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Cook C, Reid L, Elsharkawy AM, Radley A, Smith S, McPherson S, Crockford D, Dillon JF, Wright M, Morris D, Malik H, Keall S, Powell J, Catt J, Hampton H, Boothman H, Shah S, Spear J, Ustianoski A, John P, Stevens H, Khakoo SI, Parkes J, Buchanan RM. The implementation of a hepatitis C testing service in community pharmacies: I-COPTIC consensus statement. Public Health 2024; 232:153-160. [PMID: 38781782 DOI: 10.1016/j.puhe.2024.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/21/2024] [Accepted: 04/09/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVES This aimed to develop a blueprint for an effective community pharmacy Hepatitis C virus (HCV) testing service by producing a consensus statement. STUDY DESIGN This was a modified Delphi process. METHODS We recruited a heterogenous panel of experts (who had been involved in the setup or delivery of a community pharmacy HCV testing service) by purposive and chain referral methods. We had three rounds of a modified Delphi process. The first was a series of questions with free text responses and was analysed using thematic analysis, and the second and third were statements for the respondents to rate using a 7-point Likert scale. Consensus was predefined in a published protocol, and the results were reviewed by a public and patient involvement panel before the statement was finalised. RESULTS We had 24 participants, including community and hospital-based pharmacists, local pharmaceutical committee members, charity representatives (Hepatitis C Trust), local clinical service lead, nurse specialists and doctors. The response rate of the first, second and third rounds were 100%, 96% and 88%, respectively. After the third round, we had 60 statements that reached consensus. We discussed the accepted statements with a patient and public involvement group. We used these statements to produce the I-COPTIC statement and a graphical summary. CONCLUSIONS We developed a blueprint for the design of a gold standard community pharmacy HCV testing service. We believe this will support the successful implementation of community pharmacy testing for HCV. Community pharmacy testing is an important service to help achieve and maintain HCV elimination.
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Affiliation(s)
- C Cook
- University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK.
| | - L Reid
- Hepatitis C Trust, 72 Weston Street, London, SE1 3QG, UK.
| | - A M Elsharkawy
- Liver Unit and NIHR Biomedical Research Centre at University Hospitals Birmingham NHS Trust and University of Birmingham, Edgbaston, Birmingham, B15 2TH, UK.
| | - A Radley
- NHS Tayside/University of Dundee, Nethergate, Dundee, DD1 4HN, UK.
| | - S Smith
- Hepatitis C Trust, 72 Weston Street, London, SE1 3QG, UK.
| | - S McPherson
- Liver Unit and NIHR Biomedical Research Centre, The Newcastle Upon Tyne Hospitals NHS Foundation Trust and Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK.
| | - D Crockford
- Community Pharmacy South Central, Sentinel House, Harvest Crescent, Fleet, Hampshire, GU51 2UZ, UK.
| | - J F Dillon
- University of Dundee, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK.
| | - M Wright
- University Hospitals Southampton, Tremona Road, Southampton, SO16 6YD, UK.
| | - D Morris
- Hepatitis C Trust, 72 Weston Street, London, SE1 3QG, UK.
| | - H Malik
- Carter's Chemist 114-116 Fowler Street, Southshields, NE33 1PZ, UK.
| | - S Keall
- Community Pharmacy Tees Valley, UK.
| | - J Powell
- Community Pharmacy Surrey and Sussex, PO Box 1061A, Surbiton, KT1 9HJ, UK.
| | - J Catt
- Kings College Hospital, Denmark Hill, London, SE5 9RS, UK.
| | - H Hampton
- Royal Cornwall Hospital, Treliske, Truro, Cornwall, TR1 3LJ, UK.
| | - H Boothman
- St George's NHS Foundation Trust, Blackshaw Road, Tooting, London, SW17 0QT, UK.
| | - S Shah
- Kings College Hospital, Denmark Hill, London, SE5 9RS, UK.
| | - J Spear
- University Hospital of Leicester, University Road, Leicester, LE1 7RH, UK.
| | - A Ustianoski
- Manchester University Foundation Trust & University of Manchester UK, Regional Infectious Diseases Unit, North Manchester General Hospital, Delaunays Road, Manchester, M8 5RB, UK.
| | - P John
- University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK.
| | - H Stevens
- University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK.
| | - S I Khakoo
- University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK.
| | - J Parkes
- University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK.
| | - R M Buchanan
- University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK.
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Pol S, Thompson AJ, Collins M, Venier E, Cotte L, Laguno Centeno M, Mera J, Reiberger T, Burroughs M, Semizarov DG, Iacob AM, Welhaven A, Fredrick LM, Doyle JS. Effectiveness and safety of glecaprevir/pibrentasvir for 8 weeks in the treatment of patients with acute hepatitis C: A single-arm retrospective study. Hepatology 2024:01515467-990000000-00885. [PMID: 38768260 DOI: 10.1097/hep.0000000000000923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 04/24/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND AND AIMS No direct-acting antiviral is currently approved for acute HCV infection, delaying treatment. We investigated the effectiveness and safety of 8-week glecaprevir/pibrentasvir (G/P) in patients with acute HCV infection. APPROACH AND RESULTS This noninterventional, single-arm, retrospective chart review was designed to enroll adults/adolescents with acute HCV infection. Analyses were conducted on a full analysis set (FAS; all enrolled) and modified FAS (FAS excluding nonvirologic failures). The primary end point (modified FAS) was sustained virologic response at posttreatment week 12 (SVR12) with superiority to 92.6% threshold determined by historic chronic HCV G/P SVR12 rates. Secondary end points (FAS) included SVR12, on-treatment virologic failure, posttreatment relapse, and reinfection. Adverse events and safety laboratory values were assessed.Overall, 202 adults were enrolled; in the modified FAS, 150/151 (99.3%; 95% CI: 96.3-99.9) achieved SVR12, demonstrating superiority to efficacy threshold. In the FAS, the SVR12 rate was 74.3% and the on-treatment virologic failure rate was 0%. Relapse and reinfection rates after the final treatment visit (FAS) were 0.5% and 3%, respectively; 39 patients had missing SVR12 data. No on-treatment alanine aminotransferase elevations > 3 × upper limit of normal with total bilirubin > 2 × upper limit of normal were reported. All 53 patients with alanine aminotransferase Grade ≥ 2 at baseline improved to Grade 0/1 on treatment. No adverse eventss of hepatic decompensation/failure or leading to G/P discontinuation occurred. Two patients had serious adverse events unrelated to G/P. CONCLUSIONS Eight-week G/P therapy was effective and well-tolerated in patients with acute HCV infection. Data support further investigation of G/P in acute HCV to shorten care cascades, reduce transmission, and support HCV elimination.
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Affiliation(s)
- Stanislas Pol
- Department of Hepatology/Addictology, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Paris, France
- Université de Paris Cité, Paris, France
| | - Alexander J Thompson
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia
- Medicine, Dentistry and Health Services, University of Melbourne, Melbourne, Victoria, Australia
| | - Michelle Collins
- Global Medical Affairs, AbbVie Inc., North Chicago, Illinois, USA
| | - Elisa Venier
- Addiction Medical Services, Toronto, Ontario, Canada
| | - Laurent Cotte
- Maladies Infectieuses, Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Lyon, France
| | | | - Jorge Mera
- Department of Infectious Diseases, Cherokee Nation Health Services, Tahlequah, Oklahoma, United States
| | - Thomas Reiberger
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | | | | | | | - Anne Welhaven
- Global Pharmaceutical R&D, AbbVie Inc., North Chicago, Illinois, USA
| | - Linda M Fredrick
- Global Pharmaceutical R&D, AbbVie Inc., North Chicago, Illinois, USA
| | - Joseph S Doyle
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Australia
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
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3
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Kapadia SN, Jordan AE, Eckhardt BJ, Perlman DC. The Urgent Need to Implement Point-of-Care RNA Testing for Hepatitis C Virus to Support Elimination. Clin Infect Dis 2024; 78:1235-1239. [PMID: 37633653 PMCID: PMC11093654 DOI: 10.1093/cid/ciad503] [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: 05/30/2023] [Revised: 07/27/2023] [Accepted: 08/22/2023] [Indexed: 08/28/2023] Open
Abstract
Hepatitis C virus (HCV) elimination is an important global public health goal. However, the United States is not on track to meet the World Health Organization's 2030 targets for HCV elimination. Recently, the White House proposed an HCV elimination plan that includes point-of-care (POC) HCV RNA testing, which is currently in use in many countries but is not approved in the United States. POC HCV RNA testing is crucial for implementing community-based testing and for enabling test-and-treat programs, assessing cure, and monitoring for reinfection. Here, we review the status of POC HCV RNA testing in the United States, discuss factors that are needed for successful implementation, and issue specific public health and policy recommendations that would allow for the use of POC HCV RNA testing to support HCV elimination.
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Affiliation(s)
- Shashi N Kapadia
- Division of Infectious Diseases, Weill Cornell Medicine, New York, New York, USA
| | - Ashly E Jordan
- Center for Drug Use and HIV/HCV Research, New York, New York, USA
| | - Benjamin J Eckhardt
- Division of Infectious Diseases, New York University School of Medicine, New York, New York, USA
| | - David C Perlman
- Center for Drug Use and HIV/HCV Research, New York, New York, USA
- Division of Infectious Diseases, Icahn School of Medicine at Mt Sinai, New York, New York, USA
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4
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Anderson ES, Frazee BW. The Intersection of Substance Use Disorders and Infectious Diseases in the Emergency Department. Emerg Med Clin North Am 2024; 42:391-413. [PMID: 38641396 DOI: 10.1016/j.emc.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
Substance use disorders (SUDs) intersect clinically with many infectious diseases, leading to significant morbidity and mortality if either condition is inadequately treated. In this article, we will describe commonly seen SUDs in the emergency department (ED) as well as their associated infectious diseases, discuss social drivers of patient outcomes, and introduce novel ED-based interventions for co-occurring conditions. Clinicians should come away from this article with prescriptions for both antimicrobial medications and pharmacotherapy for SUDs, as well as an appreciation for social barriers, to care for these patients.
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Affiliation(s)
- Erik S Anderson
- Department of Emergency Medicine, Alameda Health System, Wilma Chan Highland Hospital, 1411 East 31st Street, Oakland, CA 94602, USA; Division of Addiction Medicine, Highland Hospital, Alameda Health System, 1411 East 31st Street, Oakland, CA 94602, USA.
| | - Bradley W Frazee
- Department of Emergency Medicine, Alameda Health System, Wilma Chan Highland Hospital, 1411 East 31st Street, Oakland, CA 94602, USA
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5
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Wolfson-Stofko B, Hirode G, Vanderhoff A, Karkada J, Capraru C, Biondi MJ, Hansen B, Shah H, Janssen HLA, Feld JJ. Real-world hepatitis C prevalence and treatment uptake at opioid agonist therapy clinics in Ontario, Canada. J Viral Hepat 2024; 31:240-247. [PMID: 38385850 DOI: 10.1111/jvh.13931] [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: 10/28/2023] [Revised: 02/02/2024] [Accepted: 02/15/2024] [Indexed: 02/23/2024]
Abstract
Widespread screening for hepatitis C virus (HCV) is necessary for Canada to meet its HCV elimination goals by 2030. People who currently or previously injected drugs are at high risk for HCV. Opioid agonist therapy (OAT, such as methadone and buprenorphine) has been shown to help stabilize the lives of people who are opioid-dependent. The distribution of OAT in North America typically requires daily, weekly, or monthly clinic visits and presents an opportunity for engagement, screening and treatment for those at high-risk of HCV. In this study, HCV screening was conducted by staff at OAT clinics in Ontario from 2016 to 2020 and those with chronic infections were treated on-site with direct-acting antivirals. Point-of-care or dried blood spot (DBS) testing was used for antibodies, DBS or serum for HCV RNA and serum for HCV RNA at SVR12 (sustained virological response). Clinics screened 1954 people (mean age 40 years ±12, 63% male). Forty-five percent were antibody positive, of whom 64% were HCV RNA+. Eighty percent of those RNA+ set an appointment in which 99% attended. Ninety-six percent started treatment with 87% completing treatment. Sixty-eight percent of people who completed treatment submitted a sample for SVR12 testing of which 97% achieved a virological cure. Results suggest that HCV screening and treatment at OAT clinics is feasible, effective and warrants expansion. Data suggest strong treatment adherence due to high rates of SVR12 comparable with other OAT-based HCV treatment programs. The lack of SVR12 sampling could be addressed by either on-site phlebotomy or incentivizing SVR12 sampling.
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Affiliation(s)
- B Wolfson-Stofko
- Viral Hepatitis Care Network (VIRCAN), Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada
- Center for Drug Use and HIV/HCV Research (CDUHR), College of Global Public Health, New York University, New York, New York, USA
| | - G Hirode
- Viral Hepatitis Care Network (VIRCAN), Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada
| | - A Vanderhoff
- Viral Hepatitis Care Network (VIRCAN), Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada
| | - J Karkada
- Viral Hepatitis Care Network (VIRCAN), Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada
| | - C Capraru
- Viral Hepatitis Care Network (VIRCAN), Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada
| | - M J Biondi
- Viral Hepatitis Care Network (VIRCAN), Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada
- School of Nursing, York University, Toronto, Ontario, Canada
| | - B Hansen
- Viral Hepatitis Care Network (VIRCAN), Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada
- Division of Gastroenterology & Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Biostatistics, Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - H Shah
- Viral Hepatitis Care Network (VIRCAN), Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada
| | - H L A Janssen
- Viral Hepatitis Care Network (VIRCAN), Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada
- Division of Gastroenterology & Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - J J Feld
- Viral Hepatitis Care Network (VIRCAN), Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada
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6
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Obeagu EI, Obeagu GU, Ubosi NI, Uzoma IC, Tayrab EMA. Concurrent management of HIV and malaria: A comprehensive review of strategies to enhance quality of life. Medicine (Baltimore) 2024; 103:e37649. [PMID: 38579091 PMCID: PMC10994515 DOI: 10.1097/md.0000000000037649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/27/2024] [Indexed: 04/07/2024] Open
Abstract
The co-occurrence of human immunodeficiency virus and malaria presents a complex medical scenario, significantly impacting the quality of life for affected individuals. This comprehensive review synthesizes current knowledge, challenges, and strategies concerning the concurrent management of these infections to improve overall well-being. Epidemiological insights reveal the prevalence and demographic trends, highlighting geographical areas of concern and socioeconomic factors contributing to the burden of co-infection. Pathophysiological interactions elucidate the compounding effects, altering disease progression and treatment outcomes. Healthcare challenges underscore the necessity for integrated care models, evaluating existing healthcare frameworks and their efficacy in addressing dual infections. In-depth analysis of interventions explores pharmacological, behavioral, and preventive measures, evaluating their efficacy and safety in co-infected individuals. Additionally, the review assesses psychosocial support mechanisms, emphasizing community-based interventions and peer networks in enhancing holistic care. Consideration is given to the role of antiretroviral therapy, malaria prevention strategies, and the evolving landscape of healthcare delivery in optimizing outcomes for this vulnerable population. The paper concludes by emphasizing the significance of multidisciplinary approaches and integrated care models, stressing the need for continued research and collaborative efforts to advance interventions and improve the quality of life for those navigating the complexities of human immunodeficiency virus and malaria co-infection.
