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Mansoor NS, Ariffin F, Suddin LS, Ahmad Zubaidi ZS. Knowledge, Attitude and Factors associated with Self-efficacy in Screening and Treatment of Hepatitis C among Primary Care Doctors in Selangor. Malays Fam Physician 2024; 19:11. [PMID: 38496773 PMCID: PMC10944644 DOI: 10.51866/oa.454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Introduction Primary care doctors (PCDs) play an increasingly important role in the management of hepatitis C. It is essential for PCDs to have good self-efficacy in screening and treating hepatitis C to achieve good outcomes. This study aimed to determine the knowledge and attitude towards and other factors associated with self-efficacy in screening and treating hepatitis C. Methods This cross-sectional study was conducted using an online Google Form. PCDs working at primary healthcare clinics were selected via simple random sampling. The online form contained items on sociodemographic and practice characteristics and a validated questionnaire on knowledge, attitude and self-efficacy towards screening and treating hepatitis C. Data were statistically analysed. Results A total of 242 PCDs were included in the analysis. The median age was 35 years (interquartile range [IQR]=5). The majority of the PCDs were women (83.9%) and Malay (71.9%) and had a median working experience of 6 years (IQR=6). The mean self-efficacy score was 12.67 (standard deviation=3.38). The factors associated with a higher level of self-efficacy in screening and treating hepatitis C were postgraduate qualification, training within the last one year, better knowledge and attitude scores and prior experience in treating hepatitis C. Conclusion The identified factors are crucial in improving the self-efficacy among PCDs in hepatitis C care services. Policymakers are suggested to implement training programmes and encourage continuous medical education, exposure to patient management and postgraduate certification in family medicine to help PCDs in treating hepatitis C better.
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Affiliation(s)
- Nurulhana Shaikh Mansoor
- MBBS, MMed Fam Med, Department of Primary Care Medicine, Faculty of Medicine UiTM, Sungai Buloh Campus, Jalan Hospital, Sungai Buloh, Selangor, Malaysia
| | - Farnaza Ariffin
- MBBS, FRCGP[Int], Department of Primary Care Medicine, Faculty of Medicine UiTM, Sungai Buloh Campus, Jalan Hospital, Sungai Buloh, Malaysia.
| | - Leny Suzana Suddin
- MD, MPH, DRPH, Department of Public Health Medicine, Faculty of Medicine UiTM, Sungai Buloh Campus, Jalan Hospital, Sungai Buloh, Selangor, Malaysia
| | - Zati Sabrina Ahmad Zubaidi
- MBBS, MMed Fam Med., Department of Primary Care Medicine, Faculty of Medicine UiTM, Sungai Buloh Campus, Jalan Hospital, Sungai Buloh, Selangor, Malaysia
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Azzeri A, Dahlui M, Mohamed R, McDonald SA, Jaafar H, Shabaruddin FH. Budget impact analysis of two treatment approaches for hepatitis C in Malaysia through the use of voluntary and compulsory licensing options. Front Public Health 2023; 11:1114560. [PMID: 36935675 PMCID: PMC10015636 DOI: 10.3389/fpubh.2023.1114560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/03/2023] [Indexed: 02/24/2023] Open
Abstract
Introduction A scaled-up treatment cascade with direct-acting antiviral (DAA) therapy is necessary to achieve global WHO targets for hepatitis C virus (HCV) elimination in Malaysia. Recently, limited access to sofosbuvir/daclatasvir (SOF/DAC) is available through compulsory licensing, with access to sofosbuvir/velpatasvir (SOF/VEL) expected through voluntary licensing due to recent agreements. SOF/VEL has superior clinical outcomes but has higher drug acquisition costs compared to SOF/DAC. A stratified treatment cascade might be the most cost-efficient approach for Malaysia whereby all HCV patients are treated with SOF/DAC except for patients with cirrhosis who are treated with SOF/VEL. Methods This study aimed to conduct a 5-year budget impact analysis of the proposed stratified treatment cascade for HCV treatment in Malaysia. A disease progression model that was developed based on model-predicted HCV epidemiology data was used for the analysis, where all HCV patients in scenario A were treated with SOF/DAC for all disease stages while in scenario B, SOF/DAC was used only for non-cirrhotic patients and SOF/VEL was used for the cirrhotic patients. Healthcare costs associated with DAA therapy and disease stage monitoring were included to estimate the downstream cost implications. Results The stratified treatment cascade with 109 in Scenario B was found to be cost-saving compared to Scenario A. The cumulative savings for the stratified treatment cascade was USD 1.4 million over 5 years. Discussion A stratified treatment cascade with SOF/VEL was expected to be cost-saving and can result in a budget impact reduction in overall healthcare expenditure in Malaysia.
