment among persons with substance use disorders. Despite persons with substance use disorders having the highest hepatitis C virus prevalence and incidence, the vast majority have not engaged into care for the infection. Previously, interferon-based treatments, with substantial side effects and the propensity to exacerbate mental health conditions, were major disincentives to pursuit of care for the infection. Direct-acting antivirals with viral eradication rates of >90%, significantly improved side effect profiles, and shorter treatment duration are dramatic improvements over prior treatment regimens that should promote widespread hepatitis C virus care among persons with substance use disorders. The major unmet need is strategies to promote persons with substance use disorders engagement into care for hepatitis C virus. Although physical integration of treatment for substance use and co-occurring conditions has been widely advocated, it has been difficult to achieve. Telemedicine offers an opportunity for virtual integration of behavioral and medical treatments that could be supplemented by conventional interventions such as hepatitis C virus education, case management, and peer navigation. Furthermore, harm reduction and strategies to reduce viral transmission are important to cease reinfection among persons with substance use disorders. Widespread prescription of therapy for hepatitis C virus infection to substance users will be required to achieve the ultimate goal of global virus elimination. Combinations of medical and behavioral interventions should be used to promote persons with substance use disorders engagement into and adherence with direct-acting antiviral-based treatment approaches. Ultimately, either physical or virtual colocation of hepatitis C virus and substance use treatment has the potential to improve adherence and consequently treatment efficacy.
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Affiliation(s)
- Stevan A. Gonzalez
- Division of Hepatology, Baylor Simmons Transplant Institute, Fort Worth, TX
| | | | - Andrew H. Talal
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, Jacobs School of Medicine, State University of New York at Buffalo, Buffalo, NY
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Machado SM, Almeida CD, Pinho JRR, Malta FDM, Capuani L, Campos AF, Abreu FRM, Nastri ACDSS, Santana RAF, Sabino EC, Mendes-Correa MC. Hepatitis C among blood donors: cascade of care and predictors of loss to follow-up. Rev Saude Publica 2017; 51:40. [PMID: 28489184 PMCID: PMC5396505 DOI: 10.1590/s1518-8787.2017051006468] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 03/07/2016] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To investigate the HCV cascade of care and to identify the factors associated with loss or absence to follow-up of patients identified as infected with hepatitis C through blood donation. METHODS Blood donors from 1994 to 2012, identified with positive anti- HCV by enzyme immunoassay and immunoblot tests were invited to participate in the study, through letters or phone calls. Patients who agreed to participate were interviewed and their blood samples were collected for further testing. The following variables were investigated: demographic data, data on comorbidities and history concerning monitoring of hepatitis C. Multiple regression analysis by Poisson regression model was used to investigate the factors associated with non-referral for consultation or loss of follow-up. RESULTS Of the 2,952 HCV-infected blood donors, 22.8% agreed to participate: 394 (58.2%) male, median age 48 years old and 364 (53.8%) Caucasian. Of the 676 participants, 39.7% did not receive proper follow-up or treatment after diagnosis: 45 patients referred not to be aware they were infected, 61 did not seek medical attention and 163 started a follow-up program, but were non-adherent. The main reasons for inadequate follow-up were not understanding the need for medical care (71%) and health care access difficulties (14%). The variables showing a significant association with inadequate follow-up after multiple regression analysis were male gender (PR = 1.40; 95%CI 1.15–1.71), age under or equal to 50 years (PR = 1.36; 95%CI 1.12–1.65) and non-Caucasians (PR = 1.53; 95%CI 1.27–1.84). CONCLUSIONS About 40.0% of patients did not receive appropriate follow-up. These data reinforce the need to establish strong links between primary care and reference centers and the need to improve access to specialists and treatments.