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Affiliation(s)
| | | | - Nwanganga Ihuoma Ubosi
- Department of Medical Laboratory Science, Kampala International University, Kampala, Uganda
- Department of Public Health Sciences, Faculty of Health Sciences, National Open University of Nigeria, Jabi, Abuja, Nigeria
| | - Ijeoma Chinwe Uzoma
- Molecular-Hematology and Immuno Genetics Unit, Department of Medical Laboratory Science, Faculty of Health Sciences and Technology, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Eltayeb Mohamed Ahmed Tayrab
- Chemical Pathology, Department of Pathology, Faculty of Medicine and Dentistry, Kampala International University, Kampala, Uganda
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7
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Midgard H, Malme KB, Pihl CM, Berg-Pedersen RM, Tanum L, Klundby I, Haug A, Tveter I, Bjørnestad R, Olsen IC, Finbråten AK, Dalgard O. Opportunistic Treatment of Hepatitis C Infection Among Hospitalized People Who Inject Drugs (OPPORTUNI-C): A Stepped Wedge Cluster Randomized Trial. Clin Infect Dis 2024; 78:582-590. [PMID: 37992203 PMCID: PMC10954343 DOI: 10.1093/cid/ciad711] [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: 07/24/2023] [Revised: 09/28/2023] [Accepted: 11/17/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND We aimed to evaluate the efficacy of opportunistic treatment of hepatitis C virus (HCV) infection among hospitalized people who inject drugs (PWID). METHODS We performed a pragmatic, stepped wedge cluster randomized trial recruiting HCV RNA positive individuals admitted for inpatient care in departments of internal medicine, addiction medicine, and psychiatry at three hospitals in Oslo, Norway. Seven departments were sequentially randomized to change from control conditions (standard of care referral to outpatient care) to intervention conditions (immediate treatment initiation). The primary outcome was treatment completion, defined as dispensing the final package of the prescribed treatment within six months after enrolment. RESULTS A total of 200 HCV RNA positive individuals were enrolled between 1 October 2019 and 31 December 2021 (mean age 47.4 years, 72.5% male, 60.5% injected past 3 months, 20.4% cirrhosis). Treatment completion was accomplished by 67 of 98 (68.4% [95% confidence interval {CI}: 58.2-77.4]) during intervention conditions and by 36 of 102 (35.3% [95% CI: 26.1-45.4]) during control conditions (risk difference 33.1% [95% CI: 20.0-46.2]; risk ratio 1.9 [95% CI: 1.4-2.6]). The intervention was superior in terms of treatment completion (adjusted odds ratio [aOR] 4.8 [95% CI: 1.8-12.8]; P = .002) and time to treatment initiation (adjusted hazard ratio [aHR] 4.0 [95% CI: 2.5-6.3]; P < .001). Sustained virologic response was documented in 60 of 98 (61.2% [95% CI: 50.8-70.9]) during intervention and in 66 of 102 (64.7% [95% CI: 54.6-73.9]) during control conditions. CONCLUSIONS An opportunistic test-and-treat approach to HCV infection was superior to standard of care among hospitalized PWID. The model of care should be considered for broader implementation. Clinical Trials Registration. NCT04220645.
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Affiliation(s)
- Håvard Midgard
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
- Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway
| | - Kristian Braathen Malme
- Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Charlotte Meinich Pihl
- Department of Medicine, Lovisenberg Diaconal Hospital, Oslo, Norway
- Unger-Vetlesen Institute, Lovisenberg Diaconal Hospital, Oslo, Norway
| | | | - Lars Tanum
- Department for Research and Development in Mental Health, Akershus University Hospital, Lørenskog, Norway
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Ingvild Klundby
- Department of Microbiology, Oslo University Hospital, Oslo, Norway
| | - Anne Haug
- Department of Acute Medicine, Oslo University Hospital, Oslo, Norway
| | - Ida Tveter
- Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway
| | | | - Inge Christoffer Olsen
- Department of Research Support for Clinical Trials, Oslo University Hospital, Oslo, Norway
| | - Ane-Kristine Finbråten
- Department of Medicine, Lovisenberg Diaconal Hospital, Oslo, Norway
- Unger-Vetlesen Institute, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Olav Dalgard
- Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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8
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Kondili LA, Craxi A. Hepatitis C elimination: Tailoring the approach to each country's needs and realities. Hepatology 2024:01515467-990000000-00776. [PMID: 38441956 DOI: 10.1097/hep.0000000000000824] [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: 02/13/2024] [Accepted: 02/13/2024] [Indexed: 05/06/2024]
Affiliation(s)
- Loreta A Kondili
- Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
- Dentistry Department, Unicamillus International Medical University, Rome, Italy
| | - Antonio Craxi
- Gastroenterology and Hepatology Unit, PROMISE, University of Palermo, Palermo, Italy
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9
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Fang K, Wang HL, Lin Y, Zheng L, Li S, Wu J. Universal screening and treatment towards the elimination of chronic hepatitis C in China: an economic evaluation. Public Health 2024; 228:186-193. [PMID: 38387115 DOI: 10.1016/j.puhe.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 11/12/2023] [Accepted: 01/12/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVES China has the largest number of hepatitis C virus (HCV) infection in the world, but current levels of diagnosis and treatment are low. The objective of this study was to assess the cost-effectiveness of various universal HCV screening and treatment strategies in China and inform decisions on health policy. STUDY DESIGN A cost-effectiveness analytical study. METHODS We developed a Markov model to investigate cost-effectiveness of different HCV screening and treatment strategies in China. We simulated several screening scenarios for Chinese people aged 18-70 years. We estimated incremental cost-effectiveness ratios (ICERs) of different intervention scenarios compared with status quo. RESULTS Expanded HCV screening and treatment strategy with prioritisation for high-risk groups (Scenario S5) was the most cost-effective strategy (ICER: USD $11,667.71/quality-adjusted life-year [QALY] gained), which resulted in great reduction in HCV-related diseases and deaths, with a 67.11% reduction in cases of chronic HCV. Universal HCV screening and treatment implementation remains a cost-effective strategy when delayed until 2025 (ICER: USD $17,093.69/QALY), yet the delayed strategy is less effective in reducing HCV-related deaths. CONCLUSIONS Expanded HCV screening and treatment strategy with prioritisation for high-risk groups is the most cost-effective strategy and has lead to a significant reduction in both HCV morbidity and mortality in China, which would essentially eliminate HCV as a public threat.
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Affiliation(s)
- Kailu Fang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Hong-Liang Wang
- Hepatobiliary and Pancreatic Interventional Treatment Center, Division of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Yushi Lin
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Luyan Zheng
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Shuwen Li
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Jie Wu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China.
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10
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Tsui J, Gojic A, Pierce K, Tung E, Connolly N, Radick A, Hunt R, Sandvold R, Taber K, Ninburg M, Kubiniec R, Scott J, Hansen R, Stekler J, Austin E, Williams E, Glick S. Pilot study of a community pharmacist led program to treat hepatitis C virus among people who inject drugs. DRUG AND ALCOHOL DEPENDENCE REPORTS 2024; 10:100213. [PMID: 38261893 PMCID: PMC10796962 DOI: 10.1016/j.dadr.2023.100213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 01/25/2024]
Abstract
Background People who inject drugs (PWID) are a key population for treatment with direct-acting antiviral medications (DAAs) to eliminate hepatitis C virus (HCV). We developed a Pharmacist, Physician, and Patient Navigator Collaborative Care Model (PPP-CCM) for delivery of HCV treatment; this study describes clinical outcomes related to HCV treatment (initial evaluation, treatment initiation, completion, and cure), as well as patient satisfaction. Methods We conducted a single-arm prospective pilot study of adult PWID living with HCV. Participants completed baseline and six-month follow-up surveys, and treatment and outcomes were abstracted from electronic health records. Primary outcome was linkage to pharmacist for HCV evaluation; secondary outcomes included DAA initiation, completion, and cure, as well as patient-reported satisfaction. Results Of the 40 PWID enrolled, mean age was 43.6 years, 12 (30 %) were female, 20 (50 %) were non-white, and 15 (38 %) were unhoused. Thirty-eight (95 %) were successfully linked to the pharmacist for initial evaluation. Of those, 21/38 (55 %) initiated DAAs, and 16/21 (76 %) completed treatment. Among those completing treatment who had viral load data to document whether they achieved "sustained virologic response", i.e. cure, 10/11 (91 %) were found to be cured. There was high satisfaction with 100 % responding "agree or strongly agree" that they had a positive experience with the pharmacist. Conclusion Nearly all participants in this pilot were successfully linked to the pharmacist for evaluation, and more than half were started on DAAs; results provide preliminary evidence of feasibility of pharmacist-led models of HCV treatment for PWID. Clinicaltrialsgov registration number NCT04698629.
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Affiliation(s)
- J.I. Tsui
- Department of Medicine, University of Washington School of Medicine, Division of General Internal Medicine University of Washington, Seattle, WA, United States
| | - A.J. Gojic
- Department of Medicine, University of Washington School of Medicine, Division of General Internal Medicine University of Washington, Seattle, WA, United States
| | - K.A. Pierce
- Kelley-Ross Pharmacy Group, Seattle, WA, United States
| | - E.L. Tung
- Kelley-Ross Pharmacy Group, Seattle, WA, United States
- Department of Pharmacy, University of Washington, Seattle, WA, United States
| | - N.C. Connolly
- Department of Medicine, University of Washington School of Medicine, Division of General Internal Medicine University of Washington, Seattle, WA, United States
| | - A.C. Radick
- Department of Medicine, University of Washington School of Medicine, Division of General Internal Medicine University of Washington, Seattle, WA, United States
| | - R.R. Hunt
- Des Moines University College of Osteopathic Medicine, Des Moines, IA, United States
| | - R. Sandvold
- Hepatitis Education Project, Seattle, WA, United States
| | - K. Taber
- Hepatitis Education Project, Seattle, WA, United States
| | - M. Ninburg
- Hepatitis Education Project, Seattle, WA, United States
| | - R.H. Kubiniec
- Evergreen Treatment Services, Seattle, WA, United States
| | - J.D. Scott
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle WA, United States
| | - R.N. Hansen
- Kelley-Ross Pharmacy Group, Seattle, WA, United States
- Department of Pharmacy, University of Washington, Seattle, WA, United States
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States
| | - J.D. Stekler
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle WA, United States
| | - E.J. Austin
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States
| | - E.C. Williams
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, VA Puget Sound, Seattle WA, United States
| | - S.N. Glick
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle WA, United States
- HIV/STI/HCV Program, Public Health - Seattle & King County, Seattle WA, United States
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11
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McGee-Avila JK, Argirion I, Engels EA, O’Brien TR, Horner MJ, Qiao B, Monterosso A, Luo Q, Shiels MS. Risk of hepatocellular carcinoma in people with HIV in the United States, 2001-2019. J Natl Cancer Inst 2024; 116:61-68. [PMID: 37610358 PMCID: PMC10777672 DOI: 10.1093/jnci/djad172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/06/2023] [Accepted: 08/17/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND People with HIV have higher risk of hepatocellular carcinoma than the general population, partly because of higher prevalence of coinfection with hepatitis B virus (HBV) or hepatitis C virus (HCV). METHODS We calculated standardized incidence ratios for hepatocellular carcinoma in people with HIV by comparing rates from people with HIV in the HIV/AIDS Cancer Match Study, a population-based HIV and cancer registry linkage, to those in the general population. We used multivariable Poisson regression to estimate adjusted incidence rate ratios among people with HIV and linked the Texas HIV registry with medical claims data to estimate adjusted odds ratios (AORs) of HBV and HCV in hepatocellular carcinoma patients with logistic regression. RESULTS Compared with the general population, hepatocellular carcinoma rates in people with HIV were elevated 2.79-fold (n = 1736; 95% confidence interval [CI] = 2.66 to 2.92). Hepatocellular carcinoma rates decreased statistically significantly from 2001-2004 to 2015-2019 (P < .001). Compared with men who have sex with men, hepatocellular carcinoma risk was elevated 4.28-fold among men who injected drugs (95% CI = 3.72 to 4.93) and 1.83-fold among women who injected drugs (95% CI = 1.49 to 2.26). In Texas, 146 hepatocellular carcinoma cases among people with HIV were linked to claims data: 25% HBV positive, 59% HCV positive, and 13% coinfected with HBV and HCV. Compared with men who had sex with men, people who inject drugs had 82% decreased odds of HBV (AOR = 0.18, 95% CI = 0.05 to 0.63) and 2 times the odds of HCV (AOR = 20.4, 95% CI = 3.32 to 125.3). CONCLUSIONS During 2001-2019, hepatocellular carcinoma risk declined among people with HIV, though rates remain statistically significantly elevated compared with the general population, particularly among people who inject drugs. Prevention and treatment of HBV/HCV are needed to reduce hepatocellular carcinoma risk among people with HIV.
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Affiliation(s)
- Jennifer K McGee-Avila
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Ilona Argirion
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Eric A Engels
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Thomas R O’Brien
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Marie-Josèphe Horner
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
- Trans-Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Baozhen Qiao
- Bureau of Cancer Epidemiology, New York State Department of Health, Albany, NY, USA
| | - Analise Monterosso
- HIV/STD/HCV Epidemiology and Surveillance Unit, Texas Department of State Health Services, Austin, TX, USA
| | - Qianlai Luo
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Meredith S Shiels
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
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12
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Scialli A, Saab S, Salimian A, Bhattacharya D, Goodman-Meza D. Hepatitis C Treatment Among Primary Care and Specialty Providers: A Single Center Study, 2015 to 2022. J Prim Care Community Health 2024; 15:21501319241253521. [PMID: 38727179 PMCID: PMC11088289 DOI: 10.1177/21501319241253521] [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: 03/25/2024] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 05/13/2024] Open
Abstract
INTRODUCTION Despite national goals to eliminate Hepatitis C (HCV) and the advancement of curative, well-tolerated direct-acting antiviral (DAAs) regimens, rates of HCV treatment have declined nationally since 2015. Current HCV guidelines encourage treatment of HCV by primary care providers (PCPs). Payors have reduced restrictions to access DAAs nationally and in California however it remains unclear if the removal of these restrictions has impacted the proportion of PCPs prescribing DAAs at a health system level. Our objective was to examine the proportion of DAAs prescribed by PCPs and specialists and to describe the population receiving treatment in a single health system from 2015 to 2022. METHODS We examined the proportion of DAAs prescribed by PCPs and specialists and the population receiving treatment through a retrospective analysis of claims data in the University of California, Los Angeles (UCLA) Health System from 2015 to 2022. We described number of prescriptions for HCV medication prescribed by PCPs and specialists by year, medication type, and physician specialty. We also described numbers of prescriptions by patient demographics and comorbidities. RESULTS A total of 1515 adult patients received a prescription for HCV medication through the UCLA Health System between 2015 and 2022. The proportion of patients receiving prescriptions for PCPs peaked at 19% in 2016, yet decreased to 5.7% in 2022, an average of 13% across all years. Median age of patients receiving treatment was 60 years old, and 56% of patients receiving HCV treatment had commercial insurance as their primary payer. CONCLUSIONS HCV treatment declined from 2015 to 2022 among specialists and PCPs in our health system. Older patients comprised the majority of patients receiving treatment, suggesting a need for novel approaches to reach patients under 40, an age group with significant increases in HCV transmission.
