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Gonzalez CJ, Kapadia SN, Niederdeppe J, Dharia A, Talal AH, Lloyd AR, Franco R, Labossiere S, Shapiro MF, Wethington E. The State of Hepatitis C Elimination from the Front Lines: A Qualitative Study of Provider-Perceived Gaps to Treatment Initiation. J Gen Intern Med 2024:10.1007/s11606-024-08807-6. [PMID: 38782810 DOI: 10.1007/s11606-024-08807-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 05/09/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Hepatitis C (HCV) is a curable chronic infection, but lack of treatment uptake contributes to ongoing morbidity and mortality. State and national strategies for HCV elimination emphasize the pressing need for people with HCV to receive treatment. OBJECTIVE To identify provider-perceived barriers that hinder the initiation of curative HCV treatment and elimination of HCV in the USA. APPROACH Qualitative semi-structured interviews with 36 healthcare providers who have evaluated patients with HCV in New York City, Western/Central New York, and Alabama. Interviews, conducted between 9/2021 and 9/2022, explored providers' experiences, perceptions, and approaches to HCV treatment initiation. Transcripts were analyzed using hybrid inductive and deductive thematic analysis informed by established health services and implementation frameworks. KEY RESULTS We revealed four major themes: (1) Providers encounter professional challenges with treatment provision, including limited experience with treatment and perceptions that it is beyond their scope, but are also motivated to learn to provide treatment; (2) providers work toward building streamlined and inclusive practice settings-leveraging partnerships with experts, optimizing efficiency through increased access, adopting inclusive cultures, and advocating for integrated care; (3) although at times overwhelmed by patients facing socioeconomic adversity, increases in public awareness and improvements in treatment policies create a favorable context for providers to treat; and (4) providers are familiar with the relative advantages of improved HCV treatments, but the reputation of past treatments continues to deter elimination. CONCLUSIONS To address the remaining barriers and facilitators providers experience in initiating HCV treatment, strategies will need to expand educational initiatives for primary care providers, further support local infrastructures and integrated care systems, promote public awareness campaigns, remove prior authorization requirements and treatment limitations, and address the negative reputation of outdated HCV treatments. Addressing these issues should be considered priorities for HCV elimination approaches at the state and national levels.
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Affiliation(s)
- Christopher J Gonzalez
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
| | - Shashi N Kapadia
- Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, USA
| | - Jeff Niederdeppe
- Cornell Jeb E. Brooks School of Public Policy and Department of Communication, Cornell University, Ithaca, NY, USA
| | - Arpan Dharia
- Division of Gastroenterology, Hepatology and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Andrew H Talal
- Division of Gastroenterology, Hepatology and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Audrey R Lloyd
- Department of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ricardo Franco
- Department of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Stephane Labossiere
- Department of Health Studies & Applied Educational Psychology, Columbia University, New York, NY, USA
| | - Martin F Shapiro
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Elaine Wethington
- Department of Psychology, College of Human Ecology, Cornell University, Ithaca, NY, USA
- Department of Sociology, College of Arts and Sciences, Cornell University, Ithaca, NY, USA
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Irvin R, Landry G, Jones MR, James A, Schexnayder J, Rodriguez S, Wendell D, Barthe K, Britton E, LeSar K, Manogue S, Sugarman OK, Brown C, Burgess S, Mehta SH, Thomas DL, Robinson W. High prevalence of hepatitis C virus infection among incarcerated persons: Results from the Louisiana Hepatitis C Elimination Plan's opt-out testing program in prisons. J Viral Hepat 2024. [PMID: 38758571 DOI: 10.1111/jvh.13941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/01/2024] [Accepted: 03/31/2024] [Indexed: 05/18/2024]
Abstract
In the United States, modelling studies suggest a high prevalence of hepatitis C virus (HCV) infection in incarcerated populations. However, limited HCV testing has been conducted in prisons. Through the Louisiana Hepatitis C Elimination Plan, persons incarcerated in the eight state prisons were offered HCV testing from 20 September 2019 to 14 July 2022, and facility entry/exit HCV testing was introduced. Multivariable logistic regression was used to evaluate associations with HCV antibody (anti-HCV) positivity and viremia. Of 17,231 persons in the eight state prisons screened for anti-HCV, 95.1% were male, 66.7% were 30-57 years old, 3% were living with HIV, 68.2% were Black and 2904 (16.9%) were anti-HCV positive. HCV RNA was detected in 69.3% of anti-HCV positive individuals tested. In the multivariable model, anti-HCV positivity was associated with older age including those 30-57 (odds ratio [OR] 3.53, 95% confidence interval [CI] 2.96-4.20) and those ≥58 (OR 10.43, 95% CI 8.66-12.55) as compared to those ≤29 years of age, living with HIV (OR 1.68, 95% CI 1.36-2.07), hepatitis B (OR 1.83, 95% CI 1.25-2.69) and syphilis (OR 1.51, 95% CI 1.23-1.86). HCV viremia was associated with male sex (OR 1.89, 95% CI 1.36-2.63) and Black race (OR 1.42, 95% CI 1.20-1.68). HCV prevalence was high in the state prisons in Louisiana compared to community estimates. To the extent that Louisiana is representative, to eliminate HCV in the United States, it will be important for incarcerated persons to have access to HCV testing and treatment.
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Affiliation(s)
- Risha Irvin
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Gia Landry
- Ochsner Health System, New Orleans, Louisiana, USA
- Louisiana Department of Health, Office of Public Health, New Orleans, Louisiana, USA
| | - Miranda R Jones
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Anthony James
- Louisiana Department of Health, Office of Public Health, New Orleans, Louisiana, USA
| | - Jean Schexnayder
- Louisiana Department of Health, Office of Public Health, New Orleans, Louisiana, USA
| | - Stacye Rodriguez
- Louisiana Department of Public Safety and Corrections, Baton Rouge, Louisiana, USA
| | - Deborah Wendell
- Louisiana Department of Health, Office of Public Health, New Orleans, Louisiana, USA
- Louisiana State University Health Sciences Center School of Public Health, New Orleans, Louisiana, USA
| | - Kathryn Barthe
- Louisiana Department of Health, Office of Public Health, New Orleans, Louisiana, USA
| | - Elizabeth Britton
- Louisiana Department of Health, Office of Public Health, New Orleans, Louisiana, USA
| | - Kendra LeSar
- Louisiana Department of Health, Office of Public Health, New Orleans, Louisiana, USA
| | - Sean Manogue
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Olivia K Sugarman
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Cynthia Brown
- Louisiana Department of Health, Office of Public Health, New Orleans, Louisiana, USA
| | - Samuel Burgess
- Louisiana Department of Health, Office of Public Health, New Orleans, Louisiana, USA
| | - Shruti H Mehta
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - David L Thomas
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - William Robinson
- Louisiana Department of Health, Office of Public Health, New Orleans, Louisiana, USA
- Louisiana State University Health Sciences Center School of Public Health, New Orleans, Louisiana, USA
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Coyle CR, Gicquelais RE, Genberg BL, Astemborski J, Falade-Nwulia O, Kirk GD, Thomas DL, Mehta SH. Temporal trends in HCV treatment uptake and success among people who inject drugs in Baltimore, MD since the introduction of direct acting antivirals. Drug Alcohol Depend 2023; 253:111007. [PMID: 38456165 PMCID: PMC10917145 DOI: 10.1016/j.drugalcdep.2023.111007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
Background Although hepatitis C virus (HCV) can be cured by direct acting antivirals (DAA), uptake is not well characterized for people who inject drugs (PWID). Methods Among 1,130 participants of a community-based cohort of PWID with chronic HCV, we longitudinally characterized HCV treatment uptake and cure early (2014-2016) and later (2017-2020). Results Cumulative HCV treatment uptake increased from 4% in 2014 to 68% in 2020 and the percent with HCV viremia declined from nearly 100% to 33%. Predictors of treatment uptake varied across periods. Age (incidence rate ratio [IRR] per 5-year increase: 1.28; 95% confidence interval [CI]: 1.15, 1.42), educational attainment (IRR for ≥ high school diploma: 1.31; 95% CI: 1.04, 1.66), HIV coinfection with suppressed viral load (IRR vs. HIV negative: 2.08; 95% CI: 1.63, 2.66) and alcohol dependence (IRR vs. no alcohol use: 0.63; 95% CI: 0.43, 0.91) were associated with treatment uptake in the early period, but not later. HIV coinfection with a detectable viral load (IRR vs. HIV negative: 0.46; 95% CI: 0.23, 0.95) and daily injecting (IRR: 0.46 vs. no injection; 95% CI: 0.27, 0.79) were significantly associated with lower treatment uptake later. Homelessness was associated with significantly reduced likelihood of viral clearance in the late DAA era (IRR: 0.51; 95% CI: 0.30, 0.88). Conclusion Treatment uptake improved substantially in this cohort of PWID in the first five years of DAA availability with commensurate declines in viremia. Additional efforts are needed to treat those actively injecting and unstably housed in order to realize elimination goals.
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Affiliation(s)
- Catelyn R. Coyle
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, United States of America
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, United States of America
- Center for Observational and Real-World Evidence (CORE), Merck & Co, Inc, 351 N Sumneytown Pike, North Wales, PA 19454, United States of America
| | - Rachel E. Gicquelais
- School of Nursing, University of Wisconsin-Madison, 701 Highland Ave, Madison, WI 53705, United States of America
| | - Becky L. Genberg
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, United States of America
| | - Jacquie Astemborski
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, United States of America
| | - Oluwaseun Falade-Nwulia
- Division of Infectious Disease, Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD 21205, United States of America
| | - Gregory D. Kirk
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, United States of America
- Division of Infectious Disease, Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD 21205, United States of America
| | - David L. Thomas
- Division of Infectious Disease, Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD 21205, United States of America
| | - Shruti H. Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, United States of America
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Giustini AB, Ioannou GN, Sirlin C, Loomba R. Review article: Available modalities for screening and imaging diagnosis of hepatocellular carcinoma-Current gaps and challenges. Aliment Pharmacol Ther 2023; 57:1056-1065. [PMID: 37038283 PMCID: PMC10792522 DOI: 10.1111/apt.17506] [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: 08/15/2022] [Revised: 09/17/2022] [Accepted: 03/24/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) incidence and mortality continue to rise worldwide. Society guidelines recommend HCC screening for patients with chronic hepatitis B (CHB) or cirrhosis. Unfortunately, HCC screening rates remain relatively low, and the performance characteristics of current screening modalities are suboptimal. AIM The aim of the study was to discuss the current state of HCC screening and imaging diagnosis utilising standard and emerging imaging modalities in addition to outlining areas of need and ongoing study. METHODS A review of the field was performed combining literature searches and expert opinion. RESULTS The development of the Liver Imaging Reporting and Data System (LI-RADS version 2018) algorithms have advanced and standardised the imaging diagnosis of HCC. While guidelines recommend US for HCC screening, the sensitivity of ultrasound is highly variable for the detection of early-stage HCC with sensitivity reports ranging from 40% to 80%. Biomarker-based scores such as GALAD and alternative imaging modalities such as abbreviated MRI are promising tools to improve HCC early detection. Patients with non-alcoholic fatty liver disease (NAFLD) and patients hepatitis C (HCV) who have achieved sustained virologic response (SVR) can present a clinical dilemma regarding the need for HCC screening. Biomarkers and elastography can aid in identification of individuals at high risk for HCC in these populations. CONCLUSIONS The LI-RADS system has standardised the imaging interpretation and diagnosis of HCC. Work remains regarding screening in special populations and optimization of screening modalities.