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Affiliation(s)
- Soraia Mafra Machado
- Departamento de Moléstias Infecciosas e Parasitárias. Faculdade de Medicina. Universidade de São Paulo. São Paulo, SP, Brasil
| | - Cesar de Almeida
- Fundação Pró-Sangue. Hemocentro de São Paulo. São Paulo, SP, Brasil
| | - João Renato Rebello Pinho
- Laboratório de Gastroenterologia e Hepatologia Tropical "João Alves de Queiroz e Castorina Bittencourt Alves" (LIM-07). Instituto de Medicina Tropical. Departamento de Gastroenterologia. Faculdade de Medicina. Universidade de São Paulo. São Paulo, Brasil.,Albert Einstein Medicina Diagnóstica. Hospital Israelita Albert Einstein. São Paulo, SP, Brasil
| | - Fernanda de Mello Malta
- Laboratório de Gastroenterologia e Hepatologia Tropical "João Alves de Queiroz e Castorina Bittencourt Alves" (LIM-07). Instituto de Medicina Tropical. Departamento de Gastroenterologia. Faculdade de Medicina. Universidade de São Paulo. São Paulo, Brasil
| | - Ligia Capuani
- Departamento de Moléstias Infecciosas e Parasitárias. Faculdade de Medicina. Universidade de São Paulo. São Paulo, SP, Brasil
| | - Aléia Faustina Campos
- Departamento de Moléstias Infecciosas e Parasitárias. Faculdade de Medicina. Universidade de São Paulo. São Paulo, SP, Brasil
| | - Fatima Regina Marques Abreu
- Departamento de Moléstias Infecciosas e Parasitárias. Faculdade de Medicina. Universidade de São Paulo. São Paulo, SP, Brasil
| | | | | | - Ester Cerdeira Sabino
- Departamento de Moléstias Infecciosas e Parasitárias. Faculdade de Medicina. Universidade de São Paulo. São Paulo, SP, Brasil
| | - Maria Cássia Mendes-Correa
- Departamento de Moléstias Infecciosas e Parasitárias. Faculdade de Medicina. Universidade de São Paulo. São Paulo, SP, Brasil.,Laboratório de Virologia (LIM-52). Instituto de Medicina Tropical de São Paulo. Departamento de Moléstias Infecciosas e Parasitárias. Faculdade de Medicina. Universidade de São Paulo, São Paulo, Brasil
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He X, Li J, Wang B, Yao Q, Li L, Song R, Shi X, Zhang JA. Diabetes self-management education reduces risk of all-cause mortality in type 2 diabetes patients: a systematic review and meta-analysis. Endocrine 2017; 55:712-731. [PMID: 27837440 DOI: 10.1007/s12020-016-1168-2] [Citation(s) in RCA: 142] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 11/01/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Diabetes self-management education is an essential part of diabetes care, but its impact on all-cause mortality risk of type 2 diabetes patients is unclear. A systematic review and meta-analysis aiming to elucidate the impact of diabetes self-management education on all-cause mortality risk of type 2 diabetes patients was performed. METHODS Randomised controlled trials were identified though literature search in Medline, Embase, CENTRAL, conference abstracts, and reference lists. Only randomised controlled trials comparing diabetes self-management education with usual care in type 2 diabetes patients and reporting outcomes after a follow-up of at least 12 months were considered eligible. Risk ratios with 95 %CIs were pooled. This study was registered at PROSPERO with the number of CRD42016043911. RESULTS 42 randomised controlled trials containing 13,017 participants were included. The mean time of follow-up was 1.5 years. There was no heterogeneity among those included studies (I 2 = 0 %). Mortality occurred in 159 participants (2.3 %) in the diabetes self-management education group and in 187 (3.1 %) in the usual care group, and diabetes self-management education significantly reduced risk of all-cause mortality in type 2 diabetes patients (pooled risk ratios : 0.74, 95 %CI 0.60-0.90, P = 0.003; absolute risk difference: -0.8 %, 95 %CI -1.4 to -0.3). Both multidisciplinary team education and nurse-led education could significantly reduce