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Affiliation(s)
- Amirah Azzeri
- Public Health Unit, Department of Primary Health Care, Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Nilai, Negeri Sembilan, Malaysia
- Department of Research, Development and Innovation, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Maznah Dahlui
- Department of Research, Development and Innovation, University Malaya Medical Centre, Kuala Lumpur, Malaysia
- Centre of Population Health, Department of Social and Preventive Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
- Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
| | - Rosmawati Mohamed
- Department of Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Scott Alexander McDonald
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Hafiz Jaafar
- Public Health Unit, Department of Primary Health Care, Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Nilai, Negeri Sembilan, Malaysia
| | - Fatiha Hana Shabaruddin
- Faculty of Pharmacy, University Malaya, Kuala Lumpur, Malaysia
- *Correspondence: Fatiha Hana Shabaruddin
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Zhou J, Wang F, Li L, Chen E. Expanding antiviral therapy indications for HBeAg-negative chronic hepatitis B patients with normal ALT and positive HBV DNA. Precis Clin Med 2022; 5:pbac030. [PMID: 36519139 PMCID: PMC9745772 DOI: 10.1093/pcmedi/pbac030] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/24/2022] [Indexed: 08/29/2023] Open
Abstract
With the improved efficacy and accessibility of antiviral agents as well as the concerns about disease progression, there is a hot discussion on whether HBeAg-negative chronic hepatitis B (CHB) patients with normal alanine aminotransferase (ALT) and positive HBV DNA should be treated. According to the international guidelines on the stages of the natural history of HBV infection, HBeAg-negative CHB patients with normal ALT and positive HBV DNA can be divided into two groups: one is the well-known "inactive carrier phase", which is defined as serum HBV DNA < 2000 IU/ml and no significant liver inflammation; and the other is the "indeterminate phase", which is defined as serum HBV DNA ≥ 2000 IU/mL regardless of the pathological changes in liver tissue, or HBV DNA < 2000 IU/mL but accompanied by significant pathological changes in the liver. In this minireview, we will expound the disease characteristics, disease progression, and clinical management status of these two groups. Based on the analysis, we propose that HBeAg-negative patients with normal ALT but detectable serum HBV DNA should be treated, regardless of their age, family history of hepatocellular carcinoma (HCC) or the severity of liver necroinflammation. Expanding the indications of antiviral therapy will help improve the survival and quality of life of patients by preventing disease progression, and consequently reduce the risk of HCC development.
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Affiliation(s)
- Jing Zhou
- Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Fada Wang
- Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Lanqing Li
- Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Enqiang Chen
- Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu 610041, China
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Alkalbani A, Alharrasi M, Achura S, Al Badi A, Al Rumhi A, Alqassabi K, Almamari R, Alomari O. Factors Affecting the Willingness to Undertake Premarital Screening Test Among Prospective Marital Individuals. SAGE Open Nurs 2022; 8:23779608221078156. [PMID: 35237718 PMCID: PMC8882947 DOI: 10.1177/23779608221078156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 01/17/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction Awareness toward premarital screening test and its influence on preventing
high risk marriages has become a concern to the health care system in Oman.
This is due to the increased rates of inherited diseases and genetic
disorders among the Omani population secondary to consanguineous
marriages. Objectives This cross-sectional study aims to describe the utilization of premarital
screening tests of selected university study participants as future
prospective couples. Methods The study included 400 Omani study participants from different majors at a
national governmental university that receives students from all over the
country. Data was collected using a self-administered questionnaire. Results Out of the 400 study participants 193 [48.3%] were females and 195 [48.8%]
were males, and 380 [95%] were unmarried and 19 [4.8%] were married.
Personal and family history of hereditary diseases and consanguinity between
parents were reported by 40 participants [10%], 158 [39.5%] and 175 [43.8%]
respectively. Three hundred and sixty-one [90.3%] of the total participants
were aware of the availability of premarital screening tests in Oman. A
total of 357 [89.3%] thought it is necessary to do a premarital screening
test and 367 [91.8%] agreed to carry out it in the future. The novel
contribution of this manuscript is that our logistic regression showed that
people with personal or family history of hereditary disease, and have
consanguinity between parents, being a female did not show willingness to
undertake the screening while those who are married, have higher GPA, and
older supported it. Conclusion Usability of the freely available premarital screening is low despite the
study participants awareness and willingness. Future studies should target
those who have a history of genetic disease and females as we found them not
willing to undertake the test in this study. We also recommend putting in
place mandatory rules and regulations for premarital screening tests with
better counselling strategies.