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Affiliation(s)
- Abbey Barnard Giustini
- Division of Gastroenterology, Veterans Affairs Puget Sound Healthcare System and University of Washington, Seattle, Washington, USA
| | - George N. Ioannou
- Division of Gastroenterology, Veterans Affairs Puget Sound Healthcare System and University of Washington, Seattle, Washington, USA
| | - Claude Sirlin
- Liver Imaging Group, Department of Radiology, University of California at San Diego, La Jolla, California, USA
| | - Rohit Loomba
- NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California at San Diego, La Jolla, California, USA
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Barranco MA, Rosenberg ES, Flanigan C, Shufelt S, Bruce EM, Wilberschied LA, Parker MM, Duncan E, Udo T. A cross-sectional study of hepatitis C prevalence and correlates among persons who inject drugs in rural and non-rural communities. J Viral Hepat 2022; 29:994-1003. [PMID: 35925950 DOI: 10.1111/jvh.13735] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 06/25/2022] [Accepted: 06/30/2022] [Indexed: 12/09/2022]
Abstract
Persons who inject drugs (PWID) have been experiencing a higher burden of new hepatitis C (HCV) due to the opioid epidemic. The greatest increases in injection have been in rural communities. However, less is known about the prevalence of HCV or its risk factors in rural compared to non-rural communities. This study compared HCV infection history, current infection, and associated behavioural and sociodemographic correlates among PWID recruited from rural and non-rural communities from Upstate New York (NY). This cross-sectional study recruited 309 PWID, using respondent-driven sampling. Blood samples were collected through finger stick for HCV antibody and RNA tests. A survey was also self-administered for HCV infection history, sociodemographics and behavioural correlates to compare by setting rurality. HCV seropositivity was significantly higher among PWID from rural than non-rural communities (71.0% vs. 46.8%), as was current infection (41.4% vs. 25.9%). High levels of past year syringe (44.4%) and equipment (62.2%) sharing were reported. Factors associated with infection history include syringe service program utilization, non-Hispanic white race, sharing needles and methamphetamine injection, which was higher in rural vs. non-rural communities (38.5% vs. 15.5%). HCV burden among PWID appears higher in rural than non-rural communities and may be increasing possibly due to greater levels of methamphetamine injection. On-going systematic surveillance of HCV prevalence and correlates is crucial to respond to the changing opioid epidemic landscape. Additionally, improving access to harm reduction services, especially with special focus on stimulants, may be important to reduce HCV prevalence among PWID in rural settings.
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Affiliation(s)
- Meredith A Barranco
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Rensselaer, New York, USA
| | - Eli S Rosenberg
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Rensselaer, New York, USA.,Center for Collaborative HIV Research in Practice and Policy, University at Albany, Rensselaer, New York, USA.,Office of Public Health, New York State Department of Health, Albany, New York, USA
| | - Colleen Flanigan
- AIDS Institute, New York State Department of Health, Albany, New York, USA
| | - Sarah Shufelt
- Center for Collaborative HIV Research in Practice and Policy, University at Albany, Rensselaer, New York, USA
| | - Emily M Bruce
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Rensselaer, New York, USA.,AIDS Institute, New York State Department of Health, Albany, New York, USA
| | | | - Monica M Parker
- Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - Eliana Duncan
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Rensselaer, New York, USA
| | - Tomoko Udo
- Center for Collaborative HIV Research in Practice and Policy, University at Albany, Rensselaer, New York, USA.,Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany, Rensselaer, New York, USA
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Hepatitis C Virus Cascade of Care Among Perinatal Patients in Maine Diagnosed With Opioid Use Disorder, 2015-2020. J Addict Med 2022:01271255-990000000-00108. [PMID: 36598484 DOI: 10.1097/adm.0000000000001098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE This is a quality improvement project to determine the best process to identify and address gaps in care for perinatal patients in receiving appropriate hepatitis C virus (HCV) testing and treatment across the largest health system in Maine. STUDY DESIGN We reviewed electronic medical record data between October 1, 2015, and February 1, 2020, to investigate rates of HCV testing and treatment among 916 perinatal patients with opioid use disorder across 8 hospitals using a "cascade of care" framework, a model used previously to identify gaps in care and treatment of chronic diseases. MAIN OUTCOME MEASURE We examined HCV testing and treatment rates along the cascade of care and patient characteristics associated with HCV antibody testing and treatment, separately, using log binomial regression models. Models were adjusted for age, residential distance to medical center, psychiatric diagnosis, and opioid agonist therapy at delivery. RESULTS Of pregnant patients eligible for screening, 64% (582/916) received HCV antibody testing. Of 136 patients with active HCV infection, 32% (n = 43) received a referral for treatment, 21% (n = 28) were treated, and 13% (n = 18) achieved sustained virologic response. In the adjusted regression models, only opioid agonist therapy was associated with HCV antibody testing (adjusted risk ratio, 1.31; 95% confidence interval, 1.18-1.46), and no factors were significantly associated with receipt of treatment among HCV viremic patients. CONCLUSION Low referral and treatment rates signify the need for quality improvement interventions to improve coordination of care between multiple disciplines and practice settings to increase access to HCV treatment.
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Su WC, Chen TT, Yang SS, Shih LN, Liu CK, Wang CC, Wu CH. The effect of a pay-for-performance program on health-related quality of life for patients with hepatitis in Taiwan. Health Qual Life Outcomes 2022; 20:130. [PMID: 36064530 PMCID: PMC9446742 DOI: 10.1186/s12955-022-02038-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 06/13/2022] [Indexed: 11/12/2022] Open
Abstract
Purpose Chronic viral hepatitis is a major global public health problem. The guidelines suggest the long-term performance of regular ongoing liver examinations to monitor liver inflammation and screen for hepatocellular carcinoma. However, the effects of regular liver examinations on health-related quality of life (HRQoL) have not been adequately evaluated. Therefore, this study evaluated the effects of regular ongoing examinations on the quality of life of patients with hepatitis.
Methods A cross-sectional study was conducted from October to December 2016 in four hospitals in northern Taiwan. A hepatitis pay-for-performance (P4P) program was launched in 2010 to ensure that hepatitis patients have regular ongoing liver examinations. The study group consisted of patients who joined and stayed in the program for more than one year. The study assessed HRQoL utilizing the five-level version of the EuroQol-5 Dimension (EQ-5D-5L) and the EuroQoL visual analog scale (EQ-VAS). The responses for the EQ-5D-5L in hepatitis patients were transformed into the EQ-5D index according to the Taiwanese population’s value set. Sociodemographic and clinical characteristics were collected by questionnaire, and descriptive statistics were presented. A two-part model and generalized linear model with a Poisson distribution and a log link function, respectively, were used to examine the associations of the EQ-5D index and EQ-VAS score with participation in the hepatitis P4P program. We applied propensity score weighting with inverse probability weighting to control for selection bias. Results In all, 508 patients (aged 57.6 ± 11.6 years; 60.8% male) were enrolled in this study. The mean (standard deviation, SD) reported EQ-5D index and EQ-VAS scores were 0.93 (0.12) and 75.1 (13.8), and the median (interquartile range, IQR) values were 1 (0.108) and 80 (15), respectively. The study group had a moderately significantly higher EQ-VAS score (mean ratio = 1.029, P < 0.001). However, the differences in the EQ-5D index scores between the study and control groups were not significant. Conclusion Patients with hepatitis partially benefited from receiving hepatitis P4P in Taiwan, which featured regular ongoing liver examinations, in that their EQ-VAS scores were enhanced but not their EQ-5D index scores.
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Affiliation(s)
- Wei-Chih Su
- Department of Gastroenterology, Buddhist Tzu Chi Medical Foundation, Taipei Tzu-Chi Hospital, New Taipei City, Taiwan.,Department of Public Health, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Tsung-Tai Chen
- Department of Public Health, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Sien-Sing Yang
- Liver Unit, Cathay General Hospital Medical Center, Taipei, Taiwan.,School of Medicine, College of Medicine, Fu-Jen Catholic University, New Taipei, Taiwan
| | - Ling-Na Shih
- Lo-Sheng Sanatorium Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan.,Department of Internal Medicine, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Chih-Kuang Liu
- Department of Urology, Fu-Jen Catholic University Hospital, New Taipei City, Taiwan.,Graduate Institute of Business Administration and College of Medicine, Fu-Jen, Catholic University, New Taipei City, Taiwan
| | - Chia-Chi Wang
- Department of Gastroenterology, Buddhist Tzu Chi Medical Foundation, Taipei Tzu-Chi Hospital, New Taipei City, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Chien-Hsien Wu
- Lo-Sheng Sanatorium Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan. .,Department of Internal Medicine, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan.
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8
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Epstein RL, Wang J, White LF, Kapadia SN, Morgan JR, Bao Y, Linas BP. Medicaid Hepatitis C Virus Treatment Policies: Impact on Testing and Treatment in the Commercially Insured. Am J Prev Med 2022; 63:e87-e98. [PMID: 35725599 PMCID: PMC9676070 DOI: 10.1016/j.amepre.2022.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 02/09/2022] [Accepted: 03/07/2022] [Indexed: 12/09/2022]
Abstract
INTRODUCTION A total of 23 state Medicaid programs continue to restrict hepatitis C virus (HCV) medication access by liver disease or substance-use criteria, creating obstacles to HCV elimination and significant care disparities. Because public insurers often set precedents for private insurer coverage and clinician practice patterns, this study sought to analyze whether spillover occurs from state Medicaid HCV treatment restrictions to HCV screening and treatment rates in commercially insured individuals. METHODS Investigators analyzed 2014‒2017 commercial claims data across 48 U.S. states (721,961,965 person-months) and used an interrupted times series design to compare hepatitis C virus screening and treatment rates before and after state Medicaid HCV treatment policy changes, adjusting for state-level random effects, Medicaid expansion status, and state drug overdose incidence rates, in states that relaxed Medicaid policy over the study period. Analysis occurred during 2019‒2021. RESULTS Hepatitis C virus screening rates among commercially insured individuals increased after the corresponding state Medicaid program relaxed HCV treatment policy. Among states that changed Medicaid policy, those that reduced fibrosis or both fibrosis and abstinence restrictions experienced increased HCV screening rates by the study end compared with states that changed only abstinence restrictions (rate ratio=1.29; 95% CI=1.15, 1.44; and rate ratio=1.32; 95% CI=1.17, 1.50, respectively). Similar patterns did not occur in HCV treatment rates, which declined after 2015 across groups. CONCLUSIONS These data show that HCV screening rates increased among commercially insured individuals after the removal of Medicaid HCV treatment restrictions in the same state. This suggests that Medicaid treatment policies can spill over to affect health outcomes among commercially insured populations.
