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Hershow RB, Love Pieczykolan L, Worthington N, Adams M, McDonald R, Wilson S, McBee S, Balleydier S, Curran KG. Were Needles Everywhere?: Differing Views on Syringe Waste and Disposal Associated With Needs-Based Syringe Services Programs Among Community Partners and Persons Who Inject Drugs. Subst Use Misuse 2024; 59:1174-1181. [PMID: 38509704 PMCID: PMC11103866 DOI: 10.1080/10826084.2024.2330895] [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: 03/22/2024]
Abstract
BACKGROUND Community concerns surrounding syringe waste are a common barrier to syringe services program (SSP) implementation. In Kanawha County, West Virginia, community opposition to SSPs resulted in the closure of needs-based SSPs prior to and during an HIV outbreak among persons who inject drugs (PWID). This qualitative analysis examines views of PWID and community partners on syringe waste and disposal associated with needs-based SSPs. METHODS Qualitative interviews with 26 PWID and 45 community partners (medical and social service providers, law enforcement personnel, policymakers, and religious leaders) were conducted. Interviews were recorded, transcribed, and coded. Code summaries described participants' views on syringe waste and disposal and needs-based SSPs. RESULTS Community partners and PWID who favored needs-based SSPs reported that needs-based SSPs had not affected or reduced syringe waste. Conversely, community partners who favored one-to-one exchange models and/or barcoded syringes described needs-based SSPs increasing syringe waste. Community partners often cited pervasive community beliefs that SSPs increased syringe waste, risk of needlesticks, drug use, and crime. Community partners were unsure how to address syringe waste concerns and emphasized that contradictory views on syringe waste posed barriers to discussing and implementing SSPs. CONCLUSIONS Participants' views on whether syringe waste was associated with needs-based SSPs often aligned with their support or opposition for needs-based SSPs. These differing views resulted in challenges finding common ground to discuss SSP operations amid an HIV outbreak among PWID. SSPs might consider addressing syringe waste concerns by expanding syringe disposal efforts and implementing community engagement and stigma reduction activities.
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Affiliation(s)
- Rebecca B. Hershow
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lauren Love Pieczykolan
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nancy Worthington
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Monica Adams
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Robert McDonald
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Suzanne Wilson
- West Virginia Bureau for Public Health, West Virginia Department of Health and Human Resources, Charleston, West Virginia, USA
| | - Shannon McBee
- West Virginia Bureau for Public Health, West Virginia Department of Health and Human Resources, Charleston, West Virginia, USA
| | - Shawn Balleydier
- West Virginia Bureau for Public Health, West Virginia Department of Health and Human Resources, Charleston, West Virginia, USA
| | - Kathryn G. Curran
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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2
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Loy DE, Kamis K, Kanatser R, Rowan SE. Barriers to Hepatitis C Treatment and Interest in Telemedicine-Based Care Among Clients of a Syringe Access Program. Open Forum Infect Dis 2024; 11:ofae088. [PMID: 38464492 PMCID: PMC10921388 DOI: 10.1093/ofid/ofae088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/07/2024] [Indexed: 03/12/2024] Open
Abstract
Background Sharing equipment for injection drug use is the most common mode of hepatitis C virus (HCV) transmission in the United States, yet people who inject drugs (PWID) historically have low rates of HCV treatment. New strategies are needed to expand access to HCV treatment among PWID. Co-locating HCV treatment at syringe access programs (SAPs) reduces barriers to treatment, and telemedicine-based treatment programs could expand access further. Methods To evaluate interest in a co-localized or telemedicine-based program at an SAP in Denver, Colorado, we surveyed 171 SAP clients to understand barriers to HCV treatment and comfort with various appointment modalities. Results Eighty-nine of the surveyed SAP clients (52%), 50 of whom had not completed treatment, reported current or prior HCV infection. The most commonly cited reasons for not seeking HCV treatment were ongoing drug use, logistic barriers, and medical system barriers. Eighty-eight percent of clients with HCV reported that they would be more likely to get treatment if they were able to do so at the SAP, and the rate was higher among people who reported reluctance to seek medical care in general (98% vs 77%, P = .011). In-person appointments were preferred, though 77% of respondents were comfortable with a video appointment. However, only 60% of SAP clients reported having access to a phone, and fewer (48%) had access to video capability. Conclusions These findings suggest that telemedicine-based treatment at an SAP could improve access to HCV treatment, but successful implementation would require attention to barriers impacting clients' ability to participate in telemedicine appointments.
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Affiliation(s)
- Dorothy E Loy
- Division of Hospital Medicine, Department of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Kevin Kamis
- Public Health Institute at Denver Health, Division of HIV/STI/Viral Hepatitis, Denver, Colorado, USA
| | | | - Sarah E Rowan
- Public Health Institute at Denver Health, Division of HIV/STI/Viral Hepatitis, Denver, Colorado, USA
- Division of Infectious Diseases, Department of Medicine, University of Colorado, Aurora, Colorado, USA
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Hershow RB, Worthington N, Adams M, McDonald R, Wilson S, McBee S, Balleydier S, Curran KG. A Qualitative Analysis of Barriers to Accessing HIV Prevention Services During an HIV Outbreak among Persons who Inject Drugs in West Virginia. AIDS Behav 2024; 28:669-681. [PMID: 38165598 PMCID: PMC10922593 DOI: 10.1007/s10461-023-04254-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2023] [Indexed: 01/04/2024]
Abstract
In response to an increase in HIV diagnoses among persons who inject drugs (PWID) in Kanawha County, West Virginia, West Virginia Bureau for Public Health and CDC conducted a qualitative assessment in Kanawha County to inform HIV outbreak response activities. Interviews with 26 PWID and 45 community partners were completed. Transcribed interviews were analyzed to identify barriers to accessing HIV prevention services among PWID using the risk environment framework. Participants identified numerous political, physical, social, and economic community-level barriers that influenced access to HIV prevention services among PWID. Political factors included low community support for syringe services programs (SSPs); physical factors included low SSP coverage, low coverage of HIV testing outreach events, low HIV preexposure prophylaxis availability, and homelessness; social factors included stigma and discrimination; economic factors included community beliefs that SSPs negatively affect economic investments and limited resources for HIV screening in clinical settings. Individual-level barriers included co-occurring acute medical conditions and mental illness. Community-level interventions, such as low-barrier one-stop shop models, are needed to increase access to sterile syringes through comprehensive harm reduction services.
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Affiliation(s)
- Rebecca B Hershow
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Nancy Worthington
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Monica Adams
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Robert McDonald
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Suzanne Wilson
- West Virginia Department of Health and Human Resources, West Virginia Bureau for Public Health, Charleston, WV, USA
| | - Shannon McBee
- West Virginia Department of Health and Human Resources, West Virginia Bureau for Public Health, Charleston, WV, USA
| | - Shawn Balleydier
- West Virginia Department of Health and Human Resources, West Virginia Bureau for Public Health, Charleston, WV, USA
| | - Kathryn G Curran
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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4
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Faghihi SH, Azarbakhsh H, Piraee E. Epidemiological study of hepatitis B and hepatitis C infection in Kohgiluyeh and Boyer-Ahmad province (Iran) from 2008 to 2021: A cross-sectional study. Health Sci Rep 2024; 7:e1812. [PMID: 38328787 PMCID: PMC10848580 DOI: 10.1002/hsr2.1812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 12/19/2023] [Accepted: 12/24/2023] [Indexed: 02/09/2024] Open
Abstract
Background and Aims Viral hepatitis is one of the top five reasons people die from infections all around the world. The present study aimed to assess the epidemiological features of hepatitis B and hepatitis C infections in Kohgiluyeh and Boyer-Ahmad province. Methods The data were obtained via the census method from the registered hepatitis B and hepatitis C data in the reportable disease care system of Yasuj University of Medical Sciences. The collected data are the result of serological tests. The χ 2 test was used to evaluate the important risk factors for hepatitis B virus (HBV) and hepatitis C virus (HCV) infection. The joinpoint regression was performed to investigate the trend of HBV and HCV in recent years. Results Here, 1270 cases of hepatitis B and C were identified and reported in Kohgiluyeh and Boyer-Ahmad province from 2008 to 2021. The median age of patients was 38 (interquartile range: 31-51), varying significantly according to the type of hepatitis. The most common hepatitis in males was hepatitis C and in females, hepatitis B. Regarding the place of residence, HBV and HCV were both more prevalent in urban areas. The age group of 25-34 years has the highest prevalence of HBV and HCV. According to the joinpoint regression analysis, there is a decrease in the 14-year trend of incidence rate due to total hepatitis B and C: the annual percent change was -5.2% (95% confidence interval [CI]: -8.4 to -1.9, p = 0.005) for hepatitis B and -0.2% (95% CI: -10.7 to 11.6, p = 0.976) for hepatitis C. Conclusion This study shows the incidence rate of hepatitis B has been decreasing during the years of study but this trend has been stable for hepatitis C. Also, the highest number of cases of hepatitis B and C were reported in the age groups of 25-34 years. Hence, preventive interventions are vital in reducing the burden of these diseases.
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Affiliation(s)
- Sayed H. Faghihi
- Department of Epidemiology, Faculty of Health, Social Determinants of Health Research CenterYasuj University of Medical SciencesYasujIran
| | - Habibollah Azarbakhsh
- Department of Epidemiology, Faculty of HealthAhvaz Jundishapur University of Medical SciencesAhvazIran
| | - Elahe Piraee
- Department of Epidemiology, Faculty of Health, Social Determinants of Health Research CenterYasuj University of Medical SciencesYasujIran
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5
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Kim RG, Price JC. A framework for approaching hepatitis C reinfection in people who use drugs. Clin Liver Dis (Hoboken) 2024; 23:e0200. [PMID: 38872769 PMCID: PMC11168836 DOI: 10.1097/cld.0000000000000200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 03/29/2024] [Indexed: 06/15/2024] Open
Affiliation(s)
- Rebecca G. Kim
- Department of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Jennifer C. Price
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
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Munari SC, Traeger MW, Menon V, Latham NH, Manoharan L, Luhmann N, Baggaley R, MacDonald V, Verster A, Siegfried N, Conway B, Klein M, Bruneau J, Stoové MA, Hellard ME, Doyle JS. Determining reinfection rates by hepatitis C testing interval among key populations: A systematic review and meta-analysis. Liver Int 2023; 43:2625-2644. [PMID: 37817387 DOI: 10.1111/liv.15705] [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] [Received: 11/15/2022] [Revised: 08/04/2023] [Accepted: 08/08/2023] [Indexed: 10/12/2023]
Abstract
BACKGROUND & AIMS Detecting hepatitis C virus (HCV) reinfection among key populations helps prevent ongoing transmission. This systematic review aims to determine the association between different testing intervals during post-SVR follow-up on the detection of HCV reinfection among highest risk populations. METHODS We searched electronic databases between January 2014 and February 2023 for studies that tested individuals at risk for HCV reinfection at discrete testing intervals and reported HCV reinfection incidence among key populations. Pooled estimates of reinfection incidence were calculated by population and testing frequency using random-effects meta-analysis. RESULTS Forty-one single-armed observational studies (9453 individuals) were included. Thirty-eight studies (8931 individuals) reported HCV reinfection incidence rate and were included in meta-analyses. The overall pooled estimate of HCV reinfection incidence rate was 4.13 per 100 per person-years (py) (95% confidence interval [CI]: 3.45-4.81). The pooled incidence estimate among people who inject drugs (PWID) was 2.84 per 100 py (95% CI: 2.19-3.50), among men who have sex with men (MSM) 7.37 per 100 py (95% CI: 5.09-9.65) and among people in custodial settings 7.23 per 100 py (95% CI: 2.13-16.59). The pooled incidence estimate for studies reporting a testing interval of ≤6 months (4.26 per 100 py; 95% CI: 2.86-5.65) was higher than studies reporting testing intervals >6 months (5.19 per 100 py; 95% CI: 3.92-6.46). CONCLUSIONS HCV reinfection incidence was highest in studies of MSM and did not appear to change with retesting interval. Shorter testing intervals are likely to identify more reinfections, help prevent onward transmission where treatment is available and enable progress towards global HCV elimination, but additional comparative studies are required.
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Affiliation(s)
| | - Michael W Traeger
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Vinay Menon
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
| | - Ned H Latham
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
| | | | - Niklas Luhmann
- World Health Organization, Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, Geneva, Switzerland
| | - Rachel Baggaley
- World Health Organization, Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, Geneva, Switzerland
| | - Virginia MacDonald
- World Health Organization, Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, Geneva, Switzerland
| | - Annette Verster
- World Health Organization, Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, Geneva, Switzerland
| | - Nandi Siegfried
- Independent Clinical Epidemiologist, Cape Town, South Africa
| | - Brian Conway
- Vancouver Infectious Diseases Centre & Simon Fraser University Vancouver, Canada
| | - Marina Klein
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Julie Bruneau
- Department of Family and Emergency Medicine, Université de Montréal, Montreal, Canada
| | - Mark A Stoové
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
| | - Margaret E Hellard
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Infectious Diseases, The Alfred Hospital and Monash University, Melbourne, Australia
| | - Joseph S Doyle
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
- Department of Infectious Diseases, The Alfred Hospital and Monash University, Melbourne, Australia
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7
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Bartholomew TS, Tookes HE, Chueng TA, Bluthenthal RN, Wenger LD, Kral AH, Lambdin BH. Availability of telehealth-based services at syringe services programs under the COVID-19 Public Health Emergency. Harm Reduct J 2023; 20:122. [PMID: 37660029 PMCID: PMC10475193 DOI: 10.1186/s12954-023-00861-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/27/2023] [Indexed: 09/04/2023] Open
Abstract
INTRODUCTION The expanded capacity of syringe services programs (SSPs) in the USA to integrate telehealth services was largely related to flexibility of buprenorphine prescription in response to the COVID-19 pandemic. SSPs demonstrated the potential of using telehealth to reach participants with both medical and non-medical services. The present study examines the implementation of medical and non-medical telehealth-based health services in 2020 at SSPs in the USA and organizational characteristics associated with adopting specific telehealth services. METHODS We administered a cross-sectional survey among all known SSPs operating in the USA as of 2021. The two primary study outcomes were (1) implementation of medical telehealth and (2) implementation of non-medical telehealth in 2020. Medical services included HIV counseling/care, hepatitis C virus (HCV) counseling/care, and buprenorphine. Non-medical services included wellbeing/check-ins, overdose prevention training, health navigation, harm reduction and psychological counseling. Bivariate and multivariable mixed effects logistic regression models were used to directly estimate the odds ratio associated with organizational characteristics on the implementation of telehealth-based health services. RESULTS Thirty percent of programs (n = 290) reported implementing telehealth-based health services. In multivariable logistic regression models, community-based organization SSPs had higher odds of implementing medical (aOR = 4.69, 95% CI [1.96, 11.19]) and non-medical (aOR = 2.18, 95% CI [1.10, 4.31]) health services compared to public health department SSPs. SSPs that received governmental funding had higher odds of implementing medical services via telehealth (aOR = 2.45, 95% CI [1.35, 4.47]) compared to programs without governmental funding. CONCLUSION Community-based organization SSPs and those with government funding had the highest odds of telehealth implementation in response to the COVID-19 Public Health Emergency. Federal, state, and local governments must increase funding for low-barrier venues like SSPs to support telehealth implementation to serve the needs of people who use drugs.