mortality risk in type 2 diabetes patients, and the pooled risk ratios were 0.66 (95 %CI 0.46-0.96, P = 0.02; I 2 = 0 %) and 0.64 (95 % CI 0.47- 0.88, P = 0.005; I 2 = 0 %), respectively. Subgroup analyses of studies with longer duration of follow-up (≥1.5 years) or larger sample size (≥300) also found a significant effect of diabetes self-management education in reducing mortality risk among type 2 diabetes. Significant effect of diabetes self-management education in reducing mortality risk was also found in those patients receiving diabetes self-management education with contact hours more than 10 h (pooled risk ratio: 0.60, 95 %CI 0.44-0.82, P = 0.001; I 2 = 0 %), those receiving repeated diabetes self-management education (pooled RR: 0.71, P = 0.001; I 2 = 0 %), those receiving diabetes self-management education using structured curriculum (pooled risk ratio: 0.72, P = 0.01; I 2 = 0 %) and those receiving diabetes self-management education using in-person communication (pooled risk ratio: 0.75, P = 0.02; I 2 = 0 %). The quality of evidence for the effect of diabetes self-management education in reducing all-cause mortality risk among type 2 diabetes patients was rated as moderate according to the Grading of Recommendations Assessment, Development, and Evaluation method, and the absolute risk reduction of all-cause mortality of type 2 diabetic patients by diabetes self-management education was estimated to be 4 fewer per 1000 person-years (from 1 fewer to 6 fewer). CONCLUSIONS The available evidence suggests that diabetes self-management education can reduce all-cause mortality risk in type 2 diabetes patients. Further clinical trials with longer time of follow-up are needed to validate the finding above.
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Affiliation(s)
- Xiaoqin He
- Department of Endocrinology, Jinshan Hospital of Fudan University, Shanghai, 201508, China
- Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Jie Li
- Department of Nephrology, Xi'an Central Hospital, Xi'an, 710003, China
| | - Bin Wang
- Department of Endocrinology, Jinshan Hospital of Fudan University, Shanghai, 201508, China
| | - Qiuming Yao
- Department of Endocrinology, Jinshan Hospital of Fudan University, Shanghai, 201508, China
| | - Ling Li
- Department of Endocrinology, Jinshan Hospital of Fudan University, Shanghai, 201508, China
| | - Ronghua Song
- Department of Endocrinology, Jinshan Hospital of Fudan University, Shanghai, 201508, China
| | - Xiaohong Shi
- Department of Endocrinology, Jinshan Hospital of Fudan University, Shanghai, 201508, China
| | - Jin-An Zhang
- Department of Endocrinology, Jinshan Hospital of Fudan University, Shanghai, 201508, China.
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Alshammari TM. Patient's medicinal knowledge in Saudi Arabia: Are we doing well? Saudi Pharm J 2016; 24:560-562. [PMID: 27752228 PMCID: PMC5059822 DOI: 10.1016/j.jsps.2015.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 03/15/2015] [Indexed: 12/02/2022] Open
Abstract
Patient education is one of the main factors of patient therapeutic plan and without it, the patient may not benefit from his/her medications. Several studies showed the effectiveness of educating patients about their disease(s) and their medication(s) which ultimately enhance their quality of life especially in chronic diseases such as diabetes mellitus and hypertension. Concept of patient education is well known and understood in the Western countries while in the Kingdom of Saudi Arabia it is not well established despite some efforts made by few big hospitals. In Saudi Arabia, different stakeholders such as hospitals, pharmaceutical companies, healthcare professionals, health societies and association and governmental agencies do not do their job as patient education. Aim of this paper was to throw some light about the current situation in Saudi Arabia.