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Affiliation(s)
- Rachel L Epstein
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts; Section of Infectious Diseases, Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts.
| | - Jianing Wang
- Department of Biostatistics, School of Public Health, Boston University, Boston, Massachusetts
| | - Laura F White
- Department of Biostatistics, School of Public Health, Boston University, Boston, Massachusetts
| | - Shashi N Kapadia
- Division of Infectious Diseases, Joan and Sanford I. Weil Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Jake R Morgan
- Department of Health Law, Policy, & Management, Boston University School of Public Health, Boston, Massachusetts
| | - Yuhua Bao
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - Benjamin P Linas
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts; Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
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Kamis KF, Wyles DL, Minturn MS, Scott T, McEwen D, Hurley H, Prendergast SJ, Gunter J, Rowan SE. A retrospective, descriptive study of hepatitis C testing, prevalence, and care continuum among adults on probation. HEALTH & JUSTICE 2022; 10:26. [PMID: 35947313 PMCID: PMC9363270 DOI: 10.1186/s40352-022-00191-9] [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: 03/24/2022] [Accepted: 07/30/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Despite constituting the largest segment of the correctional population, individuals on court-ordered probation remain largely unstudied with respect to hepatitis C virus (HCV) testing and linkage-to-care. We conducted a retrospective, descriptive analysis to estimate prevalence of diagnosed HCV and the subsequent HCV care cascade among a cohort of individuals enrolled in an adult probation program over a 25-month period in Denver, Colorado. METHODS We utilized probabilistic matching with first and last name, sex, and birthdate to identify individuals enrolled in probation between July 1, 2016 and July 30, 2018 who had a medical record at the participating safety-net healthcare institution as of December 31, 2019. Electronic medical record data were queried for evidence of HCV testing and care through June 30, 2021. The state HCV registry was also queried for prevalence of reported HCV cases among the cohort. RESULTS This cohort included 8,903 individuals; 6,920 (78%) individuals had a medical record at the participating institution, and of these, 1,037 (15%) had ever been tested for HCV (Ab or RNA) and 308 (4% of those with a medical record, 30% of those tested) had detectable HCV RNA. Of these, 105 (34%) initiated HCV treatment, 89 (29%) had a subsequent undetectable HCV viral load, and 65 (21%) had documentation of HCV cure. Eleven percent of the total cohort had records of positive HCV Ab or RNA tests in the state HCV registry. CONCLUSIONS This study demonstrates the importance of HCV screening and linkage-to-care for individuals enrolled in probation programs. A focus on this population could enhance progress towards HCV elimination goals.
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Affiliation(s)
- Kevin F Kamis
- Public Health Institute at Denver Health, Denver Health and Hospital Authority, 601 Broadway, 8th floor, MC 2800, Denver, CO, 80203-3407, USA.
| | - David L Wyles
- Division of Infectious Diseases, Denver Health Medical Center and University of Colorado School of Medicine, Aurora, CO, USA
| | - Matthew S Minturn
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Tracy Scott
- LGBTQ+ Health Services, Denver Health and Hospital Authority, Denver, CO, USA
| | - Dean McEwen
- Public Health Institute at Denver Health, Denver Health and Hospital Authority, 601 Broadway, 8th floor, MC 2800, Denver, CO, 80203-3407, USA
| | - Hermione Hurley
- Public Health Institute at Denver Health, Denver Health and Hospital Authority, 601 Broadway, 8th floor, MC 2800, Denver, CO, 80203-3407, USA
- Division of Infectious Diseases, Denver Health Medical Center and University of Colorado School of Medicine, Aurora, CO, USA
- Center for Addiction Medicine, Denver Health and Hospital Authority, Denver, CO, USA
| | | | - Jessie Gunter
- Colorado Department of Public Health & Environment, Denver, CO, USA
| | - Sarah E Rowan
- Public Health Institute at Denver Health, Denver Health and Hospital Authority, 601 Broadway, 8th floor, MC 2800, Denver, CO, 80203-3407, USA.
- Division of Infectious Diseases, Denver Health Medical Center and University of Colorado School of Medicine, Aurora, CO, USA.
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10
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Lin T, Chi X, Liu X, Pan S, Chen W, Duan H, Zhang X, Yang W. Recombinant Full-Length Hepatitis C Virus E1E2 Dimer Elicits Pangenotypic Neutralizing Antibodies. Front Immunol 2022; 13:831285. [PMID: 35837406 PMCID: PMC9273934 DOI: 10.3389/fimmu.2022.831285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 06/02/2022] [Indexed: 11/13/2022] Open
Abstract
An effective prophylactic vaccine would be beneficial for controlling and eradicating hepatitis C virus (HCV) infections. However, the high diversity across HCV genotypes is a major challenge for vaccine development. Selection of the appropriate immunogen is critical to elicit broad HCV neutralizing antibodies (NAbs). To increase the antigenic coverage of heterodimer glycoproteins, we designed and produced recombinant E1E2 antigens for genotypes 1a/1b/2a/3a/6a from an IgG Fc-tagged precursor protein in FreeStyle 293-F cells. The recombinant E1 and E2 antigens were localized and associated with the endoplasmic reticulum and co-purified from membrane extracts. By examining the interactions with HCV entry co-receptors and the blockade of HCV infection, we found that these purified Fc-E1E2 proteins displayed correct folding and function. Mouse immunization results showed that each recombinant E1E2 antigen could elicit a pangenotypic antibody response to itself and other genotypes. We also found that the pentavalent formula triggered a relatively higher and more uniform NAb titer and T cell response than monovalent antigens. Taken together, our findings may provide a useful strategy for the vaccine development of HCV and other viruses with highly heterogeneous surface glycoproteins.
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11
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Partida D, Powell J, Ricco M, Naugle J, Magee C, Zevin B, Masson CL, Fokuo JK, Gonzalez D, Khalili M. Formal Hepatitis C education increases willingness to receive therapy in an onsite shelter-based HCV model of care in persons experiencing homelessness. Open Forum Infect Dis 2022; 9:ofac103. [PMID: 35369281 PMCID: PMC8968162 DOI: 10.1093/ofid/ofac103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 02/28/2022] [Indexed: 12/09/2022] Open
Abstract
Abstract
Background
To evaluate the effectiveness of formal Hepatitis C (HCV) education on engagement in therapy in persons experiencing homelessness in an onsite shelter-based model of care. As policies to eliminate Medicaid access restrictions to HCV treatment are expanded, patient education is paramount to achieving HCV elimination targets in difficult to engage populations including persons experiencing homelessness.
Methods
This prospective study was conducted at four shelters in San Francisco and Minneapolis from August 2018 to January 2021. Of the 162 HCV Ab positive participants, 150 participated in a 30-minute HCV education session. Post-education changes in knowledge, beliefs, barriers to care and willingness to accept therapy scores were assessed.
Results
Following education, knowledge scores (mean change 4.4 ± 4.4, p<0.001) and willingness to accept therapy (70% to 86% p=0.0002) increased. Perceived barriers to HCV care decreased (mean change -0.8 ± 5.2 p=0.001). Higher baseline knowledge was associated with lesser gain in knowledge following education (coef. -0.7, p<0.001). Post-education knowledge (OR 1.2, p=0.008) was associated with willingness to accept therapy.
Conclusions
An HCV educational intervention successfully increased willingness to engage in HCV therapy in persons experiencing homelessness in an onsite shelter-based HCV model of care.
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Affiliation(s)
- Diana Partida
- Department of Medicine, University of California San Francisco, San Francisco, CA, U.S.A
| | | | | | - Jessica Naugle
- San Francisco Department of Public Health, Street Medicine and Shelter Health, San Francisco, CA, U.S.A
| | - Catherine Magee
- Department of Medicine, Division of Gastroenterology and Hepatology, Zuckerberg San Francisco General Hospital, San Francisco, CA, U.S.A
| | - Barry Zevin
- San Francisco Department of Public Health, Street Medicine and Shelter Health, San Francisco, CA, U.S.A
| | - Carmen L Masson
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, U.S.A
| | - J Konadu Fokuo
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, U.S.A
| | - Daniel Gonzalez
- University of California San Francisco Liver Center, San Francisco, CA, U.S.A. Department of Medicine, Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, CA, U.S.A
| | - Mandana Khalili
- University of California San Francisco Liver Center, San Francisco, CA, U.S.A. Department of Medicine, Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, CA, U.S.A
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12
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Kouroumalis E, Voumvouraki A. Hepatitis C virus: A critical approach to who really needs treatment. World J Hepatol 2022; 14:1-44. [PMID: 35126838 PMCID: PMC8790391 DOI: 10.4254/wjh.v14.i1.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/14/2021] [Accepted: 12/31/2021] [Indexed: 02/06/2023] Open
Abstract
Introduction of effective drugs in the treatment of hepatitis C virus (HCV) infection has prompted the World Health Organization to declare a global eradication target by 2030. Propositions have been made to screen the general population and treat all HCV carriers irrespective of the disease status. A year ago the new severe acute respiratory syndrome coronavirus 2 virus appeared causing a worldwide pandemic of coronavirus disease 2019 disease. Huge financial resources were redirected, and the pandemic became the first priority in every country. In this review, we examined the feasibility of the World Health Organization elimination program and the actual natural course of HCV infection. We also identified and analyzed certain comorbidity factors that may aggravate the progress of HCV and some marginalized subpopulations with characteristics favoring HCV dissemination. Alcohol consumption, HIV coinfection and the presence of components of metabolic syndrome including obesity, hyperuricemia and overt diabetes were comorbidities mostly responsible for increased liver-related morbidity and mortality of HCV. We also examined the significance of special subpopulations like people who inject drugs and males having sex with males. Finally, we proposed a different micro-elimination screening and treatment program that can be implemented in all countries irrespective of income. We suggest that screening and treatment of HCV carriers should be limited only in these particular groups.