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Affiliation(s)
| | - Hansel E Tookes
- University of Miami, 1120 NW 14th St #860, Miami, FL, 33136, USA.
| | - Teresa A Chueng
- University of Miami, 1120 NW 14th St #860, Miami, FL, 33136, USA
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8
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Hibbert M, Simmons R, Harris H, Desai M, Sabin CA, Mandal S. Investigating rates and risk factors for hepatitis C virus reinfection in people receiving antiviral treatment in England. J Viral Hepat 2023; 30:646-655. [PMID: 36929670 DOI: 10.1111/jvh.13835] [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] [Received: 09/23/2022] [Revised: 02/06/2023] [Accepted: 03/11/2023] [Indexed: 03/18/2023]
Abstract
England has committed to the World Health Organization target to eliminate hepatitis C virus (HCV) as a public threat by the year 2030. Given successful treatments for HCV in recent years, it is unclear whether HCV reinfection will impact England's ability to achieve HCV elimination. We aimed to estimate the HCV reinfection rate among a cohort of patients receiving antiviral treatment using available surveillance data. Linkage between a treatment dataset from 2015 to 2019 and an HCV RNA testing dataset were used to identify people who experienced reinfection using three criteria. A Cox proportional hazards model was used to determine risk factors associated with HCV reinfection among a cohort who received treatment and had follow-up HCV RNA testing. The reinfection rate among those receiving HCV treatment was 7.91 per 100 person-years (PYs, 95% confidence interval (CI) 7.37-8.49) and highest among current injecting drug users (22.55 per 100 PYs, 95% CI 19.98-25.46) and people who had been in prison (20.42 per 100 PYs, 95% CI 17.21-24.24). In the adjusted model, women had a significantly reduced risk of reinfection. Being of younger age, current injecting drug users, and receipt of first treatment in prison were each significantly associated with increased risk of reinfection. Two-fifths of those with reinfection (43%, n = 329/767) were linked to treatment after reinfection, and of those starting treatment, three quarters (75%, n = 222/296) achieved a sustained virologic response. Guidance for testing groups at risk of reinfection and harm reduction strategies to minimize transmission should be implemented if England is to achieve HCV elimination targets.
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Affiliation(s)
- Matthew Hibbert
- Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Division, UK Health Security Agency (UKHSA), London, UK
- National Institute for Health and Care Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London in partnership with UKHSA, London, UK
| | - Ruth Simmons
- Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Division, UK Health Security Agency (UKHSA), London, UK
- National Institute for Health and Care Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London in partnership with UKHSA, London, UK
| | - Helen Harris
- Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Division, UK Health Security Agency (UKHSA), London, UK
| | - Monica Desai
- Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Division, UK Health Security Agency (UKHSA), London, UK
- National Institute for Health and Care Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London in partnership with UKHSA, London, UK
| | - Caroline A Sabin
- National Institute for Health and Care Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London in partnership with UKHSA, London, UK
- Institute for Global Health, University College London, London, UK
| | - Sema Mandal
- Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Division, UK Health Security Agency (UKHSA), London, UK
- National Institute for Health and Care Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London in partnership with UKHSA, London, UK
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9
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Kapadia SN, Aponte-Melendez Y, Rodriguez A, Pai M, Eckhardt BJ, Marks KM, Fong C, Mateu-Gelabert P. "Treated like a Human Being": perspectives of people who inject drugs attending low-threshold HCV treatment at a syringe service program in New York City. Harm Reduct J 2023; 20:95. [PMID: 37501180 PMCID: PMC10375754 DOI: 10.1186/s12954-023-00831-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/16/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) treatment can effectively cure HCV among people who inject drugs (PWID). Perspectives of PWID treated in innovative models can reveal program features that address barriers to treatment, and guide implementation of similar models. METHODS We interviewed 29 participants in the intervention arm of a randomized trial. The trial enrolled PWID with HCV in New York City from 2017 to 2020 and tested the effectiveness of a low-threshold HCV treatment model at a syringe services program. Participants were purposively sampled and interviewed in English or Spanish. The interview guide focused on prior experiences with HCV testing and treatment, and experiences during the trial. Interviews were inductively coded and analyzed using thematic analysis. RESULTS Before enrollment, participants reported being tested for HCV in settings such as prison, drug treatment, and emergency rooms. Treatment was delayed because of not being seen as urgent by providers. Participants reported low self-efficacy, competing priorities, and systemic barriers to treatment such as insurance, waiting lists, and criminal-legal interactions. Stigma was a major factor. Treatment during the trial was facilitated through respect from staff, which overcame stigma. The flexible care model (allowing walk-ins and missed appointments) helped mitigate logistical barriers. The willingness of the staff to address social determinants of health was highly valued. CONCLUSION Our findings highlight the need for low-threshold programs with nonjudgmental behavior from program staff, and flexibility to adapt to participants' needs. Social determinants of health remain a significant barrier, but programs' efforts to address these factors can engender trust and facilitate treatment. Trial registration NCT03214679.
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Affiliation(s)
- Shashi N Kapadia
- Division of Infectious Diseases, Weill Cornell Medicine, 1300 York Avenue Ste A-421, New York, NY, 10065, USA.
| | - Yesenia Aponte-Melendez
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, 55 W 125th Street, New York, NY, 10027, USA
- New York University Rory Meyers College of Nursing, 433 First Avenue, New York, NY, 10010, USA
| | - Alicia Rodriguez
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, 55 W 125th Street, New York, NY, 10027, USA
| | - Melinda Pai
- Division of Infectious Diseases, Weill Cornell Medicine, 1300 York Avenue Ste A-421, New York, NY, 10065, USA
| | - Benjamin J Eckhardt
- Division of Infectious Diseases, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Kristen M Marks
- Division of Infectious Diseases, Weill Cornell Medicine, 1300 York Avenue Ste A-421, New York, NY, 10065, USA
| | - Chunki Fong
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, 55 W 125th Street, New York, NY, 10027, USA
| | - Pedro Mateu-Gelabert
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, 55 W 125th Street, New York, NY, 10027, USA
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10
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Kågström E, Lannergård A, El Khosht J, Lörelius P, Månflod J, Strömdahl S. Prevalence, risk factors, treatment uptake and treatment outcome of hepatitis C virus in people who inject drugs at the needle and syringe program in Uppsala, Sweden. Harm Reduct J 2023; 20:77. [PMID: 37328868 PMCID: PMC10273738 DOI: 10.1186/s12954-023-00806-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 06/06/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND The World Health Organization has set a goal to reach world elimination of hepatitis C virus (HCV) by 2030. Needle and syringe programs (NSP) for people who inject drugs (PWID) are crucial to achieve this goal. The NSP in Uppsala, Sweden, was opened in 2016 and has since 2018 provided HCV treatment for PWID. The aim of this study was to investigate HCV prevalence, risk factors and treatment uptake and outcome in NSP participants. METHODS Data from 450 PWID registered at the Uppsala NSP between 2016-11-01 and 2021-12-31 were collected from the national quality registry InfCare NSP. Data from the 101 PWID treated for HCV at the Uppsala NSP were collected through patient journal review. Descriptive and inferential analysis was performed. Ethical approval was obtained from the Ethical Review Board in Uppsala (dnr 2019/00215). RESULTS The mean age was 35 years. 75% were males (336/450), and 25% were females (114/450). The overall HCV prevalence was 48% (215/450) with a declining trend over time. Factors associated with a higher risk of HCV were older age at registration (OR 1.025, 95% CI 1.004-1.046), lower age at injection drug debut (OR 0.963, 95% CI 0.932-0.996), lower education level (OR 1.829, 95% CI 1.185-2.821) and higher number of total visits at the NSP (OR 1.005, 95% CI 1.001-1.009). The overall HCV treatment uptake was 47% (101/215), of which 77% (78/101) completed HCV treatment. The HCV treatment compliance was 88% (78/89). 99% (77/78) were cured with a sustained virologic response 12 weeks after completed treatment. The reinfection rate over the study period was 9/77 (11.7%); all were male with mean age of 36. CONCLUSIONS HCV prevalence, treatment uptake and treatment outcome have improved since the opening of the Uppsala NSP. However, further measures are needed to reach the HCV elimination goal. Outreach HCV treatment programs for PWID should be explored and evaluated in combination with further implementation of low-threshold programs.
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Affiliation(s)
- E Kågström
- Department of Medical Sciences, Infectious Diseases, Uppsala University, Uppsala, Sweden.
| | - A Lannergård
- Department of Medical Sciences, Infectious Diseases, Uppsala University, Uppsala, Sweden
| | - J El Khosht
- Needle and Syringe Program Uppsala, Nära Vård och Hälsa, Region Uppsala, Uppsala, Sweden
| | - P Lörelius
- Needle and Syringe Program Uppsala, Nära Vård och Hälsa, Region Uppsala, Uppsala, Sweden
| | - J Månflod
- Needle and Syringe Program Uppsala, Nära Vård och Hälsa, Region Uppsala, Uppsala, Sweden
| | - S Strömdahl
- Department of Medical Sciences, Infectious Diseases, Uppsala University, Uppsala, Sweden
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11
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Young J, Wang S, Lanièce Delaunay C, Cooper CL, Cox J, Gill MJ, Hull M, Walmsley S, Wong A, Klein MB. The rate of hepatitis C reinfection in Canadians coinfected with HIV and its implications for national elimination. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 114:103981. [PMID: 36893502 DOI: 10.1016/j.drugpo.2023.103981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 02/14/2023] [Accepted: 02/16/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND The World Health Organisation (WHO) has set targets for the rate of new infections as a way to measure progress towards the elimination of hepatitis C virus (HCV) as a public health threat. As more people are successfully treated for HCV, a higher proportion of new infections will be reinfections. We consider whether the reinfection rate has changed since the interferon era and what we can infer about national elimination efforts from the current reinfection rate. METHODS The Canadian Coinfection Cohort is representative of HIV HCV coinfected people in clinical care. We selected cohort participants successfully treated for a primary HCV infection either in the interferon era or in the era of direct acting antivirals (DAAs). Selected participants were followed from 12 weeks after completing a successful treatment until the end of 2019 or until their last measured HCV RNA. We estimated the reinfection rate in each treatment era, overall and in participant subgroups, using proportional hazard models appropriate for interval censored data. RESULTS Among 814 successfully treated participants with additional HCV RNA measurements, there were 62 reinfections. The overall reinfection rate was 2.6 (95% confidence interval, CI, 1.2-4.1) /100 person years (PY) in the interferon era and 3.4 (95% CI 2.5-4.4) /100 PY in the DAA era. The rate in those reporting injection drug use (IDU) was much higher: 4.7 (95% CI 1.4-7.9) /100 PY and 7.6 (95% CI 5.3-10) /100 PY in the interferon and DAA eras respectively. CONCLUSION The overall reinfection rate in our cohort is now above the WHO target set for new infections in people who inject drugs. The reinfection rate in those reporting IDU has increased since the interferon era. This suggests Canada is not on track to achieve HCV elimination by 2030.
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Affiliation(s)
- Jim Young
- Research Institute of the McGill University Health Centre, 5252 Boulevard de Maisonneuve Ouest, Montreal, Quebec H4A3S5, Canada; Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, 2001 McGill College Suite 1200, Montreal, Quebec H3A1G1, Canada.
| | - Shouao Wang
- Research Institute of the McGill University Health Centre, 5252 Boulevard de Maisonneuve Ouest, Montreal, Quebec H4A3S5, Canada
| | - Charlotte Lanièce Delaunay
- Research Institute of the McGill University Health Centre, 5252 Boulevard de Maisonneuve Ouest, Montreal, Quebec H4A3S5, Canada; Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, 2001 McGill College Suite 1200, Montreal, Quebec H3A1G1, Canada
| | - Curtis L Cooper
- Division of Infectious Diseases, Department of Medicine, Ottawa Hospital Research Institute, 725 Parkdale Avenue, Ottawa K1Y4E9, Canada
| | - Joseph Cox
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, 2001 McGill College Suite 1200, Montreal, Quebec H3A1G1, Canada; Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine, McGill University Health Centre, 1001 Boulevard Décarie, Montreal, Quebec H4A3J1, Canada
| | - M John Gill
- Department of Medicine, University of Calgary, 2500 University Drive, Calgary, Alberta T2N1N4, Canada
| | - Mark Hull
- BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, British Colombia V6Z1Y6, Canada
| | - Sharon Walmsley
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, University of Toronto, 6 Queen's Park Crescent West, Toronto. Ontario M5S3H2, Canada
| | - Alexander Wong
- Division of Infectious Diseases, Department of Medicine, University of Saskatchewan, 107 Wiggins Road, Saskatoon, Saskatchewan S7N5E5, Canada
| | - Marina B Klein
- Research Institute of the McGill University Health Centre, 5252 Boulevard de Maisonneuve Ouest, Montreal, Quebec H4A3S5, Canada; Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, 2001 McGill College Suite 1200, Montreal, Quebec H3A1G1, Canada; Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine, McGill University Health Centre, 1001 Boulevard Décarie, Montreal, Quebec H4A3J1, Canada; CIHR Canadian HIV Trials Network, 608-1081 Burrard Street, Vancouver, British Columbia V6Z1Y6, Canada
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12
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Donaldson SR, Radley A, Dillon JF. Transformation of identity in substance use as a pathway to recovery and the potential of treatment for hepatitis C: a systematic review. Addiction 2023; 118:425-437. [PMID: 35993427 PMCID: PMC10087584 DOI: 10.1111/add.16031] [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: 02/22/2022] [Accepted: 08/10/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIM People who inject drugs are at high risk of contracting hepatitis C (HCV). The introduction of direct acting antiviral (DAA) drugs to treat HCV has the potential to transform care; however, uptake of DAAs has been slower than anticipated. The strong link between HCV and injecting drug use frames HCV as a shameful, stigmatising disease, reinforcing an 'addict' identity. Linking HCV care to a recovery journey, 'clean' identity and social redemption may provide compelling encouragement for people to engage with treatment and re-evaluate risk and behaviours, reducing the incidence of HCV re-infection. The aim of this review was to identify actions, interventions and treatments that provide an opportunity for a change in identity and support a recovery journey and the implications for HCV care. METHODS Databases (MEDLINE, EMBASE, PsycINFO, ProQuest Public Health, ProQuest Sociological Abstracts, CINAHL and Web of Science) were searched following our published strategy and a grey literature search conducted. A narrative synthesis was undertaken to collate themes and identify common threads and provide an explanation of the findings. RESULTS Thirty-two studies fulfilled the inclusion criteria. The narrative synthesis of the studies identified five over-arching analytical themes: social factors in substance use and recovery, therapeutic communities, community treatment, online communities, and finally women and youth subsets. The change from an 'addict' identity to a 'recovery' identity is described as a key aspect of a recovery journey, and this process can be supported through social support and turning point opportunities. CONCLUSIONS Recovery from addiction is a socially mediated process. Actions, interventions and treatments that support a recovery journey provide social connections, a recovery identity and citizenship (reclaiming a place in society). There is a gap in current literature describing how pathways of care with direct acting antivirals can be designed to promote recovery, as part of hepatitis C care.