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Affiliation(s)
| | | | - Susan Achura
- Sultan Qaboos University, College of Nursing, Muscat, Oman
| | | | | | | | - Raya Almamari
- Sultan Qaboos University, College of Nursing, Muscat, Oman
| | - Omar Alomari
- Sultan Qaboos University, College of Nursing, Muscat, Oman
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Jiménez-Mendoza JC, Rivera-López FE, González-Lara MF, Valdez-Echeverría RD, Castro-Narro GE, Tore A, Uscanga-Domínguez LF, Moctezuma-Velázquez C. Seroprevalence of hepatitis B and C viruses in moderate and severe COVID-19 inpatients: A cross-sectional study at a referral center in Mexico. Ann Hepatol 2022; 27:100684. [PMID: 35167956 PMCID: PMC8839798 DOI: 10.1016/j.aohep.2022.100684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 02/03/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND OBJECTIVES The emergence of SARS-CoV-2, which causes the coronavirus disease (COVID-19) has caused a great impact on healthcare systems worldwide, including hepatitis B and C viruses screening and elimination programs. The high number of COVID-19 hospitalizations represent a great opportunity to screen patients for hepatitis B virus (HBV) and hepatitis C virus (HCV), which was the aim of this study. MATERIAL AND METHODS Cross-sectional, retrospective study performed between April 2020 and 20201 at a referral center in Mexico dedicated to the care of adults with severe/critical COVID-19. We retrieved clinical, demographic, and laboratory results from each patient´s medical records, including antibodies against HCV (anti-HCV), HBV surface antigen (HBsAg), antibodies against the HBV core antigen (anti-HBcAg), and antibodies against HBsAg (anti-HBsAg). RESULTS Out of 3620 patients that were admitted to the hospital, 24 (0.66%), 4 (0.11%), and 72 (1.99%) tested positive for anti-HCV, HBsAg, and anti-HBcAg, respectively. Of all seronegative patients, 954 (27%) had undetectable anti-HBsAg and 401 (12%) had anti-HBsAg at protective levels. Blood transfusion was the most relevant risk factor. Only 9.7% of the anti-HBc positive, 25% of the HBsAg positive, and 52% of the anti-HCV positive were aware of their serological status. CONCLUSIONS In this study we found a prevalence of anti-HCV of 0.66%, HBsAg in 0.11%, and isolated anti-HBcAg in 1.99%. We also found that HBV vaccination coverage has been suboptimal and needs to be reinforced. This study gave us a trustworthy insight of the actual seroprevalence in Mexico, which can help provide feedback to the Hepatitis National Elimination Plan.
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Affiliation(s)
- JC Jiménez-Mendoza
- Department of internal medicine. Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”. Mexico City, México
| | - FE Rivera-López
- Department of Gastroenterology. Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”. Mexico City, Mexico
| | - MF González-Lara
- Department of infectious diseases. Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”. Mexico City, Mexico
| | - RD Valdez-Echeverría
- Central Laboratory. Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”. Mexico City, Mexico
| | - GE Castro-Narro
- Department of Gastroenterology. Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”. Mexico City, Mexico
| | - A Tore
- Department of Gastroenterology. Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”. Mexico City, Mexico
| | - LF Uscanga-Domínguez
- Department of Gastroenterology. Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”. Mexico City, Mexico
| | - C Moctezuma-Velázquez
- Department of Gastroenterology. Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán". Mexico City, Mexico; Division of Gastroenterology (Liver Unit), Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
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Markby J, Shilton S, Sem X, Chan HK, Md Said R, Siva S, Zainuddin Z, Abu Bakar N, Omar H, Ruiz RJI, Gaeddert M, Tyshkovskiy A, Adee M, Chhatwal J, Kumar S, Piedagnel JM, Mohd Zain R, Menétrey C, Yuswan F, Hairizan Nasir N, Andrieux-Meyer I, Ismail F, Zakaria R, Hasim R, Murad S, Easterbrook P, Hassan MRA. Assessing the impact of simplified HCV care on linkage to care amongst high-risk patients at primary healthcare clinics in Malaysia: a prospective observational study. BMJ Open 2021; 11:e055142. [PMID: 34952885 PMCID: PMC8713014 DOI: 10.1136/bmjopen-2021-055142] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION To achieve the elimination of hepatitis C virus (HCV), substantial scale-up in access to testing and treatment is needed. This will require innovation and simplification of the care pathway, through decentralisation of testing and treatment to primary care settings and task-shifting to non-specialists. The objective of this study was to evaluate the feasibility and effectiveness of