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Marinho RT, Costa A, Pires T, Raposo H, Vasconcelos C, Polónia C, Borges J, Soares M, Vilar G, Nogueira AM. A multidimensional education program at substance dependence treatment centers improves patient knowledge and hepatitis C care. BMC Infect Dis 2016; 16:565. [PMID: 27733137 PMCID: PMC5062838 DOI: 10.1186/s12879-016-1883-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 10/01/2016] [Indexed: 12/11/2022] Open
Abstract
Background HCV treatment among people who inject drugs (PWID) is low. Education programs may be suitable strategies to improve patients’ knowledge about their condition and to overcome barriers to access treatment. Methods The Health Educational Program (HEP) consisted of patient workshops and educational videos and leaflets, and healthcare professionals’ workshops. HEP was implemented at seven substance dependence treatment centers (STDC) in Portugal. The study comprised two cross-sectional evaluations conducted before and after HEP. At both evaluations, adult patients with confirmed HCV diagnosis and registered in the STDC were consecutively included. For patients that completed both evaluations, the overall knowledge score were calculated and compared with McNemar test. Linear regression modelling was used to evaluate factors associated with baseline knowledge. Rates of referral and attendance to referral specialist, treatment proposal, initiation and retention at both evaluations were also compared with McNemar test. Results Overall, 504 patients with chronic hepatitis C were included: 78 % male, mean age 42.3 ± 6.6 years, 14 % school education ≤ 4 years, disease duration 11.0 ± 6.0 years and 26 % HIV co-infected. A higher baseline knowledge was independently associated with educational level ≥ 10 years (regression coefficient [B] =15.13, p < 0.001), current use of intravenous drugs (B = 7.99, p = 0.038), previous referral for treatment (B = 4.26, p = 0.008) and previous HCV treatment (B = 5.40, p = 0.003). Following HEP, mean knowledge score increased from 69 % to 79 % (p < 0.001). The rate of patient referral to a liver specialist increased from 56.2 % to 67.5 % (p < 0.001). Conclusions An HEP conducted at STDCs improved significantly patient knowledge about hepatitis C, even among patients with a high baseline knowledge. The HEP has also increased the rate of referral to the liver specialist and showed a great potential to support healthcare professionals in managing HCV. Education programs may promote treatment access among PWID, a population that represents the majority of HCV infected patients. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-1883-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rui Tato Marinho
- Department of Gastroenterology and Hepatology, Faculty of Medicine, University of Lisbon, Hospital Santa Maria - Centro Hospitalar Lisboa Norte, Av. Prof. Egas Moniz, Lisbon, 1649-035, Portugal.
| | - António Costa
- UD Centro das Taipas, Parque de Saúde de Lisboa - Av. Brasil n.° 53, Pavilhão 2, 1° andar, 1749-002, Lisbon, Portugal
| | - Teodomiro Pires
- ETET de Almada, Rua das Terras dos Cortes Reais n°1, 2805-025, Almada, Portugal
| | - Helena Raposo
- ETET do Barreiro, Rua Almirante Reis n°50, 2830-326, Barreiro, Portugal
| | - Carlos Vasconcelos
- ETET de Gondomar, Rua Caminho de Pevidal, R/C - S/N, 4420-264, Gondomar, Portugal
| | - Cristina Polónia
- ETET de Setúbal, Praça da República, 2900-587, Setúbal, Portugal
| | - Joaquim Borges
- ETET da Figueira da Foz, Rua Doutor Calado 2, Figueira da Foz, 3080-153, Figueira da Foz, Portugal
| | - Mariana Soares
- ETET Eixo Oeiras Cascais, Rua Professor Orlando Ribeiro, n.°3A, B, n.° 5A, B e n.° 7, 2740-222, Porto Salvo, Portugal
| | - Graça Vilar
- SICAD- General-Directorate for Intervention on Addictive Behaviours and Dependencies, Avenida da República, n° 61, 3° piso, 1050-189, Lisbon, Portugal
| | - Ana Maria Nogueira
- MSD Portugal, a subsidiary of Merck & Co., Inc., Quinta da Fonte, Edifício Vasco da Gama, 19, 2770-192, Paço de Arcos, Portugal
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Sims OT, Maynard QR, Melton PA. Behavioral Interventions to Reduce Alcohol Use Among Patients with Hepatitis C: A Systematic Review. SOCIAL WORK IN PUBLIC HEALTH 2016; 31:565-73. [PMID: 27295132 DOI: 10.1080/19371918.2016.1160346] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Alcohol use is a barrier to pharmacologic treatment for hepatitis C virus (HCV). It is advantageous for medical and clinical social workers engaged in HCV care to be knowledgeable of behavioral interventions that can be used to reduce alcohol use among patients with HCV. This article identifies and describes studies that designed and implemented behavioral interventions to reduce alcohol use among patients with HCV in clinical settings. To achieve this goal, this article conducts a rigorous systematic review to identify peer-reviewed articles, describes each behavioral intervention, and reports primary outcomes of each study included in the review.