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Affiliation(s)
- Sarah R Donaldson
- School of Medicine, University of Dundee, Dundee, UK.,Directorate of Public Health, NHS Tayside, Dundee, UK
| | - Andrew Radley
- School of Medicine, University of Dundee, Dundee, UK.,Directorate of Public Health, NHS Tayside, Dundee, UK
| | - John F Dillon
- School of Medicine, University of Dundee, Dundee, UK.,Department of Gastroenterology, Ninewells Hospital and Medical School, Dundee, UK
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13
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Akiyama MJ, Riback LR, Nyakowa M, Musyoki H, Lizcano JA, Muller A, Zhang C, Walker JG, Stone J, Vickerman P, Cherutich P, Kurth AE. Predictors of hepatitis C cure among people who inject drugs treated with directly observed therapy supported by peer case managers in Kenya. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 113:103959. [PMID: 36758335 PMCID: PMC10034760 DOI: 10.1016/j.drugpo.2023.103959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 01/12/2023] [Accepted: 01/19/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND & AIMS Directly observed therapy (DOT) maximizes adherence and minimizes treatment gaps. Peer case managers (PCM) have also shown promise as a component of integrated HCV treatment strategies. DOT and PCM-support have been underexplored, particularly in low- and middle-income countries (LMICs). The objective of this study was to evaluate predictors of sustained virologic response (SVR) among people who inject drugs (PWID) attending medication-assisted treatment (MAT) and needle and syringe programs (NSP) sites in Kenya. METHODS We recruited PWID accessing MAT and NSP in Nairobi and Coastal Kenya. PWID were treated with ledipasvir/sofosbuvir using DOT supported by PCMs. We used bivariate and multivariate logistic regression to examine the impact of sociodemographic, behavioral, and clinical factors on SVR. RESULTS Among 92 PWID who initiated HCV treatment, 79 (86%) were male with mean age of 36.3 years (SD=±6.5); 38 (41%) were HIV-positive, and 87 (95%) reported injecting drugs in the last 30 days. Just over half of participants were genotype 1a (55%), followed by genotype 4a (41%) and mixed 1a/4a (3%). Most participants, 85 (92%) completed treatment and 79 (86%) achieved SVR. While sociodemographic and behavioral factors including recent injection drug use were not significantly associated with achieving SVR, being fully adherent (p=0.042), number of doses taken (p=0.008) and treatment completion (p= 0.001) were associated with higher odds of achieving SVR. CONCLUSIONS DOT with PCM-support was an effective model for HCV treatment among PWID in this LMIC setting. Adherence was the most important driver of SVR suggesting DOT and PCM support can overcome other factors that might limit adherence. Further research is necessary to ascertain the effectiveness of other models of HCV care for PWID in LMICs given NSP and MAT access is variable, and DOT may not be sustainable with limited resources.
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Affiliation(s)
- Matthew J Akiyama
- Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, United States.
| | - Lindsey R Riback
- Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, United States
| | - Mercy Nyakowa
- Kenya Ministry of Health, National AIDS&STI Control Program (NASCOP), Nairobi, Kenya
| | - Helgar Musyoki
- Kenya Ministry of Health, National AIDS&STI Control Program (NASCOP), Nairobi, Kenya
| | - John A Lizcano
- Yale University School of Nursing, Orange, CT, United States
| | - Abbe Muller
- Yale University School of Nursing, Orange, CT, United States
| | - Chenshu Zhang
- Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, United States
| | | | - Jack Stone
- University of Bristol, Bristol, United Kingdom
| | | | - Peter Cherutich
- Kenya Ministry of Health, National AIDS&STI Control Program (NASCOP), Nairobi, Kenya
| | - Ann E Kurth
- Yale University School of Nursing, Orange, CT, United States
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14
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Robinson E, Byrne CJ, Carberry J, Radley A, Beer LJ, Inglis SK, Tait J, Macpherson I, Goldberg D, Hutchinson SJ, Hickman M, Dillon JF. Laying the foundations for hepatitis C elimination: evaluating the development and contribution of community care pathways to diagnostic efforts. BMC Public Health 2023; 23:54. [PMID: 36611156 PMCID: PMC9826577 DOI: 10.1186/s12889-022-14911-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/20/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Hepatitis C Virus (HCV) is a public health threat which contributes substantially to the global burden of liver disease. There is much debate about effective approaches to scaling up diagnosis of HCV among risk groups. Tayside, a region in the East of Scotland, developed low-threshold community pathways for HCV to lay the foundations of an elimination strategy. In this retrospective study, we sought to: quantify the contribution of community pathways to increasing HCV diagnosis; understand if shifting diagnosis to community settings led to a higher proportion of individuals tested for HCV being actively infected; and describe functional characteristics of the care pathways. METHODS Descriptive statistics were used to for analysis of routinely-collected HCV testing data from 1999 to 2017, and a review of the development of the care pathways was undertaken. Community-based testing was offered through general practices (GP); nurse outreach clinics; prisons; drug treatment services; needle and syringe provision (NSP) sites; community pharmacies; and mosques. RESULTS Anti-HCV screening was undertaken on 109,430 samples, of which 5176 (4.7%) were reactive. Of all samples, 77,885 (71.2%) were taken in secondary care; 25,044 (22.9%) in GPs; 2970 (2.7%) in prisons; 2415 (2.2%) in drug services; 753 (0.7%) in NSPs; 193 (0.2%) pharmacies; and 170 (0.1%) in mosques. The highest prevalence of HCV infection among those tested was in NSP sites (26%), prisons (14%), and drug treatment centres (12%). CONCLUSIONS Decentralised care pathways, particularly in harm reduction and other drug service settings, were key to increasing diagnosis of HCV in the region, but primary and secondary care remain central to elimination efforts.
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Affiliation(s)
- Emma Robinson
- Department of Gastroenterology, NHS Tayside, Ninewells Hospital and Medical School, Dundee, UK.,Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Christopher J Byrne
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK. .,Directorate of Public Health, Kings Cross Hospital, NHS Tayside, Dundee, UK. .,Tayside Clinical Trials Unit, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK.
| | - James Carberry
- Department of Gastroenterology, NHS Tayside, Ninewells Hospital and Medical School, Dundee, UK.,Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Andrew Radley
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK.,Directorate of Public Health, Kings Cross Hospital, NHS Tayside, Dundee, UK
| | - Lewis J Beer
- Tayside Clinical Trials Unit, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Sarah K Inglis
- Tayside Clinical Trials Unit, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Jan Tait
- Department of Gastroenterology, NHS Tayside, Ninewells Hospital and Medical School, Dundee, UK
| | - Iain Macpherson
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - David Goldberg
- Public Health Scotland, Meridian Court, Glasgow, UK.,School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Sharon J Hutchinson
- Public Health Scotland, Meridian Court, Glasgow, UK.,School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - John F Dillon
- Department of Gastroenterology, NHS Tayside, Ninewells Hospital and Medical School, Dundee, UK.,Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
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15
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Bartholomew TS, Andraka-Cristou B, Totaram RK, Harris S, Doblecki-Lewis S, Ostrer L, Serota DP, Forrest DW, Chueng TA, Suarez E, Tookes HE. "We want everything in a one-stop shop": acceptability and feasibility of PrEP and buprenorphine implementation with mobile syringe services for Black people who inject drugs. Harm Reduct J 2022; 19:133. [PMID: 36463183 PMCID: PMC9719627 DOI: 10.1186/s12954-022-00721-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/21/2022] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION A recent surge in HIV outbreaks, driven by the opioid and stimulant use crises, has destabilized our progress toward targets set forth by Ending the HIV Epidemic: A Plan for America for the high-priority community of people who inject drugs (PWID), particularly Black PWID. METHODS In order to ascertain the acceptability and feasibility of using a mobile syringe services program (SSP) for comprehensive HIV prevention via PrEP and medications for opioid use disorder (MOUD), our mixed methods approach included a quantitative assessment and semi-structured qualitative interviews with Black PWID (n = 30) in Miami-Dade County who were actively engaged in mobile syringe services. RESULTS Participants felt that delivery of MOUD and PrEP at a mobile SSP would be both feasible and acceptable, helping to address transportation, cost, and stigma barriers common within traditional healthcare settings. Participants preferred staff who are compassionate and nonjudgmental and have lived experience. CONCLUSIONS A mobile harm reduction setting could be an effective venue for delivering comprehensive HIV prevention services to Black PWID, a community that experiences significant barriers to care via marginalization and racism in a fragmented healthcare system.
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Affiliation(s)
- Tyler S. Bartholomew
- grid.26790.3a0000 0004 1936 8606Division of Health Services Research and Policy, Department of Public Health Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th St., #1020, Miami, FL 33136 USA
| | - Barbara Andraka-Cristou
- grid.170430.10000 0001 2159 2859Department of Health Management and Informatics, University of Central Florida, Orlando, FL USA ,grid.170430.10000 0001 2159 2859Department of Internal Medicine, University of Central Florida, Orlando, FL USA
| | - Rachel K. Totaram
- grid.170430.10000 0001 2159 2859Department of Health Management and Informatics, University of Central Florida, Orlando, FL USA
| | - Shana Harris
- grid.170430.10000 0001 2159 2859Department of Internal Medicine, University of Central Florida, Orlando, FL USA ,grid.170430.10000 0001 2159 2859Department of Anthropology, University of Central Florida, Orlando, FL USA
| | - Susanne Doblecki-Lewis
- grid.26790.3a0000 0004 1936 8606Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL USA
| | - Lily Ostrer
- grid.26790.3a0000 0004 1936 8606Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL USA
| | - David P. Serota
- grid.26790.3a0000 0004 1936 8606Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL USA
| | - David W. Forrest
- grid.26790.3a0000 0004 1936 8606Department of Anthropology, College of Arts and Sciences, University of Miami, Miami, FL USA
| | - Teresa A. Chueng
- grid.26790.3a0000 0004 1936 8606Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL USA
| | - Edward Suarez
- grid.26790.3a0000 0004 1936 8606Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL USA
| | - Hansel E. Tookes
- grid.26790.3a0000 0004 1936 8606Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL USA
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16
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Kapadia SN, Eckhardt BJ, Leff JA, Fong C, Mateu-Gelabert P, Marks KM, Aponte-Melendez Y, Schackman BR. Cost of providing co-located hepatitis C treatment at a syringe service program exceeds potential reimbursement: Results from a clinical trial. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 5:100109. [PMID: 36644226 PMCID: PMC9836210 DOI: 10.1016/j.dadr.2022.100109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 09/14/2022] [Accepted: 10/04/2022] [Indexed: 06/17/2023]
Abstract
Background Co-located hepatitis C treatment at syringe service programs (SSP) is an emerging model of care for people who inject drugs (PWID). Implementation of these models can be informed by understanding the program costs. Methods We conducted an economic evaluation of a hepatitis C treatment intervention at an SSP in New York City implemented as one arm of a randomized trial from 2017 to 2021. Start-up and operating costs were determined from the treatment program's perspective using micro-costing and were compared to potential Medicaid reimbursement. We applied nationally representative unit costs and wage rates. Results are reported in 2020 USD. Results The treatment program was staffed by one physician and one care coordinator. Participants were offered hepatitis C clinical evaluation and treatment, a 45-min reinfection prevention education session, and additional care coordination as needed. The trial enrolled 84 PWID with hepatitis C in the intervention arm; 64 initiated treatment and 55 achieved sustained virological response. Start-up costs including training and equipment totaled $4677. Overhead costs including rent, utilities and software totaled $2229 per month. Clinical and care coordination totaled $4867 per participant, of which $3722 was care coordination. The total cost excluding startup was $6035 per enrolled participant and $7921 per treated participant; estimated potential reimbursement was $628 per enrolled participant. Conclusion Our results provide insight to US-based SSPs seeking to provide co-located hepatitis C care and highlight the intensive care coordination services provided. Successful implementation likely requires funding sources beyond health insurers or substantial changes to insurance reimbursement for care coordination.
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Affiliation(s)
- Shashi N Kapadia
- Weill Cornell Medicine, Division of Infectious Diseases, 1300 York Ave Rm A-421, New York, NY 10065, United States
- Weill Cornell Medicine, Department of Population Health Sciences, 425 E 61st Street, Ste 301, New York, NY 10065, United States
| | - Benjamin J Eckhardt
- Division of Infectious Diseases, New York University Grossman School of Medicine, 550 First Avenue, New York, NY 10016, United States
| | - Jared A Leff
- Weill Cornell Medicine, Department of Population Health Sciences, 425 E 61st Street, Ste 301, New York, NY 10065, United States
| | - Chunki Fong
- CUNY Graduate School of Public Health and Health Policy, 55W 125th Street, New York, NY 10027, United States
| | - Pedro Mateu-Gelabert
- CUNY Graduate School of Public Health and Health Policy, 55W 125th Street, New York, NY 10027, United States
| | - Kristen M Marks
- Weill Cornell Medicine, Division of Infectious Diseases, 1300 York Ave Rm A-421, New York, NY 10065, United States
| | - Yesenia Aponte-Melendez
- CUNY Graduate School of Public Health and Health Policy, 55W 125th Street, New York, NY 10027, United States
- New York University Rory Meyers College of Nursing, 433 1st Avenue, New York, NY 10010, United States
| | - Bruce R Schackman
- Weill Cornell Medicine, Department of Population Health Sciences, 425 E 61st Street, Ste 301, New York, NY 10065, United States
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17
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Beer L, Inglis S, Malaguti A, Byrne C, Sharkey C, Robinson E, Gillings K, Radley A, Hapca A, Stephens B, Dillon J. Randomized clinical trial: Direct-acting antivirals as treatment for hepatitis C in people who inject drugs: Delivered in needle and syringe programs via directly observed therapy versus fortnightly collection. J Viral Hepat 2022; 29:646-653. [PMID: 35582875 PMCID: PMC9544056 DOI: 10.1111/jvh.13701] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/18/2022] [Accepted: 04/03/2022] [Indexed: 12/09/2022]
Abstract
Hepatitis C virus (HCV) treatment in people who inject drugs (PWID) is delivered within settings frequented by PWID, such as needle and syringe programs (NSP). The optimal direct-acting antiviral (DAA) dispensing regimen among NSP clients is unknown. This study compared cures (Sustained virologic response 12 weeks post-treatment, [SVR12 ]) across three dispensing schedules to establish non-inferiority of fortnightly dispensing versus directly observed therapy. The ADVANCE HCV study was a randomized, unblinded trial, recruiting PWID attending NSP in Tayside, Scotland, between January 2018 and November 2019. HCV-positive participants were randomized to receive DAAs via directly observed therapy, fortnightly provision or fortnightly provision with psychological intervention. A modified intention to treat analysis was used to identify differences in cures between the three treatment regimes. The study was registered with clinicaltrials.gov; NCT03236506. A total of 110 participants completed the study. 33 participants received directly observed therapy, with 90.91% SVR12 ; 37 received fortnightly provision, with 86.49% SVR12 and 40 received fortnightly provision and psychological intervention at treatment initiation, with 92.50% SVR12 . Analysis showed no significant difference in SVR12 (p = 0.67). This study did not demonstrate a statistically significant difference in cure rate between groups. This provides evidence of the non-inferiority of fortnightly dispensing of direct-acting antivirals (DAAs) compared to directly observed therapy among PWID. It suggests that tight control of adherence through directly observed therapy dispensing of DAAs among this population offers no therapeutic advantage. Therefore, less restrictive dispensing patterns can be used, tailored to patient convenience.