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Affiliation(s)
| | - Sammy Saab
- University of California, Los Angeles, CA, USA
- Pfleger Liver Institute, Los Angeles, CA, USA
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13
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Rennert L, Howard KA, Kickham CM, Gezer F, Coleman A, Roth P, Boswell K, Gimbel RW, Litwin AH. Implementation of a mobile health clinic framework for Hepatitis C virus screening and treatment: a descriptive study. LANCET REGIONAL HEALTH. AMERICAS 2024; 29:100648. [PMID: 38124995 PMCID: PMC10733089 DOI: 10.1016/j.lana.2023.100648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 11/21/2023] [Accepted: 11/28/2023] [Indexed: 12/23/2023]
Abstract
Background Although treatment for Hepatitis C Virus (HCV) is effective, individuals face access barriers. The utility of mobile health clinics (MHC), effective mechanisms for providing healthcare to underserved populations, is understudied for HCV-related interventions. We aimed to describe implementation of, and factors associated with, screening and treatment via MHCs. Methods Clemson Rural Health implemented a novel MHC program to reach and treat populations at-risk for HCV with a focus on care for uninsured individuals. We examined HCV screening and treatment initiation/completion indicators between May 2021 and January 2023. Findings Among 607 individuals screened across 31 locations, 94 (15.5%) tested positive via antibody and viral load testing. Treatment initiation and completion rates were 49.6% and 86.0%, respectively. Among those screened, the majority were male (57.5%), White (61.3%; Black/Hispanic: 28.2%/7.7%), and without personal vehicle as primary transportation mode (54.4%). Injection drug use (IDU) was 27.2% and uninsured rate was 42.8%. Compared to HCV-negative, those infected included more individuals aged 30-44 (52.1% vs. 36.4%, p = 0.023), male (70.2% vs. 55.2%, p = 0.009), White (78.5% vs. 60.2%, p < 0.0001), without personal vehicle (58.5% vs. 43.5%, p = 0.028), IDU (83.7% vs. 21.0%, p < 0.0001), and uninsured (61.2% vs. 48.8%, p = 0.050). Uninsured rates were higher among those initiating compared to not initiating treatment (74.5% vs. 45.3%, p = 0.004). Interpretation The MHC framework successfully reaching its target population: at-risk individuals with access barriers to healthcare. The high HCV screening and treatment initiation/completion rates demonstrate the utility of MHCs as effective and acceptable intervention settings among historically difficult-to-treat populations. Funding Gilead Sciences, Inc., and SC Center for Rural and Primary Healthcare.
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Affiliation(s)
- Lior Rennert
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
- Center for Public Health Modeling and Response, Clemson University, Clemson, SC, USA
| | - Kerry A. Howard
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
- Center for Public Health Modeling and Response, Clemson University, Clemson, SC, USA
| | | | - Fatih Gezer
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
- Center for Public Health Modeling and Response, Clemson University, Clemson, SC, USA
| | | | - Prerana Roth
- Prisma Health-Upstate, Greenville, SC, USA
- Clemson University School of Health Research, Clemson University, Clemson, SC, USA
- University of South Carolina School of Medicine Greenville, Greenville, SC, USA
| | | | - Ronald W. Gimbel
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
- Clemson Rural Health, Clemson University, Clemson, SC, USA
| | - Alain H. Litwin
- Prisma Health-Upstate, Greenville, SC, USA
- Clemson University School of Health Research, Clemson University, Clemson, SC, USA
- University of South Carolina School of Medicine Greenville, Greenville, SC, USA
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14
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Barbati S, Strasser J, Allemann SS, Arnet I. Initiation of oral hepatitis C virus treatment: Which barriers are pertinent for ambulatory individuals with a history of illicit substance use? A qualitative interview study. Health Sci Rep 2024; 7:e1814. [PMID: 38260184 PMCID: PMC10802086 DOI: 10.1002/hsr2.1814] [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: 08/22/2023] [Revised: 11/01/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024] Open
Abstract
Background and Aims The World Health Organization has set a goal to eradicate hepatitis C virus (HCV) by the year 2030. Nonadherence to HCV treatment has substantial economic implications due to high treatment costs, among others. Barriers to start HCV treatment may be critical. The aim of this study was to assess pertinent barriers to HCV treatment in ambulatory patients with a history of illicit substance use and to compare them to the literature. Methods Barriers to HCV treatment mentioned by the key risk group (i.e., people who inject drugs) were retrieved from literature through a pragmatic literature search. From 34 published articles, we identified 80 modifiable barriers that were bundled in 23 items within the four topics "Personal difficulties and barriers to treatment," "Personal motivation to be treated," "Knowledge about the disease," and "Received information about the medicine." In-depth semistructured interviews were performed face-to-face with ambulatory patients from the University Psychiatric Clinics in Basel, Switzerland. Transcripts were coded inductively. Results Interviews were performed with seven individuals (mean age: 48.3 years; range: 38-63 years; one woman) treated with oral direct-acting antivirals between 2014 and 2022. Thirteen barriers to start HCV treatment were mentioned that corresponded to the five categories: information, attitudes, swallowing difficulties, social environment, and unfavorable lifestyle. The barrier "swallowing difficulties" emerged exclusively from the statements provided by the interviewees. Conclusion Barriers to the initiation of HCV treatment indicated by our interviewees clearly differed from the literature. Notably, the challenge of swallowing medicines may be particularly relevant for physicians prescribing and pharmacists dispensing HCV medication.
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Affiliation(s)
- Selina Barbati
- Pharmaceutical Care Research Group, Department of Pharmaceutical SciencesUniversity of BaselBaselSwitzerland
| | | | - Samuel S. Allemann
- Pharmaceutical Care Research Group, Department of Pharmaceutical SciencesUniversity of BaselBaselSwitzerland
| | - Isabelle Arnet
- Pharmaceutical Care Research Group, Department of Pharmaceutical SciencesUniversity of BaselBaselSwitzerland
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15
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Dawe J, Hughes M, Christensen S, Walsh L, Richmond JA, Pedrana A, Wilkinson AL, Owen L, Doyle JS. Evaluation of a person-centred, nurse-led model of care delivering hepatitis C testing and treatment in priority settings: a mixed-methods evaluation of the Tasmanian Eliminate Hepatitis C Australia Outreach Project, 2020-2022. BMC Public Health 2023; 23:2289. [PMID: 37985979 PMCID: PMC10662700 DOI: 10.1186/s12889-023-17066-9] [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: 06/30/2023] [Accepted: 10/25/2023] [Indexed: 11/22/2023] Open
Abstract
INTRODUCTION Australia has experienced sustained reductions in hepatitis C testing and treatment and may miss its 2030 elimination targets. Addressing gaps in community-based hepatitis C prescribing in priority settings that did not have, or did not prioritise, hepatitis C testing and treatment care pathways is critical. METHODS The Tasmanian Eliminate Hepatitis C Australia Outreach Project delivered a nurse-led outreach model of care servicing hepatitis C priority populations in the community through the Tasmanian Statewide Sexual Health Service, supported by the Eliminating Hepatitis C Australia partnership. Settings included alcohol and other drug services, needle and syringe programs and mental health services. The project provided clients with clinical care across the hepatitis C cascade of care, including testing, treatment, and post-treatment support and hepatitis C education for staff. RESULTS Between July 2020 and July 2022, a total of 43 sites were visited by one Clinical Nurse Consultant. There was a total of 695 interactions with clients across 219 days of service delivery by the Clinical Nurse Consultant. A total of 383 clients were tested for hepatitis C (antibody, RNA, or both). A total of 75 clients were diagnosed with hepatitis C RNA, of which 95% (71/75) commenced treatment, 83% (62/75) completed treatment and 52% (39/75) received a negative hepatitis C RNA test at least 12 weeks after treatment completion. CONCLUSIONS Providing outreach hepatitis C services in community-based services was effective in engaging people living with and at-risk of hepatitis C, in education, testing, and care. Nurse-led, person-centred care was critical to the success of the project. Our evaluation underscores the importance of employing a partnership approach when delivering hepatitis C models of care in community settings, and incorporating workforce education and capacity-building activities when working with non-specialist healthcare professionals.
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Affiliation(s)
- Joshua Dawe
- Disease Elimination, Burnet Institute, Melbourne, Australia.
| | - Megan Hughes
- Sexual Health Service Tasmania, Hobart, Australia
| | | | - Louisa Walsh
- Disease Elimination, Burnet Institute, Melbourne, Australia
- Centre for Health Communication and Participation, La Trobe University, Melbourne, Australia
| | | | - Alisa Pedrana
- Disease Elimination, Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Anna L Wilkinson
- Disease Elimination, Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Louise Owen
- Sexual Health Service Tasmania, Hobart, Australia
| | - Joseph S Doyle
- Disease Elimination, Burnet Institute, Melbourne, Australia
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Australia
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16
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Sheehan Y, Cunningham EB, Cochrane A, Byrne M, Brown T, McGrath C, Lafferty L, Tedla N, Dore GJ, Lloyd AR, Grebely J. A 'one-stop-shop' point-of-care hepatitis C RNA testing intervention to enhance treatment uptake in a reception prison: The PIVOT study. J Hepatol 2023; 79:635-644. [PMID: 37116714 DOI: 10.1016/j.jhep.2023.04.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 03/26/2023] [Accepted: 04/11/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND & AIMS Prisons are key venues for scaling-up hepatitis C virus (HCV) testing and treatment. Complex clinical pathways and frequent movements of people in prison remain barriers to HCV care. This study evaluated the impact of a 'one-stop-shop' point-of-care HCV RNA testing intervention on treatment uptake compared with standard of care among people recently incarcerated in Australia. METHODS PIVOT was a prospective, non-concurrent, controlled study comparing HCV treatment uptake during 'standard of care' (n = 239; November 2019-May 2020) and a 'one-stop-shop' intervention (n = 301; June 2020-April 2021) in one reception prison in Australia. The primary endpoint was uptake of direct-acting antiviral treatment at 12 weeks from enrolment. Secondary outcomes included the time taken from enrolment to each stage in the care cascade. RESULTS A total of 540 male participants were enrolled. Median age (29 vs. 28 years) and history of injecting drug use (48% vs. 42%) were similar between standard of care and intervention phases. Among people diagnosed with current HCV infection (n = 18/63 in the standard of care phase vs. n = 30/298 in the intervention phase), the proportion initiating direct-acting antiviral treatment within 12 weeks from enrolment in the intervention phase was higher (93% [95% CI 0.78-0.99] vs. 22% [95% CI 0.64-0.48]; p <0.001), and the median time to treatment initiation was shorter (6 days [IQR 5-7] vs. 99 days [IQR 57-127]; p <0.001) compared to standard of care. CONCLUSIONS The 'one-stop-shop' intervention enhanced treatment uptake and reduced time to treatment initiation among people recently incarcerated in Australia, thereby overcoming key barriers to treatment scale-up in the prison sector. IMPACT AND IMPLICATIONS This study provides important insights for policymakers regarding optimal HCV testing and treatment pathways for people newly incarcerated in prisons. The findings will improve health outcomes in people in prison with chronic HCV infection by increasing testing and treatment, thereby reducing infections, liver-related morbidity/mortality, and comorbidities. The findings will change clinical practice, clinical guidelines, and international guidance, and will inform future research and national and regional strategies, in particular regarding point-of-care testing, which is being rapidly scaled-up in various settings globally. The economic impact will likely include health budget savings resulting from reduced negative health outcomes relating to HCV, and health system efficiencies resulting from the introduction of simplified models of care. CLINICAL TRIALS REGISTRATION This study is registered at Clinicaltrials.gov (NCT04809246).
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Affiliation(s)
- Yumi Sheehan
- The Kirby Institute, University of New South Wales, Sydney, Australia.
| | - Evan B Cunningham
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Amanda Cochrane
- Justice Health and Forensic Mental Health Network (Justice Health NSW), NSW Health, Sydney, Australia
| | - Marianne Byrne
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Tracey Brown
- Justice Health and Forensic Mental Health Network (Justice Health NSW), NSW Health, Sydney, Australia
| | - Colette McGrath
- Justice Health and Forensic Mental Health Network (Justice Health NSW), NSW Health, Sydney, Australia
| | - Lise Lafferty
- The Kirby Institute, University of New South Wales, Sydney, Australia; Centre for Social Research in Health, University of New South Wales, Sydney, Australia
| | - Nicodemus Tedla
- School of Biomedical Sciences, University of New South Wales, Sydney, Australia
| | - Gregory J Dore
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Andrew R Lloyd
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Jason Grebely
- The Kirby Institute, University of New South Wales, Sydney, Australia
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17
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Abstract
Clinical trials have been a central driver of change and have provided the evidence base necessary to advance new therapies for liver diseases. This review provides a perspective on the status of trials in hepatology and a vantage point into the emerging capabilities and external forces that will shape the conduct of clinical trials in the future. The adaptations to clinical trial operations in response to the disruptions by the COVID-19 pandemic and opportunities for innovation in hepatology trials are emphasized. Future trials in hepatology will be driven by unmet therapeutic needs and fueled by technological advances incorporating digital capabilities with expanded participant-derived data collection, computing, and analytics. Their design will embrace innovative trial designs adapted to these advances and that emphasize broader and more inclusive participant engagement. Their conduct will be further shaped by evolving regulatory needs and the emergence of new stakeholders in the clinical trials ecosystem. The evolution of clinical trials will offer unique opportunities to advance new therapeutics that will ultimately improve the lives of patients with liver diseases.
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Affiliation(s)
- Paul Y Kwo
- Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Tushar Patel
- Department of Transplantation, Mayo Clinic, Jacksonville, Florida, USA
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18
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Nagot N, Binh NT, Hong TT, Vinh VH, Quillet C, Vallo R, Huong DT, Hai Oanh KT, Thanh NTT, Rapoud D, Quynh BTN, Nguyen DQ, Feelemyer J, Michel L, Vickerman P, Fraser H, Weiss L, Lemoine M, Lacombe K, Des Jarlais D, Khue PM, Moles JP, Laureillard D. A community-based strategy to eliminate hepatitis C among people who inject drugs in Vietnam. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 37:100801. [PMID: 37693880 PMCID: PMC10485672 DOI: 10.1016/j.lanwpc.2023.100801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/27/2023] [Accepted: 05/10/2023] [Indexed: 09/12/2023]
Abstract
Background Towards hepatitis C elimination among people who inject drugs (PWID), we assessed the effectiveness of a strategy consisting of a community-based respondent-driven sampling (RDS) as wide screening, a simplified and integrated hospital-based care, and prevention of reinfection supported by community-based organisations (CBO), in Hai Phong, Vietnam. Methods Adults who injected heroin were enrolled in a RDS survey implemented in two CBO premises. Rapid HIV and HCV tests were done on site, and blood was taken for HCV RNA testing. Those with detectable HCV RNA were referred with CBO support to three public hospitals for 12-week sofosbuvir/daclatasvir, plus ribavirin for patients with cirrhosis. Participants were followed-up 12 weeks post-treatment (SVR12) and 48 weeks after enrolment. The primary endpoint was the rate of undetectable HCV RNA participants at 48 weeks. Findings Among the 1444 RDS survey participants, 875 had hepatitis C. Their median age was 41 years (IQR 36-47), 96% were males, 36% were HIV-coinfected. Overall, 686 (78.4%) started sofosbuvir/daclatasvirs, and 629 of the 647 (97.2%) patients tested at SVR12 were cured. At week 48 (581/608) 95.6% had undetectable HCV RNA, representing 66.4% of all PWID identified with hepatitis C. The reinfection rate after SVR12 was 4/100 person-years (95% CI: 2-7). Interpretation Our strategy, involving CBO and addressing all steps from wide HCV screening to prevention of reinfection, stands as a promising approach to eliminate HCV among PWID in low and middle-income countries. Funding France ANRS|MIE (#ANRS12380). The RDS survey was implemented with grants from the NIDA (#R01DA041978) and ANRS|MIE (#ANRS12353).