decentralisation of HCV testing and treatment using rapid diagnostic tests (RDTs) in primary healthcare clinics (PHCs) among high-risk populations, with referral of seropositive patients for confirmatory viral load testing and treatment. METHODS This observational study was conducted between December 2018 and October 2019 at 25 PHCs in three regions in Malaysia. Each PHC was linked to one or more hospitals, for referral of seropositive participants for confirmatory testing and pretreatment evaluation. Treatment was provided in PHCs for non-cirrhotic patients and at hospitals for cirrhotic patients. RESULTS During the study period, a total of 15 366 adults were screened at the 25 PHCs, using RDTs for HCV antibodies. Of the 2020 (13.2%) HCV antibody-positive participants, 1481/2020 (73.3%) had a confirmatory viral load test, 1241/1481 (83.8%) were HCV RNA-positive, 991/1241 (79.9%) completed pretreatment assessment, 632/991 (63.8%) initiated treatment, 518/632 (82.0%) completed treatment, 352/518 (68.0%) were eligible for a sustained virological response (SVR) cure assessment, 209/352 (59.4%) had an SVR cure assessment, and SVR was achieved in 202/209 (96.7%) patients. A significantly higher proportion of patients referred to PHCs initiated treatment compared with those who had treatment initiated at hospitals (71.0% vs 48.8%, p<0.001). CONCLUSIONS This study demonstrated the effectiveness and feasibility of a simplified decentralised HCV testing and treatment model in primary healthcare settings, targeting high-risk groups in Malaysia. There were good outcomes across most steps of the cascade of care when treatment was provided at PHCs compared with hospitals.
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Affiliation(s)
| | | | | | - Huan Keat Chan
- Clinical Research Centre, Hospital Sultanah Bahiyah, Alor Setar, Malaysia
| | | | - Sasikala Siva
- Drugs for Neglected Diseases initiative, Geneva, Switzerland
| | | | | | | | | | - Mary Gaeddert
- Division of Clinical Tropical Medicine, Center of Infectious Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Alexander Tyshkovskiy
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Belozersky Institute of Physico-Chemical Biology, Moscow State University, Moscow, Russia
| | - Madeline Adee
- Institute for Technology Assessment, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jagpreet Chhatwal
- Institute for Technology Assessment, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | | | - Fazidah Yuswan
- Disease Control Division, Ministry of Health, Putrajaya, Malaysia
| | | | | | - Fatanah Ismail
- Family Health Development Division, Ministry of Health, Putrajaya, Malaysia
| | - Rozita Zakaria
- Family Health Development Division, Ministry of Health, Putrajaya, Malaysia
| | - Ruziaton Hasim
- Family Health Development Division, Ministry of Health, Putrajaya, Malaysia
| | - Shahnaz Murad
- Drugs for Neglected Diseases initiative, Geneva, Switzerland
| | - Philippa Easterbrook
- Global HIV, Hepatitis & STI Programmes, World Health Organization, Geneva, Switzerland
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Sun J, Cheng H, Hassan MRA, Chan HK, Piedagnel JM. What China can learn from Malaysia to achieve the goal of "eliminate hepatitis C as a public health threat" by 2030 - a narrative review. Lancet Reg Health West Pac 2021; 16:100261. [PMID: 34590064 DOI: 10.1016/j.lanwpc.2021.100261] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 02/04/2023]
Abstract
Background: To discuss a range of strategic options for China to improve the accessibility of direct antiviral agents (DAAs) as the treatment for hepatitis C. Methods: We adopted a narrative review approach for comprehensive comparisons and in-depth analyses of the country context, and barriers of increasing the DAA treatment rate of hepatitis C in Malaysia and China, and how the two countries have been navigating the hepatitis C agenda. Findings: Malaysia adopted a series of successful strategies to scale up the diagnosis of hepatitis C and DAA treatment, which have valuable implications for China. Interpretation: The potential game-changing strategies for China to adapt from Malaysian experiences range from the stepping-up of political commitment and leadership, enhanced market competition, simplified and decentralized treatment at the strengthened primary care level, integrated healthcare services, coordinated government initiatives, to multi-organizational participation and civil society's active role in raising public awareness, and training of non-specialist physicians. Embarking on scale-up of hepatitis C treatment marks another contribution of China to improve the health of not only the Chinese citizens but also mankind, which is an important component for building healthy Chinese and global communities. Funding: No funding supported this study.