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Affiliation(s)
- Lewis Beer
- Tayside Clinical Trials UnitUniversity of DundeeDundeeUK
| | - Sarah Inglis
- Tayside Clinical Trials UnitUniversity of DundeeDundeeUK
| | - Amy Malaguti
- Tayside Drug & Alcohol Recovery Psychology ServiceNHS TaysideDundeeUK
| | - Christopher Byrne
- Tayside Clinical Trials UnitUniversity of DundeeDundeeUK,Department of Molecular and Clinical MedicineUniversity of DundeeDundeeUK
| | | | - Emma Robinson
- Department of Molecular and Clinical MedicineUniversity of DundeeDundeeUK,Ninewells Hospital and Medical SchoolNHS TaysideDundeeScotland
| | | | | | - Adrian Hapca
- Tayside Clinical Trials UnitUniversity of DundeeDundeeUK
| | - Brian Stephens
- Ninewells Hospital and Medical SchoolNHS TaysideDundeeScotland
| | - John Dillon
- Department of Molecular and Clinical MedicineUniversity of DundeeDundeeUK,Ninewells Hospital and Medical SchoolNHS TaysideDundeeScotland
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18
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Yeung A, Palmateer NE, Dillon JF, McDonald SA, Smith S, Barclay S, Hayes PC, Gunson RN, Templeton K, Goldberg DJ, Hickman M, Hutchinson SJ. Population-level estimates of hepatitis C reinfection post scale-up of direct-acting antivirals among people who inject drugs. J Hepatol 2022; 76:549-557. [PMID: 34634387 PMCID: PMC8852744 DOI: 10.1016/j.jhep.2021.09.038] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/08/2021] [Accepted: 09/27/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND & AIMS Scale-up of highly effective direct-acting antivirals (DAAs) for HCV among people who inject drugs (PWID) in Scotland has led to a reduction in the prevalence of viraemia in this population. However, the extent of reinfection among those treated with DAAs remains uncertain. We estimated HCV reinfection rates among PWID in Scotland by treatment setting, pre- and post-introduction of DAAs, and the potential number of undiagnosed reinfections resulting from incomplete follow-up testing. METHODS Through linkage of national clinical and laboratory HCV data, a retrospective cohort of PWID who commenced treatment between 2000-2018 and achieved a sustained virological response (SVR) were followed up for reinfection to December 2019. Reinfection was defined as a positive HCV antigen or RNA test. RESULTS Of 5,686 SVRs among 5,592 PWID, 4,126 (73%) had an HCV RNA or antigen test post-SVR. Of those retested, we identified 361 reinfections (3.9/100 person-years [PY]). The reinfection rate increased from 1.5/100 PY among PWID treated in 2000-2009 to 8.8/100 PY in 2017-2018. The highest reinfection rates were observed among those treated in prison (14.3/100 PY) and community settings (9.5/100 PY). Among those treated in the DAA era (2015-2018), 68% were tested within the first year post-SVR but only 30% in the second year; while 169 reinfections were diagnosed in follow-up, an estimated 200 reinfections (54% of the estimated total) had gone undetected. CONCLUSIONS HCV reinfection rates among PWID in Scotland have risen alongside the scale-up of DAAs and broadened access to treatment for those at highest risk, through delivery in community drug services. Promotion of HCV testing post-SVR among PWID is essential to ensure those reinfected are identified and retreated promptly. LAY SUMMARY Increased rates of hepatitis C reinfection in Scotland were observed following the rapid scale-up of highly effective direct-acting antiviral (DAA) treatments among people who inject drugs. This demonstrates that community-based treatment pathways are reaching high-risk groups, regarded vital in efforts to eliminate the virus. However, we estimate that less than half of reinfections have been detected in the DAA era because of inadequate levels of retesting beyond the first year following successful treatment. Sustained efforts that involve high coverage of harm reduction measures and high uptake of annual testing are required to ensure prompt diagnosis and treatment of those reinfected if the goals of elimination are to be met.
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Affiliation(s)
- Alan Yeung
- Glasgow Caledonian University, Glasgow, United Kingdom; Public Health Scotland, Edinburgh, United Kingdom.
| | - Norah E Palmateer
- Glasgow Caledonian University, Glasgow, United Kingdom; Public Health Scotland, Edinburgh, United Kingdom
| | | | - Scott A McDonald
- Glasgow Caledonian University, Glasgow, United Kingdom; Public Health Scotland, Edinburgh, United Kingdom
| | - Shanley Smith
- Glasgow Caledonian University, Glasgow, United Kingdom; Public Health Scotland, Edinburgh, United Kingdom
| | | | - Peter C Hayes
- Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Rory N Gunson
- West of Scotland Specialist Virology Centre, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - Kate Templeton
- Royal Infirmary of Edinburgh, Specialist Virology Centre, Edinburgh, United Kingdom
| | - David J Goldberg
- Public Health Scotland, Edinburgh, United Kingdom; Glasgow Caledonian University, Glasgow, United Kingdom
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; NIHR Health Protection Research Unit in Behavioural Science and Evaluation, Bristol, United Kingdom
| | - Sharon J Hutchinson
- Glasgow Caledonian University, Glasgow, United Kingdom; Public Health Scotland, Edinburgh, United Kingdom
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19
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Universal screening for hepatitis C - in for a penny, in for a pound. Eur J Clin Microbiol Infect Dis 2022; 41:341-347. [PMID: 35022892 DOI: 10.1007/s10096-021-04395-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 12/06/2021] [Indexed: 12/09/2022]
Abstract
Infection with hepatitis C virus (HCV) is a major public health problem. In fact, chronic HCV is a leading cause of cirrhosis, hepatocellular carcinoma, and death from liver disease in most countries. The advent of highly effective oral direct-acting antiviral therapy is the most significant advance in the treatment of HCV in decades and now allows us to cure chronic HCV. However, a large number of infected patients have not been diagnosed since hepatitis C is a largely asymptomatic disease. Thus, it is fundamental to improve the screening system in order to identify individuals who are currently infected and to treat them. Risk-based hepatitis C testing and birth cohort screening have had limited success and many patients living with the infection are not aware of their status. Universal screening for HCV is a tremendous improvement compared with the previous strategies. Indeed, global screening leads to the appropriate identification and treatment of all individuals chronically infected with HCV and prevents the progression of liver disease and the associated morbidity and mortality. In addition, universal HCV testing appears to be cost-effective. In this article, we review the current barriers to HCV eradication and the different strategies for HCV infection screening.
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20
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Bankwitz D, Krey T, Pietschmann T. [Development approaches for vaccines against hepatitis C virus infections]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2022; 65:183-191. [PMID: 35015104 PMCID: PMC8749110 DOI: 10.1007/s00103-021-03477-9] [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: 09/16/2021] [Accepted: 12/07/2021] [Indexed: 11/04/2022]
Abstract
Mehr als 10 Jahre nach der Zulassung der ersten direkt wirkenden antiviralen Wirkstoffe zur Behandlung der Hepatitis C bleibt die Inzidenz der Hepatitis-C-Virus-(HCV-)Infektion ungebrochen hoch. In manchen Ländern stecken sich mehr Menschen neu mit dem Virus an, als Patienten durch eine erfolgreiche Therapie geheilt werden. Die Entwicklung eines prophylaktischen Impfstoffes könnte die Transmission des Virus unterbinden und dadurch einen wesentlichen Beitrag zur Kontrolle dieser weltweit verbreiteten Infektion leisten. In diesem Artikel werden die besonderen Herausforderungen und die aktuellen Ansätze der HCV-Impfstoffentwicklung dargestellt. HCV ist ein hochgradig diverses und wandlungsfähiges Virus, das zumeist dem Immunsystem entkommt und chronische Infektionen etabliert. Andererseits heilt die HCV-Infektion bei bis zu einem Drittel der exponierten Individuen aus, sodass eine schützende Immunität erreichbar ist. Zahlreiche Untersuchungen zu den Determinanten einer schützenden Immunität gegen HCV zeichnen ein immer kompletteres Bild davon, welche Ziele ein Impfstoff erreichen muss. Sehr wahrscheinlich werden sowohl starke neutralisierende Antikörper als auch wirkungsvolle zytotoxische T‑Zellen gebraucht, um sicher vor einer chronischen Infektion zu schützen. Die Schlüsselfrage ist, welche Ansätze besonders breit wirksame Antikörper und T‑Zellen heranreifen lassen. Dies wird erforderlich sein, um vor der großen Fülle unterschiedlicher HCV-Varianten zu schützen. Die jüngsten Erfolge von mRNA-Impfstoffen öffnen neue Türen auch für die HCV-Impfstoffforschung. Kombiniert mit einem tieferen Verständnis der Struktur und Funktion der viralen Hüllproteine, der Identifizierung kreuzprotektiver Antikörper- und T‑Zellepitope sowie der Nutzung standardisierter Verfahren zur Quantifizierung der Wirksamkeit von Impfkandidaten ergeben sich neue Perspektiven für die Entwicklung eines Impfstoffes.
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Affiliation(s)
- Dorothea Bankwitz
- Twincore Zentrum für Experimentelle und Klinische Infektionsforschung, Institut für Experimentelle Virologie, Feodor-Lynen-Str. 7, 30625, Hannover, Deutschland
| | - Thomas Krey
- Medizinische Hochschule Hannover, RESIST Exzellenzcluster EXC2155, Hannover, Deutschland.,Zentrum für Strukturbiologie und Zellbiologie in der Medizin, Institut für Biochemie, Universität Lübeck, Lübeck, Deutschland.,Deutsches Zentrum für Infektionsforschung (DZIF), Partnerstandort Hamburg-Lübeck-Borstel-Riems, Braunschweig, Deutschland.,Institut für Virologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Thomas Pietschmann
- Twincore Zentrum für Experimentelle und Klinische Infektionsforschung, Institut für Experimentelle Virologie, Feodor-Lynen-Str. 7, 30625, Hannover, Deutschland. .,Medizinische Hochschule Hannover, RESIST Exzellenzcluster EXC2155, Hannover, Deutschland. .,Deutsches Zentrum für Infektionsforschung (DZIF), Partnerstandort Hannover-Braunschweig, Braunschweig, Deutschland.
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21
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Garrido-Estepa M, Herruzo R, Flores-Herrera J. Co-infections, comorbidities, and alcohol or other substances abuses in chronic hepatitis C-related hospitalisations in Spain. GASTROENTEROLOGIA Y HEPATOLOGIA 2022; 45:677-689. [DOI: 10.1016/j.gastrohep.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/08/2021] [Accepted: 01/14/2022] [Indexed: 11/26/2022]
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22
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Primary Care Associated With Follow Up Viral Load Testing in Patients Cured of Hepatitis C Infection With Direct Acting Antivirals at a Multidisciplinary Addiction Treatment Program: Insights From a Real-World Setting. J Addict Med 2022; 16:333-339. [PMID: 34483278 PMCID: PMC9033626 DOI: 10.1097/adm.0000000000000910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Treatment of hepatitis C virus infection (HCV) with direct acting antiviral therapy is encouraged regardless of substance use status. Patients with substance use disorder are at risk of HCV reinfection after cure. Follow up viral load testing (FUVL) with HCV RNA is recommended. We investigated factors associated with adoption of FUVL in real-world clinical settings. METHODS Medical records of all patients with SUD who achieved HCV cure with direct acting antivirals at a multidisciplinary addiction treatment program between 2014 and 2019 were reviewed as part of a quality improvement initiative. Demographic and clinical characteristics including SUD treatment, urine toxicology results, and medical service use were collected. Factors associated with FUVL were analyzed and the rate of HCV reinfection was determined. RESULTS Among 149 patients, 58.4% received FUVL. Receipt of FUVL was associated with engagement in ongoing primary medical care after cure (AOR 4.39, 95% CI [1.67, 11.49]). The HCV reinfection rate among those who received FUVL was 1.95 per 100 person-years of follow up (95% CI [0.64, 5.98]). There was no significant difference in the percentage of negative urine toxicology results before and after cure. CONCLUSIONS Over half of a cohort of patients with substance use disorder cured of HCV received FUVL. The relationship between FUVL and engagement in primary medical and substance use treatment highlights the importance of integrated systems in providing longitudinal care for patients cured of HCV. Standardized interventions that facilitate FUVL testing and management of infectious complications of SUD in addiction treatment settings are needed.
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23
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Caven M, Baiano CX, Robinson EM, Stephens B, Macpherson I, Dillon JF. Hepatitis C reinfection by treatment pathway among people who inject drugs in Tayside, Scotland. J Viral Hepat 2021; 28:1744-1750. [PMID: 34525228 DOI: 10.1111/jvh.13614] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/06/2021] [Accepted: 09/08/2021] [Indexed: 01/03/2023]
Abstract
The efficacy of direct-acting antivirals (DAA) provides an excellent opportunity to scale up HCV diagnosis and treatment, achieving the WHO target of HCV elimination by 2030. However, HCV reinfection among people who inject drugs (PWID) remains a concern and may impede elimination efforts. We assessed reinfection rates among PWID across six specialized treatment pathways, following DAA-based and interferon-based therapies in Tayside, Scotland. Data were collected retrospectively for every treatment episode that resulted in a sustained viral response (SVR) after undergoing treatment. Reinfection rates were calculated for each treatment pathway: hospital outpatient clinic; community pharmacy; drug treatment outreach; prison clinic; nurse-led outreach clinic; and injection equipment provision site. Reinfection is defined as a positive RNA test result after SVR. Incidences of reinfection are expressed in 100 person-years (PYs). In total, 916 treatment episodes met selection criteria. Of these, 100 reinfections were identified, generating an overall reinfection rate of 5.27 per 100 PYs (95%CI: 4.36-6.38). The hospital outpatient clinic had the lowest reinfection incidence (1.81 per 100 PYs, 95%CI: 1.11-2.93), with the injection equipment provision site treatment pathway having the highest reinfection incidence (19.89 per 100 PYs, 95%CI: 14.91-26.54). The incidence of reinfection among those treated with interferon-based therapies and those treated with DAA-based therapies was 4.93 per 100 PYs (95%CI: 3.97-6.11) and 7.17 per 100 PYs (95%CI: 4.75-10.82), respectively. Specialized treatment pathways in Tayside yield varying reinfection incidence rates, with different subpopulations of patients at varying risk of reinfection post-SVR. Results suggest that resources should be targeted at the injection equipment provision site pathway in order to reduce the incidence of reinfection and achieve elimination targets. The study found comparable rates of reinfection following interferon-based and DAA-based therapies, providing support for widening access to treatment services.
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Affiliation(s)
- Madeleine Caven
- Gut Group, Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Cassandra X Baiano
- Gut Group, Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Emma M Robinson
- Gut Group, Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, United Kingdom.,Department of Gastroenterology, NHS Tayside, Ninewells Hospital, Dundee, United Kingdom
| | - Brian Stephens
- Gut Group, Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Iain Macpherson
- Gut Group, Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - John F Dillon
- Gut Group, Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, United Kingdom.,Department of Gastroenterology, NHS Tayside, Ninewells Hospital, Dundee, United Kingdom
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24
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Bartholomew TS, Patel H, McCollister K, Feaster DJ, Tookes HE. Implementation and first-year operating costs of an academic medical center-based syringe services program. Harm Reduct J 2021; 18:116. [PMID: 34798887 PMCID: PMC8602990 DOI: 10.1186/s12954-021-00563-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 10/29/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Syringe services programs (SSPs) remain highly effective, cost-saving interventions for the prevention of blood-borne infections among people who inject drugs. However, there have been restrictions regarding financial resources allocated to these programs, particularly in the US South. This study aimed to provide cost data regarding the implementation and first-year operations of an academic-based SSP utilizing fixed and mobile strategies, including the integration of onsite wound care. METHODS We conducted a micro-costing study that retrospectively collected detailed resource utilization and unit cost data for both the fixed and mobile SSP strategies, including onsite wound care, from both healthcare and societal perspectives. A three-step approach was used to identify, measure, and value intervention costs, and cost components were categorized into implementation, variable program, and time-dependent costs. Sensitivity analysis was performed to examine the impact of SSP operational changes (i.e., needs-based distribution and opt-out HIV/HCV testing) on the cost-per-participant. Cost data we presented as overall cost and cost-per-participant adjusted to 2017 US dollars. RESULTS A total of 452 and 129 participants enrolled in fixed and mobile SSP services, respectively. The total cost associated with implementation and first year operations for the fixed site was $407,217.22 or $729.72 per participant and $311,625.52 or $2415.70 per participant for the mobile unit. The largest cost component for both modalities was time-dependent costs (personnel and overhead), while intervention materials (syringes, injection equipment, naloxone) were less than 15% of the total program cost. DISCUSSION/CONCLUSION Implementation and operation of new SSP models continue to be low cost compared to treatment for the multitude of harms PWID face without access to evidence-based prevention. Future cost-effectiveness and cost-benefit analyses integrating a comprehensive SSP model within an academic institution, including onsite wound care and other medical services, will provide a more comprehensive understanding of this model, and state-level policy action must be taken to lift the prohibition of state and local funds for the implementation, sustainability, and maintenance of these programs in Florida.