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Affiliation(s)
- Nicolas Nagot
- Pathogenesis and Control of Chronic and Emerging Infections, Université de Montpellier, Inserm, Etablissement Français du Sang, Montpellier, France
| | - Nguyen Thanh Binh
- Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Tran Thi Hong
- Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Vu Hai Vinh
- Infectious and Tropical Diseases Department, Viet Tiep Hospital, Hai Phong, Vietnam
| | - Catherine Quillet
- Pathogenesis and Control of Chronic and Emerging Infections, Université de Montpellier, Inserm, Etablissement Français du Sang, Montpellier, France
| | - Roselyne Vallo
- Pathogenesis and Control of Chronic and Emerging Infections, Université de Montpellier, Inserm, Etablissement Français du Sang, Montpellier, France
| | - Duong Thi Huong
- Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | | | | | - Delphine Rapoud
- Pathogenesis and Control of Chronic and Emerging Infections, Université de Montpellier, Inserm, Etablissement Français du Sang, Montpellier, France
| | - Bach Thi Nhu Quynh
- Department of Molecular Biology, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Duc Quang Nguyen
- Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | | | - Laurent Michel
- CESP Inserm UMRS 1018, Paris Saclay University, Pierre Nicole Center, French Red Cross, Paris, France
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Hannah Fraser
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Laurence Weiss
- Université de Paris Cité, Department of Clinical Immunology, Hôpital Hôtel Dieu AP-HP, Paris, France
| | - Maud Lemoine
- Liver Unit, Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Karine Lacombe
- Sorbonne Université Inserm IPLESP, Hôpital St Antoine AP-HP, Paris, France
| | - Don Des Jarlais
- School of Global Public Health, New York University, New York, USA
| | - Pham Minh Khue
- Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Jean Pierre Moles
- Pathogenesis and Control of Chronic and Emerging Infections, Université de Montpellier, Inserm, Etablissement Français du Sang, Montpellier, France
| | - Didier Laureillard
- Pathogenesis and Control of Chronic and Emerging Infections, Université de Montpellier, Inserm, Etablissement Français du Sang, Montpellier, France
- Infectious and Tropical Diseases Department, Caremeau University Hospital, Nîmes, France
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Rockstroh JK, Swan T, Chang J, Elamouri F, Lloyd AR. The path to hepatitis C elimination: who are we leaving behind and why? J Int AIDS Soc 2023; 26:e26136. [PMID: 37494827 PMCID: PMC10371387 DOI: 10.1002/jia2.26136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 06/13/2023] [Indexed: 07/28/2023] Open
Affiliation(s)
| | - Tracy Swan
- GlobalHealth Consultant, Barcelona, Spain
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Williams KP, Dunn KPR, Lee SS. The Canadian hepatitis C treatment landscape: Time to turn chaos into order. CANADIAN LIVER JOURNAL 2023; 6:187-189. [PMID: 37503522 PMCID: PMC10370726 DOI: 10.3138/canlivj-2023-0008] [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: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 07/29/2023]
Affiliation(s)
- Kienan P Williams
- Indigenous Wellness Core, Alberta Health Services, Calgary, Alberta, Canada
| | - Kate PR Dunn
- Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
- Project ECHO HCV, Calgary, Alberta, Canada
| | - Samuel S Lee
- Project ECHO HCV, Calgary, Alberta, Canada
- Liver Unit, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
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21
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Lindqvist K, Thorin Z, Kåberg M. Real-world hepatitis C treatment outcomes and reinfections among people who inject drugs at a needle and syringe program in Stockholm, Sweden. Harm Reduct J 2023; 20:72. [PMID: 37308951 DOI: 10.1186/s12954-023-00801-1] [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: 12/21/2022] [Accepted: 06/03/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND People who inject drugs (PWID) represent a population with an increased prevalence of hepatitis C (HCV) infections. HCV treatment among PWID is essential to reach the WHO goal of eliminating HCV as a major public health threat by 2030. Despite better understanding of PWID subgroups and changes in risk behaviors over time, more knowledge about HCV treatment outcomes in different HCV prevalence populations and settings is warranted to enhance the continuum of care. METHODS All Stockholm Needle and Syringe Program (NSP) participants who initiated HCV treatment between October 2017 and June 2020 were HCV RNA tested at end of treatment and twelve weeks thereafter to confirm cure with a sustained virological response (SVR). All cured participants were prospectively followed from SVR to the last negative HCV RNA test or a subsequent reinfection, until October 31, 2021. RESULTS Overall, 409 NSP participants initiated HCV treatment, 162 at the NSP and 247 in another treatment setting. There were a total of 6.4% treatment dropouts (n = 26), 11.7% among participants treated at the NSP and 2.8% among those treated elsewhere (p < 0.001). Stimulant use (p < 0.05) and not being in an opioid agonist treatment program (p < 0.05) was associated with dropout. More participants treated outside the NSP were lost to follow-up between end of treatment and SVR (p < 0.05). During follow-up post-SVR, 43 reinfections occurred, corresponding to a reinfection rate of 9.3/100 PY (95% CI 7.0, 12.3). Factors associated with reinfection were younger age (p < 0.001), treatment while in prison (p < 0.01) and homelessness (p < 0.05). DISCUSSION In this high HCV prevalence NSP setting, with a majority of stimulant users, treatment success was high and the level of reinfections manageable. To reach HCV elimination, there is a need to target specific PWID subgroups for HCV treatment, in both harm reduction and adjacent healthcare settings frequented by PWID.
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Affiliation(s)
- K Lindqvist
- Stockholm Centre for Dependency Disorders, Stockholm Needle Syringe Program, Stockholm, Sweden
| | - Z Thorin
- Stockholm Centre for Dependency Disorders, Stockholm Needle Syringe Program, Stockholm, Sweden
| | - M Kåberg
- Stockholm Centre for Dependency Disorders, Stockholm Needle Syringe Program, Stockholm, Sweden.
- Department of Global Public Health, Karolinska Institutet, Sprututbytet, S:t Görans Sjukhus, Akutvägen 29, 112 81, Stockholm, Sweden.
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Herink MC, Seaman A, Leichtling G, Larsen JE, Gailey T, Cook R, Thomas A, Korthuis PT. A randomized controlled trial for a peer-facilitated telemedicine hepatitis c treatment intervention for people who use drugs in rural communities: study protocol for the "peer tele-HCV" study. Addict Sci Clin Pract 2023; 18:35. [PMID: 37245041 PMCID: PMC10221743 DOI: 10.1186/s13722-023-00384-z] [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: 08/16/2022] [Accepted: 05/01/2023] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) transmission is primarily driven by injection drug use, and acute HCV infection rates are increased in rural communities with substantial barriers to care. Treatment of HCV in persons who use drugs (PWUD) is cost effective, decreases high risk behaviors and HCV transmission, and achieves high rates of treatment completion and sustained viral response. Adapting HCV care delivery to utilize peer support specialists, telemedicine technology, and streamlined testing and treatment strategies can better reach rural populations living with HCV. METHODS This is an open label, two-arm, non-blinded, randomized controlled trial designed to test the superiority of peer-facilitated and streamlined telemedicine HCV care (peer tele-HCV) compared to enhanced usual care (EUC) among PWUD in rural Oregon. In the intervention arm, peers conduct HCV screening in the community, facilitate pretreatment evaluation and linkage to telemedicine hepatitis C treatment providers, and support participants in HCV medication adherence. For participants assigned to EUC, peers facilitate pretreatment evaluation and referral to community-based treatment providers. The primary outcome is sustained virologic response at 12 weeks post treatment (SVR12). Secondary outcomes include: (1) HCV treatment initiation, (2) HCV treatment completion, (3) engagement with harm reduction resources, (4) rates of substance use, and (5) engagement in addiction treatment resources. The primary and secondary outcomes are analyzed using intention-to-treat (ITT) comparisons between telemedicine and EUC. A qualitative analysis will assess patient, peer, and clinician experiences of peer-facilitated telemedicine hepatitis C treatment. DISCUSSION This study uses a novel peer-based telemedicine delivery model with streamlined testing protocols to improve access to HCV treatment in rural communities with high rates of injection drug use and ongoing disease transmission. We hypothesize that the peer tele-HCV model will increase treatment initiation, treatment completion, SVR12 rates, and engagement with harm reduction services compared to EUC. Trial registration This trial has been registered with ClinicalTrials.gov (clinicaltrials.gov NCT04798521).
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Affiliation(s)
- Megan C Herink
- College of Pharmacy, Oregon State University / Oregon Health & Science University, Portland, USA.
| | - Andrew Seaman
- Division of Addiction Medicine, Department of Internal Medicine, Oregon Health & Science University, Portland, USA
| | | | | | - Tonhi Gailey
- Oregon Health & Science University, Portland, USA
| | - Ryan Cook
- Section of Addiction Medicine, Oregon Health & Science University, Portland, OR, USA
| | | | - P Todd Korthuis
- Section of Addiction Medicine, Oregon Health & Science University, Portland, OR, USA
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23
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Su WW, Yang CC, Chang RWJ, Yeh YH, Yen HH, Yang CC, Lee YL, Liu CE, Liang SY, Sung ML, Ko SY, Kuo CY, Chen SLS, Yeh YP, Hu TH. A new collaborative care approach toward hepatitis C elimination in marginalized populations. J Infect Public Health 2023; 16:1201-1208. [PMID: 37271101 DOI: 10.1016/j.jiph.2023.05.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/15/2023] [Accepted: 05/17/2023] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Treating marginalized populations with HCV infection for elimination is faced with the challenge for the integration of HCV screening service offered for patients often moving across multiple settings. We envisaged a novel collaborative care approach to identify to what extent HCV patients overlapped between and within these multiple institutions and reported the findings of treatment coverage of these marginalized populations after HCV care cascades. METHODS We enrolled 7765 patients residing in the Changhua County, Taiwan offered with HCV screening from correctional institutions, HIV clinics, methadone clinics, and the existing HIV surveillance program (four subgroups including police-arrested people, probationers, non-injection drug user, and high-risk behavior people) between 2019 and 2020. The collaborative care and information were integrated through a teamwork of gastroenterologists, psychologists, infectious disease specialists, and nursing coordinators under the auspices of local health authority. RESULTS The overall participation rate in HCV screening was 92.65% (7194/7765). The prevalence rate was the highest in methadone clinics (90.17%) followed by correctional institutions (37.67%), HIV clinics (34.60%), and the surveillance program (18.14%). We found 25.41% (77/303) of methadone clinic patients, 17.65% (129/731) of HIV clinic patients, and various proportions for 44.09% (41/93) of deferred prosecuted or probationers under surveillance program were also recruited into other settings. Individuals' patient flow within setting was more frequent than that between setting. After calibrating the overlap of patient flow, a total of 1700 anti-HCV positives out of 4074 after screening were traced with available follow-up information to complete 92.52% treatment coverage of 1177 RNA-positives (77.23%) diagnosed from 1524 undergoing RNA testing with similar findings across multiple settings. CONCLUSION A new collaborative integrated care was adopted for elucidating patient flow between and within multiple settings in order to calibrate the accurate demand for HCV care cascades and enhance HCV treatment coverage in marginalized populations.
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Affiliation(s)
- Wei-Wen Su
- Changhua Christian Hospital, Changhua, Taiwan
| | - Chih-Chao Yang
- Changhua Hospital, Ministry of Health and Welfare, Changhua, Taiwan
| | - Rene Wei-Jung Chang
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | | | | | | | - Yu-Lin Lee
- Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | | | - Sun-Yuan Liang
- Changhua Hospital, Ministry of Health and Welfare, Changhua, Taiwan
| | - Man-Li Sung
- Changhua Public Health Bureau, Changhua, Taiwan
| | - Shu-Yu Ko
- Changhua Public Health Bureau, Changhua, Taiwan
| | | | - Sam Li-Sheng Chen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yen-Po Yeh
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan; Changhua Public Health Bureau, Changhua, Taiwan.
| | - Tsung-Hui Hu
- Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
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Malme KB, Ulstein K, Finbråten AK, Wüsthoff LEC, Kielland KB, Hauge J, Dalgard O, Midgard H. Hepatitis C treatment uptake among people who inject drugs in Oslo, Norway: A registry-based study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 116:104044. [PMID: 37149914 DOI: 10.1016/j.drugpo.2023.104044] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 04/18/2023] [Accepted: 04/23/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND Improving HCV treatment uptake among people who inject drugs (PWID) is crucial to achieving the WHO elimination targets. The aims were to evaluate HCV treatment uptake and HCV RNA prevalence in a large cohort of PWID in Norway. METHODS Registry-based observational study where all users of the City of Oslo's low-threshold social and health services for PWID between 2010-2016 (n = 5330) were linked to HCV notifications (1990-2019) and dispensions of HCV treatment, opioid agonist treatment (OAT) and benzodiazepines (2004-2019). Cases were weighted to account for spontaneous HCV clearance. Treatment rates were calculated using person-time of observation, and factors associated with treatment uptake were analysed using logistic regression. HCV RNA prevalence was estimated among individuals alive by the end of 2019. RESULTS Among 2436 participants with chronic HCV infection (mean age 46.8 years, 30.7% female, 73.3% OAT), 1118 (45.9%) had received HCV treatment between 2010-2019 (88.7% DAA-based). Treatment rates increased from 1.4/100 PY (95% CI 1.1-1.8) in the pre-DAA period (2010-2013) to 3.5/100 PY (95% CI 3.0-4.0) in the early DAA period (2014-2016; fibrosis restrictions) and 18.4/100 PY (95% CI 17.2-19.7) in the late DAA period (2017-2019; no restrictions). Treatment rates for 2018 and 2019 exceeded a previously modelled elimination threshold of 50/1000 PWID. Treatment uptake was less likely among women (aOR 0.74; 95% CI 0.62-0.89) and those aged 40-49 years (aOR 0.74; 95% CI 0.56-0.97), and more likely among participants with current OAT (aOR 1.21; 95% CI 1.01-1.45). The estimated HCV RNA prevalence by the end of 2019 was 23.6% (95% CI 22.3-24.9). CONCLUSION Although HCV treatment uptake among PWID increased, strategies to improve treatment among women and individuals not engaged in OAT should be addressed.
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Affiliation(s)
- Kristian Braathen Malme
- Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Norway.
| | - Kjersti Ulstein
- Agency for Social and Welfare Services, City of Oslo, Norway
| | | | - Linda Elise Couëssurel Wüsthoff
- Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, Norway; Unit for Clinical Research on Addictions, Oslo University Hospital Health Trust, Oslo, Norway
| | - Knut Boe Kielland
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumundal, Norway
| | - Joakim Hauge
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumundal, Norway
| | - Olav Dalgard
- Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Norway
| | - Håvard Midgard
- Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway; Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
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Seroprevalence of hepatitis C virus in Jinan, China, 2008-2020. Eur J Med Res 2023; 28:112. [PMID: 36894961 PMCID: PMC9997000 DOI: 10.1186/s40001-023-01063-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 02/14/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND The updated estimates of hepatitis C virus (HCV) seroprevalence are critical for developing strategies to manage or eliminate HCV infection. METHODS A comprehensive study on HCV seroprevalence was conducted among 365,210 patients at Jinan Central Hospital, China, from 2008 to 2020. The patients were tested for anti-HCV, HCV core antigen, hepatitis B surface antigen, syphilis antibody, human immunodeficiency virus antigen + antibody, antihepatitis A virus IgM, and antihepatitis E virus IgM. RESULTS HCV seroprevalence was 0.79% and was related to age. HCV seropositivity was lower in children (aged < 18 years) than in adults (aged ≥ 18 years) (0.15% vs. 0.81%). High HCV prevalence was reported in adults aged ≥ 41 years, and HCV seropositivity in those aged 41-80 years accounted for 74.56% of all seropositive individuals. Notably, the rate of HCV-HIV coinfection was 0. HCV seroprevalence was considerably higher in patients at the Kidney Disease Unit and Dialysis Department than in those at other departments (inpatient or outpatient). CONCLUSIONS HCV seroprevalence was lower in Jinan region but higher in patients at the Kidney Disease Unit and Dialysis Department, especially in those undergoing hemodialysis.