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Heffernan A, Ma Y, Nayagam S, Chan P, Chen Z, Cooke GS, Guo Y, Liu C, Thursz M, Zhang W, Zhang X, Zhang X, Jia M, Hallett TB. Economic and epidemiological evaluation of interventions to reduce the burden of hepatitis C in Yunnan province, China. PLoS One 2021; 16:e0245288. [PMID: 33439903 PMCID: PMC7806158 DOI: 10.1371/journal.pone.0245288] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 12/24/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The paradigm shift in hepatitis C virus (HCV) treatment options in the last five years has raised the prospect of eliminating the disease as a global health threat. This will require a step-change in the number being treated with the new direct-acting antivirals (DAAs). Given constrained budgets and competing priorities, policy makers need information on how to scale-up access to HCV treatment. To inform such decisions, we examined the cost effectiveness of screening and treatment interventions in Yunnan, China. METHODS AND FINDINGS We simulated the HCV epidemic using a previously published model of HCV transmission and disease progression, calibrated to Yunnan data, and implemented a range of treatment and screening interventions from 2019. We incorporated treatment, diagnosis, and medical costs (expressed in 2019 US Dollars, USD) to estimate the lifetime benefits and costs of interventions. Using this model, we asked: is introducing DAAs cost effective from a healthcare sector perspective; what is the optimal combination of screening interventions; and what is the societal return on investment of intervention? The incremental cost-effectiveness ratio (ICER) of switching to DAAs with a median cost of 7,400 USD (50,000 Chinese Yuan) per course is 500 USD/disability adjusted life year (DALY) averted; at a threshold of 50% of Yunnan gross domestic product (2,600 USD), switching to DAAs is cost effective 94% of the time. At this threshold, the optimal, cost-effective intervention comprises screening people who inject drugs, those in HIV care, men who have sex with men, and ensuring access to DAAs for all those newly diagnosed with HCV. For each USD invested in this intervention, there is an additional 0·80 USD (95% credible interval: 0·17-1·91) returned through reduced costs of disease or increased productivity. Returns on investment are lower (and potentially negative) if a sufficiently long-term horizon, encompassing the full stream of future benefits, is not adopted. The study had two key limitations: costing data were not always specific to Yunnan province but were taken from China-level studies; and modelled interventions may require more operational research to ensure they can be effectively and efficiently rolled-out to the entire province. CONCLUSIONS Introducing DAAs is cost effective, the optimal package of screening measures is focussed on higher risk groups, and there are likely to be positive returns from investing in such HCV interventions. Our analysis shows that targeted investment in HCV interventions will have net benefits to society; these benefits will only increase as DAA costs fall.
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Affiliation(s)
- Alastair Heffernan
- School of Public Health, Imperial College London, London, United Kingdom
| | - Yanling Ma
- Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Shevanthi Nayagam
- School of Public Health, Imperial College London, London, United Kingdom
| | - Polin Chan
- World Health Organization Western Pacific Regional Office, Manila, Philippines
| | - Zhongdan Chen
- World Health Organization Western Pacific Regional Office, Manila, Philippines
| | - Graham S. Cooke
- School of Public Health, Imperial College London, London, United Kingdom
| | - Yan Guo
- Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Chuntao Liu
- Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Mark Thursz
- School of Public Health, Imperial College London, London, United Kingdom
| | - Wanyue Zhang
- Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Xiaobing Zhang
- Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Xiujie Zhang
- Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Manhong Jia
- Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Timothy B. Hallett
- School of Public Health, Imperial College London, London, United Kingdom
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Tordrup D, Hutin Y, Stenberg K, Lauer JA, Hutton DW, Toy M, Scott N, Chhatwal J, Ball A. Cost-Effectiveness of Testing and Treatment for Hepatitis B Virus and Hepatitis C Virus Infections: An Analysis by Scenarios, Regions, and Income. Value Health 2020; 23:1552-1560. [PMID: 33248510 PMCID: PMC7806510 DOI: 10.1016/j.jval.2020.06.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 05/21/2020] [Accepted: 06/03/2020] [Indexed: 05/03/2023]
Abstract
OBJECTIVES Testing and treatment for hepatitis B virus (HBV) and hepatitis C virus (HCV) infection are highly effective, high-impact interventions. This article aims to estimate the cost-effectiveness of scaling up these interventions by scenarios, regions, and income groups. METHODS We modeled costs and impacts of hepatitis elimination in 67 low- and middle-income countries from 2016 to 2030. Costs included testing and treatment commodities, healthcare consultations, and future savings from cirrhosis and hepatocellular carcinomas averted. We modeled disease progression to estimate disability-adjusted life-years (DALYs) averted. We estimated incremental cost-effectiveness ratios (ICERs) by regions and World Bank income groups, according to 3 scenarios: flatline (status quo), progress (testing/treatment according to World Health Organization guidelines), and ambitious (elimination). RESULTS Compared with no action, current levels of testing and treatment had an ICER of $807/DALY for HBV and -$62/DALY (cost-saving) for HCV. Scaling up to progress scenario, both interventions had ICERs less than the average gross domestic product/capita of countries (HBV: $532/DALY; HCV: $613/DALY). Scaling up from flatline to elimination led to higher ICERs across countries (HBV: $927/DALY; HCV: $2528/DALY, respectively) that remained lower than the average gross domestic product/capita. Sensitivity analysis indicated discount rates and commodity costs were main factors driving results. CONCLUSIONS Scaling up testing and treatment for HBV and HCV infection as per World Health Organization guidelines is a cost-effective intervention. Elimination leads to a much larger impact though ICERs are higher. Price reduction strategies are needed to achieve elimination given the substantial budget impact at current commodity prices.