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Affiliation(s)
- Tyler S Bartholomew
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th St, Miami, FL, 33136, USA.
| | - Hardik Patel
- Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Kathryn McCollister
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th St, Miami, FL, 33136, USA
| | - Daniel J Feaster
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th St, Miami, FL, 33136, USA
| | - Hansel E Tookes
- Department of Infectious Diseases, Miller School of Medicine, University of Miami, Miami, FL, USA
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25
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Palmateer NE, McAuley A, Dillon JF, McDonald S, Yeung A, Smith S, Barclay S, Hayes P, Shepherd SJ, Gunson RN, Goldberg DJ, Hickman M, Hutchinson SJ. Reduction in the population prevalence of hepatitis C virus viraemia among people who inject drugs associated with scale-up of direct-acting anti-viral therapy in community drug services: real-world data. Addiction 2021; 116:2893-2907. [PMID: 33651446 DOI: 10.1111/add.15459] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/10/2020] [Accepted: 02/17/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS There has been little empirical evidence to show the 'real-world' impact of scaling-up direct-acting anti-viral (DAA) treatment among people who inject drugs (PWID) on hepatitis C virus (HCV) viraemia at a population level. We aimed to assess the population impact of rapid DAA scale-up to PWID delivered through community services-including drug treatment, pharmacies, needle exchanges and prisons-in the Tayside region of Scotland, compared with Greater Glasgow and Clyde (GGC) and the Rest of Scotland (RoS). DESIGN, SETTING AND PARTICIPANTS Natural experiment, evaluated using data from national biennial surveys of PWID and national clinical data. Services providing injecting equipment (2010-18) and HCV treatment clinics (2017-18) across Scotland. A total of 12 492 PWID who completed a questionnaire and provided a blood spot (tested for HCV-antibodies and RNA); 4105 individuals who initiated HCV treatment. INTERVENTION AND COMPARATOR, MEASUREMENTS The intervention was rapid DAA scale-up among PWID, which occurred in Tayside. The comparator was GGC/RoS. Trends in HCV viraemia and uptake of HCV therapy over time; sustained viral response (SVR) rates to therapy by region and treatment setting. FINDINGS Uptake of HCV therapy (last year) among PWID between 2013-14 and 2017-18 increased from 15 to 43% in Tayside, 6 to 16% in GGC and 11 to 23% in RoS. Between 2010 and 2017-18, the prevalence of HCV viraemia (among antibody-positives) declined from 73 to 44% in Tayside, 67 to 58% in GGC and 64 to 55% in RoS. The decline in viraemia was greater in Tayside [2017-18 adjusted odds ratio (aOR) = 0.47, 95% confidence interval (CI) = 0.30-0.75, P = 0.001] than elsewhere in Scotland (2017-18 aOR = 0.89, 95% CI = 0.74-1.07, P = 0.220) relative to the baseline of 2013-14 in RoS (including GGC). Per-protocol SVR rates among PWID treated in community sites did not differ from those treated in hospital sites in Tayside (97.4 versus 100.0%, P = 0.099). CONCLUSIONS Scale-up of direct-acting anti-viral treatment among people who inject drugs can be achieved through hepatitis C virus (HCV) testing and treatment in community drug services while maintaining high sustained viral response rates and, in the Tayside region of Scotland, has led to a substantial reduction in chronic HCV in the population.
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Affiliation(s)
- Norah E Palmateer
- Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK.,Public Health Scotland, Glasgow, UK
| | - Andrew McAuley
- Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK.,Public Health Scotland, Glasgow, UK
| | | | - Scott McDonald
- Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK
| | - Alan Yeung
- Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK.,Public Health Scotland, Glasgow, UK
| | - Shanley Smith
- Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK.,Public Health Scotland, Glasgow, UK
| | - Stephen Barclay
- Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK.,Glasgow Royal Infirmary, Glasgow, UK
| | | | | | - Rory N Gunson
- West of Scotland Specialist Virology Centre, Glasgow, UK
| | - David J Goldberg
- Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK.,Public Health Scotland, Glasgow, UK
| | | | - Sharon J Hutchinson
- Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK.,Public Health Scotland, Glasgow, UK
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26
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Bartholomew TS, Feaster DJ, Patel H, Forrest DW, Tookes HE. Reduction in injection risk behaviors after implementation of a syringe services program, Miami, Florida. J Subst Abuse Treat 2021; 127:108344. [PMID: 34134863 PMCID: PMC8221088 DOI: 10.1016/j.jsat.2021.108344] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 01/21/2021] [Accepted: 02/15/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Syringe services programs (SSPs) are evidence-based HIV prevention programs for people who inject drugs. However, not all SSPs operate evidence-based syringe distribution models, such as needs-based distribution. This study aims to provide preliminary evidence from the IDEA SSP on changes in injection risk behaviors over time, and to examine factors, including syringe coverage, associated with injection risk behavior trajectories over time under a one-for-one syringe distribution model. METHODS We used a prospective observational study design to generate a cohort of SSP clients who completed three behavioral assessments at SSP service visits between December 2016 and January 2020 (N = 115). The study used generalized estimating equations (GEE) to examine the relationship between covariate measures and the primary outcomes. The primary outcomes were 1) sharing of any injection equipment (e.g. syringes, needles, cookers, cottons) in the previous 30 days (yes/no) and 2) reusing of needles/syringes in the previous 30 days (yes/no). RESULTS Men were more likely to report reusing syringes (aRR = 1.15, 95% CI: 1.01-1.37) and those who reported injecting in public were less likely to report reusing syringes (aRR = 0.90, 95% CI: 0.82-0.99). HCV-positive clients had a 62% reduction in sharing injection equipment and those who reported public injection had a 62% increase in sharing injection equipment over time. Most importantly, increasing syringe coverage was associated with a decrease in both sharing injection equipment (aRR = 0.42, 95% CI: 0.25-0.72) and reusing syringes (aRR = 0.79, 95% CI: 0.66-0.95). CONCLUSION This study provides preliminary evidence of reductions in injection-related risk behaviors from the IDEA SSP and highlights potential high priority groups, such as people experiencing homelessness, that may need additional intervention. In addition, improving syringe coverage among SSP clients may be an important factor in reducing behaviors that place individuals at risk for contracting HIV and HCV.
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Affiliation(s)
- Tyler S Bartholomew
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA.
| | - Daniel J Feaster
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Hardik Patel
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - David W Forrest
- Department of Anthropology, College of Arts and Sciences, University of Miami, Miami, FL, USA
| | - Hansel E Tookes
- Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA
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27
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Arum C, Fraser H, Artenie AA, Bivegete S, Trickey A, Alary M, Astemborski J, Iversen J, Lim AG, MacGregor L, Morris M, Ong JJ, Platt L, Sack-Davis R, van Santen DK, Solomon SS, Sypsa V, Valencia J, Van Den Boom W, Walker JG, Ward Z, Stone J, Vickerman P. Homelessness, unstable housing, and risk of HIV and hepatitis C virus acquisition among people who inject drugs: a systematic review and meta-analysis. Lancet Public Health 2021; 6:e309-e323. [PMID: 33780656 PMCID: PMC8097637 DOI: 10.1016/s2468-2667(21)00013-x] [Citation(s) in RCA: 92] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 01/12/2021] [Accepted: 01/14/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND People who inject drugs (PWID) are at increased risk for HIV and hepatitis C virus (HCV) infection and also have high levels of homelessness and unstable housing. We assessed whether homelessness or unstable housing is associated with an increased risk of HIV or HCV acquisition among PWID compared with PWID who are not homeless or are stably housed. METHODS In this systematic review and meta-analysis, we updated an existing database of HIV and HCV incidence studies published between Jan 1, 2000, and June 13, 2017. Using the same strategy as for this existing database, we searched MEDLINE, Embase, and PsycINFO for studies, including conference abstracts, published between June 13, 2017, and Sept 14, 2020, that estimated HIV or HCV incidence, or both, among community-recruited PWID. We only included studies reporting original results without restrictions to study design or language. We contacted authors of studies that reported HIV or HCV incidence, or both, but did not report on an association with homelessness or unstable housing, to request crude data and, where possible, adjusted effect estimates. We extracted effect estimates and pooled data using random-effects meta-analyses to quantify the associations between recent (current or within the past year) homelessness or unstable housing compared with not recent homelessness or unstable housing, and risk of HIV or HCV acquisition. We assessed risk of bias using the Newcastle-Ottawa Scale and between-study heterogeneity using the I2 statistic and p value for heterogeneity. FINDINGS We identified 14 351 references in our database search, of which 392 were subjected to full-text review alongside 277 studies from our existing database. Of these studies, 55 studies met inclusion criteria. We contacted the authors of 227 studies that reported HIV or HCV incidence in PWID but did not report association with the exposure of interest and obtained 48 unpublished estimates from 21 studies. After removal of duplicate data, we included 37 studies with 70 estimates (26 for HIV; 44 for HCV). Studies originated from 16 countries including in North America, Europe, Australia, east Africa, and Asia. Pooling unadjusted estimates, recent homelessness or unstable housing was associated with an increased risk of acquiring HIV (crude relative risk [cRR] 1·55 [95% CI 1·23-1·95; p=0·0002]; I2= 62·7%; n=17) and HCV (1·65 [1·44-1·90; p<0·0001]; I2= 44·8%; n=28]) among PWID compared with those who were not homeless or were stably housed. Associations for both HIV and HCV persisted when pooling adjusted estimates (adjusted relative risk for HIV: 1·39 [95% CI 1·06-1·84; p=0·019]; I2= 65·5%; n=9; and for HCV: 1·64 [1·43-1·89; p<0·0001]; I2= 9·6%; n=14). For risk of HIV acquisition, the association for unstable housing (cRR 1·82 [1·13-2·95; p=0·014]; n=5) was higher than for homelessness (1·44 [1·13-1·83; p=0·0036]; n=12), whereas no difference was seen between these outcomes for risk of HCV acquisition (1·72 [1·48-1·99; p<0·0001] for unstable housing, 1·66 [1·37-2·00; p<0·0001] for homelessness). INTERPRETATION Homelessness and unstable housing are associated with increased risk of HIV and HCV acquisition among PWID. Our findings support the development of interventions that simultaneously address homelessness and unstable housing and HIV and HCV transmission in this population. FUNDING National Institute for Health Research, National Institute on Drug Abuse, National Institute of Allergy and Infectious Diseases, and Commonwealth Scholarship Commission.
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Affiliation(s)
- Chiedozie Arum
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Hannah Fraser
- Population Health Sciences, University of Bristol, Bristol, UK
| | | | - Sandra Bivegete
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Adam Trickey
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Michel Alary
- Centre de recherche du CHU de Québec, Université Laval, Quebec City, QC, Canada; Département de médecine sociale et préventive, Université Laval, Quebec City, QC, Canada; Institut national de santé publique du Québec, Québec, QC, Canada
| | - Jacquie Astemborski
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jennifer Iversen
- Kirby Institute for Infection and Immunity, UNSW Sydney, NSW, Australia
| | - Aaron G Lim
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Louis MacGregor
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Meghan Morris
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Jason J Ong
- Population Health Sciences, University of Bristol, Bristol, UK; Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Lucy Platt
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Rachel Sack-Davis
- Burnet Institute, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Daniela K van Santen
- Burnet Institute, Melbourne, VIC, Australia; Department of Infectious Disease Research and Prevention, Public Health Service of Amsterdam, Amsterdam, Netherlands
| | - Sunil S Solomon
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Jorge Valencia
- Harm Reduction Unit "SMASD", Department of Addictions and Mental Health, Madrid, Spain
| | | | | | - Zoe Ward
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Jack Stone
- Population Health Sciences, University of Bristol, Bristol, UK.
| | - Peter Vickerman
- Population Health Sciences, University of Bristol, Bristol, UK
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Ingiliz P, Wehmeyer MH, Boesecke C, Schulze Zur Wiesch J, Schewe K, Lutz T, Baumgarten A, Simon KG, Hueppe D, Rockstroh JK, Mauss S, Christensen S. Reinfection With the Hepatitis C Virus in Men Who Have Sex With Men After Successful Treatment With Direct-acting Antivirals in Germany: Current Incidence Rates, Compared With Rates During the Interferon Era. Clin Infect Dis 2021; 71:1248-1254. [PMID: 31562816 DOI: 10.1093/cid/ciz949] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 09/23/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Micro-elimination of the hepatitis C virus (HCV) includes treatment in populations at risk of ongoing HCV transmission, such as men who have sex with men (MSM) or people who inject drugs (PWID). We analyzed the HCV reinfection incidence rates of participants in the German hepatitis C cohort (GECCO) and compared our data to previous findings from the interferon era. METHODS Patients with HCV reinfections in the multi-centric GECCO cohort were compared to patients in whom no reinfection occurred. The HCV reinfection incidence rate in MSM was also compared to the incidence rate in the interferon era (using data from the European Acquired Immunodeficiency Syndrome Treatment Network [NEAT]). RESULTS Between January 2014 and April 2018, 48 HCV reinfections occurred in 2298 individuals (2%), with 2346 cured HCV episodes. The median time to reinfection was 500 days (range 16-1160) and the overall HCV reinfection incidence rate was 1.89 per 100 person-years (py; 95% confidence interval [CI], 1.41-2.48). In a multivariate analysis, the transmission risk in MSM was the only independent risk factor of HCV reinfection (odds ratio, 39.3; 95% CI, 4.57-334.40; P = .001). The incidence rate in MSM was 9.02 (95% CI, 6.48-12.26) per 100 py, compared to 1.14 per 100 py in PWID (95% CI, .56-2.09). The incidence rate for a first HCV reinfection in MSM was similar in the direct-acting antiviral era, compared to the interferon era, with a hazard ratio of 1.05 (95% CI, .64-1.74; P = .831). CONCLUSIONS HCV reinfection remains a frequent finding among MSM in Germany. In addition to behavioral interventions, early HCV treatment and retreatment should be implemented for this subgroup to prevent HCV transmission.
