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Harrison GI, Murray K, Gore R, Lee P, Sreedharan A, Richardson P, Hughes AJ, Wiselka M, Gelson W, Unitt E, Ratcliff K, Orton A, Trinder K, Simpson C, Ryder SD, Oelbaum S, Foster GR, Christian A, Smith S, Thomson BJ, Reynolds R, Harris M, Hickman M, Irving WL. The Hepatitis C Awareness Through to Treatment (HepCATT) study: improving the cascade of care for hepatitis C virus-infected people who inject drugs in England. Addiction 2019; 114:1113-1122. [PMID: 30694582 DOI: 10.1111/add.14569] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [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] [Received: 05/23/2018] [Revised: 09/17/2018] [Accepted: 01/24/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND AND AIMS Previous studies have shown low rates of diagnosis and treatment of hepatitis C virus (HCV) infection in people who inject drugs (PWID). Our aims were to test the effect of a complex intervention [Hepatitis C Awareness Through to Treatment (HepCATT)] in drug and alcohol clinics-primarily, on engagement of HCV-positive PWID with therapy and, secondarily, on testing for HCV, referral to hepatology services and start of HCV treatment. DESIGN AND SETTING A non-randomized pilot study in three specialist addiction clinics in England comparing an intervention year (starting between September 2015 and February 2016) with a baseline year (2014), together with three control clinics. PARTICIPANTS Analysis included all attendees at the intervention and control specialist addiction clinics identified as PWID. INTERVENTION The intervention comprised the placement of a half-time facilitator in each clinic for 12 months with the brief to increase diagnosis of HCV infection within clients at those services and the engagement of diagnosed individuals with an appropriate care pathway. The facilitator undertook various activities, which could include training of key workers, direct interaction with clients, streamlining and support for hepatology appointments and introduction of dried blood-spot testing. MEASUREMENTS For each clinic and period, we obtained the total number of clients and, as relevant, their status as PWID, tested for HCV, known HCV-positive, engaged with HCV therapy or treated. FINDINGS Compared with baseline, there was strong evidence that engagement with HCV therapy in the intervention year increased (P < 0.001) more in the HepCATT centres than controls, up + 31 percentage points [95% confidence interval (CI) = 19-43] versus -12 (CI = -31 to + 6) and odds ratio (OR) = 9.99 (CI = 4.42-22.6) versus 0.35 (CI = 0.08-1.56). HepCATT centres also had greater increases in HCV testing (OR = 3.06 versus 0.78, P < 0.001), referral to hepatology (OR = 9.60 versus 0.56, P < 0.001) and treatment initiation (OR = 9.5 versus 0.74, P < 0.001). CONCLUSIONS Introducing a half-time facilitator into drug and alcohol clinics in England increased engagement of HCV-positive people who inject drugs with hepatitis C virus care pathways, with increased uptake also of testing, referral to hepatology and initiation of treatment.
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Affiliation(s)
- Graham I Harrison
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - Karen Murray
- United Lincolnshire Hospitals Lincoln County Hospital, Lincoln, UK
| | - Roxanne Gore
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | | | | | - Paul Richardson
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | | | - Martin Wiselka
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Will Gelson
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
| | - Esther Unitt
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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- Population Health Sciences, University of Bristol, Bristol, UK
| | - Magdalena Harris
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Matthew Hickman
- Population Health Sciences, University of Bristol, Bristol, UK
| | - William L Irving
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
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Burhan H, Young R, Byrne T, Peat R, Furlong J, Renwick S, Elkin T, Oelbaum S, Walker PP. Screening Heroin Smokers Attending Community Drug Services for COPD. Chest 2018; 155:279-287. [PMID: 30189189 DOI: 10.1016/j.chest.2018.08.1049] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 08/03/2018] [Accepted: 08/08/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Heroin smoking is associated with deprivation, early onset severe emphysema, premature morbidity and mortality, and high use of health care, but individuals engage poorly with traditional health services. METHODS In this cross-sectional study, we screened a population of heroin smokers, prescribed opiate substitution therapy by community drug services, for airway disease. We assessed drug exposure, respiratory symptoms, health status, and COPD prevalence. Subjects completed spirometry, completed Medical Research Council (MRC) Dyspnea Scale, COPD Assessment Tool (CAT) questionnaire, recorded drug exposure, and provided feedback. RESULTS A total of 753 people (73% of those approached) completed screening, with 260 participants (35%) having COPD using FEV1/FVC < 0.7 and 293 (39%) participants having COPD using the lower limit of normal. A further 112 participants (15%) had asthma-COPD overlap (ACO) with features of COPD and asthma. Compared with those with normal spirometry, participants with COPD were more breathless (MRC score 3.1 vs 1.9; P < .001) and had worse health status (CAT score 22.9 vs 13.4; P < .001), respectively. Individuals with COPD had smoked cigarettes (P < .001), heroin (P < .001), and crack (P = .03) for longer and were more likely to still be smoking heroin (P < .01). Feedback was strongly positive, with 92% of respondents happy for other health-care appointments to be colocated with drug key worker appointments. CONCLUSIONS Most heroin smokers had COPD or ACO, most commonly mild to moderate disease. In high-risk areas, screening this population provides an opportunity to reduce symptoms and risk. Anchoring respiratory health screening to drug center appointments delivers high completion and satisfaction and is an appropriate model for screening other hard-to-reach populations.
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Affiliation(s)
- Hassan Burhan
- Royal Liverpool University Hospital, Liverpool, England
| | - Ryan Young
- University Hospital Aintree, Liverpool, England
| | | | - Robert Peat
- Liverpool Heart and Chest Hospital, Liverpool, England
| | | | - Susan Renwick
- Liverpool Clinical Commissioning Group, Liverpool, England
| | - Tristan Elkin
- Liverpool Clinical Commissioning Group, Liverpool, England
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Peat R, Furlong J, Byrne T, Young R, Kangombe A, Elkin T, Renwick S, Russell D, Oelbaum S, Burhan H, Walker PP. P198 Anchoring copd screening to drug services in heroin and crack smokers to improve diagnosis. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Killick SR, Bancroft K, Oelbaum S, Morris J, Elstein M. Extending the duration of the pill-free interval during combined oral contraception. Adv Contracept 1990; 6:33-40. [PMID: 2378291 DOI: 10.1007/bf01849485] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The effect of increasing the duration of the pill-free interval from 7 to 9 and 11 days during the first 4 months of combined oral contraceptive therapy was studied by hormonal, ovarian follicle and mucus changes. Increasing the pill-free interval allowed more follicular development and more estradiol production. In some cases, pre-ovulatory values were achieved although ovulation did not occur. No differences could be detected between different types of combined oral contraceptive, including monophasic, triphasic, levonorgestrel-containing and gestodene-containing. The variation between individuals in the group of 28 was far greater than any variation in dose.
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Affiliation(s)
- S R Killick
- University Hospital of South Manchester, West Didsbury
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