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26
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Saayman E, Hechter V, Kayuni N, Sonderup MW. A simplified point-of-service model for hepatitis C in people who inject drugs in South Africa. Harm Reduct J 2023; 20:27. [PMID: 36870990 PMCID: PMC9985434 DOI: 10.1186/s12954-023-00759-0] [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: 12/08/2022] [Accepted: 02/20/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Globally, 9% of people who inject drugs (PWID), a key hepatitis C-infected population, reside in sub-Saharan Africa. In South Africa, hepatitis C seroprevalence in PWID is high. It is almost 84% in Pretoria and hepatitis C genotypes 1 and 3 predominate. Access to hepatitis C care for PWID is inadequate given low referral rates, socio-structural barriers, homelessness and limited access to harm reduction. Traditional care models do not address the needs of this population. We piloted a simplified complete point-of-service care model, a first of its kind in the country and sub-continental region. METHODS Community-based recruitment from Pretoria's PWID population occurred over 11 months. Participants were screened with point-of-care rapid diagnostic tests for HBsAg (Alere Determine™), hepatitis C and HIV antibodies (OraQuick®). Qualitative HCV viremia was confirmed on site with Genedrive® (Sysmex), similarly at week 4, end of treatment and to confirm sustained virological response. Viremic hepatitis C participants were initiated on 12 weeks of daily sofosbuvir and daclatasvir. Harm reduction and adherence support, through directly observed therapy, peer support, a stipend and transport, was provided. RESULTS A total of 163 participants were screened for hepatitis C antibody, and 66% were positive with 80 (87%) viremic. An additional 36 confirmed hepatitis C viremic participants were referred. Of those eligible to initiate treatment, 87 (93%) were commenced on sofosbuvir and daclatasvir, with 98% (n = 85) male, 35% (n = 30) HIV co-infected, 1% (n = 1) HBV co-infected and 5% (n = 4) HIV/HBV/HCV triple infected. Some 67% (n = 58) accessed harm reduction packs, 57% (n = 50) opioid substitution therapy and 18% (n = 16) stopped injecting. A per protocol sustained virological response of 90% (n = 51) was achieved with 14% (n = 7) confirmed reinfections following a sustained virological response. HCV RNA qualitative testing performance was acceptable with all sustained virological responses validated against a laboratory assay. Mild adverse effects were reported in 6% (n = 5). Thirty-eight percent (n = 33) of participants were lost to follow-up. CONCLUSION In our setting, a simplified point-of-service hepatitis C care model for PWID yielded an acceptable sustained virological response rate. Retention in care and follow-up remains both challenging and central to success. We have demonstrated the utility of a model of care for our country and region to utilize this more community acceptable and simplified practice.
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Affiliation(s)
| | | | - Ndoliwe Kayuni
- Tshwane Project, Medecins Sans Frontieres, Tshwane, South Africa
| | - Mark W Sonderup
- Division of Hepatology, Department of Medicine, Faculty of Health Sciences and Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
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Bryce K, Smith C, Rodger A, Macdonald D. Falling treatment uptake in the hepatitis C care cascade is a growing threat to achieving elimination. J Viral Hepat 2023; 30:46-55. [PMID: 36197840 PMCID: PMC10091771 DOI: 10.1111/jvh.13757] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 09/07/2022] [Accepted: 09/10/2022] [Indexed: 12/13/2022]
Abstract
Most high-income countries are not on track to achieve the World Health Organization hepatitis C elimination targets. As elimination programmes assess growing proportions of patients in community-based pathways, rates of treatment uptake may fall. We aimed to identify factors associated with DAA treatment uptake and measure changes in their prevalence over time. We performed a time-to-treatment analysis on 2728 patients approved for hepatitis C Direct-Acting Antiviral treatment in the North Central London region between January 2016 and October 2019. We investigated the association between treatment uptake and factors including assessment/treatment setting (hospital, drug service or prison), patient age, gender, injection drug use, harmful alcohol use, cirrhosis status and previous treatment. The likelihood of treatment uptake was reduced by three independent risk factors. These included assessment setting: prison-based or drug-service pathways (aHR 0.29 or 0.81 vs. hospital outpatient pathway, 95% CI 0.21-0.40 and 0.70-0.94 respectively, p < .001); being UK-born (aHR 0.89 vs. non-UK born, 0.82-0.98, p = .01); and history of harmful alcohol use (aHR 0.84 vs. no history, 0.72-0.99, p = .04). The average number of these risk factors for not starting treatment per patient increased over time (R2 = 0.66 p < .001). Independent of these, there was an additional 5% reduction in rate of treatment initiation in each successive year of the programme (aHR 0.95, 0.91-0.99, p = .02). In conclusion, disengagement from care before treatment uptake was found to be a growing threat to elimination. Despite provision of community-based test-to-cure pathways, there are persistent barriers to treatment uptake and these are increasing over time.
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Affiliation(s)
- Kathleen Bryce
- Institute for Global HealthUniversity College LondonLondonUK
- Royal Free London NHS Foundation TrustLondonUK
| | - Colette Smith
- Institute for Global HealthUniversity College LondonLondonUK
| | - Alison Rodger
- Institute for Global HealthUniversity College LondonLondonUK
- Royal Free London NHS Foundation TrustLondonUK
| | - Douglas Macdonald
- Royal Free London NHS Foundation TrustLondonUK
- Institute for Liver and Digestive HealthUniversity College LondonLondonUK
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Austin EJ, Gojic AJ, Bhatraju EP, Pierce KA, Pickering EI, Tung EL, Scott JD, Hansen RN, Glick SN, Stekler JD, Connolly NC, Villafuerte S, McPadden M, Deutsch S, Ninburg M, Kubiniec R, Williams EC, Tsui JI. Barriers and facilitators to implementing a Pharmacist, Physician, and Patient Navigator-Collaborative Care Model (PPP-CCM) to treat hepatitis C among people who inject drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 111:103924. [PMID: 36521197 PMCID: PMC9868078 DOI: 10.1016/j.drugpo.2022.103924] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/21/2022] [Accepted: 11/26/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Direct-acting antivirals (DAAs) offer an unprecedented opportunity to eliminate hepatitis C virus (HCV) infection, yet barriers among people who inject drugs (PWID) remain. Having pharmacists provide care through collaborative drug therapy agreements (CDTAs) offers a promising solution. We developed and piloted a Pharmacist, Physician, and Patient Navigator-Collaborative Care Model (PPP-CCM) which utilized pharmacists to directly deliver HCV care at community organizations serving PWID. We conducted formative evaluation of the PPP-CCM pilot to characterize implementation experiences. METHODS The PPP-CCM was implemented from November of 2020 through July of 2022. Formative evaluation team members observed implementation-related meetings and conducted multiple site visits, taking detailed fieldnotes. Fieldnotes were iteratively reviewed to identify barriers and facilitators to implementation and used to inform 7 key informant interviews conducted with programmatic staff at the end of the pilot. All data were analyzed using a Rapid Assessment Process (RAP) guided by the Consolidated Framework for Implementation Research (CFIR). The formative evaluation team shared results with program stakeholders (pharmacists, physicians, and other site staff) to verify and expand on learnings. RESULTS Evaluation of PPP-CCM revealed 5 themes, encompassing all CFIR domains: 1) PPP-CCM was feasible but challenging to deliver efficiently; 2) the pharmacist role and characteristics (e.g., being flexible, available, and patient-centered) were key to PPP-CCM successes; 3) the PPP-CCM team met challenges engaging patients over time, but some team-based strategies helped; 4) community site characteristics (e.g., existing trusting relationships with PWID and physical space that enabled program visibility) were important contributors; and 5) financial barriers may limit PPP-CCM scale-up and sustainability. CONCLUSION PPP-CCM is a novel and promising approach to HCV care delivery for PWID who may previously lack engagement in traditional care models, but careful attention needs to be paid to financial barriers to ensure scalability and sustainability.
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Affiliation(s)
- Elizabeth J Austin
- Department of Health Systems and Population Health, University of Washington, Seattle WA, United States.
| | - Alexander J Gojic
- Department of Medicine, Division of General Internal Medicine University of Washington, Seattle WA, United States
| | - Elenore P Bhatraju
- Department of Medicine, Division of General Internal Medicine University of Washington, Seattle WA, United States
| | - Kathleen A Pierce
- Department of Pharmacy, University of Washington, Seattle WA, United States; Kelley-Ross Pharmacy Group, Seattle WA, United States
| | - Eleanor I Pickering
- Department of Social and Behavioral Sciences, Yale School of Public Health, United States
| | - Elyse L Tung
- Department of Pharmacy, University of Washington, Seattle WA, United States; Kelley-Ross Pharmacy Group, Seattle WA, United States
| | - John D Scott
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle WA, United States
| | - Ryan N Hansen
- Department of Pharmacy, University of Washington, Seattle WA, United States; Kelley-Ross Pharmacy Group, Seattle WA, United States
| | - Sara N Glick
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle WA, United States; HIV/STD Program, Public Health - Seattle & King County, Seattle WA, United States
| | - Joanne D Stekler
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle WA, United States
| | - Nancy C Connolly
- Department of Medicine, Division of General Internal Medicine University of Washington, Seattle WA, United States
| | - Sarah Villafuerte
- Hepatitis Education Project, Seattle WA, United States (affiliation at the time of research)
| | - Madison McPadden
- Hepatitis Education Project, Seattle WA, United States (affiliation at the time of research)
| | - Sarah Deutsch
- Hepatitis Education Project, Seattle WA, United States (affiliation at the time of research)
| | - Michael Ninburg
- Hepatitis Education Project, Seattle WA, United States (affiliation at the time of research)
| | | | - Emily C Williams
- Department of Health Systems and Population Health, University of Washington, Seattle WA, United States; Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, VA Puget Sound, Seattle WA, United States
| | - Judith I Tsui
- Department of Medicine, Division of General Internal Medicine University of Washington, Seattle WA, United States
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Cook C, Reid L, Smith S, Crockford D, El Sharkawy AM, McPherson S, Wright M, Radley A, Malik H, Keall S, Catt J, Shah S, Hampton H, Powell J, Morris D, Boothman H, Khakoo SI, Parkes J, Buchanan RM. I-COPTIC: Implementation of community pharmacy-based testing for hepatitis C: Delphi consensus protocol. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2022; 30:541-547. [PMID: 35997159 DOI: 10.1093/ijpp/riac064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 07/22/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVE The World Health Organisation aims to eliminate Hepatitis C (HCV) by 2030. To achieve this, targeted testing needs to be widely available. Studies have demonstrated that community pharmacies can deliver effective targeted testing for HCV and the National Health Service in England has commissioned a national service. However, a recent survey of HCV operational delivery networks has shown limited uptake of this service. The objective of this protocol is to guide the formation of a consensus statement to facilitate the widespread implementation of community pharmacy-based targeted testing for HCV. METHOD We will use a modified Delphi method. A purposive selection of panel participants will be identified and recruited from a national survey and via chain-referral sampling. The main inclusion criteria for selection is direct involvement in the implementation of an HCV testing service in pharmacies. We aim for a heterogenous group, encompassing all aspects of the testing service. We will conduct a three round Delphi. The first round will consist of open questions which will be qualitatively analysed using thematic analysis with a framework method based on the WHO Health Systems Framework. This analysis will generate statements, that will be sent to the participants in the second round. A third round will be used where consensus is not reached. CONCLUSIONS The findings from this Delphi consensus study will facilitate the widespread implementation of targeted testing for HCV in community pharmacies.
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Affiliation(s)
| | | | | | | | - Deborah Crockford
- Hampshire & Isle of Wight LPC (operating as Community Pharmacy South Central) , Hampshire , UK
| | - Ahmed M El Sharkawy
- Liver Unit, Queen Elizabeth Hospital Birmingham , Birmingham , UK
- National Institute for Health Research, Birmingham Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust , Birmingham , UK
| | - Stuart McPherson
- Liver Unit, The Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle upon Tyne , UK
- The Translational and Clinical Research Institute, Newcastle University , Newcastle upon Tyne , UK
| | - Mark Wright
- University Hospital Southampton NHS Foundation Trust , Southampton , UK
| | - Andrew Radley
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee , Dundee , UK
- Ninewells Hospital, NHS Tayside , Dundee , UK
| | | | | | - Janet Catt
- Kings College NHS Foundation Trust , London , UK
| | - Sital Shah
- Kings College NHS Foundation Trust , London , UK
| | | | - Julia Powell
- Community Pharmacy Surrey and Sussex , Surrey , UK
| | | | | | - Salim I Khakoo
- Faculty of Medicine, University of Southampton , Southampton , UK
| | - Julie Parkes
- Faculty of Medicine, University of Southampton , Southampton , UK
| | - Ryan M Buchanan
- Faculty of Medicine, University of Southampton , Southampton , UK
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Maasoumy B, Ingiliz P, Spinner CD, Cordes C, Stellbrink HJ, Schulze zur Wiesch J, Schneeweiß SM, Deterding K, Müller T, Kahlhöfer J, Dörge P, von Karpowitz M, Manns MP, Wedemeyer H, Cornberg M. Sofosbuvir plus velpatasvir for 8 weeks in patients with acute hepatitis C: The HepNet acute HCV-V study. JHEP Rep 2022; 5:100650. [PMID: 36852107 PMCID: PMC9957891 DOI: 10.1016/j.jhepr.2022.100650] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/01/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
Background & Aims EASL guidelines recommend 8 weeks of treatment with sofosbuvir plus velpatasvir (SOF/VEL) for the treatment of acute or recently acquired HCV infection, but only 6- and 12-week data are available. Therefore, the aim of this study was to evaluate the safety and efficacy of a shortened 8-week SOF/VEL treatment for acute HCV monoinfection. Methods In this investigator-initiated, prospective, multicentre, single-arm study, we recruited 20 adult patients with acute HCV monoinfection from nine centers in Germany. Patients received SOF/VEL (400/100 mg) as a fixed-dose combination tablet once daily for 8 weeks. The primary efficacy endpoint was the proportion of patients with sustained virological response 12 weeks after the end of treatment (SVR12). Results The median HCV RNA viral load at baseline was 104,307 IU/ml; the distribution of HCV genotypes was as follows: GT1a/1b/2/3/4: n = 12/1/1/3/3. Thirteen (65%) of the 20 patients were taking medication for HIV pre-exposure prophylaxis. SVR12 was achieved in all patients who complied with the study protocol (n = 18/18 [100%], per protocol analysis), but the primary endpoint was not met in the intention-to-treat analysis (n = 18/20 [90%]) because two patients were lost to follow-up. One serious adverse event (unrelated to study drug) occurred during 12 weeks of post-treatment follow-up. Conclusions The 8-week treatment with SOF/VEL was well tolerated and highly effective in all adherent patients with acute HCV monoinfection. Early treatment of hepatitis C might effectively prevent the spread of HCV in high-risk groups. Clinical Trial Number NCT03818308. Impact and implications The HepNet acute HCV-V study (NCT03818308), an investigator-initiated, single-arm, multicenter pilot study, demonstrates the efficacy and safety of 8 weeks of daily treatment with the fixed-dose combination sofosbuvir/velpatasvir (400/100 mg) in patients with acute hepatitis C virus (HCV) infection. All patients who completed therapy and were followed-up achieved sustained virologic response. Thus, early treatment with SOF/VEL which might effectively prevent the spread of HCV in high-risk groups can be recommended for patients with acute HCV monoinfection.