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Affiliation(s)
- Patrick Ingiliz
- Center for Infectiology, Berlin, Germany.,Department of Gastroenterology and Hepatology, Charité University Medical Center, Berlin, Germany
| | - Malte H Wehmeyer
- Medical Department, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Boesecke
- Department of Medicine I, University Hospital Bonn, Bonn, Germany.,German Centre for Infection Research, Partner Site Cologne-Bonn, Bonn, Germany.,Infectious Diseases, European Acquired Immunodeficiency Syndrome Treatment Network, Brussels, Belgium
| | - Julian Schulze Zur Wiesch
- Medical Department, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Centre for Infection Research, Partner Site Cologne-Bonn, Bonn, Germany
| | - Knud Schewe
- Infectiology Center Hamburg Study Center, Hamburg, Germany
| | | | | | | | | | - Juergen K Rockstroh
- Department of Medicine I, University Hospital Bonn, Bonn, Germany.,German Centre for Infection Research, Partner Site Cologne-Bonn, Bonn, Germany.,Infectious Diseases, European Acquired Immunodeficiency Syndrome Treatment Network, Brussels, Belgium
| | - Stefan Mauss
- Center for Human Immunodeficiency Virus and Hepatogastroenterology, Duesseldorf, Germany
| | - Stefan Christensen
- Infectious Diseases, Center for Interdisciplinary Medicine, Muenster, Germany.,Department of Gastroenterology and Hepatology, Muenster University Hospital, Muenster, Germany
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Wiegand J, Berg T. Hepatitis C-committing the world to an eradication of the infection. Hepatobiliary Surg Nutr 2021; 10:96-99. [PMID: 33575293 DOI: 10.21037/hbsn.2020.03.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 03/17/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Johannes Wiegand
- Klinik für Onkologie, Gastroenterologie, Hepatologie, Pneumologie und Infektiologie, Bereich Hepatologie, Leipzig, Germany
| | - Thomas Berg
- Klinik für Onkologie, Gastroenterologie, Hepatologie, Pneumologie und Infektiologie, Bereich Hepatologie, Leipzig, Germany
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Donaldson SR, Radley A, Dillon JF. Identifying the Hidden Population: Former Intravenous Drug Users Who Are No Longer in Contact with Services. "Ask a Friend". Diagnostics (Basel) 2021; 11:diagnostics11020170. [PMID: 33504077 PMCID: PMC7911884 DOI: 10.3390/diagnostics11020170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/21/2021] [Accepted: 01/23/2021] [Indexed: 01/08/2023] Open
Abstract
People who, after a period of drug use, have changed their lifestyle and left substance use behind them are a hidden population within our communities. Lack of contact with drug services may mean that they are not tested for hepatitis C (HCV) infection through service-led initiatives and, therefore, may be exposed to the chronic morbidity and risk of death inherent with a legacy of HCV infection. This study utilized respondent-driven sampling (RDS) in a novel fashion to find those at historical risk of HCV. The social networks of people with a history of drug use were mapped, and individuals not currently in contact with services were invited to come forward for testing by members of their social network. The study used a reference group to inform study methodology and communication methods to reach out to this hidden population. One hundred and nine individuals received dry blood spot tests for HCV, 17.4% were antibody positive. Fifty one individuals met the inclusion criteria for this study. One hundred and twenty three invite-to-test coupons were issued; however, only one wave of recruitment consisting of one participant resulted from this method. Using RDS in historical social networks was not effective in this study and did not reach this hidden population and increase testing for HCV. This study is registered with clinicaltrials.gov (Ref NCT03697135).
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Affiliation(s)
- Sarah R. Donaldson
- School of Medicine, University of Dundee, Dundee DD1 9SY, UK; (A.R.); (J.F.D.)
- Directorate of Public Health, NHS Tayside, Dundee DD3 8EA, UK
- Correspondence:
| | - Andrew Radley
- School of Medicine, University of Dundee, Dundee DD1 9SY, UK; (A.R.); (J.F.D.)
- Directorate of Public Health, NHS Tayside, Dundee DD3 8EA, UK
| | - John F. Dillon
- School of Medicine, University of Dundee, Dundee DD1 9SY, UK; (A.R.); (J.F.D.)
- Department of Gastroenterology, Ninewells Hospital & Medical School, Dundee DD1 9SY, UK
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31
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Smith S, Honegger JR, Walker C. T-Cell Immunity against the Hepatitis C Virus: A Persistent Research Priority in an Era of Highly Effective Therapy. Cold Spring Harb Perspect Med 2021; 11:cshperspect.a036954. [PMID: 32205413 PMCID: PMC7778213 DOI: 10.1101/cshperspect.a036954] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Approximately 70% of acute hepatitis C virus (HCV) infections become chronic, indicating that the virus is exceptionally well adapted to persist in humans with otherwise normal immune function. Robust, lifelong replication of this small RNA virus does not require a generalized failure of immunity. HCV effectively subverts innate and adaptive host defenses while leaving immunity against other viruses intact. Here, the role of CD4+ and CD8+ T-cell responses in control of HCV infection and their failure to prevent virus persistence in most individuals are reviewed. Two issues of practical importance remain priorities in an era of highly effective antiviral therapy for chronic hepatitis C. First, the characteristics of successful T-cell responses that promote resolution of HCV infection are considered, as they will underpin development of vaccines that prevent HCV persistence. Second, defects in T-cell immunity that facilitate HCV persistence and whether they are reversed after antiviral cure to provide protection from reinfection are also addressed.
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Affiliation(s)
- Stephanie Smith
- The Center for Vaccines and Immunity, The Abigail Wexner Research Institute at Nationwide Children's, Columbus, Ohio 43205, USA,Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio 43004, USA
| | - Jonathan R. Honegger
- The Center for Vaccines and Immunity, The Abigail Wexner Research Institute at Nationwide Children's, Columbus, Ohio 43205, USA,Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio 43004, USA
| | - Christopher Walker
- The Center for Vaccines and Immunity, The Abigail Wexner Research Institute at Nationwide Children's, Columbus, Ohio 43205, USA,Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio 43004, USA
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32
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Lazarus JV, Øvrehus A, Demant J, Krohn-Dehli L, Weis N. The Copenhagen test and treat hepatitis C in a mobile clinic study: a protocol for an intervention study to enhance the HCV cascade of care for people who inject drugs (T'N'T HepC). BMJ Open 2020; 10:e039724. [PMID: 33168560 PMCID: PMC7654134 DOI: 10.1136/bmjopen-2020-039724] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 10/06/2020] [Accepted: 10/08/2020] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Injecting drug use is the primary driver of hepatitis C virus (HCV) infection in Europe. Despite the need for more engagement with care, people who inject drugs (PWID) are hard to reach with HCV testing and treatment. We initiated a study to evaluate the efficacy for testing and linkage to care among PWID consulting peer-based testing at a mobile clinic in Copenhagen, Denmark. METHODS AND ANALYSIS In this intervention study, we will recruit participants at a single community-based, peer-run mobile clinic. In a single visit, we will first offer participants a point-of-care HCV antibody test, and if they test positive, then they will receive an HCV RNA test. If they are HCV-RNA+, we will administer facilitated referrals to designated 'fast-track' clinics at a hospital or an addiction centre for treatment. The primary outcomes for this study are the number of tested and treated individuals. Secondary outcomes include individuals lost at each step in the care cascade. ETHICS AND DISSEMINATION The results of this study could provide a model for targeting PWID for HCV testing and treatment in Demark and other settings, which could help achieve WHO HCV elimination targets. The Health Research Ethics Committee of Denmark and the Danish Data Protection Agency confirmed (December 2018/January 2019) that this study did not require their approval. Study findings will be disseminated through peer-reviewed publications, conference presentations and social media.
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Affiliation(s)
- Jeffrey Victor Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Anne Øvrehus
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | | | - Louise Krohn-Dehli
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark
| | - Nina Weis
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Ward Z, Reynolds R, Campbell L, Martin NK, Harrison G, Irving W, Hickman M, Vickerman P. Cost-effectiveness of the HepCATT intervention in specialist drug clinics to improve case-finding and engagement with HCV treatment for people who inject drugs in England. Addiction 2020; 115:1509-1521. [PMID: 31984606 PMCID: PMC10762643 DOI: 10.1111/add.14978] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 10/04/2019] [Accepted: 01/17/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND AIMS People who inject drugs (PWID) are at high risk of hepatitis C virus (HCV) infection; however, ~50% are undiagnosed in England and linkage-to-care is poor. This study investigated the cost-effectiveness of an intervention (HepCATT) to improve case-finding and referral to HCV treatment compared with standard-of-care pathways in drug treatment centres in England. DESIGN HCV transmission and disease progression model with cost-effectiveness analysis using a health-care perspective. Primary outcome and cost data from the HepCATT study parameterized the intervention, suggesting that HepCATT increased HCV testing in drug treatment centres 2.5-fold and engagement onto the HCV treatment pathway 10-fold. A model was used to estimate the decrease in HCV infections and HCV-related deaths from 2016, with costs and health benefits (quality-adjusted life-years or QALYs) tracked over 50 years. Univariable and probabilistic sensitivity analyses (PSA) were undertaken. SETTING England-specific epidemic with 40% prevalence of chronic HCV among PWID. PARTICIPANTS PWID attending drug treatment centres. INTERVENTION Nurse facilitator in drug treatment centres to improve the HCV care pathway from HCV case-finding to referral and linkage to specialist care. Comparator was the standard-of-care HCV care pathway. MEASUREMENTS Incremental cost-effectiveness ratio (ICER) in terms of cost per QALY gained through improved case-finding. FINDINGS Over 50 years per 1000 PWID, the HepCATT intervention could prevent 75 (95% central interval 37-129) deaths and 1330 (827-2040) or 51% (30-67%) of all new infections. The mean ICER was £7986 per QALY gained, with all PSA simulations being cost-effective at a £20 000 per QALY willingness-to-pay threshold. Univariable sensitivity analyses suggest the intervention would become cost-saving if the cost of HCV treatment reduces to £3900. If scaled up to all PWID in England, the intervention would cost £8.8 million and decrease incidence by 56% (33-70%) by 2030. CONCLUSIONS Increasing hepatitis C virus infection case-finding and treatment referral in drug treatment centres could be a highly cost-effective strategy for decreasing hepatitis C virus incidence among people who inject drugs.
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Affiliation(s)
- Zoe Ward
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Rosie Reynolds
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Linda Campbell
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Natasha K. Martin
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, CA, USA
| | | | - William Irving
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
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34
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Williams J, Vickerman P, Douthwaite S, Nebbia G, Hunter L, Wong T, Ruf M, Miners A. An Economic Evaluation of the Cost-Effectiveness of Opt-Out Hepatitis B and Hepatitis C Testing in an Emergency Department Setting in the United Kingdom. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:1003-1011. [PMID: 32828211 DOI: 10.1016/j.jval.2020.03.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 02/14/2020] [Accepted: 03/30/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES The prevalence of hepatitis is high in emergency department (ED) attendees in the United Kingdom, with a prevalence of up to 2% for hepatitis B (HBV) HBsAg, and 2.9% for hepatitis C (HCV) RNA. The aim of this paper is to perform an economic evaluation of opt-out ED-based HCV and HBV testing. METHODS A Markov model was developed to analyze the cost-effectiveness of opt-out HCV and HBV testing in EDs in the UK. The model used data from UK studies of ED testing to parameterize the HCV and HBV prevalence (1.4% HCV RNA, 0.84% HBsAg), test costs, and intervention effects (contact rates and linkage to care). For HCV, we used an antibody test cost of £3.64 and RNA test cost of £68.38, and assumed direct-acting antiviral treatment costs of £10 000. For HBV, we used a combined HBsAg and confirmatory test cost of £5.79. We also modeled the minimum prevalence of HCV (RNA-positive) and HBV (HBsAg) required to make ED testing cost-effective at a £20 000 willingness to pay per quality-adjusted life-year threshold. RESULTS In the base case, ED testing was highly cost-effective, with HCV and HBV testing costing £8019 and £9858 per quality-adjusted life-year gained, respectively. HCV and HBV ED testing remained cost-effective at 0.25% HCV RNA or HBsAg prevalence or higher. CONCLUSIONS Emergency department testing for HCV and HBV is highly likely to be cost-effective in many areas across the UK depending on their prevalence. Ongoing studies will help evaluate ED testing across different regions to inform testing guidelines.
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Affiliation(s)
- Jack Williams
- Department of Health Service Research and Policy, London School of Hygiene & Tropical Medicine, London, England, UK; The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College, London, England, UK.
| | - Peter Vickerman
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College, London, England, UK; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England, UK
| | - Sam Douthwaite
- Department of Infection, Guy's and St Thomas' NHS Trust, London, England, UK
| | - Gaia Nebbia
- Department of Infection, Guy's and St Thomas' NHS Trust, London, England, UK
| | - Laura Hunter
- Emergency Department, Guy's and St Thomas' NHS Trust, London, England, UK
| | - Terry Wong
- Department of HIV/GU Medicine, Guy's and St Thomas' NHS Trust, London, England, UK
| | - Murad Ruf
- Gilead Sciences Medical Department, London, England, UK
| | - Alec Miners
- Department of Health Service Research and Policy, London School of Hygiene & Tropical Medicine, London, England, UK; The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College, London, England, UK
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35
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Manca F, Robinson E, Dillon JF, Boyd KA. Eradicating hepatitis C: Are novel screening strategies for people who inject drugs cost-effective? THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 82:102811. [PMID: 32585583 DOI: 10.1016/j.drugpo.2020.102811] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/20/2020] [Accepted: 05/25/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND In developed countries, people who inject drugs (PWID) have a high prevalence of hepatitis C virus (HCV), yet they are often under-diagnosed. The World Health Organization has set 2030 as a target year for HCV elimination. To meet this target, improving screening in convenient community settings in order to reach infected undiagnosed individuals is a priority. This study assesses the cost-effectiveness of alternative novel strategies for diagnosing HCV infection in PWID. METHODS A cost-effectiveness analysis was undertaken to compare HCV screening at needle exchange centres, substance misuse services and at community pharmacies, with the standard practice of detection during general practitioners' consultations. A decision tree model was developed to assess the incremental cost per positive diagnosis, and a Markov model explored the net monetary benefit (NMB) and the cost per Quality Adjusted Life Years (QALYs) gained over a lifetime horizon. RESULTS Needle exchange services provided a 7.45-fold increase in detecting positive individuals and an incremental cost of £12,336 per QALY gained against current practice (NMB £163,827), making this the most cost-effective strategy over a lifetime horizon. Screening at substance misuse services and pharmacies was cost-effective only at a £30,000/QALY threshold. With a 24% discount to HCV treatment list prices, all three screening strategies become cost-effective at £20,000/QALY. CONCLUSIONS Targeting PWID populations with screening at needle exchange services is a highly cost-effective strategy for reaching undiagnosed HCV patients. When applying realistic discounts to list prices of drug treatments, all three strategies were highly cost-effective from a UK NHS perspective. All of these strategies have the potential to make a cost-effective contribution to the eradication of HCV by 2030.
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Affiliation(s)
- Francesco Manca
- Health Economics and Health Technology Assessment (HEHTA), Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow G12 8RZ, UK.
| | - Emma Robinson
- School of Medicine, University of Dundee, Ninewells hospital and Medical school, DD1 9SY Dundee, UK.
| | - John F Dillon
- School of Medicine, University of Dundee, Ninewells hospital and Medical school, DD1 9SY Dundee, UK.
| | - Kathleen Anne Boyd
- Health Economics and Health Technology Assessment (HEHTA), Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow G12 8RZ, UK.
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Castillo M, Ginoza MEC, Bartholomew TS, Forrest DW, Greven C, Serota DP, Tookes HE. When is an abscess more than an abscess? Syringe services programs and the harm reduction safety-net: a case report. Harm Reduct J 2020; 17:34. [PMID: 32487084 PMCID: PMC7268493 DOI: 10.1186/s12954-020-00381-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 05/22/2020] [Indexed: 11/10/2022] Open
Abstract
Background Syringe services programs (SSPs) are able to offer wrap-around services for people who inject drugs (PWID) and improve health outcomes. Case presentation A 47-year-old man screened positive for a skin and soft tissue infection (SSTI) at an SSP and was referred to a weekly on-site student-run wound care clinic. He was evaluated by first- and third-year medical students, and volunteer attending physicians determined that the infection was too severe to be managed on site. Students escorted the patient to the emergency department, where he was diagnosed with a methicillin-resistant Staphylococcus aureus arm abscess as well as acute HIV infection. Conclusion Student-run wound care clinics at SSPs, in conjunction with ongoing harm reduction measures, screenings, and treatment services, provide a safety-net of care for PWID and help mitigate the harms of injection drug use.