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Affiliation(s)
- Omar T Sims
- a Department of Social Work, College of Arts and Sciences , The University of Alabama at Birmingham , Birmingham , Alabama , USA
- b Department of Health Behavior, School of Public Health , The University of Alabama at Birmingham , Birmingham , Alabama , USA
- c Center for AIDS Research, The University of Alabama at Birmingham , Birmingham , Alabama , USA
- d Center for Comprehensive Healthy Aging, The University of Alabama at Birmingham , Birmingham , Alabama , USA
| | - Quentin R Maynard
- e School of Social Work, The University of Alabama , Tuscaloosa , Alabama , USA
| | - Pam A Melton
- e School of Social Work, The University of Alabama , Tuscaloosa , Alabama , USA
- f School of Social Work, Tulane University , New Orleans , Louisiana , USA
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Yang M, Wu E, Rao H, Du FH, Xie A, Cheng S, Rodd C, Lin A, Wei L, Lok AS. A Comparative Study of Liver Disease Care in the USA and Urban and Rural China. Dig Dis Sci 2016; 61:2847-2856. [PMID: 27256156 DOI: 10.1007/s10620-016-4206-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 05/17/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND Chronic liver disease is a major cause of morbidity and mortality in the USA and China, but the etiology of liver disease, medical practice, and patient expectations in these two countries are different. AIMS To compare patient knowledge about their liver disease, patient satisfaction with liver disease care, and patient medical decision-making preference in the USA and China. METHODS Three cohorts of established adult patients with liver disease seen in liver clinics in Ann Arbor, USA, and Beijing (urban) and Hebei (rural), China, completed a survey between May and September 2014. RESULTS A total of 990 patients (395 USA, 398 Beijing, and 197 Hebei) were analyzed. Mean liver disease knowledge score (maximum 5) in the USA, Beijing, and Hebei patients was 4.1, 3.6, and 3.0, respectively (p < 0.001). US patients had a greater preference for collaborative decision-making: 71.8 % preferred to make treatment decisions together with the doctor, while most Chinese patients (74.6 % Beijing and 84.8 % Hebei) preferred passive decision-making. Mean satisfaction score (maximum 85) in the USA was higher than in Beijing, which in turn was higher than in Hebei (78.2 vs. 66.5 vs. 60.3, p < 0.001). There was a positive correlation between liver disease knowledge score and satisfaction score (r = 0.27, p < 0.001) and with collaborative medical decision-making (r = 0.22, p < 0.001) when responses from all sites were combined. CONCLUSIONS Liver disease knowledge and patient satisfaction were greatest in the USA, followed by Beijing and then Hebei patients. Understanding these differences and associated factors may help to improve patient outcomes.
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Affiliation(s)
- Ming Yang
- Hepatology Institute, Peking University People's Hospital, Peking University Health Science Center, 11 South Xizhimen St, Beijing, 100044, China
| | - Elizabeth Wu
- Division of Gastroenterology and Hepatology, University of Michigan Health System, 1150 W Medical Center Drive, 4321 Med Sci I, Ann Arbor, MI, 48109, USA
| | - Huiying Rao
- Hepatology Institute, Peking University People's Hospital, Peking University Health Science Center, 11 South Xizhimen St, Beijing, 100044, China
| | - Fanny H Du
- University of Michigan Medical School, 1301 Catherine Street, Ann Arbor, MI, 48109, USA
| | - Angela Xie
- Division of Gastroenterology and Hepatology, University of Michigan Health System, 1150 W Medical Center Drive, 4321 Med Sci I, Ann Arbor, MI, 48109, USA
| | - Shanna Cheng
- Division of Gastroenterology and Hepatology, University of Michigan Health System, 1150 W Medical Center Drive, 4321 Med Sci I, Ann Arbor, MI, 48109, USA
| | - Cassandra Rodd
- Division of Gastroenterology and Hepatology, University of Michigan Health System, 1150 W Medical Center Drive, 4321 Med Sci I, Ann Arbor, MI, 48109, USA
| | - Andy Lin
- The Molecular and Behavioral Neuroscience Institute, University of Michigan, 205 Zina Pitcher Pl, Ann Arbor, MI, 48109, USA
| | - Lai Wei
- Hepatology Institute, Peking University People's Hospital, Peking University Health Science Center, 11 South Xizhimen St, Beijing, 100044, China
| | - Anna S Lok
- Division of Gastroenterology and Hepatology, University of Michigan Health System, 1150 W Medical Center Drive, 4321 Med Sci I, Ann Arbor, MI, 48109, USA. .,University of Michigan Health System, 1500 E Medical Center Drive, 3912 Taubman Center, SPC 5362, Ann Arbor, MI, 48109, USA.