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Affiliation(s)
- Benjamin Maasoumy
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Germany,German Center for Infection Research (DZIF), HepNet Study-House, Hannover, Germany,German Center for Infection Research (DZIF), Partner Site Hannover-Braunschweig, Germany
| | - Patrick Ingiliz
- Zentrum für Infektiologie Berlin-Prenzlauer Berg, Berlin, Germany,University Hospital Henri-Mondor, INSERM U955, Créteil, France
| | - Christoph D. Spinner
- Technical University of Munich, School of Medicine, University Hospital Rechts der Isar, Department of Internal Medicine II, Munich, Germany
| | | | | | - Julian Schulze zur Wiesch
- Medical Department, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Germany
| | | | - Katja Deterding
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Germany,Department of Gastroenterology and Hepatology, University Hospital Essen, 45147 Essen, Germany
| | - Tobias Müller
- Department of Hepatology and Gastroenterology, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Julia Kahlhöfer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Germany,German Center for Infection Research (DZIF), HepNet Study-House, Hannover, Germany
| | - Petra Dörge
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Germany,German Center for Infection Research (DZIF), HepNet Study-House, Hannover, Germany
| | | | - Michael P. Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Germany
| | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Germany
| | - Markus Cornberg
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Germany,German Center for Infection Research (DZIF), HepNet Study-House, Hannover, Germany,German Center for Infection Research (DZIF), Partner Site Hannover-Braunschweig, Germany,Center for Individualized Infection Medicine (CiiM), Hannover, Germany,Corresponding author. Address: Carl-Neuberg-Str. 1, 30625 Hannover, Germany; Tel.: +49 511 5326821
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Wong NS, Chan DPC, Chan CP, Poon CM, Wong GLH, Wong VWS, Lee SS. Point-of-care hepatitis C reflex testing and treatment referral in methadone clinic settings in Hong Kong—a pilot study. IJID REGIONS 2022; 5:8-12. [PMID: 36119439 PMCID: PMC9471432 DOI: 10.1016/j.ijregi.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/20/2022] [Accepted: 08/22/2022] [Indexed: 12/04/2022]
Abstract
Hepatitis C virus (HCV) prevalence is high among attendees of methadone clinics in Hong Kong. Finger-prick sampling and reflex HCV testing constitute an acceptable strategy. Linkage of RNA-positive methadone clinic attendees to direct-acting antiviral treatment referral is high. Methadone clinics could be enabled to contribute to HCV micro-elimination.
Objectives People who inject drugs (PWID) constitute a population group with a high hepatitis C virus (HCV) burden. With the objectives of assessing the HCV prevalence in PWID and determining the proportion requiring treatment who could be linked to care, this study piloted onsite reflex HCV testing at low threshold methadone clinics, with prompt referral of HCV RNA-positive participants for treatment. Methods This was a prospective study on methadone clinic attendees in Hong Kong. Questionnaires were completed, finger-prick anti-HCV rapid testing was performed, and positive blood samples were collected for laboratory HCV RNA testing. The proportions of participants along the cascade of HCV care were calculated. Results In 2021–2022, after 14 evening screening sessions at three methadone clinics, 86 of 354 regular attendees (24%) were recruited. The anti-HCV prevalence was 63% (54/86, 95% confidence interval 52–73%), with 78% (42/54) testing positive for HCV RNA and 79% (33/42) successfully referred. Almost all (31/33) referred participants received direct-acting antiviral (DAA) treatment, 94% (29/31) with full treatment compliance; 55% (16/29) of these compliant participants achieved a sustained virological response, while the remainder had not received post-treatment testing. Conclusions The use of a simplified testing algorithm in the setting of substitution treatment services, incorporating reflex HCV testing, could be an effective strategy for contributing towards the micro-elimination of HCV in PWID.
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Ozga JE, Syvertsen JL, Pollini RA. Hepatitis C antibody prevalence, correlates and barriers to care among people who inject drugs in Central California. J Viral Hepat 2022; 29:518-528. [PMID: 35357738 DOI: 10.1111/jvh.13677] [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: 07/13/2021] [Revised: 02/02/2022] [Accepted: 03/16/2022] [Indexed: 12/09/2022]
Abstract
Hepatitis C (HCV) infection among people who inject drugs (PWID) is a major public health concern. We examined correlates of HCV antibody (anti-HCV) seropositivity and characteristics of prior HCV testing and treatment among PWID in Fresno, California, which has among the highest prevalence of injection drug use (IDU) in the United States. We surveyed 494 peer-recruited PWID (≥18 years of age) in 2016 about their experiences with HCV testing and treatment, and conducted HCV and HIV antibody testing for all participants. Bivariate analyses and multivariable logistic regressions were used to identify correlates of anti-HCV seropositivity. A majority (65%) tested positive for anti-HCV, with 32% of those being unaware of their HCV status. Anti-HCV seroprevalence was independently and positively associated with older age (AOR = 1.11 per year, 95% CI = 1.06, 1.17), years injecting (AOR = 1.08 per year, 95% CI = 1.03, 1.13), distributive syringe sharing (AOR = 2.76, 95% CI = 1.29, 5.94), having syringes confiscated by police (AOR = 2.65, 95% CI = 1.22, 5.74), ever trading sex (AOR = 3.51, 95% CI = 1.40, 8.81) and negatively associated with being Black/African American (non-Hispanic) (AOR = 0.06, 95% CI = 0.01, 0.47). Prior HCV testing was associated with older age, ever getting syringes from a syringe services program, and having interactions with police. For those aware of their anti-HCV seropositivity, only 11% had initiated treatment; reasons for not seeing a physician regarding diagnosis included not feeling sick (23%), currently using drugs/alcohol (19%) and not knowing where to go for HCV medical care (19%). Our findings highlight the importance of expanding community-based access to sterile syringes alongside HCV testing and treatment services, particularly at syringe service programs where PWID may be more comfortable seeking testing and treatment.
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Affiliation(s)
- Jenny E Ozga
- Department of Behavioral Medicine & Psychiatry, West Virginia University, Morgantown, West Virginia, USA
| | - Jennifer L Syvertsen
- Department of Anthropology, University of California Riverside, Riverside, California, USA
| | - Robin A Pollini
- Department of Behavioral Medicine & Psychiatry, West Virginia University, Morgantown, West Virginia, USA.,Department of Epidemiology, West Virginia University, Morgantown, West Virginia, USA.,Pacific Institute for Research and Evaluation, Calverton, Maryland, USA
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Changes in the profile and therapeutic care of people who use drugs with HCV mono-infection: a retrospective study between 2015 and 2019 from a monocentric tertiary referent center in France. Eur J Gastroenterol Hepatol 2022; 34:560-566. [PMID: 35421021 DOI: 10.1097/meg.0000000000002307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND AIMS People who use drugs (PWUDs) are the main group at risk for hepatitis C virus (HCV) transmission and a key population for hepatitis C elimination. Multidisciplinary team (MDT) meetings were set up in France in December 2014 within regional reference centers to supervise the prescriptions and delivery of direct-acting antivirals (DAAs) to optimize the management of HCV infection. The aim of this retrospective study was to analyze the changes in the profile and therapeutic care of PWUDs with HCV mono-infection according to the evolution of MDT meetings in a regional tertiary reference center. METHODS Between 2015 and 2019, overall 1912 HCV-infected patients presented at the MDT meetings, 547 were PWUDs with HCV mono-infection treated with DAAs. Five periods were defined according to the evolution of MDT meetings. The profile and management of PWUDs were compared among these five periods. RESULTS Over time, the frequency of advanced stage of fibrosis decreased from 90.8 to 36.3% (P < 0.001), whereas the therapeutic care of the patients in primary addictology centers and networks of general practitioners increased from 17.4 to 55% (P < 0.001). The frequency of excessive alcohol consumption varied between 9.1 and 30% (P = 0.003) and that of opioid substitution therapy between 42.5 and 70% (P < 0.001). The Sustained virologic response assessed 12 weeks after the end of treatment rate was above 95% for the five periods. CONCLUSION Between 2015 and 2019, the changes in the profile and management of PWUDs have followed the evolution of MDT meetings concerning patients with less advanced fibrosis and more therapeutic hepatitis C care made by the primary care centers.
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Larney S, Madden A, Marshall AD, Martin NK, Treloar C. A gender lens is needed in hepatitis C elimination research. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 103:103654. [PMID: 35306279 DOI: 10.1016/j.drugpo.2022.103654] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/07/2022] [Accepted: 03/10/2022] [Indexed: 01/18/2023]
Abstract
The World Health Organisation has established a goal of eliminating the hepatitis C virus (HCV) as a public health threat by 2030. Considerable effort is being directed towards research to support and enhance HCV treatment uptake among people who inject drugs, but there is a distinct lack of attention given to gender in this work. We argue that a gender lens is needed to make visible the limitations of current HCV elimination research, and support the development of innovative, inclusive approaches to HCV treatment. Partnerships between researchers and people who inject drugs are essential in this work, particularly in the development and evaluation of programs by and for women who inject drugs. Failure to acknowledge the gendered dimensions of HCV elimination risks entrenching gender disparities in access to treatment and cure.
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Affiliation(s)
- Sarah Larney
- Department of Family Medicine and Emergency Medicine, University of Montreal, Canada; Centre de recherche du Centre hospitalier de l'Université de Montréal, Canada.
| | - Annie Madden
- The Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Alison D Marshall
- The Centre for Social Research in Health, UNSW Sydney, Sydney, Australia; The Kirby Institute, UNSW Sydney, Australia
| | - Natasha K Martin
- Division of Infectious Diseases and Global Public Health, University of California San Diego, USA; School of Population Health Sciences, University of Bristol, UK
| | - Carla Treloar
- The Centre for Social Research in Health, UNSW Sydney, Sydney, Australia; Social Policy Research Centre, UNSW Sydney, Australia
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Schwarz T, Horváth I, Fenz L, Schmutterer I, Rosian-Schikuta I, Mårdh O. Interventions to increase linkage to care and adherence to treatment for hepatitis C among people who inject drugs: A systematic review and practical considerations from an expert panel consultation. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 102:103588. [PMID: 35101667 PMCID: PMC9005784 DOI: 10.1016/j.drugpo.2022.103588] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 01/03/2022] [Accepted: 01/07/2022] [Indexed: 11/03/2022]
Abstract
Integrated care and cooperation between service providers optimize the HCV care continuum among people who inject drugs. Results suggest that people who inject drugs with HCV infection can be effectively linked and treated with direct-acting antivirals regimens in settings outside of hospital. Interventions that facilitate HCV care must be implemented at settings where people who inject drugs are already accessing services. The experts' reflections complement the findings of the literature review and inform public health practice by considering the heterogeneity of health systems and national regulatory frameworks. Higher quality studies investigating interventions addressing the entire care cascade from testing to cure and prevention of reinfections among highly vulnerable populations are urgently needed.
Background Methods Results Conclusions
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Karasz A, Merchant K, Arnstein J, Feinberg J, Kim A, McKee M, Meissner P. A Video Observed Treatment (VOT) Strategy to Improve Adherence to Treatment Among Persons who Inject Drugs infected with Hepatitis C Virus: A Qualitative Study of Stakeholder Perceptions and Experiences (Preprint). J Med Internet Res 2022. [DOI: 10.2196/38176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
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Sun HY, Cheng CY, Lin CY, Yang CJ, Lee NY, Liou BH, Tang HJ, Liu YM, Lee CY, Chen TC, Huang YC, Lee YT, Tsai MJ, Lu PL, Tsai HC, Wang NC, Hung TC, Cheng SH, Hung CC. Real-world effectiveness of direct-acting antivirals in people living with human immunodeficiency virus and hepatitis C virus genotype 6 infections. World J Gastroenterol 2022; 28:1172-1183. [PMID: 35431505 PMCID: PMC8985481 DOI: 10.3748/wjg.v28.i11.1172] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/26/2021] [Accepted: 01/29/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) genotype 6 (HCV-6) infection is prevalent predominantly in Southeast Asia, and the data on the virologic response of HCV-6 to direct-acting antivirals (DAAs) are sparse in people living with human immunodeficiency virus (HIV) (PLWH).
AIM To assess the virologic response of HCV-6 to DAAs in PLWH.
METHODS From September 2016 to July 2019, PLWH coinfected with HCV-6 initiating DAAs were included. Laboratory investigations were performed at baseline, the end of treatment, and 12 wk off-therapy.
RESULTS Of the 349 PLWH included (mean age 48.9 years, 82.5% men), 80.5% comprised people who inject drugs, 18.1% men who have sex with men, and 1.4% heterosexuals. Coexistent hepatitis B virus infection was present in 12.3% of the included PLWH, liver cirrhosis 10.9%, hepatocellular carcinoma 0.9%, and previous HCV treatment experience 10.9%. The mean baseline plasma HCV RNA was 6.2 log10 IU/mL. Treatment with glecaprevir/pibrentasvir was initiated in 51.9%, sofosbuvir/ledipasvir 41.5%, sofosbuvir/velpatasvir 6.3%, and sofosbuvir/daclatasvir 0.3%. At DAA initiation, antiretroviral therapy containing tenofovir alafenamide was given in 26.4%, tenofovir disoproxil fumarate 34.4%, non-tenofovir alafenamide/tenofovir disoproxil fumarate 39.3%, non-nucleoside reverse-transcriptase inhibitors 30.4%, protease inhibitors 4.0%, and integrase strand transfer inhibitors 66.8%; 94.8% of the included patients had CD4 counts ≥ 200 cells/mm3 and 96.0% had plasma HIV RNA < 50 copies/mL. Overall, 96.8% achieved undetectable plasma HCV RNA (< 30 IU/mL) at end of treatment; and 92.3% achieved sustained virologic response 12 wk off-therapy in the intention-to-treat analysis (93.5% in patients receiving sofosbuvir-based DAAs and 91.2% in those receiving glecaprevir/pibrentasvir).
CONCLUSION Similar to the observation made in HIV-negative patients, sustained virologic response 12 wk off-therapy with DAAs is high in PLWH coinfected with HCV-6.
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Affiliation(s)
- Hsin-Yun Sun
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100225, Taiwan
| | - Chien-Yu Cheng
- Department of Infectious Diseases, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan 330215, Taiwan
- School of Public Health, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
| | - Chi-Ying Lin
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin County 640203, Taiwan
| | - Chia-Jui Yang
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City 220216, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
| | - Nan-Yao Lee
- Department of Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan
| | - Bo-Huang Liou
- Department of Internal Medicine, Hsinchu MacKay Memorial Hospital, Hsin-Chu 300044, Taiwan
| | - Hung-Jen Tang
- Department of Internal Medicine, Chi Mei Medical Center, Tainan 710402, Taiwan
- Department of Health and Nutrition, Chia Nan University of Pharmacy and Sciences, Tainan 717301, Taiwan
| | - Yuang-Meng Liu
- Department of Internal Medicine, Changhua Christian Hospital, Changhua 500209, Taiwan
| | - Chun-Yuan Lee
- Department of Internal Medicine, Kaohsiung Medical University Hospital and College of Medicine, Kaohsiung Medical University, Kaohsiung 807378, Taiwan
| | - Tun-Chieh Chen
- Department of Internal Medicine, Kaohsiung Medical University Hospital and College of Medicine, Kaohsiung Medical University, Kaohsiung 807378, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung 801735, Taiwan
| | - Yi-Chia Huang
- Department of Internal Medicine, National Taiwan University Hospital Biomedical Park Branch, Hsin-Chu 302058, Taiwan
| | - Yuan-Ti Lee
- Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung 402306, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung 402306, Taiwan
| | - Ming-Jui Tsai
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin County 640203, Taiwan
| | - Po-Liang Lu
- Department of Internal Medicine, Kaohsiung Medical University Hospital and College of Medicine, Kaohsiung Medical University, Kaohsiung 807377, Taiwan
| | - Hung-Chin Tsai
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813414, Taiwan
| | - Ning-Chi Wang
- Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan
| | - Tung-Che Hung
- Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi 600566, Taiwan
| | - Shu-Hsing Cheng
- Department of Infectious Diseases, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan 330215, Taiwan
- School of Public Health, Taipei Medical University, Taipei 110301, Taiwan
| | - Chien-Ching Hung
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100225, Taiwan
- Department of Tropical Medicine and Parasitology, National Taiwan University College of Medicine, Taipei 100233, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung, 404332, Taiwan
- China Medical University, Taichung 406040, Taiwan
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Romagnoli D. Elimination of hepatitis C virus infection in Europe: targeting the obstacles. EXPLORATION OF MEDICINE 2022. [DOI: 10.37349/emed.2022.00075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Dante Romagnoli
- Gastroenterology Unit, Polyclinic, Azienda Ospedaliero-Universitaria di Modena, 41124 Modena, Italy
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Mafirakureva N, Stone J, Fraser H, Nzomukunda Y, Maina A, Thiong’o AW, Kizito KW, Mucara EWK, Diaz CIG, Musyoki H, Mundia B, Cherutich P, Nyakowa M, Lizcano J, Chhun N, Kurth A, Akiyama MJ, Waruiru W, Bhattacharjee P, Cleland C, Donchuk D, Luhmann N, Loarec A, Maman D, Walker J, Vickerman P. An intensive model of care for hepatitis C virus screening and treatment with direct-acting antivirals in people who inject drugs in Nairobi, Kenya: a model-based cost-effectiveness analysis. Addiction 2022; 117:411-424. [PMID: 34184794 PMCID: PMC8737065 DOI: 10.1111/add.15630] [Citation(s) in RCA: 3] [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: 09/09/2020] [Revised: 12/22/2020] [Accepted: 06/16/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND AIMS Hepatitis C virus (HCV) treatment is essential for eliminating HCV in people who inject drugs (PWID), but has limited coverage in resource-limited settings. We measured the cost-effectiveness of a pilot HCV screening and treatment intervention using directly observed therapy among PWID attending harm reduction services in Nairobi, Kenya. DESIGN We utilized an existing model of HIV and HCV transmission among current and former PWID in Nairobi to estimate the cost-effectiveness of screening and treatment for HCV, including prevention benefits versus no screening and treatment. The cure rate of treatment and costs for screening and treatment were estimated from intervention data, while other model parameters were derived from literature. Cost-effectiveness was evaluated over a life-time horizon from the health-care provider's perspective. One-way and probabilistic sensitivity analyses were performed. SETTING Nairobi, Kenya. POPULATION PWID. MEASUREMENTS Treatment costs, incremental cost-effectiveness ratio (cost per disability-adjusted life year averted). FINDINGS The cost per disability-adjusted life-year averted for the intervention was $975, with 92.1% of the probabilistic sensitivity analyses simulations falling below the per capita gross domestic product for Kenya ($1509; commonly used as a suitable threshold for determining whether an intervention is cost-effective). However, the intervention was not cost-effective at the opportunity cost-based cost-effectiveness threshold of $647 per disability-adjusted life-year averted. Sensitivity analyses showed that the intervention could provide more value for money by including modelled estimates for HCV disease care costs, assuming lower drug prices ($75 instead of $728 per course) and excluding directly-observed therapy costs. CONCLUSIONS The current strategy of screening and treatment for hepatitis C virus (HCV) among people who inject drugs in Nairobi is likely to be highly cost-effective with currently available cheaper drug prices, if directly-observed therapy is not used and HCV disease care costs are accounted for.