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Affiliation(s)
- Marcus Castillo
- Department of Medical Education, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Margaret E C Ginoza
- Department of Medical Education, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Tyler S Bartholomew
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St, Miami, FL, 33136, USA.
| | - David W Forrest
- Department of Anthropology, College of Arts and Sciences, University of Miami, Miami, FL, USA
| | - Costaki Greven
- IDEA Exchange, University of Miami Miller School of Medicine, Miami, FL, USA
| | - David P Serota
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Hansel E Tookes
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
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Aspinall EJ, Fernandez-Montero JV. Commentary on Bretana et al. (2020): Prevention and treatment in the prison setting will be key to achieving HCV elimination. Addiction 2020; 115:915-916. [PMID: 32128895 DOI: 10.1111/add.14995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 01/24/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Esther J Aspinall
- Blood Borne Virus Programme, NHS Ayrshire and Arran, Kilmarnock, UK.,School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.,Health Protection Scotland, Glasgow, UK
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Hajarizadeh B, Cunningham EB, Valerio H, Martinello M, Law M, Janjua NZ, Midgard H, Dalgard O, Dillon J, Hickman M, Bruneau J, Dore GJ, Grebely J. Hepatitis C reinfection after successful antiviral treatment among people who inject drugs: A meta-analysis. J Hepatol 2020; 72:643-657. [PMID: 31785345 DOI: 10.1016/j.jhep.2019.11.012] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 10/30/2019] [Accepted: 11/05/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS HCV reinfection following successful treatment can compromise treatment outcomes. This systematic review assessed the rate of HCV reinfection following treatment among people with recent drug use and those receiving opioid agonist therapy (OAT). METHODS We searched bibliographic databases and conference abstracts for studies assessing post-treatment HCV reinfection rates among people with recent drug use (injecting or non-injecting) or those receiving OAT. Meta-analysis was used to cumulate reinfection rates and meta-regression was used to explore heterogeneity across studies. RESULTS Thirty-six studies were included (6,311 person-years of follow-up). The overall rate of HCV reinfection was 5.9/100 person-years (95% CI 4.1-8.5) among people with recent drug use (injecting or non-injecting), 6.2/100 person-years (95% CI 4.3-9.0) among people recently injecting drugs, and 3.8/100 person-years (95% CI 2.5-5.8) among those receiving OAT. Reinfection rates were comparable following interferon-based (5.4/100 person-years; 95% CI 3.1-9.5) and direct-acting antiviral (3.9/100 person-years; 95% CI 2.5-5.9) therapy. In stratified analysis, reinfection rates were 1.4/100 person-years (95% CI 0.8-2.6) among people receiving OAT with no recent drug use, 5.9/100 person-years (95% CI 4.0-8.6) among people receiving OAT with recent drug use, and 6.6/100 person-years (95% CI 3.4-12.7) among people with recent drug use not receiving OAT. In meta-regression analysis, longer follow-up was associated with lower reinfection rate (adjusted rate ratio [aRR] per year increase in mean/median follow-up 0.77; 95% CI 0.69-0.86). Compared with people receiving OAT with no recent drug use, those with recent drug use receiving OAT (aRR 3.50; 95% CI 1.62-7.53), and those with recent drug use not receiving OAT (aRR 3.96; 95% CI 1.82-8.59) had higher reinfection rates. CONCLUSION HCV reinfection risk following treatment was higher among people with recent drug use and lower among those receiving OAT. The lower rates of reinfection observed in studies with longer follow-up suggested higher reinfection risk early post-treatment. LAY SUMMARY Our findings demonstrate that although reinfection by hepatitis C virus occurs following successful treatment in people with recent drug use, the rate of hepatitis C reinfection is lower than the rates of primary infection reported in the literature for this population - reinfection should not be used as a reason to withhold therapy from people with ongoing injecting drug use. The rate of hepatitis C reinfection was lowest among people receiving opioid agonist therapy with no recent drug use. These data illustrate that harm reduction services are required to reduce the reinfection risk, while regular post-treatment hepatitis C assessment is required for early detection and retreatment.
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Affiliation(s)
| | | | | | | | - Matthew Law
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Naveed Z Janjua
- British Columbia Centre for Disease Control, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Håvard Midgard
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
| | | | - John Dillon
- Ninewells Hospital and Medical School, University of Dundee, Dundee, The United Kingdom
| | - Matthew Hickman
- Population Health Sciences, University of Bristol, Bristol, The United Kingdom
| | - Julie Bruneau
- Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Gregory J Dore
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
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39
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Cox AL. Challenges and Promise of a Hepatitis C Virus Vaccine. Cold Spring Harb Perspect Med 2020; 10:cshperspect.a036947. [PMID: 31548228 DOI: 10.1101/cshperspect.a036947] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
An estimated 1.5-2 million new hepatitis C virus (HCV) infections occur globally each year. Critical to the World Health Organization's (WHO) HCV elimination strategy is an 80% reduction in incidence of HCV infections by 2030. However, even among high-income countries, few are on target to achieve the WHO's incident infection-reduction goal. A preventative vaccine could have a major impact in achieving incidence-reduction targets globally. However, barriers to HCV vaccine development are significant and include at-risk populations that are often marginalized: viral diversity, limited options for testing HCV vaccines, and an incomplete understanding of protective immune responses. In part because of those factors, testing of only one vaccine strategy has been completed in at-risk individuals as of 2019. Despite challenges, immunity against HCV protects against chronic infection in some repeated HCV exposures and an effective HCV vaccine could prevent transmission regardless of risk factors. Ultimately, prophylactic vaccines will likely be necessary to achieve global HCV elimination.
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Affiliation(s)
- Andrea L Cox
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland 21205, USA
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40
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Behzadifar M, Behzadifar M, Bragazzi NL. A systematic review and meta-analysis of the prevalence of hepatitis C virus infection in people who inject drugs in Iran. BMC Public Health 2020; 20:62. [PMID: 31937278 PMCID: PMC6961327 DOI: 10.1186/s12889-020-8175-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 01/08/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) infection is one of the major public health challenges generating a relevant burden. High-risk groups, including people who inject drugs (PWID), are at serious risk for developing HCV. In recent years, several investigations have been conducted in Iran to assess the prevalence e of HCV among PWID. The aim of the present study was to synthesize the literature performing a comprehensive search and meta-analysis. METHODS A comprehensive literature search was carried out from January 2000 to September 2019. Several international databases, namely Scopus, PubMed/MEDLINE, Embase, ISI/Web of Science, PsycINFO, CINAHL, the Cochrane Library and the Directory of Open Access Journals (DOAJ), as well as Iranian databases (Barakathns, SID and MagIran), were consulted. Eligible studies were identified according to the following PECOS (population, exposure, comparison/comparator, outcome and study type) criteria: i) population: Iranian population; ii) exposure: injection drug users; iii) comparison/comparator: type of substance injected and level of substance use, iv) outcome: HCV prevalence; and v) study type: cross-sectional study. After finding potentially related studies, authors extracted relevant data and information based on an ad hoc Excel spreadsheet. Extracted data included the surname of the first author, the study journal, the year of publication, the number of participants examined, the type of diagnostic test performed, the number of positive HCV patients, the number of participants stratified by gender, the reported prevalence, the duration of drug injection practice and the history of using a shared syringe. RESULTS Forty-two studies were included. 15,072 PWID were assessed for determining the prevalence of HCV. The overall prevalence of HCV among PWID in Iran was computed to be 47% (CI 95: 39-56). The prevalence ranged between 7 and 96%. Men and subjects using a common/shared syringe were 1.46 and 3.95 times more likely to be at risk, respectively. CONCLUSION The findings of the present study showed that the prevalence of HCV among PWIDs in Iran is high. The support and implementation of ad hoc health-related policies and programs that reduce this should be put into action.
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Affiliation(s)
- Masoud Behzadifar
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Meysam Behzadifar
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Nicola Luigi Bragazzi
- School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
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Marshall AD, Madden A, Treloar C. Enhancing engagement in hepatitis C care among people who inject drugs. Addiction 2019; 114:2104-2106. [PMID: 31140205 DOI: 10.1111/add.14698] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/24/2019] [Accepted: 05/10/2019] [Indexed: 01/26/2023]
Affiliation(s)
- Alison D Marshall
- The Kirby Institute, University of New South Wales, Sydney, Australia.,Centre for Social Research in Health, University of New South Wales, Sydney, Australia
| | - Annie Madden
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia
| | - Carla Treloar
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia
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Persico M, Masarone M, Aglitti A, Armenante C, Giordano A, Guardiola A, Raimondi G, Contaldi C, Nigro C, Marena G, De Luna A. HCV point-of-care screening programme and treatment options for people who use drugs in a metropolitan area of Southern Italy. Liver Int 2019; 39:1845-1851. [PMID: 31169953 DOI: 10.1111/liv.14166] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 05/22/2019] [Accepted: 06/02/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS People who use drugs (PWUD) represent an active reservoir of HCV infection. The prevalence of chronic HCV infection in PWUD in Italy remains unknown because of the lack of systematic screening. Thanks to direct-acting antiviral agents (DAAs), hepatitis C can now be cured in most patients. Thus, the next challenge is to provide linkage-to-care for these patients. METHODS In this scenario, we conducted a screening programme in PWUD attending seven Addiction Centers in Southern Italy, as well as a treatment programme in the Liver Unit of the University Hospital of Salerno. We used the OraQuick HCV antibody test to screen the PWUD (from 1 April to 30 September 2018). RESULTS 593 subjects were consecutively enrolled in the programme; 250 (41.8%) were HCV-Ab-positive. 143 (24.1%) were aware of their infection and had been HCV-RNA-tested: 83 were positive and 60 negative. The remaining 107 subjects (18.1%) had never previously been tested and were unaware of their infection. A total of 160 (26.9%) HCV RNA-positive patients were found and offered antiviral therapy with DAAs. The sustained virological response rate was 98.5% and no adverse events were recorded. Two patients voluntarily discontinued treatment. No reinfections have been recorded to date. CONCLUSIONS The prevalence of HCV-Ab positivity was high in the PWUDs enrolled in this study, and almost half the patients were unaware of being HCV-positive. The linkage-to-care provided was safe and effective, and no case of reinfection was recorded.
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Affiliation(s)
- Marcello Persico
- Internal Medicine and Hepatology Unit, Department of Medicine and Surgery "Scuola Medica Salernitana", University of Salerno, Baronissi (Salerno), Italy
| | - Mario Masarone
- Internal Medicine and Hepatology Unit, Department of Medicine and Surgery "Scuola Medica Salernitana", University of Salerno, Baronissi (Salerno), Italy
| | - Andrea Aglitti
- Internal Medicine and Hepatology Unit, Department of Medicine and Surgery "Scuola Medica Salernitana", University of Salerno, Baronissi (Salerno), Italy
| | - Ciro Armenante
- Ser.T 40, Dipartimento Dipendenze ASL Salerno, Cava de'Tirreni (Salerno), Italy
| | - Aniello Giordano
- Ser.T 42-Distretto Sanitario 65, Dipartimento Dipendenze ASL Salerno, Battipaglia (Salerno), Italy
| | | | - Gabriella Raimondi
- Ser.T 41-Distretto Sanitario 60, Dipartimento Dipendenze ASL Salerno, Nocera Inferiore (Salerno), Italy
| | - Carlo Contaldi
- Ser.T 48, Dipartimento Dipendenze Asl Salerno, Sapri (Salerno), Italy
| | - Carmine Nigro
- Ser.T 45, Dipartimento Dipendenze ASL Salerno, Agropoli (Salerno), Italy
| | - Giustina Marena
- Ser.T 47, Dipartimento Dipendenze ASL Salerno, Sant'Arsenio (Salerno), Italy
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Hickman M, Dillon JF, Elliott L, De Angelis D, Vickerman P, Foster G, Donnan P, Eriksen A, Flowers P, Goldberg D, Hollingworth W, Ijaz S, Liddell D, Mandal S, Martin N, Beer LJZ, Drysdale K, Fraser H, Glass R, Graham L, Gunson RN, Hamilton E, Harris H, Harris M, Harris R, Heinsbroek E, Hope V, Horwood J, Inglis SK, Innes H, Lane A, Meadows J, McAuley A, Metcalfe C, Migchelsen S, Murray A, Myring G, Palmateer NE, Presanis A, Radley A, Ramsay M, Samartsidis P, Simmons R, Sinka K, Vojt G, Ward Z, Whiteley D, Yeung A, Hutchinson SJ. Evaluating the population impact of hepatitis C direct acting antiviral treatment as prevention for people who inject drugs (EPIToPe) - a natural experiment (protocol). BMJ Open 2019; 9:e029538. [PMID: 31551376 PMCID: PMC6773339 DOI: 10.1136/bmjopen-2019-029538] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 07/25/2019] [Accepted: 07/29/2019] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Hepatitis C virus (HCV) is the second largest contributor to liver disease in the UK, with injecting drug use as the main risk factor among the estimated 200 000 people currently infected. Despite effective prevention interventions, chronic HCV prevalence remains around 40% among people who inject drugs (PWID). New direct-acting antiviral (DAA) HCV therapies combine high cure rates (>90%) and short treatment duration (8 to 12 weeks). Theoretical mathematical modelling evidence suggests HCV treatment scale-up can prevent transmission and substantially reduce HCV prevalence/incidence among PWID. Our primary aim is to generate empirical evidence on the effectiveness of HCV 'Treatment as Prevention' (TasP) in PWID. METHODS AND ANALYSIS We plan to establish a natural experiment with Tayside, Scotland, as a single intervention site where HCV care pathways are being expanded (including specialist drug treatment clinics, needle and syringe programmes (NSPs), pharmacies and prison) and HCV treatment for PWID is being rapidly scaled-up. Other sites in Scotland and England will act as potential controls. Over 2 years from 2017/2018, at least 500 PWID will be treated in Tayside, which simulation studies project will reduce chronic HCV prevalence among PWID by 62% (from 26% to 10%) and HCV incidence will fall by approximately 2/3 (from 4.2 per 100 person-years (p100py) to 1.4 p100py). Treatment response and re-infection rates will be monitored. We will conduct focus groups and interviews with service providers and patients that accept and decline treatment to identify barriers and facilitators in implementing TasP. We will conduct longitudinal interviews with up to 40 PWID to assess whether successful HCV treatment alters their perspectives on and engagement with drug treatment and recovery. Trained peer researchers will be involved in data collection and dissemination. The primary outcome - chronic HCV prevalence in PWID - is measured using information from the Needle Exchange Surveillance Initiative survey in Scotland and the Unlinked Anonymous Monitoring Programme in England, conducted at least four times before and three times during and after the intervention. We will adapt Bayesian synthetic control methods (specifically the Causal Impact Method) to generate the cumulative impact of the intervention on chronic HCV prevalence and incidence. We will use a dynamic HCV transmission and economic model to evaluate the cost-effectiveness of the HCV TasP intervention, and to estimate the contribution of the scale-up in HCV treatment to observe changes in HCV prevalence. Through the qualitative data we will systematically explore key mechanisms of TasP real world implementation from provider and patient perspectives to develop a manual for scaling up HCV treatment in other settings. We will compare qualitative accounts of drug treatment and recovery with a 'virtual cohort' of PWID linking information on HCV treatment with Scottish Drug treatment databases to test whether DAA treatment improves drug treatment outcomes. ETHICS AND DISSEMINATION Extending HCV community care pathways is covered by ethics (ERADICATE C, ISRCTN27564683, Super DOT C Trial clinicaltrials.gov: NCT02706223). Ethical approval for extra data collection from patients including health utilities and qualitative interviews has been granted (REC ref: 18/ES/0128) and ISCRCTN registration has been completed (ISRCTN72038467). Our findings will have direct National Health Service and patient relevance; informing prioritisation given to early HCV treatment for PWID. We will present findings to practitioners and policymakers, and support design of an evaluation of HCV TasP in England.