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Affiliation(s)
- Elias Kouroumalis
- Department of Gastroenterology, University of Crete Medical School, Heraklion 71500, Crete, Greece
| | - Argyro Voumvouraki
- First Department of Internal Medicine, AHEPA University Hospital, Thessaloniki 54621, Greece
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13
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Cacciola I, Pitrone C, Franzè MS, Mazzeo C, Muscianisi M, Porcari S, Pintabona G, Morace C, Basile G, Cucinotta E, Pollicino T, Raimondo G. Prevalence of hepatitis B and C viral infections in hospitalized patients with increased liver enzyme levels and with no known history of hepatic disease. Ann Hepatol 2022; 27 Suppl 1:100578. [PMID: 34752948 DOI: 10.1016/j.aohep.2021.100578] [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: 04/17/2021] [Accepted: 05/27/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND OBJECTIVES Identification of asymptomatic hepatitis B virus (HBV) and hepatitis C virus (HCV) carriers is fundamental to reach the World Health Organization objective to eradicate viral hepatitis. The aim of this study was to evaluate the HBV and HCV prevalence among patients hospitalized for a non-liver-related disease but showing increased liver enzyme values. PATIENTS AND METHODS All consecutive patients without history of hepatic disease but showing increased amino-transferase and/or gamma-glutamil-transpeptidase levels at admission to the Internal Medicine and Surgery divisions of the Messina University Hospital from 1st January to 31st December 2019 ("study group") were tested for HBV surface antigen (HBsAg) and anti-HCV antibody. Analogously, HBsAg and anti-HCV were tested for in all the individuals with normal liver enzyme values consecutively admitted from October 1st to December 31st, 2019 ("control group"). RESULTS Of the 332 "study group" patients, 13 (3.9%) were anti-HCV positive versus 5/306 (1.6%) patients of the "control group" (p=0.008). HCV RNA was detected in 11/13 and in 0/5 anti-HCV patients of the "study group" and "control group", respectively (p=0.001). HBsAg was detected in 5 (1.5%) "study group" patients and in none of the "control group" (p=0.03). Prevalence of diabetes, arterial hypertension, and dyslipidaemia was comparable between the two groups, whereas 75/332 (22.3%) patients of the "study group" and 34/306 (11.1%) patients of the "control group" drank > 2 alcohol units/day (p < 0.001). CONCLUSION Testing HBsAg and anti-HCV in subjects showing increased liver enzyme values may represent an efficacious tool to identify asymptomatic carriers of hepatitis virus infections.
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Affiliation(s)
- Irene Cacciola
- Department of Clinical and Experimental Medicine, University of Messina and University Hospital of Messina, Italy; Division of Medicine and Hepatology, University of Messina and University Hospital of Messina, Italy
| | - Concetta Pitrone
- Department of Clinical and Experimental Medicine, University of Messina and University Hospital of Messina, Italy; Division of Medicine and Hepatology, University of Messina and University Hospital of Messina, Italy
| | - Maria Stella Franzè
- Department of Clinical and Experimental Medicine, University of Messina and University Hospital of Messina, Italy; Division of Medicine and Hepatology, University of Messina and University Hospital of Messina, Italy
| | - Carmelo Mazzeo
- Division of Emergency Surgery, University of Messina and University Hospital of Messina, Italy
| | - Marco Muscianisi
- Division of Internal Medicine, University of Messina and University Hospital of Messina, Italy
| | - Serena Porcari
- Department of Clinical and Experimental Medicine, University of Messina and University Hospital of Messina, Italy; Division of Medicine and Hepatology, University of Messina and University Hospital of Messina, Italy
| | - Giusy Pintabona
- Division of Emergency Surgery, University of Messina and University Hospital of Messina, Italy
| | - Carmela Morace
- Division of Internal Medicine, University of Messina and University Hospital of Messina, Italy
| | - Giorgio Basile
- Division of Geriatrics, University of Messina and University Hospital of Messina, Italy
| | - Eugenio Cucinotta
- Division of Emergency Surgery, University of Messina and University Hospital of Messina, Italy; Department of Human Pathology, University of Messina and University Hospital of Messina, Italy
| | - Teresa Pollicino
- Department of Human Pathology, University of Messina and University Hospital of Messina, Italy; Laboratory of Molecular Hepatology University of Messina and University Hospital of Messina, Italy.
| | - Giovanni Raimondo
- Department of Clinical and Experimental Medicine, University of Messina and University Hospital of Messina, Italy; Division of Medicine and Hepatology, University of Messina and University Hospital of Messina, Italy.
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14
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Del Rosario A, Eldredge JD, Doorley S, Mishra SI, Kesler D, Page K. Hepatitis C virus care cascade in persons experiencing homelessness in the United States in the era of direct-acting antiviral agents: A scoping review. J Viral Hepat 2021; 28:1506-1514. [PMID: 34314081 PMCID: PMC9829430 DOI: 10.1111/jvh.13583] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 05/26/2021] [Accepted: 07/12/2021] [Indexed: 01/12/2023]
Abstract
The hepatitis C virus (HCV) care cascade has been well characterized in the general United States population and other subpopulations since curative medications have been available. However, information is limited on care cascade outcomes in persons experiencing homelessness. The main objective of this study was to map the available evidence on HCV care cascade outcomes in people experiencing homelessness in the U.S. in the era of direct-acting antiviral agents (DAAs). Primary and secondary outcomes included linkage to care (evaluation by a provider that can treat HCV) and sustained virologic response (SVR) or cure. Exploratory outcomes included other cascade data, like treatment initiation, which precedes SVR. PubMed was the primary database accessed for this scoping review. We characterized the HCV care cascade in people experiencing homelessness using sources of evidence published in 2014 onwards that reported the proportions of persons who were linked to care, achieved SVR, and completed other cascade steps. We synthesized our results into a scoping review. The proportion of persons linked to care among chronically infected cohorts with unstable housing ranged from 29.3% to 88.7%. Among those chronically infected, 5%-58.8% were started on DAAs and 5%-50% achieved SVR. In conclusion, these results show that persons experiencing homelessness achieve high rates of linkage to care in non-specialist community-based settings compared to the general U.S. population pre-DAAs. However, DAA initiation was found to be a rate-limiting step along the care cascade, resulting in commensurate low rates of cure.
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Affiliation(s)
- Aubrey Del Rosario
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Jonathan D Eldredge
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Sara Doorley
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Shiraz I Mishra
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Denece Kesler
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Kimberly Page
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
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15
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Irvin R, Gamble T, Malone J, Wang Z, Wilson E, Hughes JP, Farley J, Mayer KH, Del Rio C, Batey DS, Cummings V, Remien RH, Beyrer C, Thio CL. HIV Prevention Trials Network 078: High Prevalence of Hepatitis C Virus Antibodies Among Urban US Men Who Have Sex With Men, Independent of Human Immunodeficiency Virus Status. Clin Infect Dis 2021; 73:e2205-e2210. [PMID: 33346798 PMCID: PMC8492204 DOI: 10.1093/cid/ciaa1869] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Sexual transmission of hepatitis C virus (HCV) is uncommon, yet documented among men who have sex with men (MSM), primarily among those with human immunodeficiency virus (HIV). METHODS In the HIV Prevention Trials Network 078 study (HPTN 078), which assessed an integrated strategy to achieve HIV viral suppression, 1305 MSM were screened across 4 geographically diverse US cities. At screening, demographic/behavioral/psychosocial questionnaires were completed, along with HIV and HCV testing. Multivariable logistic regression was used to evaluate associations with HCV antibody positivity. RESULTS Among the 1287 (99%) of the MSM with HCV antibody results, the median age was 41, 69% were black, 85% had a high school education or more, 35% were employed, 70% had HIV, and 21% had undergone substance use counseling. The median lifetime number of male sexual partners was 17 (interquartile range, 6-50), and 246 (19%) were HCV antibody positive. HCV antibody positivity was high in MSM with HIV (20%) and MSM without HIV (17%) (P = .12) and was higher in those receiving substance use counseling (36%) than in those who had not (15%) (P ≤ .01). Substance use counseling (odds ratio, 2.51; 95% confidence interval, 1.80-3.51) and unstable housing (2.16; 1.40-3.33) were associated with HCV antibody positivity. CONCLUSIONS Nearly 1 in 5 MSM screened for HPTN 078 have been infected with HCV. The prevalence is high regardless of HIV status and is high even in those who did not undergo substance use counseling. In HIV burden networks, high HCV infection prevalence may occur in MSM without HIV. As implementation of preexposure prophylaxis expands and condom use declines, routine HCV counseling and screening among MSM are important.
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Affiliation(s)
- Risha Irvin
- Johns Hopkins University, Baltimore, Maryland, USA
| | - Theresa Gamble
- HPTN Leadership and Operations Center, FHI 360, Durham, North Carolina, USA
| | | | - Zhe Wang
- Statistical Center for HIV/AIDS Research and Prevention, Seattle, Washington , USA
| | - Ethan Wilson
- Statistical Center for HIV/AIDS Research and Prevention, Seattle, Washington , USA
| | | | - Jason Farley
- Johns Hopkins University, Baltimore, Maryland, USA
| | - Kenneth H Mayer
- The Fenway Institute and Harvard Medical School, Boston, Massachusetts, USA
| | - Carlos Del Rio
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - D Scott Batey
- The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Robert H Remien
- HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, New York, New York, USA
| | - Chris Beyrer
- Johns Hopkins University, Baltimore, Maryland, USA
| | - Chloe L Thio
- Johns Hopkins University, Baltimore, Maryland, USA
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16
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High Sustained Virologic Response Rates of Glecaprevir/Pibrentasvir in Patients With Dosing Interruption or Suboptimal Adherence. Am J Gastroenterol 2021; 116:1896-1904. [PMID: 34465693 PMCID: PMC8389353 DOI: 10.14309/ajg.0000000000001332] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 05/06/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Pangenotypic, all-oral direct-acting antivirals, such as glecaprevir/pibrentasvir (G/P), are recommended for treatment of hepatitis C virus (HCV) infection. Concerns exist about the impact on efficacy in patients with suboptimal adherence, particularly with shorter treatment durations. These post hoc analyses evaluated adherence (based on pill count) in patients prescribed 8- or 12-week G/P, the impact of nonadherence on sustained virologic response at post-treatment week 12 (SVR12), factors associated with nonadherence, and efficacy in patients interrupting G/P treatment. METHODS Data were pooled from 10 phase 3 clinical trials of treatment-naive patients with HCV genotype 1-6 without cirrhosis/with compensated cirrhosis (treatment adherence analysis) and 13 phase 3 clinical trials of all patients with HCV (interruption analysis). RESULTS Among 2,149 patients included, overall mean adherence was 99.4%. Over the treatment duration, adherence decreased (weeks 0-4: 100%; weeks 5-8: 98.3%; and weeks 9-12: 97.1%) and the percentage of patients with ≥80% or ≥90% adherence declined. SVR12 rate in the intention-to-treat (ITT) population was 97.7% (modified ITT SVR12 99.3%) and remained high in nonadherent patients in the modified ITT population (<90%: 94.4%-100%; <80%: 83.3%-100%). Psychiatric disorders were associated with <80% adherence, and shorter treatment duration was associated with ≥80% adherence. Among 2,902 patients in the interruption analysis, 33 (1.1%) had a G/P treatment interruption of ≥1 day, with an SVR12 rate of 93.9% (31/33). No virologic failures occurred. DISCUSSION These findings support the impact of treatment duration on adherence rates and further reinforce the concept of "treatment forgiveness" with direct-acting antivirals.