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Affiliation(s)
| | - Jack Stone
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Hannah Fraser
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Aron Maina
- Médecins Sans Frontières (MSF), Nairobi, Kenya
| | | | | | | | | | - Helgar Musyoki
- National AIDS and STI Control Programme (NASCOP), Nairobi, Kenya
| | | | | | - Mercy Nyakowa
- Ministry of Health—Republic of Kenya, Nairobi, Kenya
| | | | | | | | - Matthew J. Akiyama
- Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, USA
| | - Wanjiru Waruiru
- University of California - San Francisco, San Francisco, CA, USA
| | | | | | | | | | | | | | - Josephine Walker
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Valencia J, Lazarus JV, Ceballos FC, Troya J, Cuevas G, Resino S, Torres-Macho J, Ryan P. Differences in the hepatitis C virus cascade of care and time to initiation of therapy among vulnerable subpopulations using a mobile unit as point-of-care. Liver Int 2022; 42:309-319. [PMID: 34767680 DOI: 10.1111/liv.15095] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 10/31/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS People who inject drugs (PWID) and other marginalized populations with high hepatitis C virus (HCV) infection rates represent a unique challenge for treatment initiation due to health, administrative and social barriers. We analysed the HCV cascade of care (CoC) in some vulnerable subpopulations in Madrid, Spain, when using a mobile point-of-care (PoC). METHODS From 2019 to 2021, a mobile unit was used to screen active HCV using a linkage-to-care and two-step PoC-based strategy. Viremic participants were grouped into four subgroups: PWID, homeless individuals and people with a mental health disorder (MHD) and alcohol use disorder (AUD). Logistic regression, and Cox and Aalen's additive models were used to analyse associated factors and differences between groups. RESULTS A prospectively recruited cohort of 214 HCV-infected individuals (73 PWID, 141 homeless, 57 with a MHD and 91 with AUD) participated in the study. The overall HCV CoC analysis found that 178 (83.1%) attended a hospital, 164 (76.6%) initiated direct-acting antiviral therapy and 141 (65.8%) completed therapy, of which 99 (95.2%) achieved sustained virological response (SVR). PWID were significantly less likely to initiate treatment, whereas individuals with AUD waited longer before starting the treatment. Both people with AUD and PWID were significantly less likely to complete HCV treatment. CONCLUSIONS Overall, SVR was achieved in the majority of the participants treated. However, PWID need better linkage to care and treatment, whereas PWID and AUD need more support for treatment completion.
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Affiliation(s)
- Jorge Valencia
- Internal Medicine Service, University Hospital Infanta Leonor, Madrid, Spain.,Harm Reduction Unit 'SMASD', Addictions and Mental Health Department, Madrid, Spain
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain.,Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Francisco C Ceballos
- Viral Infection and Immunity Unit, National Centre for Microbiology, Health Institute Carlos III, Madrid, Spain
| | - Jesús Troya
- Internal Medicine Service, University Hospital Infanta Leonor, Madrid, Spain
| | - Guillermo Cuevas
- Internal Medicine Service, University Hospital Infanta Leonor, Madrid, Spain
| | - Salvador Resino
- Viral Infection and Immunity Unit, National Centre for Microbiology, Health Institute Carlos III, Madrid, Spain
| | - Juan Torres-Macho
- Internal Medicine Service, University Hospital Infanta Leonor, Madrid, Spain
| | - Pablo Ryan
- Internal Medicine Service, University Hospital Infanta Leonor, Madrid, Spain.,School of Medicine, Complutense University of Madrid, Madrid, Spain.,Gregorio Marañón Health Research Institute, Madrid, Spain
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Lazarus JV, Mark HE, Colombo M, Demaio S, Dillon JF, George J, Hagström H, Hocking S, Lee N, Nieuwenhuijsen MJ, Rinella ME, Romero-Gomez M, Soriano JB, Schattenberg JM, Tacke F, Tsochatzis EA, Valenti L, Zelber-Sagi S, Ashworth Dirac M, Huang TTK. A sustainable development goal framework to guide multisectoral action on NAFLD through a societal approach. Aliment Pharmacol Ther 2022; 55:234-243. [PMID: 34866201 DOI: 10.1111/apt.16720] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/07/2021] [Accepted: 11/18/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is a highly prevalent condition that requires a comprehensive and coordinated response across sectors and disciplines. AIMS In the absence of a multisectoral framework to tackle this condition, we developed one using the sustainable development goals (SDGs) as the basis for converging thinking about the design and delivery of public health responses. METHODS A multidisciplinary group identified the SDG targets and indicators for inclusion in the new framework through a two-stage process. Firstly, a core team of three researchers independently reviewed the 169 targets and 231 indicators of the SDGs to select a shortlist. Over two Delphi rounds, a multidisciplinary group of 12 experts selected which of the shortlisted targets and indicators to include. Respondents also provided written feedback on their selection. Targets and indicators with 75% or greater agreement were included in the final framework. RESULTS The final framework comprises 16 targets-representing 9% of all targets and 62% (16/26) of the shortlisted targets-and seven indicators, accounting for 50% (7/14) of the shortlisted indicators and 3% of all indicators. The selected targets and indicators cover a broad range of factors, from health, food and nutrition to education, the economy, and the built environment. CONCLUSIONS Addressing the challenge of NAFLD will require a re-envisioning of the liver health landscape, with greater focus on joined-up systems thinking and action. This new framework can help guide this process, including by outlining the stakeholders with whom the liver health community needs to engage.
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Chan K, Mangla N. Prevalence and risk factors of hepatitis C virus infection in the rural northeastern United States. Ann Hepatol 2022; 27 Suppl 1:100576. [PMID: 34752949 DOI: 10.1016/j.aohep.2021.100576] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/22/2021] [Accepted: 05/06/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND OBJECTIVES The majority of studies regarding hepatitis C virus (HCV) prevention, screening, and treatment have been conducted in urban populations, and it is unlikely that their findings are broadly generalizable to nonurban populations. This study aimed to measure the prevalence and risk factors of HCV infection in the rural northeastern United States (US) to provide further clinical guidance for HCV screening. MATERIALS AND METHODS This was a retrospective review of all patients older than 18 years evaluated at an integrated healthcare system, serving northern Pennsylvania and southern and central New York, who received first-time HCV screening from January 2014 to December 2019. RESULTS 30,549 patients were screened, of which 1.7% were HCV antibody positive. From 2014 to 2018, the incidence of positive HCV antibody screening cases per 100,000 population increased two-fold from 18.1 in 2014 to 40.4 in 2018. The age of positive HCV antibody patients peaked at 29.13 (95% CI 26.15-31.77) and 59.93 (95% CI 58.71-61.17). Positive HCV antibody was associated with positive urine drug screen (OR 5.9; 95% CI 3.8-9.3), narcotic use (OR 25.4; 95% CI 8.7-77.8), and overdose (OR 17.5; 95% CI 3.0-184.6). CONCLUSIONS In this rural northeastern US population, there is an increasing incidence of positive HCV screening with a bimodal age of distribution. Risk factors associated with opioid use reflect challenges to disease eradication in this population. We propose a one-time screening for persons aged 35 to 40 will aid in earlier HCV infection diagnosis and treatment in rural populations.
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Affiliation(s)
- Kelley Chan
- Geisinger Commonwealth School of Medicine, 525 Pine St, Scranton, PA 18510, USA.
| | - Neeraj Mangla
- Division of Gastroenterology and Hepatology, Guthrie Robert Packer Hospital, 402 S Wilbur Ave 1 Guthrie Square, Sayre, PA 18840, USA
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Lazarus JV, Herranz A, Picchio CA, Villota-Rivas M, Rodríguez A, Alonso JM, Moratinos A, Perrotta A, Tegeo E, Bibiloni F, Buti M, Vilella À. Eliminating hepatitis C on the Balearic Islands, Spain: a protocol for an intervention study to test and link people who use drugs to treatment and care. BMJ Open 2021; 11:e053394. [PMID: 34675021 PMCID: PMC8532552 DOI: 10.1136/bmjopen-2021-053394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION The hepatitis C virus (HCV) is a highly infectious and deadly disease, affecting some 58 million people worldwide. Of the 1.13 million people living in the Balearic Islands, Spain, about 1350 individuals have untreated HCV. Of these, about 1120 (83%) are estimated to be people who use drugs (PWUD), who are one of the key at-risk groups for HCV infection globally. Carrying out micro-elimination approaches focused on this population is crucial to achieve the WHO goal of eliminating HCV by 2030. Thus, the primary objective of this study is to validate a model of care that simplifies the screening and linkage to HCV care pathways for PWUD on the Balearic Islands. METHODS AND ANALYSIS This intervention study will be implemented across 17 sites, in 4 different settings: addiction service centres (n=12), non-governmental organisation centres (n=3), a mobile methadone unit and a prison, with an estimated 3725 participants. Together with the healthcare staff at each centre, the intervention protocols will be adapted, focusing on four phases: recruitment and testing; linkage to care; treatment for those who test positive; and monitoring of sustained virological response 12 weeks after treatment and reinfection. The primary outcomes will be the number of tested and treated individuals and the secondary outcomes will include individuals lost at each step in the cascade of care. Descriptive analysis and multivariable logistic regression of the data will be undertaken. ETHICS AND DISSEMINATION The Hospital Clínic Barcelona, Spain, Ethics Committee approved this study on 18 February 2021 (HCB/2020/2018). Findings will be disseminated through peer-reviewed publications, conference presentations and social media. The results of this study could provide a model for targeting PWUD for HCV testing and treatment in the rest of Spain and in other settings, helping to achieve the WHO HCV elimination goal.
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Affiliation(s)
- Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Andrea Herranz
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Camila A Picchio
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Marcela Villota-Rivas
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Antonia Rodríguez
- Servicio médico, Centro Penitenciario de Mallorca, Palma de Mallorca, Spain
| | | | - Albert Moratinos
- Unitat de Conductes Addictives, Institut d'Afers Socials Mallorquí (IMAS), Palma de Mallorca, Spain
| | | | - Elisabet Tegeo
- Sector mèdic, Projecte Home Balears, Illes Balears, Spain
| | - Francisca Bibiloni
- Pla d'addiccions i drogodependències de les Illes Balears (PADIB), Conselleria de Salut i Consum, Govern de les Illes Balears, Spain
| | - Maria Buti
- Liver Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- CIBER-EHD, Instituto de Salud Carlos III, Madrid, Spain
| | - Àngels Vilella
- Department of Gastroenterology, Hospital Universitari Son Llàtzer, Palma de Mallorca, Spain
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Grebely J, Collins AB, Artenie AA, Sutherland R, Meyer JP, Barocas JA, Falade-Nwulia O, Cepeda JA, Cunningham EB, Hajarizadeh B, Lafferty L, Lazarus JV, Bonn M, Marshall AD, Treloar C. Progress and remaining challenges to address hepatitis C, other infectious diseases, and drug-related harms to improve the health of people who use drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 96:103469. [PMID: 34610884 DOI: 10.1016/j.drugpo.2021.103469] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/08/2021] [Accepted: 09/09/2021] [Indexed: 12/31/2022]
Affiliation(s)
- Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, Australia.
| | | | | | - Rachel Sutherland
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Jaimie P Meyer
- AIDS Program, Yale School of Medicine, New Haven, United States; Chronic Disease Epidemiology, Yale School of Public Health, New Haven, United States
| | - Joshua A Barocas
- Divisions of General Internal Medicine and Infectious Diseases, University of Colorado School of Medicine, Aurora, United States
| | - Oluwaseun Falade-Nwulia
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, United States
| | - Javier A Cepeda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health,Baltimore, United States
| | | | | | - Lise Lafferty
- The Kirby Institute, UNSW Sydney, Sydney, Australia; Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Matthew Bonn
- Canadian Association of People Who Use Drugs, Dartmouth, Canada
| | - Alison D Marshall
- The Kirby Institute, UNSW Sydney, Sydney, Australia; Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
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Fernández de Cañete Camacho JC, Mancebo Martínez A, García Mena MA, Moreno Planas JM. Influence of psychiatric disorders and opioid substitution therapy on hepatitis C treatment with direct-acting antivirals in people who inject drugs. GASTROENTEROLOGIA Y HEPATOLOGIA 2021; 45:265-273. [PMID: 34543719 DOI: 10.1016/j.gastrohep.2021.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/25/2021] [Accepted: 09/01/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The effectiveness of the hepatitis C virus (HCV) treatment seems to be lower in people who inject drugs (PWID). We analyze the influence of various factors as psychiatric disorders and opioid substitution therapy (OST) on the treatment with direct-acting antivirals (DAA) in this collective. PATIENTS AND METHODS Three hundred thirty-two PWID patients were treated with DAA in 12 Spanish hospitals between 2004 and 2020. They were catalogued in recent and former consumers (if the last consumption was in the last 3 years) and several variables were included, evaluating the effectiveness of the treatment according to the viral load 12 weeks after the end of the treatment with the parameter «sustained viral response» (SVR12). RESULTS 23.4% were recent consumers and 27.7% were on OST. The 41.5% had any diagnosis of psychiatric disorder. SVR12 was 84.04%, ascending to 96.21% when excluded from the analyses the patients lost to follow-up (12.7%). SVR12 was lower due to an increase in the loss to follow-up in recent consumers and other factors like OST, being in prison the last 5 years, naïve patients, generalized anxiety disorder and benzodiazepine consumption. CONCLUSIONS The effectiveness of the HCV treatment with DAA in PWID is similar than in general population in patients whit an appropriate follow-up. It is important to maintain a closer follow-up in patients on OST, recent consumers and those with psychiatric disorders.