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Affiliation(s)
- Matthew Hickman
- Population Health Sciences, Bristol Medical School, Bristol, Bristol, UK
| | - John F Dillon
- Hepatology & Gastroenterology, Clinical & Molecular Medicine, School of Medicine, University of Dundee, Dundee, UK
| | | | - Daniela De Angelis
- MRC Biostatistics Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, Bristol, Bristol, UK
| | - Graham Foster
- Blizard Institute, Queen Mary University of London, London, UK
- Barts Health NHS Trust, London, UK
| | - Peter Donnan
- Dundee Epidemiology and Biostatistics Unit, University of Dundee, Dundee, UK
| | | | | | - David Goldberg
- Glasgow Caledonian University, Glasgow, UK
- Health Protection Scotland, Glasgow, UK
| | | | - Samreen Ijaz
- National Infection Service, Public Health England, London, UK
| | | | - Sema Mandal
- National Infection Service, Public Health England, London, UK
| | - Natasha Martin
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, UK
| | - Lewis J Z Beer
- Tayside Clinical Trials Unit, Tayside Medical Science Centre, University of Dundee, Dundee, UK
| | - Kate Drysdale
- Blizard Institute, Queen Mary University of London, London, UK
- Barts Health NHS Trust, London, UK
| | - Hannah Fraser
- Population Health Sciences, Bristol Medical School, Bristol, Bristol, UK
| | - Rachel Glass
- National Infection Service, Public Health England, London, UK
| | | | - Rory N Gunson
- West Of Scotland Specialist Virology Centre, NHS Greater Glasgow & Clyde Board, Glasgow, UK
| | | | - Helen Harris
- National Infection Service, Public Health England, London, UK
| | | | - Ross Harris
- National Infection Service, Public Health England, London, UK
| | | | - Vivian Hope
- Liverpool John Moores University, Liverpool, UK
| | - Jeremy Horwood
- Population Health Sciences, Bristol Medical School, Bristol, Bristol, UK
| | - Sarah Karen Inglis
- Tayside Clinical Trials Unit, Tayside Medical Science Centre, University of Dundee, Dundee, UK
| | - Hamish Innes
- Glasgow Caledonian University, Glasgow, UK
- Health Protection Scotland, Glasgow, UK
| | - Athene Lane
- Population Health Sciences, Bristol Medical School, Bristol, Bristol, UK
| | - Jade Meadows
- Population Health Sciences, Bristol Medical School, Bristol, Bristol, UK
| | - Andrew McAuley
- Glasgow Caledonian University, Glasgow, UK
- Health Protection Scotland, Glasgow, UK
| | - Chris Metcalfe
- Population Health Sciences, Bristol Medical School, Bristol, Bristol, UK
| | | | | | - Gareth Myring
- Population Health Sciences, Bristol Medical School, Bristol, Bristol, UK
| | - Norah E Palmateer
- Glasgow Caledonian University, Glasgow, UK
- Health Protection Scotland, Glasgow, UK
| | - Anne Presanis
- MRC Biostatistics Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Andrew Radley
- Hepatology & Gastroenterology, Clinical & Molecular Medicine, School of Medicine, University of Dundee, Dundee, UK
- Directorate of Public Health, NHS Tayside, Dundee, UK
| | - Mary Ramsay
- National Infection Service, Public Health England, London, UK
| | - Pantelis Samartsidis
- MRC Biostatistics Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Ruth Simmons
- National Infection Service, Public Health England, London, UK
| | - Katy Sinka
- National Infection Service, Public Health England, London, UK
| | | | - Zoe Ward
- Population Health Sciences, Bristol Medical School, Bristol, Bristol, UK
| | | | - Alan Yeung
- Glasgow Caledonian University, Glasgow, UK
- Health Protection Scotland, Glasgow, UK
| | - Sharon J Hutchinson
- Glasgow Caledonian University, Glasgow, UK
- Health Protection Scotland, Glasgow, UK
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Inglis SK, Beer LJ, Byrne C, Malaguti A, Robinson E, Sharkey C, Gillings K, Stephens B, Dillon JF. Randomised controlled trial conducted in injecting equipment provision sites to compare the effectiveness of different hepatitis C treatment regimens in people who inject drugs: A Direct obserVed therApy versus fortNightly CollEction study for HCV treatment-ADVANCE HCV protocol study. BMJ Open 2019; 9:e029516. [PMID: 31399460 PMCID: PMC6701606 DOI: 10.1136/bmjopen-2019-029516] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 06/17/2019] [Accepted: 07/02/2019] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Hepatitis C is a blood-borne virus (HCV) that can seriously damage the liver and is spread mainly through blood-to-blood contact with an infected person. Over 85% of individuals who have HCV in Scotland became infected following injecting drug use. Since people who inject drugs (PWID) are the main source of new infections, theoretical modelling has suggested that treatment of HCV infection in PWID may effectively reduce HCV prevalence and accomplish elimination. This protocol describes a clinical trial delivering HCV treatment within injecting equipment provision sites (IEPS) in Tayside, Scotland. METHODS AND ANALYSIS PWID attending IEPS are tested for HCV and, if they are chronically infected with HCV and eligible, invited to receive treatment within the IEPS. They are randomised to one of three treatment regimens; daily observed treatment, treatment dispensed every 2 weeks and treatment dispensed every 2 weeks together with an adherence psychological intervention (administered before treatment begins). The primary outcome is comparison of the rate of successful treatment (SVR12) in each treatment group. Secondary analyses include assessment of adherence, reinfection rates, viral resistance to treatment and interaction of the treatment with illicit drugs. ETHICS AND DISSEMINATION The ADVANCE (A Direct obserVed therApy versus fortNightly CollEction) HCV trial was given favourable opinion by East of Scotland Research Ethics Committee (LR/17/ES/0089) prior to commencement. TRIAL REGISTRATION NUMBERS European Clinical Trials Database (EudraCT) (2017-001039-38) and ClinicalTrials.gov (NCT03236506).
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Affiliation(s)
- Sarah K Inglis
- Tayside Clinical Trials Unit, University of Dundee, Dundee, UK
| | - Lewis Jz Beer
- Tayside Clinical Trials Unit, University of Dundee, Dundee, UK
| | | | - Amy Malaguti
- School of Social Sciences (Psychology), University of Dundee, Dundee, UK
| | - Emma Robinson
- Molecular and Clinical Medicine, University of Dundee, Dundee, UK
- Specialist liver service, NHS Tayside, Dundee, UK
| | | | | | | | - John F Dillon
- Molecular and Clinical Medicine, University of Dundee, Dundee, UK
- Specialist liver service, NHS Tayside, Dundee, UK
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Alavi M, Poustchi H, Merat S, Kaveh-Ei S, Rahimi-Movaghar A, Shadloo B, Hajarizadeh B, Grebely J, Dore GJ, Malekzadeh R. An intervention to improve HCV testing, linkage to care, and treatment among people who use drugs in Tehran, Iran: The ENHANCE study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 72:99-105. [PMID: 31303262 DOI: 10.1016/j.drugpo.2019.07.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/21/2019] [Accepted: 07/02/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Globally, HCV testing, linkage to care and treatment is sub-optimal among people who use drugs (PWUD). This study aimed to evaluate the impact of an innovative intervention to enhance HCV testing, linkage to care, and treatment initiation among PWUD in Tehran, Iran. METHODS ENHANCE is a non-randomized trial evaluating the effect of on-site rapid HCV antibody testing, venepuncture for HCV RNA testing (HCV antibody positive only), liver fibrosis assessment, and linkage to care to enhance direct-acting antiviral (DAA) therapy (sofosbuvir/daclatasvir) initiation for HCV among people with a history of drug use. Recruitment was from April 2018 and will continue to July 2019, through three opioid substitution treatment (OST) clinics, five community-based drop-in centres, and one homeless reception centre. Participants initiated DAA therapy at a specialist clinic (OST clinics) or on-site (other sites), with monitoring provided on-site or at the specialist clinic (for those with cirrhosis attending OST clinics). RESULTS Among 632 participants enrolled (median age, 44 years), 97% were male, 28% had a history of injecting drug use, and 58% had used drugs within the previous year. HCV antibody prevalence was 27%; 62% and 15% among those with and without a history of injecting drug use. Among 170 HCV antibody positive participants, 168 had HCV RNA testing (99%), of whom 134 (80%) were positive. Among HCV RNA positive participants, treatment initiation was 84%: 100% (45/45), 96% (46/48) and 54% (22/41) in OST clinics, drop-in centres, and homeless reception settings, respectively. CONCLUSION Following on-site HCV testing and linkage to care, HCV treatment uptake was extremely high among PWUD, apart from the homeless reception population. This intervention could be explored in other settings globally to enhance HCV scale-up and elimination efforts.
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Affiliation(s)
- Maryam Alavi
- Viral Hepatitis Clinical Research Program, The Kirby Institute, UNSW Sydney, Sydney, NSW 2052, Australia; Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Hossein Poustchi
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahin Merat
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Soudeh Kaveh-Ei
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Afarin Rahimi-Movaghar
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Behrang Shadloo
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Behzad Hajarizadeh
- Viral Hepatitis Clinical Research Program, The Kirby Institute, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Jason Grebely
- Viral Hepatitis Clinical Research Program, The Kirby Institute, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Gregory J Dore
- Viral Hepatitis Clinical Research Program, The Kirby Institute, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Reza Malekzadeh
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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High rates of early HCV reinfection after DAA treatment in people with recent drug use attended at mobile harm reduction units. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 72:181-188. [PMID: 31253391 DOI: 10.1016/j.drugpo.2019.06.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 06/15/2019] [Accepted: 06/17/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS The World Health Organization recently called for the elimination of hepatitis C virus (HCV) and has identified people who inject drugs (PWID) as a key target population. Clinical trials analyzing currently available all-oral regimens have demonstrated a high degree of efficacy in this population, with a relatively low reinfection rate. There is an urgent need to confirm these data in a harm reduction and active consumption setting. The primary aim of this study was to evaluate the HCV reinfection rate in people with recent drug use followed at low-threshold mobile harm reduction units. METHOD We included people with recent drug use (smoked or injected heroin/cocaine in the previous 6 months) who received HCV treatment and were attended at two low-threshold mobile harm reduction units over 19 months. Sustained virologic response was assessed 12 weeks after therapy (SVR12). The incidence density of HCV reinfection was defined as the number of reinfections per 100-person years (PY) using person-time of observation and was stratified by drug consumption at initiation of HCV treatment. Cox proportional hazard regression analysis was used to assess factors associated with reinfection. RESULTS During the study period, 160 people who used drugs in the past 6 months completed HCV therapy. 122 (73.9%) and 88 (53.3%) reported injecting drug use in the 6 months and 30 days prior to HCV treatment, respectively. The overall SVR12 was 68% in the ITT analysis (reinfection = failure) and 90.7% in the modified intent-to-treat analysis (considering reinfections as response and removing people who were missing SVR data). The cohort at-risk for reinfection (n = 121) included 47 (39.2%) people who initiated HCV treatment with recently reported abstinence. Reinfection was identified in 10 persons (8.3%), and the median time to reinfection was 7.2 (IQR 4.2-18) months. Total follow-up time at-risk was 101.1-PY (median 0.6 years, IQR 0.3-1.3). The overall incidence of reinfection was 9.8 per 100-PY (95% CI 4.7,18.2). The incidence of reinfection was higher amongst those who had injected drugs in the previous 6 months (16.7 [95%CI 8.0; 30.7] per 100-PY) and in the previous 30 days (18.9 [95% CI 8.1; 37.2] per 100-PY). In the adjusted analysis, only injecting drugs use in the month prior to initiation of HCV therapy was associated with reinfection (aHR 8.7, 95%CI 1.0; 73.6; p 0.04). CONCLUSION High efficacy of HCV treatment, was found in people with recent drug use attended and followed at low-threshold mobile harm reduction units. The high rate of early HCV reinfections in this setting should promote surveillance for reinfection at 7-month intervals after ending the treatment or earlier.
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Cachay ER, Mena A, Morano L, Benitez L, Maida I, Ballard C, Hill L, Torriani F, Castro A, Dore E, Castro S, de Mendoza Fernández C, Soriano V, Mathews WC. Predictors of Hepatitis C Treatment Failure After Using Direct-Acting Antivirals in People Living With Human Immunodeficiency Virus. Open Forum Infect Dis 2019; 6:ofz070. [PMID: 30949524 PMCID: PMC6440685 DOI: 10.1093/ofid/ofz070] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 02/10/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Little is known about the influence of ongoing barriers to care in the persistence of hepatitis C virus (HCV) viremia after treatment with direct-acting antivirals (DAAs) among people living with human immunodeficiency virus (PLWH). METHODS We conducted a retrospective cohort analysis of PLWH treated through the standard of care in 3 Western countries, to investigate the predictors of HCV treatment failure (clinical or virologic), defined as having a detectable serum HCV ribonucleic acid within 12 weeks after DAA discontinuation. In addition to HCV and liver-related predictors, we collected data on ongoing illicit drug use, alcohol abuse, mental illness, and unstable housing. Logistic regression analyses were used to identify predictors of HCV treatment failure. RESULTS Between January 2014 and December 2017, 784 PLWH were treated with DAA, 7% (n = 55) of whom failed HCV therapy: 50.9% (n = 28) had a clinical failure (discontinued DAA therapy prematurely, died, or were lost to follow-up), 47.3% (n = 26) had an HCV virologic failure, and 1 (1.8%) was reinfected with HCV. Ongoing drug use (odds ratio [OR] = 2.60) and mental illness (OR = 2.85) were independent predictors of any HCV treatment failure. Having both present explained 20% of the risk of any HCV treatment failure due to their interaction (OR = 7.47; P < .0001). Predictors of HCV virologic failure were ongoing illicit drug use (OR = 2.75) and advanced liver fibrosis (OR = 2.29). CONCLUSIONS People living with human immunodeficiency virus with ongoing illicit drug use, mental illness, and advanced liver fibrosis might benefit from enhanced DAA treatment strategies to reduce the risk of HCV treatment failure.
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Affiliation(s)
- Edward R Cachay
- Department of Medicine, Division of Infectious Diseases, Owen Clinic, UC San Diego, California
| | - Alvaro Mena
- Unidad de Enfermedades Infecciosas, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Luis Morano
- Unidad de Patología Infecciosa, Hospital Universitario Álvaro Cunqueiro, Instituto de Investigación Sanitaria Galicia Sur, Vigo, Spain
| | - Laura Benitez
- Servicio de Medicina Interna, Puerta de Hierro Research Institute and University Hospital, Madrid, Spain
| | | | - Craig Ballard
- Skaggs School of Pharmacy and Pharmaceutical Sciences, UC San Diego, California
| | - Lucas Hill
- Skaggs School of Pharmacy and Pharmaceutical Sciences, UC San Diego, California
| | - Francesca Torriani
- Department of Medicine, Division of Infectious Diseases, Owen Clinic, UC San Diego, California
| | - Angeles Castro
- Unidad de Enfermedades Infecciosas, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | | | - Sheila Castro
- Unidad de Patología Infecciosa, Hospital Universitario Álvaro Cunqueiro, Instituto de Investigación Sanitaria Galicia Sur, Vigo, Spain
| | | | - Vicente Soriano
- UNIR Health Sciences School and La Paz University Hospital, Madrid, Spain
| | - Wm C Mathews
- Department of Medicine, Division of Infectious Diseases, Owen Clinic, UC San Diego, California
| | - HCV-TREN Cohort
- Department of Medicine, Division of Infectious Diseases, Owen Clinic, UC San Diego, California
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