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Affiliation(s)
- David Tordrup
- WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Utrecht University, Utrecht, The Netherlands; World Health Organization Headquarters (Department of HIV and Global Hepatitis Programme and Department of Health Systems Governance and Financing), Geneva, Switzerland.
| | - Yvan Hutin
- World Health Organization Headquarters (Department of HIV and Global Hepatitis Programme and Department of Health Systems Governance and Financing), Geneva, Switzerland.
| | - Karin Stenberg
- World Health Organization Headquarters (Department of HIV and Global Hepatitis Programme and Department of Health Systems Governance and Financing), Geneva, Switzerland
| | - Jeremy A Lauer
- World Health Organization Headquarters (Department of HIV and Global Hepatitis Programme and Department of Health Systems Governance and Financing), Geneva, Switzerland; Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland
| | - David W Hutton
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Mehlika Toy
- Stanford University School of Medicine, Palo Alto, CA, USA
| | - Nick Scott
- Burnet Institute, Melbourne, Victoria, Australia
| | - Jagpreet Chhatwal
- Massachusetts, General Hospital, Harvard Medical School, Boston, MA, USA
| | - Andrew Ball
- World Health Organization Headquarters (Department of HIV and Global Hepatitis Programme and Department of Health Systems Governance and Financing), Geneva, Switzerland; Division of Universal Health Coverage, Communicable and Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
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Hasan F, Alfadhli A, Al-Gharabally A, Alkhaldi M, Colombo M, Lazarus JV. Accelerating the elimination of hepatitis C in Kuwait: An expert opinion. World J Gastroenterol 2020; 26:4415-4427. [PMID: 32874054 PMCID: PMC7438195 DOI: 10.3748/wjg.v26.i30.4415] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/04/2020] [Accepted: 07/23/2020] [Indexed: 02/06/2023] Open
Abstract
The hepatitis C virus (HCV) is estimated to affect 71 million people worldwide. In 2016, the World Health Organization adopted the first global health sector strategy to eliminate viral hepatitis as a public health threat by 2030. In December 2018, the European Association for the Study of the Liver, International Liver Foundation convened an expert panel to address the elimination of HCV in Kuwait. Several steps have already been taken to eliminate HCV in Kuwait, including free HCV treatment for Kuwait’s citizens, high blood safety standards, and the implementation of screening and awareness programs. The expert panel made several recommendations aimed at accelerating the elimination of HCV in Kuwait: The development of a national strategy and action plan to guide all HCV elimination activities; the formation of a coordination mechanism to support collaboration between hepatitis working committees; the prioritization of micro-elimination at primary, secondary or tertiary facilities, in prisons and rehabilitation centers; and ensuring the involvement of multiple stakeholders – including relevant civil society groups – in all activities. Enhanced screening and linkage to care should be prioritized in Kuwait, with the expansion of the prescriber base to primary healthcare providers and nurse practitioners to be considered. Raising awareness and educating people about HCV infection also remain essential to achieve the goal of HCV elimination. Lastly, a national HCV registry should be developed to help monitor the implementation of viral hepatitis plans and progress towards achieving national and international targets.