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Zhou K, Fitzpatrick T, Walsh N, Kim JY, Chou R, Lackey M, Scott J, Lo YR, Tucker JD. Interventions to optimise the care continuum for chronic viral hepatitis: a systematic review and meta-analyses. THE LANCET. INFECTIOUS DISEASES 2016; 16:1409-1422. [PMID: 27615026 DOI: 10.1016/s1473-3099(16)30208-0] [Citation(s) in RCA: 115] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 06/21/2016] [Accepted: 06/21/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND Advances in therapy for hepatitis B virus (HBV) and hepatitis C virus (HCV) have ushered in a new era in chronic hepatitis treatment. To maximise the effectiveness of these medicines, individuals must be engaged and retained in care. We analysed operational interventions to enhance chronic viral hepatitis testing, linkage to care, treatment uptake, adherence, and viral suppression or cure. METHODS We did a systematic review of operational interventions, and did meta-analyses for sufficiently comparable data. We searched PubMed, Embase, WHO library, International Clinical Trials Registry Platform, PsycINFO, and CINAHL for randomised controlled trials and controlled non-randomised studies that examined operational interventions along the chronic viral hepatitis care continuum, published in English up to Dec 31, 2014. We included non-pharmaceutical intervention studies with primary or secondary outcomes of testing, linkage to care, treatment uptake, treatment adherence, treatment completion, treatment outcome, or viral endpoints. We excluded dissertations and studies of children only. Data were extracted by two independent reviewers, with disagreements resolved by a third reviewer. Studies were assessed for bias. Data from similar interventions were pooled and quality of evidence was assessed using GRADE. This study was registered in PROSPERO (42014015094). FINDINGS We identified 7583 unduplicated studies, and included 56 studies that reported outcomes along the care continuum (41 for HCV and 18 for HBV). All studies except one were from high-income countries. Lay health worker HBV test promotion interventions increased HBV testing rates (relative risk [RR] 2·68, 95% CI 1·82-3·93). Clinician reminders to prompt HCV testing during clinical visits increased HCV testing rates (3·70, 1·81-7·57). Nurse-led educational interventions improved HCV treatment completion (1·14, 1·05-1·23) and cure (odds ratio [OR] 1·93, 95% CI 1·44-2·59). Coordinated mental health, substance misuse, and hepatitis treatment services increased HCV treatment uptake (OR 3·03, 1·24-7·37), adherence (RR 1·22, 1·05-1·41), and cure (RR 1·21, 1·07-1·38) compared with usual care. INTERPRETATION Several simple, inexpensive operational interventions can substantially improve engagement and retention along the chronic viral hepatitis care continuum. Further operational research to inform scale-up of hepatitis services is needed in low-income and middle-income countries. FUNDING World Health Organization and US Fulbright Program.
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Affiliation(s)
- Kali Zhou
- Department of Medicine, Division of Gastroenterology, University of California, San Francisco, CA, USA
| | | | - Nick Walsh
- World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
| | - Ji Young Kim
- World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
| | - Roger Chou
- Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
| | - Mellanye Lackey
- Spencer S Eccles Health Sciences Library, University of Utah, Salt Lake City, UT, USA
| | - Julia Scott
- World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
| | - Ying-Ru Lo
- World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
| | - Joseph D Tucker
- UNC-Project China, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; International Diagnostics Centre, London School of Hygiene & Tropical Medicine, London, UK.