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Epstein RL, Moloney C, Garfinkel J, Saia K, Wachman EM, Lodi S, Pelton SI. Enhancing Linkage to Hepatitis C Virus Treatment Following Pregnancy in Women Identified During Perinatal Care. Hepatol Commun 2021; 5:1543-1554. [PMID: 34510828 PMCID: PMC8435278 DOI: 10.1002/hep4.1748] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 04/05/2021] [Accepted: 04/25/2021] [Indexed: 02/04/2023] Open
Abstract
Amid the current US opioid crisis, hepatitis C virus (HCV) infection rates continue to rise in young adults, including among pregnant women, yet few studies describe linkage to care and treatment in pregnant or postpartum women with HCV infection. We used electronic health record data to estimate HCV treatment rates for postpartum women before (January 2014-September 2016) and during (October 2016-March 2018) implementation of a maternal-infant HCV linkage program in combination with a multidisciplinary clinic to colocate mother and infant care. Using Poisson regression models, we compared HCV treatment initiation rates, adjusting for demographics, substance use, and treatment. From January 2014 through March 2018, 343 women who were HCV seropositive delivered at our institution. Of these, 95% completed HCV nucleic acid testing and 255 women had chronic HCV infection. Mean age was 30 years, 96% were publicly insured, and 94% had documented substance use. HCV treatment initiation increased from 28/164 (17.1%) women with chronic HCV infection in the preintervention period to 16/66 (24.2%) with the linkage-only intervention and 13/25 (52.0%) with the linkage intervention and colocated care. Adjusted analyses demonstrated that women delivering during the intervention period initiated HCV treatment at 2.40 times (95% confidence interval [CI], 1.10-5.25; linkage only) and 3.36 times (95% CI, 1.57-7.17; linkage and colocated care) the rate of women delivering preintervention. Women on buprenorphine had higher HCV treatment initiation rates compared with those on methadone (rate ratio, 2.10; 95% CI, 1.05-4.21). Conclusion: HCV linkage to care and treatment rates improved in the setting of mother-infant linkage and colocated care interventions. Perinatal care may represent a critical venue to identify, link, and treat women for HCV infection to improve their own health and prevent transmission to subsequent pregnancies.
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Affiliation(s)
- Rachel L Epstein
- Department of MedicineSection of Infectious DiseasesBoston University School of MedicineBostonMAUSA.,Department of PediatricsSection of Infectious DiseasesBoston University School of MedicineBostonMAUSA
| | - Carole Moloney
- Department of PediatricsSection of Infectious DiseasesBoston University School of MedicineBostonMAUSA
| | | | - Kelley Saia
- Department of Obstetrics and GynecologyBoston University School of MedicineBostonMAUSA
| | - Elisha M Wachman
- Department of PediatricsBoston University School of MedicineBostonMAUSA
| | - Sara Lodi
- Department of BiostatisticsBoston University School of Public HealthBostonMAUSA
| | - Stephen I Pelton
- Department of PediatricsSection of Infectious DiseasesBoston University School of MedicineBostonMAUSA
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18
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Chevaliez S, Roudot-Thoraval F, Hézode C, Pawlotsky JM, Njouom R. Performance of rapid diagnostic tests for HCV infection in serum or plasma. Future Microbiol 2021; 16:713-719. [PMID: 34227402 DOI: 10.2217/fmb-2020-0295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: HCV diagnosis will become the bottleneck in eliminating hepatitis C. Simple, accurate and cost-effective testing strategies are urgently needed to improve hepatitis C screening and diagnosis. Materials & methods: Performance of seven rapid diagnostic tests (RDT) have been assessed in a large series (n = 498) of serum or plasma specimens collected in France and in Cameroon. Results: Specificity varied from 96.1 to 100%. The clinical sensitivity, compared with immunoassays as the reference, was high for all seven RDT (97.2-100%). The Multisure HCV antibody assay and OraQuick HCV rapid antibody test reached sensitivity ≥99%. Conclusion: A number of RDT may be suitable for WHO prequalification and may be implemented in the framework of large-scale low-cost treatment programs to achieve the WHO viral hepatitis objectives by 2030.
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Affiliation(s)
- Stéphane Chevaliez
- Department of Virology, National Reference Center for Viral Hepatitis B, C & Delta, Hôpital Henri Mondor, Université Paris-Est, Créteil, France.,INSERM U955, Créteil, France
| | - Françoise Roudot-Thoraval
- INSERM U955, Créteil, France.,Department of Hepatology, Hôpital Henri Mondor, Université Paris-Est, Créteil, France
| | - Christophe Hézode
- INSERM U955, Créteil, France.,Department of Hepatology, Hôpital Henri Mondor, Université Paris-Est, Créteil, France
| | - Jean-Michel Pawlotsky
- Department of Virology, National Reference Center for Viral Hepatitis B, C & Delta, Hôpital Henri Mondor, Université Paris-Est, Créteil, France.,INSERM U955, Créteil, France
| | - Richard Njouom
- Department of Virology, Centre Pasteur du Cameroun, Yaounde, Cameroon
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19
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Ziff J, Vu T, Dvir D, Riazi F, Toribio W, Oster S, Sigel K, Weiss J. Predictors of hepatitis C treatment outcomes in a harm reduction-focused primary care program in New York City. Harm Reduct J 2021; 18:38. [PMID: 33789691 PMCID: PMC8010955 DOI: 10.1186/s12954-021-00486-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 03/22/2021] [Indexed: 12/15/2022] Open
Abstract
Background The social determinants of health that influence steps in the entire Hepatitis C Virus (HCV) treatment cascade must be identified to achieve HCV elimination goals. This project aimed to evaluate the association of these factors with HCV treatment completion and return for sustained virologic response (SVR) testing. Methods We used retrospective cohort data from our primary care-based HCV treatment program that provides comprehensive harm reduction care to those who use or formerly used drugs. Among persons who began direct-acting antiviral HCV treatment between December 2014 and March 2018, we identified two outcomes: HCV treatment completion and return for SVR assessment 12 weeks after treatment end. Several predictors were ascertained including sociodemographic information, substance use, psychiatric symptoms and history, housing instability, and HCV treatment regimen. We then evaluated associations between predictors and outcomes using univariate and multivariable statistical methods. Results From a cohort of 329 patients treated in an urban primary care center, multivariable analysis identified housing instability as a single significant predictor for HCV treatment completion (odds ratio [OR]: 0.3; 95% confidence interval [CI]: 0.1–0.9). Among patients completing treatment, 226 (75%) returned for SVR assessment; the sole predictor of this outcome was Medicaid as primary insurance (compared to other insurances; OR 0.3; 0.1–0.7). Conclusions Innovative strategies to help unstably housed persons complete HCV treatment are urgently needed in order to reach HCV elimination targets. Educational and motivational strategies should be developed to promote individuals with Medicaid in particular to return for SVR viral load testing, a critical post-treatment component of the HCV treatment cascade. Trial registration Not applicable.
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Affiliation(s)
- Jacob Ziff
- Respectful and Equitable Access to Comprehensive Healthcare (REACH) Program, Division of General Internal Medicine, Icahn School of Medicine At Mount Sinai, 17 East 102nd Street, 7th floor, New York City, NY, 10029, United States.
| | - Trang Vu
- Respectful and Equitable Access to Comprehensive Healthcare (REACH) Program, Division of General Internal Medicine, Icahn School of Medicine At Mount Sinai, 17 East 102nd Street, 7th floor, New York City, NY, 10029, United States
| | - Danielle Dvir
- Respectful and Equitable Access to Comprehensive Healthcare (REACH) Program, Division of General Internal Medicine, Icahn School of Medicine At Mount Sinai, 17 East 102nd Street, 7th floor, New York City, NY, 10029, United States
| | - Farah Riazi
- Respectful and Equitable Access to Comprehensive Healthcare (REACH) Program, Division of General Internal Medicine, Icahn School of Medicine At Mount Sinai, 17 East 102nd Street, 7th floor, New York City, NY, 10029, United States
| | - Wilma Toribio
- Respectful and Equitable Access to Comprehensive Healthcare (REACH) Program, Division of General Internal Medicine, Icahn School of Medicine At Mount Sinai, 17 East 102nd Street, 7th floor, New York City, NY, 10029, United States
| | - Scott Oster
- Respectful and Equitable Access to Comprehensive Healthcare (REACH) Program, Division of General Internal Medicine, Icahn School of Medicine At Mount Sinai, 17 East 102nd Street, 7th floor, New York City, NY, 10029, United States
| | - Keith Sigel
- Respectful and Equitable Access to Comprehensive Healthcare (REACH) Program, Division of General Internal Medicine, Icahn School of Medicine At Mount Sinai, 17 East 102nd Street, 7th floor, New York City, NY, 10029, United States
| | - Jeffrey Weiss
- Respectful and Equitable Access to Comprehensive Healthcare (REACH) Program, Division of General Internal Medicine, Icahn School of Medicine At Mount Sinai, 17 East 102nd Street, 7th floor, New York City, NY, 10029, United States
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20
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Facente SN, Patel S, Hecht J, Wilson E, McFarland W, Page K, Vickerman P, Fraser H, Burk K, Morris MD. Hepatitis C Care Cascades for 3 Populations at High Risk: Low-income Trans Women, Young People Who Inject Drugs, and Men Who Have Sex With Men and Inject Drugs. Clin Infect Dis 2021; 73:e1290-e1295. [PMID: 33768236 PMCID: PMC8442786 DOI: 10.1093/cid/ciab261] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND To achieve elimination of hepatitis C virus (HCV) infection, limited resources can be best allocated through estimation of "care cascades" among groups disproportionately affected. In San Francisco and elsewhere, these groups include young (age ≤ 30 years) people who inject drugs (YPWID), men who have sex with men who inject drugs (MSM-IDU), and low-income trans women. METHODS We developed cross-sectional HCV care cascades for YPWID, MSM-IDU, and trans women using diverse data sources. Population sizes were estimated using an inverse variance-weighted average of estimates from the peer-reviewed literature between 2013 and 2019. Proportions of past/current HCV infection, diagnosed infection, treatment initiation, and evidence of cure (sustained virologic response at 12 weeks posttreatment) were estimated from the literature using data from 7 programs and studies in San Francisco between 2015 and 2020. RESULTS The estimated number of YPWID in San Francisco was 3748; 58.4% had past/current HCV infection, of whom 66.4% were diagnosed with current infection, 9.1% had initiated treatment, and 50% had confirmed cure. The corresponding figures for the 8135 estimated MSM-IDU were: 29.4% with past/current HCV infection, 70.3% diagnosed with current infection, 28.4% initiated treatment, and 38.9% with confirmed cure. For the estimated 951 low-income trans women, 24.8% had past/current HCV infection, 68.9% were diagnosed with current infection, 56.5% initiated treatment, and 75.5% had confirmed cure. CONCLUSIONS In all 3 populations, diagnosis rates were relatively high; however, attention is needed to urgently increase treatment initiation in all groups, with a particular unmet need among YPWID.