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Affiliation(s)
- Fuad Hasan
- Department of Internal Medicine, Faculty of Medicine, Kuwait University, Kuwait 12037, Kuwait
| | - Ahmad Alfadhli
- Department of Internal Medicine, Faculty of Medicine, Kuwait University, Kuwait 12037, Kuwait
| | | | - Mahmoud Alkhaldi
- Public Health Department, Ministry of Health, Kuwait 13110, Kuwait
| | - Massimo Colombo
- Head Center of Translational Research in Hepatology, Humanitas Clinical and Research Center, Rozzano 20089, Italy
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health, Barcelona Institute for Global Health (ISGlobal), University of Barcelona, Barcelona 08036, Spain
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Hiebert L, Azzeri A, Dahlui M, Hecht R, Mohamed R, Hana Shabaruddin F, McDonald SA. Estimating the Population Size of People Who Inject Drugs in Malaysia for 2014 and 2017 Using the Benchmark-Multiplier Method. Subst Use Misuse 2020; 55:871-877. [PMID: 31933411 DOI: 10.1080/10826084.2019.1708943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background: As hepatitis C elimination efforts are launched, national strategies for screening and treatment scale-up in countries, such as Malaysia, must be designed and implemented. Strategic information, including estimates of the total number of patients chronically-infected with hepatitis C virus (HCV) and the size of key populations, such as people who inject drugs (PWID), is critical to informing these efforts. For Malaysia, the estimate of the PWID population size most frequently reported in global systematic reviews is for the year 2009. Objectives: To support ongoing national HCV planning efforts, we aimed to estimate the national population size of active PWID in Malaysia, for the years 2014 and 2017. Methods: To estimate the PWID population size, we applied standard benchmark-multiplier methodology, frequently used for PWID population size estimation, and extended it by adjusting for cessation of injecting drug use within the benchmark and calculating statistical uncertainty intervals. Results: The estimated active PWID population size was 153,000 (95% uncertainty interval (UI): 136,000-172,000) for 2014 and 156,000 (95% UI: 137,000-188,000) for 2017. Conclusions/importance: This updated estimate of the active PWID population size in Malaysia will help inform effective planning for the scale-up of HCV screening and treatment services. The proposed methodology is applicable to other countries that maintain national HIV registries and have conducted Integrated Biological and Behavioral Surveys among active PWID.
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Affiliation(s)
| | - Amirah Azzeri
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Maznah Dahlui
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Julius Centre, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Robert Hecht
- Pharos Global Health Advisors, Boston, Massachusetts, USA
| | | | | | - Scott A McDonald
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands.,School of Health & Life Sciences, Glasgow Caledonian University, Glasgow, Scotland
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Mohd Suan MA, Said SM, Lim PY, Azman AZF, Abu Hassan MR. Risk factors for hepatitis C infection among adult patients in Kedah state, Malaysia: A case-control study. PLoS One 2019; 14:e0224459. [PMID: 31661525 PMCID: PMC6818779 DOI: 10.1371/journal.pone.0224459] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 10/14/2019] [Indexed: 02/07/2023] Open
Abstract
Hepatitis C infection is a global public health problem. This study was designed to identify the risk factors associated with hepatitis C infection among adult patients in Kedah state, Malaysia. A matched, hospital-based, case–control study was conducted at a tertiary hospital. Cases were adult (aged ≥ 18 years) patients with positive serology test results for hepatitis C virus antibody and detectable hepatitis C virus RNA from January 2015 to December 2018, and controls were age-, sex- and ethnicity-matched patients who were not infected with hepatitis C virus. Self-administered questionnaires were used to collect data on demographic characteristics and previous exposure to selected risk factors among the study participants. Associations between hepatitis C and demographic and risk factors were assessed using univariable and multivariable logistic regression analyses. A total of 255 case–control patient pairs were enrolled. The multivariable analysis indicated that having a history of blood or blood product transfusion before 1992 (adjusted odds ratio [AOR] = 6.99, 95% confidence interval [CI]: 3.73–13.81), injection drug use (AOR = 6.60, 95% CI: 3.66–12.43), imprisonment (AOR = 4.58, 95% CI: 1.62–16.40), tattooing (AOR = 3.73, 95% CI: 1.37–12.00), having more than one sexual partner (AOR = 2.06, 95% CI: 1.16–3.69), piercing (AOR = 1.71, 95% CI: 1.04–2.80), and having only secondary education (AOR = 1.92, 95% CI: 1.06–3.57) were independently associated with hepatitis C. No associations were found between health care occupation, needle-prick injury, surgical procedures, haemodialysis, acupuncture, cupping, or contact sports and hepatitis C infection. These findings demonstrate that hepatitis C risk is multifactorial. Having a history of blood or blood product transfusion before 1992, injection drug use, imprisonment, tattooing, having more than one sexual partner, piercing, and having only secondary education were associated with increased odds of hepatitis C.