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Tamayo A, Shah SR, Bhatia S, Chowdhury A, Rao PN, Dinh P, Knox SJ, Gaggar A, Subramanian GM, Mohan VG, Sood A, Mehta R, Sarin SK. Correlates of disease-specific knowledge among patients with chronic hepatitis B or hepatitis C infection in India. Hepatol Int 2016; 10:988-995. [PMID: 27146692 PMCID: PMC5083769 DOI: 10.1007/s12072-016-9728-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 03/21/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Patient knowledge about chronic diseases increases health-promoting behaviors and improves clinical outcomes. We assessed this association for patients with chronic viral hepatitis. METHODS Untreated patients chronically infected with HBV (n = 500) or HCV (n = 500) were enrolled at 19 centers across India. A survey, adapted from the US CDC National Health and Nutrition Examination Survey (NHANES) questionnaire, was administered at a single visit to assess HBV/HCV knowledge, community disease awareness, treatment quality, and healthcare barriers. We developed the India Hepatitis Knowledge Index (IHKI), where a higher IHKI score (range 0-10) indicates increased hepatitis knowledge. Multivariate regression models evaluated demographic and disease factors. RESULTS The overall mean IHKI score was 5.6 out of 10, with higher scores among patients with HBV (5.9) than HCV (5.3); p < 0.001. In HBV patients lower IHKI was associated with shorter disease duration, government clinic attendance (p < 0.0001), fewer personal experiences with HBV (p < 0.0001), and residing in northern India. Among HCV patients, lower IHKI was associated with shorter disease duration, community (p < 0.0001) and government clinic attendance (p < 0.0001), and fewer personal experiences with HCV (p < 0.0001). Among HBV patients, IHKI was independently associated with disease severity as assessed by MELD score, albumin, and APRI. This association was strongest for HBV patients with elevated ALT and HBV DNA >2000 IU/ml. Among HCV patients, IHKI results had no significant associations with disease severity. CONCLUSIONS The association of IHKI with disease underscores the need to understand connections between hepatitis knowledge and progression and may guide efforts to address patient education and awareness of chronic viral hepatitis in India.
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Affiliation(s)
- Aracely Tamayo
- University of California Berkeley School of Public Health, Berkeley, CA, USA.
| | - Samir R Shah
- Jaslok Hospital and Research Centre and Breach Candy Hospital, Mumbai, India
| | - Shobna Bhatia
- Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Abhijit Chowdhury
- Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Padaki N Rao
- Asian Institute of Gastroenterology, Hyderabad, India
| | | | | | | | | | | | - Ajit Sood
- Dayanand Medical College and Hospital, Ludhiana, India
| | | | - Shiv K Sarin
- Institute of Liver and Biliary Sciences, New Delhi, India
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Arain A, De Sousa J, Corten K, Verrando R, Thijs H, Mathei C, Buntinx F, Robaeys G. Pilot Study: Combining Formal and Peer Education with FibroScan to Increase HCV Screening and Treatment in Persons who use Drugs. J Subst Abuse Treat 2016; 67:44-9. [PMID: 27296661 DOI: 10.1016/j.jsat.2016.04.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 04/07/2016] [Accepted: 04/19/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Treatment uptake for hepatitis C virus (HCV) infection remains low in persons who inject drugs (PWID), due to lack of knowledge and low perceived need for treatment. Therefore, we conducted a pilot study to assess the influence on knowledge and willingness for HCV screening and treatment among persons who use drugs (PWUD) by combining formal and peer education with FibroScan measurement. METHODS Clients of the Center for Alcohol and other Drug problems (CAD) in Limburg (Belgium) were randomized into a control group, which received the standard of care, and an intervention group, which received an innovative combination of formal and peer education followed by FibroScan. Knowledge of HCV infection and willingness for screening and treatment were evaluated at baseline, after intervention and 1 and 3months after intervention by means of questionnaires. RESULTS Baseline knowledge was similar for the control (n=27) and the intervention group (n=25) (58 vs. 59%; p=0.67). Immediately after the information session, knowledge increased to 86% (p<0.001) in the intervention group. After 3months, knowledge decreased significantly (69%; p=0.01). No significant changes in knowledge were found in the control group. Baseline willingness for treatment was 81% in both the control and intervention groups, but after 1 month decreased in the control group (44%) and remained stable in the intervention group (75%). Differences in actual screening uptake between the control and intervention group were not significant (7% vs. 20%). Four percent of the intervention group and no one in the control group started treatment. CONCLUSION The small number of subjects should be considered when interpreting the results of this study. In brief, the single information session significantly improved HCV knowledge among PWUD, but did not result in a higher uptake for screening and treatment. This could signify that there are other important reasons, besides lack of knowledge, not to undergo screening or start treatment. The fact that knowledge decreased after 3months indicates that it would be beneficial to repeat the information session regularly.