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Affiliation(s)
- Shelley N Facente
- School of Public Health, Division of Epidemiology and Biostatistics, University of California Berkeley, Berkeley, California, USA,Facente Consulting, Richmond, California, USA
| | - Sheena Patel
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Jennifer Hecht
- San Francisco AIDS Foundation, San Francisco, California, USA
| | - Erin Wilson
- San Francisco Department of Public Health, San Francisco, California, USA
| | - Willi McFarland
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA,San Francisco Department of Public Health, San Francisco, California, USA
| | - Kimberly Page
- University of New Mexico, Albuquerque, New Mexico, USA
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Hannah Fraser
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Katie Burk
- San Francisco Department of Public Health, San Francisco, California, USA
| | - Meghan D Morris
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA,Correspondence: M. D. Morris, 550 16th St, Box 124, San Francisco, CA 94153, USA ()
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21
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Kardashian A, Wilder J, Terrault NA, Price JC. Addressing Social Determinants of Liver Disease During the COVID-19 Pandemic and Beyond: A Call to Action. Hepatology 2021; 73:811-820. [PMID: 33150599 DOI: 10.1002/hep.31605] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/28/2020] [Accepted: 10/06/2020] [Indexed: 12/16/2022]
Abstract
The COVID-19 pandemic has exposed healthcare inequities in the USA and highlighted the importance of social conditions in shaping the health of persons. In the field of hepatology, social determinants of health (SDOH) are closely linked to disparities in liver disease prevalence, outcomes, and access to treatment. The economic disruption and physical distancing policies brought on by the COVID-19 pandemic have further exacerbated these disparities, and may have long-lasting health consequences for marginalized patients with chronic liver disease. There are several ways that hepatology providers can bridge the gap in health equity through addressing SDOH, extending from the individual to the community and societal levels. Interventions at the individual level include implementation of systematic screening for social barriers in our hepatology practices to identify gaps in the care cascade. At the community and societal levels, interventions include creating collaborative partnerships with public health workers to expand healthcare access to the community, increasing funding for research investigating the association of SDOH, health disparities, and liver disease, engaging in advocacy to support policy reform that tackles the upstream social determinants, and addressing racism and implicit bias. As hepatology practices adapt to the "new normal," now is the time for us to address our patients' social needs within the context of healthcare delivery and reimagine ways in which to provide care to best serve our most vulnerable patients with liver disease in the COVID-19 era and beyond.
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Affiliation(s)
- Ani Kardashian
- Division of Gastrointestinal and Liver DiseasesUniversity of Southern CaliforniaLos AngelesCA
| | - Julius Wilder
- Division of GastroenterologyDepartment of MedicineDuke University School of MedicineDurhamNC.,Duke Clinical Research InstituteDurhamNC
| | - Norah A Terrault
- Division of Gastrointestinal and Liver DiseasesUniversity of Southern CaliforniaLos AngelesCA
| | - Jennifer C Price
- Division of Gastroenterology and HepatologyDepartment of MedicineUniversity of California San FranciscoSan FranciscoCA
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22
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Sulkowski M, Cheng WH, Marx S, Sanchez Gonzalez Y, Strezewski J, Reau N. Estimating the Year Each State in the United States Will Achieve the World Health Organization's Elimination Targets for Hepatitis C. Adv Ther 2021; 38:423-440. [PMID: 33145648 PMCID: PMC7609357 DOI: 10.1007/s12325-020-01535-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/14/2020] [Indexed: 12/12/2022]
Abstract
Introduction Although hepatitis C virus (HCV) infection remains a major clinical, economic, and societal burden, the development of curative antiviral therapy may accelerate the path toward elimination. This analysis assessed the progress of United States (US) states towards achieving the World Health Organization’s (WHO) 2030 HCV elimination targets for incidence, mortality, diagnosis, and treatment. Methods A previously published Markov model was used to simulate HCV progression over time to estimate the path to HCV elimination in each state based on prevalence, annual treatment, and diagnosis inputs from two large US laboratory datasets from January 2013 to December 2017. State-specific fibrosis stage restrictions on treatment in 2017 were included. The model estimated the year individual states would meet the WHO targets for diagnosing 90% of the HCV-infected population, treating 80% of the eligible population, reducing new HCV infections by 80%, and reducing HCV-related deaths by 65%. The minimum number of annual treatments needed between 2020 and 2030 to achieve the WHO treatment target was also calculated. Results Overall, the USA is projected to achieve HCV elimination by 2037, with individual targets related to mortality, diagnosis, treatment, and incidence being achieved by 2020, 2027, 2033, and 2037, respectively. Three states (Connecticut, South Carolina, and Washington) are on track to meet all four elimination targets by 2030, and 18 states are not expected to meet these targets before 2040. The estimated annual number of treatments required during 2020–2030 nationally to reach the WHO treatment target is 173,514. Conclusion With the exception of three states, the USA is not on target to meet the WHO 2030 elimination targets and 35% are off track by 10 years or more. Strategies must be implemented to reduce overall prevalence by preventing new infections, increasing rates of screening, improving linkage to care, and implementing unfettered access to curative therapy. Electronic supplementary material The online version of this article (10.1007/s12325-020-01535-3) contains supplementary material, which is available to authorized users.
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23
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Dhiman RK, Premkumar M. Hepatitis C Virus Elimination by 2030: Conquering Mount Improbable. Clin Liver Dis (Hoboken) 2020; 16:254-261. [PMID: 33489098 PMCID: PMC7805299 DOI: 10.1002/cld.978] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 01/28/2020] [Accepted: 04/22/2020] [Indexed: 02/06/2023] Open
Affiliation(s)
- Radha K. Dhiman
- Department of HepatologyPostgraduate Institute of Medical Education and ResearchChandigarhIndia
- Mukh‐Mantri Punjab Hepatitis C Relief FundPunjab GovernmentPunjabIndia
- Ministry of Health and Family WelfareNew DelhiIndia
- Injection Safety Project, Punjab GovernmentPunjabIndia
| | - Madhumita Premkumar
- Department of HepatologyPostgraduate Institute of Medical Education and ResearchChandigarhIndia
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24
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Chen Q, Ayer T, Adee MG, Wang X, Kanwal F, Chhatwal J. Assessment of Incidence of and Surveillance Burden for Hepatocellular Carcinoma Among Patients With Hepatitis C in the Era of Direct-Acting Antiviral Agents. JAMA Netw Open 2020; 3:e2021173. [PMID: 33206188 PMCID: PMC7675109 DOI: 10.1001/jamanetworkopen.2020.21173] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
IMPORTANCE In the US, hepatocellular carcinoma (HCC), primarily associated with hepatitis C virus (HCV) infection, is the fastest rising cause of cancer-related death. Wider use of highly effective direct-acting antiviral agents (DAAs) substantially reduces the burden of chronic HCV infection, but the subsequent impacts with HCV-associated HCC remain unknown. OBJECTIVE To assess projected changes in the incidence rate of and surveillance burden for HCC in the era of DAA treatment for HCV. DESIGN, SETTING, AND PARTICIPANTS This decision analytical model study was performed from January 2019 to February 2020, using an individual-level state-transition simulation model to simulate disease progression, screening, and different waves of antiviral treatments for HCV in the US from 2012 to 2040. INTERVENTIONS Current clinical management for chronic HCV infection. MAIN OUTCOMES AND MEASURES Model outcomes were projected temporal trends and age distribution of incident HCC cases and candidates for HCC surveillance among patients with viremia and patients with virologically cured HCV. RESULTS The simulation model projected that the annual incidence of HCC among patients with viremia and patients with virologically cured HCV will continue increasing to 24 000 (95% uncertainty interval [UI], 18 000-31 000) cases until 2021. In patients with virologically cured HCV, incident HCC cases are projected to increase from 1000 (95% UI, 500-2100) in 2012 to the peak of 7000 (95% UI, 5000-9600) in 2031 with a subsequent decrease to 6000 (95% UI, 4300-8300) by 2040. The proportion of incident HCC cases that occur in individuals with virologically cured HCV is estimated to increase from 5.3% in 2012 to 45.8% in 2040. The number of candidates for HCC surveillance in the population with virologically cured HCV is projected to increase from 106 000 (95% UI, 70 000-178 000) in 2012 to the peak of 649 000 (95% UI, 512 000-824 000) in 2030 and decrease to 539 000 (95% UI, 421 000-687 000) by 2040, while the proportion of all candidates for surveillance who are virologically cured is estimated to increase from 8.5% to 64.6% during the same period. The average age of HCC incidence and surveillance candidates is estimated to increase from 55 in 2012 to 72 and 71, respectively, by 2040. CONCLUSIONS AND RELEVANCE The results of this study suggest that the burden of HCC will shift from patients with viremia to patients with virologically cured HCV, and to older populations. Appropriate management may be warranted for early detection of HCC in patients who may no longer be receiving specialty care for liver conditions.