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Affiliation(s)
- Mohd Azri Mohd Suan
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- Clinical Research Centre, Ministry of Health Malaysia, Hospital Sultanah Bahiyah, Alor Setar, Kedah, Malaysia
| | - Salmiah Md Said
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- * E-mail:
| | - Poh Ying Lim
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Ahmad Zaid Fattah Azman
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Muhammad Radzi Abu Hassan
- Clinical Research Centre, Ministry of Health Malaysia, Hospital Sultanah Bahiyah, Alor Setar, Kedah, Malaysia
- Department of Medicine, Ministry of Health Malaysia, Hospital Sultanah Bahiyah, Alor Setar, Kedah, Malaysia
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Tordrup D, Hutin Y, Stenberg K, Lauer JA, Hutton DW, Toy M, Scott N, Bulterys M, Ball A, Hirnschall G. Additional resource needs for viral hepatitis elimination through universal health coverage: projections in 67 low-income and middle-income countries, 2016-30. Lancet Glob Health 2019; 7:e1180-e1188. [PMID: 31353061 DOI: 10.1016/s2214-109x(19)30272-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/17/2019] [Accepted: 05/01/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND The World Health Assembly calls for elimination of viral hepatitis as a public health threat by 2030 (ie, -90% incidence and -65% mortality). However, WHO's 2017 cost projections to achieve health-related Sustainable Development Goals did not include the resources needed for hepatitis testing and treatment. We aimed to estimate the incremental commodity cost of adding scaled up interventions for testing and treatment of hepatitis to WHO's investment scenarios. METHODS We added modelled costs for implementing WHO recommended hepatitis testing and treatment to the 2017 WHO cost projections. We quantified additional requirements for diagnostic tests, medicines, health workers' time, and programme support across 67 low-income and middle-income countries, from 2016-30. A progress scenario scaled up interventions and a more ambitious scenario was modelled to reach elimination by 2030. We used 2018 best available prices of diagnostics and generic medicines. We estimated total costs and the additional investment needed over the projection of the 2016 baseline cost. FINDINGS The 67 countries considered included 230 million people living with hepatitis B virus (HBV) and 52 million people living with hepatitis C virus (HCV; 90% and 73% of the world's total, respectively). Under the progress scenario, 3250 million people (2400 million for HBV and 850 million for HCV) would be tested and 58·2 million people (24·1 million for HBV and 34·1 million for HCV) would be treated (total additional cost US$ 27·1 billion). Under the ambitious scenario, 11 631 million people (5502 million for HBV and 6129 million for HCV) would be tested and 93·8 million people (32·2 million for HBV and 61·6 million for HCV) would be treated (total additional cost $58·7 billion), averting 4·5 million premature deaths and leading to a gain of 51·5 million healthy life-years by 2030. However, if affordable HCV medicines remained inaccessible in 13 countries where medicine patents are protected, the additional cost of the ambitious scenario would increase to $118 billion. Hepatitis elimination would account for a 1·5% increase to the WHO ambitious health-care strengthening scenario costs, avert an additional 4·6% premature deaths, and add an additional 9·6% healthy life-years from 2016-30. INTERPRETATION Access to affordable medicines in all countries will be key to reach hepatitis elimination. This study suggests that elimination is feasible in the context of universal health coverage. It points to commodities as key determinants for the overall price tag and to options for cost reduction strategies. FUNDING WHO, United States Centers for Disease Control and Prevention, Unitaid.
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Affiliation(s)
- David Tordrup
- WHO Collaborating Centre for Pharmaceutical Policy and Regulation, University of Utrecht, Utrecht, Netherlands; Department of HIV and Global Hepatitis Programme, and Department of Health Systems Governance and Financing, WHO, Geneva, Switzerland
| | - Yvan Hutin
- Department of HIV and Global Hepatitis Programme, and Department of Health Systems Governance and Financing, WHO, Geneva, Switzerland.
| | - Karin Stenberg
- Department of HIV and Global Hepatitis Programme, and Department of Health Systems Governance and Financing, WHO, Geneva, Switzerland
| | - Jeremy A Lauer
- Department of HIV and Global Hepatitis Programme, and Department of Health Systems Governance and Financing, WHO, Geneva, Switzerland
| | - David W Hutton
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Mehlika Toy
- School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Nick Scott
- Burnet Institute, Melbourne, VIC, Australia
| | - Marc Bulterys
- Department of HIV and Global Hepatitis Programme, and Department of Health Systems Governance and Financing, WHO, Geneva, Switzerland
| | - Andrew Ball
- Department of HIV and Global Hepatitis Programme, and Department of Health Systems Governance and Financing, WHO, Geneva, Switzerland
| | - Gottfried Hirnschall
- Department of HIV and Global Hepatitis Programme, and Department of Health Systems Governance and Financing, WHO, Geneva, Switzerland
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Affiliation(s)
- Shui-Shan Lee
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong.
| | - Nick Crofts
- School of Population and Global Health, University of Melbourne, Australia
| | - Chien-Ching Hung
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Tropical Medicine and Parasitology, National Taiwan University College of Medicine, Taipei, Taiwan
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