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Affiliation(s)
- Amber Arain
- Department of Gastroenterology and Hepatology, Ziekenhuis Oost-Limburg, Genk, Belgium; Faculty of Medicine and Life Sciences, Universiteit Hasselt, Hasselt, Belgium.
| | - Jessica De Sousa
- Faculty of Medicine and Life Sciences, Universiteit Hasselt, Hasselt, Belgium
| | - Kirsten Corten
- Faculty of Medicine and Life Sciences, Universiteit Hasselt, Hasselt, Belgium
| | | | | | - Catharina Mathei
- Free Clinic, Antwerp, Belgium; Department of Public Health and Primary Care KU Leuven, Leuven, Belgium
| | - Frank Buntinx
- Department of General Practice, KU Leuven, Belgium and Maastricht University, The Netherlands
| | - Geert Robaeys
- Department of Gastroenterology and Hepatology, Ziekenhuis Oost-Limburg, Genk, Belgium; Faculty of Medicine and Life Sciences, Universiteit Hasselt, Hasselt, Belgium; Department of Hepatology, University Hospitals KU Leuven, Leuven, Belgium
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Hepatitis C virus-related knowledge and willingness to receive treatment among patients on methadone maintenance. J Addict Med 2016; 8:249-57. [PMID: 24820257 DOI: 10.1097/adm.0000000000000041] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Although persons who inject drugs have high prevalence of hepatitis C virus (HCV) infection, few receive treatment mostly because of lack of knowledge about the infection and its treatment. We assessed the level of HCV-related knowledge and willingness to participate in HCV treatment among methadone-maintained patients. METHODS A 30-item survey covering HCV-related knowledge and willingness to engage in HCV-related education and treatment was developed and completed by 320 methadone-maintained patients. RESULTS Respondents' mean age was 53 ± 8.7 years, 59.5% were male, 55.1% were African American, and 38.3% were Hispanic. The mean duration of methadone maintenance was 7 ± 6.7 years. In the preceding 6 months, 6.9% of patients reported injection drug use, whereas 37.3% used noninjection drugs. Hepatitis C virus seropositivity was self-reported by 46.3% of patients. The majority of patients (78%) expressed willingness to participate in HCV-related education and to receive HCV treatment. Most patients (54.7%) correctly answered 5 or more of 7 questions assessing HCV knowledge. Hepatitis C virus-seropositive individuals and prior attendees at HCV-related educational activities demonstrated a higher level of HCV-related knowledge (P < 0.001 and P = 0.002, respectively). Younger patients (P = 0.014), those willing to attend an HCV-related educational activity (P < 0.001), and those with higher-HCV-related knowledge (P = 0.029) were more accepting of HCV treatment. Fear of medication-related side effects was the most common reason for treatment avoidance. CONCLUSIONS The majority of patients reported willingness to receive HCV-related education and treatment. Treatment willingness was significantly associated with previous attendance at an HCV educational activity and a higher level of HCV-related knowledge.
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