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Affiliation(s)
- Qiushi Chen
- Institute for Technology Assessment, Massachusetts General Hospital, Harvard Medical School, Boston
- Harold and Inge Marcus Department of Industrial and Manufacturing Engineering, Pennsylvania State University, University Park
| | - Turgay Ayer
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta
| | - Madeline G. Adee
- Institute for Technology Assessment, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Xiaojie Wang
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta
| | - Fasiha Kanwal
- Department of Medicine, Baylor College of Medicine, Houston, Texas
- Houston Veterans Affairs Health Services Research and Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Jagpreet Chhatwal
- Institute for Technology Assessment, Massachusetts General Hospital, Harvard Medical School, Boston
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25
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Qin Y, Sha R, Feng Y, Huang Y. Comparison of double antigen sandwich and indirect enzyme-linked immunosorbent assay for the diagnosis of hepatitis C virus antibodies. J Clin Lab Anal 2020; 34:e23481. [PMID: 33245583 PMCID: PMC7676215 DOI: 10.1002/jcla.23481] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/10/2020] [Accepted: 06/02/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The aim of this study is to compare double-antigen sandwich enzyme-linked immunosorbent assay (ELISA) and indirect ELISA in the diagnosis of hepatitis C virus(HCV)infection. METHODS AND MATERIALS A total of 176 samples from the Tumor Hospital Affiliated to Xin Jiang Medical University were utilized to comparison. All serum samples were tested using double-antigen sandwich ELISA and indirect ELISA. Cohen's kappa statistics were used to assess the agreement between the two assays, and multivariate analysis was used to evaluate risk factors for the discordance between the double-antigen ELISA and indirect ELISA. RESULTS The positivities of indirect ELISA (Beijing Wantai), double-antigen sandwich ELISA (Beijing Wantai), and indirect ELISA (Beijing Jinhao) were 74.43%, 68.75%, and 73.30%, respectively. The agreement between the indirect ELISA (Beijing Wantai) and double-antigen sandwich ELISA (Beijing Wantai) was high (κ = 0.829;P < .001), and the agreement between the double-antigen sandwich ELISA (Beijing Wantai) and indirect ELISA (Beijing Jinhao) was high (κ = 0.847;P < .001). Variables associated with discordant results between the double-antigen sandwich and indirect ELISA in multivariate analysis were as follows: female (OR:1.462; P < .05), age (<35 years old; OR:3.667; P < .05), and cancer (suffer from malignant tumor; OR:3.621; P < .05). CONCLUSION In detection of HCV, high agreement was found between the double-antigen sandwich ELISA and indirect ELISA. Female, younger age, and suffer from malignant tumor were significant risk factors for the discordance. Based on double-antigen sandwich ELISA has distinct methodological advantages over indirect ELISA. It is recommended for the diagnosis of HCV infection.
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Affiliation(s)
- Ya‐Juan Qin
- Clinical Laboratory CenterThe Tumor Hospital Affiliated to Xin Jiang Medical UniversityUrumqiChina
| | - Ruo‐cheng Sha
- Clinical Laboratory CenterThe Tumor Hospital Affiliated to Xin Jiang Medical UniversityUrumqiChina
| | - Yang‐Chun Feng
- Clinical Laboratory CenterThe Tumor Hospital Affiliated to Xin Jiang Medical UniversityUrumqiChina
| | - Yan‐Chun Huang
- Clinical Laboratory CenterThe Tumor Hospital Affiliated to Xin Jiang Medical UniversityUrumqiChina
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26
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French hepatitis C care cascade: substantial impact of direct-acting antivirals, but the road to elimination is still long. BMC Infect Dis 2020; 20:759. [PMID: 33059617 PMCID: PMC7559725 DOI: 10.1186/s12879-020-05478-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 10/05/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) elimination by 2030, as targeted by the World Health Organization (WHO), requires that 90% of people with chronic infection be diagnosed and 80% treated. We estimated the cascade of care (CoC) for chronic HCV infection in mainland France in 2011 and 2016, before and after the introduction of direct-acting antivirals (DAAs). METHODS The numbers of people (1) with chronic HCV infection, (2) aware of their infection, (3) receiving care for HCV and (4) on antiviral treatment, were estimated for 2011 and 2016. Estimates for 1) and 2) were based on modelling studies for 2011 and on a virological sub-study nested in a national cross-sectional survey among the general population for 2016. Estimates for 3) and 4) were made using the National Health Data System. RESULTS Between 2011 and 2016, the number of people with chronic HCV infection decreased by 31%, from 192,700 (95% Credibility interval: 150,900-246,100) to 133,500 (95% Confidence interval: 56,900-312,600). The proportion of people aware of their infection rose from 57.7 to 80.6%. The number of people receiving care for HCV increased by 22.5% (representing 25.7% of those infected in 2016), while the number of people on treatment increased by 24.6% (representing 12.1% of those infected in 2016). CONCLUSIONS This study suggests that DAAs substantially impact CoC. However, access to care and treatment for infected people remained insufficient in 2016. Updating CoC estimates will help to assess the impact of new measures implemented since 2016 as part of the goal to eliminate HCV.
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Rosecrans AM, Cheedalla A, Rives ST, Scotti LA, Harris RE, Greenbaum AH, Irvin RR, Ntiri-Reid BA, Brown HT, Alston KE, Smith JA, Page KR, Falade-Nwulia OO. Public Health Clinic-Based Hepatitis C Treatment. Am J Prev Med 2020; 59:420-427. [PMID: 32430222 DOI: 10.1016/j.amepre.2020.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 02/20/2020] [Accepted: 03/11/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The availability of safe, effective treatments for hepatitis C virus infection has led to a call for the elimination of hepatitis C, but barriers to care persist. METHODS In July 2015, the Baltimore City Health Department sexual health clinics began on-site hepatitis C virus treatment. Investigators conducted a retrospective evaluation of the first 2.5 years of this program. Data were extracted from the medical record through June 2019, and data analysis was completed in September 2019. RESULTS Between July 2015 and December 2017, a total of 560 patients infected with hepatitis C virus accessed care at the Baltimore City Health Department sexual health clinics. Of these patients, 423 (75.5%) were scheduled for hepatitis C virus evaluation at the clinics, 347 (62.0%) attended their evaluation appointment, 266 (47.5%) were prescribed treatment, 227 (40.5%) initiated treatment, and 199 (35.5%) achieved sustained virologic response. Older age was independently associated with hepatitis C virus evaluation appointment attendance (aged 40-59 years: AOR=3.64, 95% CI=1.88, 7.06; aged ≥60 years: AOR=5.61, 95% CI=2.58, 12.21) compared with those aged 20-39 years. Among those who attended hepatitis C virus evaluation appointments, advanced liver disease was independently and positively associated with treatment initiation (AOR=11.89, 95% CI=6.35, 22.25). Conversely, illicit substance use in the past 12 months was negatively associated with hepatitis C virus treatment initiation (AOR=0.49, 95% CI=0.25, 0.96). CONCLUSIONS The integration of hepatitis C virus testing and on-site treatment in public sexual health clinics is an innovative approach to improve access to hepatitis C virus treatment for medically underserved populations.
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Affiliation(s)
- Amanda M Rosecrans
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Population Health and Disease Prevention, Baltimore City Health Department, Baltimore, Maryland.
| | - Aneesha Cheedalla
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sarah T Rives
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Population Health and Disease Prevention, Baltimore City Health Department, Baltimore, Maryland
| | - Lisa A Scotti
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Population Health and Disease Prevention, Baltimore City Health Department, Baltimore, Maryland
| | - Robert E Harris
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Population Health and Disease Prevention, Baltimore City Health Department, Baltimore, Maryland
| | - Adena H Greenbaum
- Division of Population Health and Disease Prevention, Baltimore City Health Department, Baltimore, Maryland
| | - Risha R Irvin
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Boatemaa A Ntiri-Reid
- Prevention and Health Promotion Administration, Maryland Department of Health, Baltimore, Maryland
| | - Holly T Brown
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Population Health and Disease Prevention, Baltimore City Health Department, Baltimore, Maryland
| | - Karen E Alston
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Population Health and Disease Prevention, Baltimore City Health Department, Baltimore, Maryland
| | - Jaeson A Smith
- Division of Population Health and Disease Prevention, Baltimore City Health Department, Baltimore, Maryland
| | - Kathleen R Page
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Population Health and Disease Prevention, Baltimore City Health Department, Baltimore, Maryland
| | - Oluwaseun O Falade-Nwulia
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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28
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Thomas DL. State of the Hepatitis C Virus Care Cascade. Clin Liver Dis (Hoboken) 2020; 16:8-11. [PMID: 32714516 PMCID: PMC7373772 DOI: 10.1002/cld.915] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 12/05/2019] [Indexed: 02/04/2023] Open
Abstract
Watch the interview with the author.
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29
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Sulkowski M, Luetkemeyer AF, Wyles DL, Martorell C, Muir A, Weisberg I, Gordon SC, McLain R, Huhn G. Impact of a digital medicine programme on hepatitis C treatment adherence and efficacy in adults at high risk for non-adherence. Aliment Pharmacol Ther 2020; 51:1384-1396. [PMID: 32352586 DOI: 10.1111/apt.15707] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/20/2020] [Accepted: 03/12/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Direct-acting anti-virals (DAA) are highly effective for hepatitis C virus (HCV) treatment, but perceived risks of medication non-adherence may restrict access to care. Digital medicine programme (DMP) has improved adherence and outcomes for some conditions. AIMS To conduct a prospective, single-arm, open-label study across the United States to assess the impact of DMP on adherence and efficacy in adults with chronic HCV infection at high risk for non-adherence. METHODS Eligible participants were placed on the DMP to evaluate real-time adherence; primary outcome was sustained virological response (SVR) at ≥10 weeks post-treatment. RESULTS Between August 2017 and April 2019, 288 participants (Medicaid, 64.9%; psychiatric disorders, 61.1%; homeless, 9.4%) received DAAs for 8-12 weeks (sofosbuvir/velpatasvir or ledipasvir, 45%; glecaprevir/pibrentasvir, 55%). SVR was achieved in 99.1% of 218 participants who had HCV RNA assessed at ≥10 weeks post-treatment; of the 70 participants who did not have SVR assessed, 17 had SVR4 with HCV RNA assessed at a median (IQR; interquartile range) 5.6 weeks (4.1, 7.9) post-treatment; one completed treatment but did not have HCV RNA assessed, and 52 discontinued treatment early without assessment. Overall, the primary analysed participants (n = 218) actively used the DMP for median (range) 92.9% (12.5%, 100%) of their prescribed treatment time, and overall pill-taking adherence was 95.0% (57.1%, 100%). Participants reported the programme was useful and easy to use through satisfaction surveys. CONCLUSIONS HCV treatment with DMP was accepted by patients and clinicians and may support HCV treatment outcomes among patients at high risk for treatment non-adherence (Clinical trials.gov NCT03164902).