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Affiliation(s)
| | - Antonio Mancebo Martínez
- Servicio de Aparato Digestivo, Complejo Hospitalario Universitario de Albacete, Albacete, España
| | | | - José María Moreno Planas
- Servicio de Aparato Digestivo, Complejo Hospitalario Universitario de Albacete, Albacete, España; Universidad de Castilla-La Mancha, Albacete, España
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46
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Khalsa JH, Mathur P. Hepatitis C Virus Infection in Persons Who Inject Drugs in the Middle East and North Africa: Intervention Strategies. Viruses 2021; 13:1363. [PMID: 34372569 PMCID: PMC8310161 DOI: 10.3390/v13071363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/04/2021] [Accepted: 07/11/2021] [Indexed: 12/12/2022] Open
Abstract
There is a high incidence and prevalence of hepatitis C viral infection in persons with or without substance use disorders (SUDs) in the Middle East and North Africa (MENA) region, but only a small number receive comprehensive care. Highly effective direct-acting antiviral (DAA) medications are available at substantially lower costs; however, complete elimination of the hepatitis C virus (HCV) can only be achieved if integrated care strategies target those at highest risk for HCV infection and transmission and improve access to care. Due to the high prevalence of SUD in the MENA region, strategies to eliminate HCV must focus on integrated healthcare across multiple subspecialties, including addiction medicine, psychiatry, infectious diseases, hepatology, and social work. In this invited manuscript, we review the epidemiology of HCV in the MENA region and highlight intervention strategies to attain the WHO's goal of HCV eradication by 2030.
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Affiliation(s)
- Jag H. Khalsa
- Medical Consequences of Drug Abuse and Infections Branch, Division of Therapeutics and Medical Consequences, National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD 20892, USA
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
| | - Poonam Mathur
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
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Patel EU, Solomon SS, Lucas GM, McFall AM, Tomori C, Srikrishnan AK, Kumar MS, Laeyendecker O, Celentano DD, Thomas DL, Quinn TC, Mehta SH. Drug use stigma and its association with active hepatitis C virus infection and injection drug use behaviors among community-based people who inject drugs in India. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 96:103354. [PMID: 34247900 DOI: 10.1016/j.drugpo.2021.103354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/09/2021] [Accepted: 06/13/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Although drug use stigma is globally pervasive, quantitative evidence of its role in hepatitis C virus (HCV) transmission is limited. We evaluated the psychometric properties of a drug use stigma scale and examined the association between drug use stigma and active HCV infection among a community-based sample of people who inject drugs (PWID) in India. METHODS Between 8/2016 and 5/2017, a cross-sectional sample of PWID was recruited from 12 Indian cities (~1000/city) using respondent-driven sampling. Participants were ≥18 years old and reported injection drug use (IDU) in the past 2 years. Multivariable logistic regression with a random-intercept for each city was used to estimate adjusted odds ratios (aOR) of active HCV infection (RNA>30 IU/mL). Analyses incorporated RDS-II weights. RESULTS Of 11,663 participants, 73.1% reported IDU in the past 6 months and 33.8% had active HCV infection. Exploratory factor analysis yielded a four-factor solution of enacted, vicarious, felt normative and internalized drug use stigma with high internal consistency (Cronbach's α: 0.85-0.92). In analyses adjusted for age, gender, northeast region, education, homelessness, incarceration, alcohol dependence, HIV status, frequency of IDU, and ever sharing needles/syringes, PWID reporting any enacted stigma had greater odds of active HCV infection (aOR = 1.27 [95% CI = 1.13-1.43]) as did PWID with internalized stigma scores in the highest quartile (vs. lowest quartile; aOR = 1.69 [95% CI = 1.11-2.56]). Among PWID who reported IDU in the past 6 months, multiple forms of stigma were associated with higher frequency of IDU, sharing needles/syringes, having multiple injection partners, and IDU in public spaces. CONCLUSION Using a multidimensional drug use stigma scale, various forms of stigma were significantly associated with active HCV infection and injection drug use-related risk behaviors. Collectively, these data suggest that drug use stigma may play a role in HCV transmission and impede efforts to achieve HCV elimination. Strategies to diminish drug use stigma are warranted.
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Affiliation(s)
- Eshan U Patel
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sunil S Solomon
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; YR Gaitonde Centre for AIDS Research and Education, Chennai, India
| | - Gregory M Lucas
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Allison M McFall
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Cecília Tomori
- Johns Hopkins University School of Nursing, Baltimore, MD, USA; Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Oliver Laeyendecker
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Baltimore MD, USA
| | - David D Celentano
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David L Thomas
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Thomas C Quinn
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Baltimore MD, USA
| | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Havens JR, Schaninger T, Fraser H, Lofwall M, Staton M, Young AM, Hoven A, Walsh SL, Vickerman P. Eliminating hepatitis C in a rural Appalachian county: protocol for the Kentucky Viral Hepatitis Treatment Study (KeY Treat), a phase IV, single-arm, open-label trial of sofosbuvir/velpatasvir for the treatment of hepatitis C. BMJ Open 2021; 11:e041490. [PMID: 34226208 PMCID: PMC8258565 DOI: 10.1136/bmjopen-2020-041490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The overall goal of the Kentucky Viral Hepatitis Treatment Study (KeY Treat) is to eliminate hepatitis C transmission from a county in Appalachian Kentucky by removing the barriers to accessing hepatitis C virus (HCV) treatment. METHODS/ANALYSIS KeY Treat is a phase IV, open-label, single-arm clinical trial of sofosbuvir/velpatasvir (SOF/VEL) for the treatment of viraemic HCV infections. Those eligible for KeY Treat are at least 18 years of age, viraemic and are residents of the target county. Pregnant women are not eligible. Rapid HCV RNA screening is used to determine eligibility, and those with a quantifiable viral load (VL) consenting to participate initiate SOF/VEL on the same day. All pharmacologic treatment and related medical care is provided free of charge using a non-specialist provider model. Follow-up visits occur at 2, 6 and 12 weeks during treatment to assess medication adherence (measured via VL and self-report), side effects and engagement in risk behaviours. Post-treatment visits occur at 12 weeks (sustained virologic response (SVR12) visit), 6 months and 12 months post-treatment completion to assess re-infection. A control county has also been identified, and prevalence and incidence of chronic HCV infections will be compared with the target community longitudinally. The primary outcome to assess elimination is SVR12. However, several outcomes will be measured to assess the effectiveness of removing the barriers to HCV treatment, including treatment entry, completion and re-infection. Analyses will be conducted via a generalised linear model framework that can incorporate flexible covariate adjustment and multiple outcome types with a compatible link function. Mathematical modelling will be completed assessing the impact and cost-effectiveness of the intervention. ETHICS AND DISSEMINATION KeY Treat has been approved by the Institutional Review Board at the University of Kentucky. Results from KeY Treat will be presented at conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT03949764.
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Affiliation(s)
- Jennifer R Havens
- Behavioral Science, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Takako Schaninger
- Infectious Diseases, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Hannah Fraser
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Michelle Lofwall
- Behavioral Science, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Michele Staton
- Behavioral Science, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - April M Young
- Epidemiology, University of Kentucky College of Public Health, Lexington, Kentucky, USA
| | - Ardis Hoven
- Infectious Diseases, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Sharon L Walsh
- Behavioral Science, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Peter Vickerman
- Population Health Sciences, University of Bristol, Bristol, UK
- London School of Hygiene & Tropical Medicine, London, UK
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Metsch LR, Feaster DJ, Gooden LK, Masson C, Perlman DC, Jain MK, Matheson T, Nelson CM, Jacobs P, Tross S, Haynes L, Lucas GM, Colasanti JA, Rodriguez A, Drainoni ML, Osorio G, Nijhawan AE, Jacobson JM, Sullivan M, Metzger D, Vergara-Rodriguez P, Lubelchek R, Duan R, Batycki JN, Matthews AG, Munoz F, Jelstrom E, Mandler R, Del Rio C. Care Facilitation Advances Movement Along the Hepatitis C Care Continuum for Persons With Human Immunodeficiency Virus, Hepatitis C, and Substance Use: A Randomized Clinical Trial (CTN-0064). Open Forum Infect Dis 2021; 8:ofab334. [PMID: 34377726 PMCID: PMC8339611 DOI: 10.1093/ofid/ofab334] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/24/2021] [Indexed: 12/13/2022] Open
Abstract
Background Direct-acting antivirals can cure hepatitis C virus (HCV). Persons with HCV/HIV and living with substance use are disadvantaged in benefiting from advances in HCV treatment. Methods In this randomized controlled trial, participants with HCV/HIV were randomized between February 2016 and January 2017 to either care facilitation or control. Twelve-month follow-up assessments were completed in January 2018. Care facilitation group participants received motivation and strengths-based case management addressing retrieval of HCV viral load results, engagement in HCV/HIV care, and medication adherence. Control group participants received referral to HCV evaluation and an offer of assistance in making care appointments. Primary outcome was number of steps achieved along a series of 8 clinical steps (eg, receiving HCV results, initiating treatment, sustained virologic response [SVR]) of the HCV/HIV care continuum over 12 months postrandomization. Results Three hundred eighty-one individuals were screened and 113 randomized. Median age was 51 years; 58.4% of participants were male and 72.6% were Black/African American. Median HIV-1 viral load was 27 209 copies/mL, with 69% having a detectable viral load. Mean number of steps completed was statistically significantly higher in the intervention group vs controls (2.44 vs 1.68 steps; χ 2 [1] = 7.36, P = .0067). Men in the intervention group completed a statistically significantly higher number of steps than controls. Eleven participants achieved SVR with no difference by treatment group. Conclusions The care facilitation intervention increased progress along the HCV/HIV care continuum, as observed for men and not women. Study findings also highlight continued challenges to achieve individual-patient SVR and population-level HCV elimination. Clinical Trials Registration NCT02641158.
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Affiliation(s)
- Lisa R Metsch
- Department of Sociomedical Sciences, Columbia University, New York, New York, USA
| | - Daniel J Feaster
- Department of Public Health Sciences, University of Miami, Miami, Florida, USA
| | - Lauren K Gooden
- Department of Sociomedical Sciences, Columbia University, New York, New York, USA
| | - Carmen Masson
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - David C Perlman
- Division of Infectious Diseases, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mamta K Jain
- Division of Infectious Diseases, University of Texas Southwestern Medical Center and Parkland Health & Hospital System, Dallas, Texas, USA
| | - Tim Matheson
- Center on Substance Use and Health, San Francisco Department of Public Health, San Francisco, California, USA
| | - C Mindy Nelson
- Department of Public Health Sciences, University of Miami, Miami, Florida, USA
| | - Petra Jacobs
- Center for Clinical Trials Network, National Institute on Drug Abuse, Rockville, Maryland, USA
| | - Susan Tross
- Department of Psychiatry, Columbia University, New York, New York, USA
| | - Louise Haynes
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Gregory M Lucas
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Allan Rodriguez
- Infectious Disease, University of Miami, Miami, Florida, USA
| | - Mari-Lynn Drainoni
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Georgina Osorio
- Division of Infectious Diseases, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ank E Nijhawan
- Division of Infectious Diseases, University of Texas Southwestern Medical Center and Parkland Health & Hospital System, Dallas, Texas, USA
| | - Jeffrey M Jacobson
- Division of Infectious Diseases and HIV Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Meg Sullivan
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - David Metzger
- HIV/AIDS Prevention Research Division, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Pamela Vergara-Rodriguez
- Mental Health and Substance Abuse Division, John H. Stroger, Jr Hospital of Cook County, Chicago, Illinois, USA
| | - Ronald Lubelchek
- Infectious Diseases, John H. Stroger, Jr Hospital of Cook County, Chicago, Illinois, USA
| | - Rui Duan
- Department of Public Health Sciences, University of Miami, Miami, Florida, USA
| | - Jacob N Batycki
- Department of Public Health Sciences, University of Miami, Miami, Florida, USA
| | - Abigail G Matthews
- Data Statistical Center, The Emmes Company, LLC, Rockville, Maryland, USA
| | - Felipe Munoz
- Data Statistical Center, The Emmes Company, LLC, Rockville, Maryland, USA
| | - Eve Jelstrom
- Clinical Coordinating Center, The Emmes Company, LLC, Rockville, Maryland, USA
| | - Raul Mandler
- Clinical/Medical Branch, National Institute on Drug Abuse, Rockville, Maryland, USA
| | - Carlos Del Rio
- Division of Infectious Diseases, Emory University, Atlanta, Georgia, USA
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Martínez-Pérez GZ, Nikitin DS, Bessonova A, Fajardo E, Bessonov S, Shilton S. Values and preferences for hepatitis C self-testing among people who inject drugs in Kyrgyzstan. BMC Infect Dis 2021; 21:609. [PMID: 34171990 PMCID: PMC8233180 DOI: 10.1186/s12879-021-06332-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 06/09/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The prevalence of hepatitis C virus (HCV) among people who inject drugs (PWID) continues to be a major public-health burden in this highly stigmatised population. To halt transmission of HCV, rapid HCV self-testing kits represent an innovative approach that could enable PWID to know their HCV status and seek treatment. As no HCV test has yet been licenced for self-administration, it is crucial to obtain knowledge around the factors that may deter or foster delivery of HCV self-testing among PWID in resource-constrained countries. METHODS A qualitative study to assess values and preferences relating to HCV self-testing was conducted in mid-2020 among PWID in the Bishkek and Chui regions of Kyrgyzstan. Forty-seven PWID participated in 15 individual interviews, two group interviews (n = 12) and one participatory action-research session (n = 20). Responses were analysed using a thematic analysis approach with 4 predefined themes: awareness of HCV and current HCV testing experiences, and acceptability and service delivery preferences for HCV self-testing. Informants' insights were analysed using a thematic analysis approach. This research received local ethics approval. RESULTS Awareness of HCV is low and currently PWID prefer community-based HCV testing due to stigma encountered in other healthcare settings. HCV self-testing would be accepted and appreciated by PWID. Acceptability may increase if HCV self-testing: was delivered in pharmacies or by harm reduction associations; was free of charge; was oral rather than blood-based; included instructions with images and clear information on the test's accuracy; and was distributed alongside pre- and post-testing counselling with linkage to confirmatory testing support. CONCLUSIONS HCV self-testing could increase awareness of and more frequent testing for HCV infection among PWID in Kyrgyzstan. It is recommended that peer-driven associations are involved in the delivery of any HCV self-testing. Furthermore, efforts should be maximised to end discrimination against PWID at the healthcare institutions responsible for confirmatory HCV testing and treatment provision.
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Affiliation(s)
- Guillermo Z Martínez-Pérez
- Department of Physiatrics and Nursing, University of Zaragoza, Calle Domingo Miral s/n, 50009, Zaragoza, Spain
| | - Danil S Nikitin
- Global Research Institute Foundation (GLORI), 125 Suyumbaev Street apt 21, 720011, Bishkek, Kyrgyzstan
| | - Alla Bessonova
- Kyrgyz Network of Harm Reduction (KNHR), 21 Yug-2 Microdistrict apt 55, 720052, Bishkek, Kyrgyzstan
| | - Emmanuel Fajardo
- Foundation for Innovative New Diagnostics, Chemin des Mines 9, 1202, Geneva, Switzerland
| | - Sergei Bessonov
- Kyrgyz Network of Harm Reduction (KNHR), 21 Yug-2 Microdistrict apt 55, 720052, Bishkek, Kyrgyzstan
| | - Sonjelle Shilton
- Foundation for Innovative New Diagnostics, Chemin des Mines 9, 1202, Geneva, Switzerland.
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