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30
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Masson CL, Fokuo JK, Anderson A, Powell J, Zevin B, Bush D, Khalili M. Clients' perceptions of barriers and facilitators to implementing hepatitis C virus care in homeless shelters. BMC Infect Dis 2020; 20:386. [PMID: 32471376 PMCID: PMC7260732 DOI: 10.1186/s12879-020-05103-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 05/18/2020] [Indexed: 01/14/2023] Open
Abstract
Background Hepatitis C virus (HCV) is highly prevalent among homeless persons, yet barriers continue to impede HCV testing and treatment in this population. We studied the experiences of homeless individuals related to accessing HCV care to inform the design of a shelter-based HCV prevention and treatment program. Methods Homeless shelter clients (10 women and 10 men) of a large shelter in San Francisco participated in gender segregated focus groups. Focus groups followed a semi-structured interview format, which assessed individual, program/system, and societal-level barriers and facilitators to universal HCV testing and linkage to HCV care. Focus group interviews were transcribed, coded, and analyzed using thematic analysis. Results We identified key barriers to HCV testing and treatment at the individual level (limited knowledge and misconceptions about HCV infection, mistrust of health care providers, co-morbid conditions of substance use, psychiatric and chronic medical conditions), system level (limited advocacy for HCV services by shelter staff), and social level (stigma of homelessness). Individual, system, and social facilitators to HCV care described by participants included internal motivation, financial incentives, prior experiences with rapid HCV testing, and availability of affordable direct acting antiviral (DAA) treatment, respectively. Conclusions Interrelated individual- and social-level factors were the predominant barriers affecting homeless persons’ decisions to engage in HCV prevention and treatment. Integrated models of care for homeless persons at risk for or living with HCV address many of these factors, and should include interventions to improve patient knowledge of HCV and the availability of effective treatments.
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Affiliation(s)
- Carmen L Masson
- Department of Psychiatry, University of California San Francisco, Zuckerberg San Francisco General, Hospital and Trauma Center, 1001 Potrero Avenue, Building 20, Suite 2100, San Francisco, CA, 94110, USA.
| | - J Konadu Fokuo
- Department of Psychiatry, University of California San Francisco, Zuckerberg San Francisco General, Hospital and Trauma Center, 1001 Potrero Avenue, Building 20, Suite 2100, San Francisco, CA, 94110, USA
| | - August Anderson
- Department of Medicine, University of California San Francisco, Zuckerberg San Francisco General, Hospital and Trauma Center, 1001 Potrero Avenue, NH-3D, San Francisco, CA, 94110, USA
| | - Jesse Powell
- Hennepin Healthcare, 715 South 8th Street, Minneapolis, MN, 55404, USA
| | - Barry Zevin
- Street Medicine and Shelter Health, at the San Francisco Department of Public Health, 50 Ivy St, San Francisco, CA, 94102, USA
| | - Dylan Bush
- Department of Medicine, University of California San Francisco, Zuckerberg San Francisco General, 1001 Potrero Avenue, NH-3D, San Francisco, CA, 94110, USA
| | - Mandana Khalili
- Department of Medicine, University of California San Francisco, Zuckerberg San Francisco General, Hospital and Trauma Center, 1001 Potrero Avenue, NH-3D, San Francisco, CA, 94110, USA
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31
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Tran JN, Wong RJ, Lee JS, Bancroft T, Buikema AR, Ting J, Terrault N. Hepatitis C Screening Rates and Care Cascade in a Large US Insured Population, 2010-2016: Gaps to Elimination. Popul Health Manag 2020; 24:198-206. [PMID: 32392454 DOI: 10.1089/pop.2019.0237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Understanding the health care system's ability to move patients through the hepatitis C virus (HCV) care cascade from screening to treatment is essential for HCV elimination. This retrospective study describes real-world HCV screening rates and care cascade steps to identify gaps in care for patients with HCV in the United States. Eligible patients were aged ≥18 years as of the measurement year (calendar year between January 1, 2010-December 31, 2016) and were commercial and Medicare Advantage with Part D members in the Optum Research database with continuous health plan enrollment 5 years prior to and during the measurement year. Incident and prevalent screening rates were calculated for each measurement year. Care cascade steps were analyzed via Kaplan-Meier analysis and logistic regression among patients with a positive HCV ribonucleic acid test. Cohorts were selected based on birth year (pre-1945 birth cohort, 1945-1965 birth cohort, post-1965 birth cohort). Among the 1945-1965 birth cohort, incident and prevalent screening rates increased from 1.6% to 4.7% and 10% to 18%, respectively, from 2010 to 2016. The proportion of patients attaining each independent cascade step within 1 year of screening increased significantly over time for genotype testing (P = 0.0283) and receipt of treatment (P < 0.0001). Median time from screening to treatment decreased from 1627 days (95% CI 1335-1871) in 2010 to 282 days (95% CI 223-498) in 2015. HCV screening and completion of the care cascade has improved for certain patient populations; however, gaps remain, highlighting the urgent need to address barriers to meeting HCV elimination goals.
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Affiliation(s)
- Josephine Nhu Tran
- Health Economics and Outcomes Research, Optum, Eden Prairie, Minnesota, USA
| | - Robert J Wong
- Gastroenterology/Hepatology, Alameda Health System-Highland Hospital, Oakland, California, USA
| | - Janet S Lee
- Health Economics and Outcomes Research, Gilead Sciences, Inc., Foster City, California, USA
| | - Tim Bancroft
- Health Economics and Outcomes Research, Optum, Eden Prairie, Minnesota, USA
| | - Ami R Buikema
- Health Economics and Outcomes Research, Optum, Eden Prairie, Minnesota, USA
| | - Jie Ting
- Health Economics and Outcomes Research, Gilead Sciences, Inc., Foster City, California, USA
| | - Norah Terrault
- Gastroenterology & Hepatology, University of Southern California, Los Angeles, California, USA
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Kapila N, Muir AJ. A Big Step Forward in Hepatitis C Screening. Clin Liver Dis (Hoboken) 2020; 15:149-152. [PMID: 32395241 PMCID: PMC7206325 DOI: 10.1002/cld.922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 01/12/2020] [Indexed: 02/04/2023] Open
Abstract
http://aasldpubs.onlinelibrary.wiley.com/hub/journal/10.1002/(ISSN)2046-2484/video/15-4-reading-kapila a video presentation of this article.
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Affiliation(s)
- Nikhil Kapila
- Division of GastroenterologyDepartment of MedicineDuke University School of MedicineDurhamNC
| | - Andrew J. Muir
- Division of GastroenterologyDepartment of MedicineDuke University School of MedicineDurhamNC,Duke Clinical Research InstituteDuke University School of MedicineDurhamNC
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Affiliation(s)
- Jennifer C Price
- Division of Gastroenterology, Department of Medicine, School of Medicine, University of California, San Francisco
| | - Danielle Brandman
- Division of Gastroenterology, Department of Medicine, School of Medicine, University of California, San Francisco
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Roingeard P, Beaumont E. Hepatitis C Vaccine: 10 Good Reasons for Continuing. Hepatology 2020; 71:1845-1850. [PMID: 32060946 DOI: 10.1002/hep.31182] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 02/11/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Philippe Roingeard
- Faculté de Médecine, INSERM U1259, Université de Tours and CHRU de Tours, Tours, France
| | - Elodie Beaumont
- Faculté de Médecine, INSERM U1259, Université de Tours and CHRU de Tours, Tours, France
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Fierer DS, Wyles DL. Re-treatment of Hepatitis C Infection After Multiple Failures of Direct-Acting Antiviral Therapy. Open Forum Infect Dis 2020; 7:ofaa095. [PMID: 32296728 PMCID: PMC7148001 DOI: 10.1093/ofid/ofaa095] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 03/12/2020] [Indexed: 12/23/2022] Open
Abstract
Background Direct-acting antiviral (DAA) therapies for hepatitis C virus (HCV) result in initial cure rates of 95% to 99% and re-treatment cure rates of 95%. Nevertheless, given the sheer magnitude of infected persons, some will ultimately fail multiple DAA therapies, and re-treatment of these persons has not been adequately studied. Methods We evaluated treated an HIV-infected man with cirrhosis from genotype 1b HCV who had failed 3 DAA regimens. Results We treated and cured our “particularly difficult-to-cure” patient with sofosbuvir plus glecaprevir/pibrentasvir plus ribavirin for 24 weeks. We discuss the literature on potential biological factors behind his treatment failures such as lack of HCV seroconversion during his infection course, and multiple failures of hepatitis B seroconversion after vaccination, and the rationale for choosing his curative salvage regimen. Discussion There are no clinical trials-proven re-treatment regimens for “particularly difficult-to-cure” patients. Multiple patient- and virus-related factors that do not affect cure rates in treatment-naive patients may need to be considered in choosing a re-treatment regimen for these patients. These regimens may need to include combinations drugs that are not available in single-tablet form, addition of ribavirin, and longer durations of treatment than standard.
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Affiliation(s)
- Daniel S Fierer
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - David L Wyles
- Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, Colorado, USA
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Cousineau SE, Erman A, Liu L, Saeed S, Fradette L, Feld JJ, Grebely J, MacParland SA, Shoukry NH, Sebastiani G, Sagan SM. The 8 th Canadian Symposium on Hepatitis C virus: “Improving diagnosis and linkage to care”. CANADIAN LIVER JOURNAL 2020; 3:3-14. [DOI: 10.3138/canlivj.2019-0032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 12/22/2019] [Indexed: 11/20/2022]
Abstract
Hepatitis C virus (HCV) affects approximately 250,000 Canadians. Although safe and effective (>95% cure rates) antiviral therapies have become available within the past 5 years, chronic HCV infection still remains a major driver of end-stage liver disease and liver transplantation. Both the Canadian Institute for Health Research and the Public Health Agency of Canada recognize the impact of HCV-related liver diseases and support the Canadian Network for Hepatitis C (CanHepC), a National network for the scientific study of hepatitis C that organizes an annual symposium as part of its knowledge translation mandate. At the 8th Canadian Symposium on Hepatitis C Virus in May 2019, basic scientists, clinicians, epidemiologists, social scientists, and community members came together to share their work under the theme of “Improving diagnosis and linkage to care”. This symposium also marked the launch of the Blueprint to inform hepatitis C elimination efforts in Canada, a policy framework that outlines specific targets, suggested activities, and evidence-based best practices to guide provincial, territorial and federal organizations developing their own HCV elimination strategies.
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Affiliation(s)
- Sophie E Cousineau
- Department of Microbiology and Immunology, McGill University, Montreal, Quebec
| | - Aysegul Erman
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
- Toronto Health Economics and Technology Assessment Collaborative (THETA), Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario
| | - Lewis Liu
- Department of Immunology, University of Toronto, Toronto, Ontario
| | - Sahar Saeed
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec
| | - Lorraine Fradette
- Centre de Recherche du Centre Hospitalier Universitaire de Montréal (CHUM), Montreal, Quebec
| | - Jordan J Feld
- Toronto Centre for Liver Disease, Toronto General Hospital, Toronto, Ontario
| | - Jason Grebely
- Kirby Institute, UNSW Sydney, New South Wales, Australia
| | | | - Naglaa H Shoukry
- Centre de Recherche du Centre Hospitalier Universitaire de Montréal (CHUM), Montreal, Quebec
| | - Giada Sebastiani
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec
- co-corresponding authors
| | - Selena M Sagan
- Department of Microbiology and Immunology, McGill University, Montreal, Quebec
- Department of Biochemistry, McGill University, Montreal, Quebec
- co-corresponding authors
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