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Saeed S, Thomas T, Dinh DA, Moodie E, Cox J, Cooper C, Gill J, Martel-Laferriere V, Panagiotoglou D, Walmsley S, Wong A, Klein MB. Frequent Disengagement and Subsequent Mortality Among People With HIV and Hepatitis C in Canada: A Prospective Cohort Study. Open Forum Infect Dis 2024; 11:ofae239. [PMID: 38798898 PMCID: PMC11127478 DOI: 10.1093/ofid/ofae239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 04/23/2024] [Indexed: 05/29/2024] Open
Abstract
Background The cascade of care, commonly used to assess HIV and hepatitis C (HCV) health service delivery, has limitations in capturing the complexity of individuals' engagement patterns. This study examines the dynamic nature of engagement and mortality trajectories among people with HIV and HCV. Methods We used data from the Canadian HIV-HCV Co-Infection Cohort, which prospectively follows 2098 participants from 18 centers biannually. Markov multistate models were used to evaluate sociodemographic and clinical factors associated with transitioning between the following states: (1) lost-to-follow-up (LTFU), defined as no visit for 18 months; (2) reengaged (reentry into cohort after being LTFU); (3) withdrawn from the study (ie, moved); (4) death; otherwise remained (5) engaged-in-care. Results A total of 1809 participants met the eligibility criteria and contributed 12 591 person-years from 2003 to 2022. LTFU was common, with 46% experiencing at least 1 episode, of whom only 57% reengaged. One in 5 (n = 383) participants died during the study. Participants who transitioned to LTFU were twice as likely to die as those who were consistently engaged. Factors associated with transitioning to LTFU included detectable HCV RNA (adjusted hazards ratio [aHR], 1.37; 95% confidence interval [CI], 1.13-1.67), evidence of HCV treatment but no sustained virologic response result (aHR, 1.99; 95% CI, 1.56-2.53), and recent incarceration (aHR, 1.94; 95% CI, 1.58-2.40). Being Indigenous was a significant predictor of death across all engagement trajectories. Interpretation Disengagement from clinical care was common and resulted in higher death rates. People LTFU were more likely to require HCV treatment highlighting a priority population for elimination strategies.
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Affiliation(s)
- Sahar Saeed
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Tyler Thomas
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Duy A Dinh
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Erica Moodie
- School of Population and Global Health, McGill University, Montreal, Quebec, Canada
| | - Joseph Cox
- School of Population and Global Health, McGill University, Montreal, Quebec, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Curtis Cooper
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - John Gill
- Department of Medicine, Centre de recherche du Centre hospitalier de l'Université Montréal, Montreal, Quebec, Canada
| | - Valerie Martel-Laferriere
- Department of Medicine, Centre de recherche du Centre hospitalier de l'Université Montréal, Montreal, Quebec, Canada
| | | | - Sharon Walmsley
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Alexander Wong
- Department of Medicine, Regina Qu’Appelle Health Region, Regina, Saskatchewan, Canada
| | - Marina B Klein
- Department of Medicine, Division of Infectious Diseases/Chronic Viral Illness Service, McGill University Health Center, Quebec, Canada
- Canadian HIV Trials Network, Vancouver, British Columbia, Canada
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Chan J, Akiyama MJ, Julian E, Joseph R, McGahee W, Rosner Z, Yang P, MacDonald R. Treating Hepatitis C Virus Infection in Jails as an Offset to Declines in Treatment Activity in the Community, New York City, NY, 2014-2020. AJPM FOCUS 2024; 3:100185. [PMID: 38322001 PMCID: PMC10844960 DOI: 10.1016/j.focus.2024.100185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Introduction There are scant data on implementation of large-scale direct-acting antiviral treatment for hepatitis C virus in jails in the U.S. New York City Health + Hospitals/Correctional Health Services aimed to scale up hepatitis C virus treatment in the New York City jail system. This study describes the trends in annual hepatitis C virus treatment in New York City jails compared with those in Medicaid-funded treatment in the New York City community from 2014 to 2020. Methods In this observational study, we extracted annual counts of direct-acting antiviral prescriptions for hepatitis C virus for those (1) in the New York City community who were covered by Medicaid and (2) those detained in New York City jails for 2014-2020. Data sources were New York City Department of Health and Mental Hygiene annual reports and Correctional Health Services treatment records, respectively. We used linear regression analysis to test for significant trends in annual treatment in these 2 cohorts during 2015-2019. Results From 2015 to 2019, treatments started in New York City jails increased annually (p=0.001), whereas Medicaid-funded prescriptions in the New York City community declined since a peak in 2015 (p<0.001). In 2019, New York City jail-based treatment initiations totaled the equivalent of 10% of treatment covered by Medicaid in New York City, up from 0.3% in 2015. Conclusions Scale up of jail-based hepatitis C virus treatment is an important strategy to offset declines observed in the community. Addressing barriers to care in jail, such as improving testing, linkage to care, and affordability of direct-acting antivirals for jail-based health services, can help sustain high levels of treatment in U.S. jails and other carceral facilities.
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Affiliation(s)
- Justin Chan
- NYC Health + Hospitals/Bellevue, New York, New York
- Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Matthew J. Akiyama
- NYC Health + Hospitals/Correctional Health Services, NYC Health + Hospitals, New York, New York
- Montefiore Einstein Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Emily Julian
- NYC Health + Hospitals/Correctional Health Services, NYC Health + Hospitals, New York, New York
| | - Rodrigue Joseph
- NYC Health + Hospitals/Correctional Health Services, NYC Health + Hospitals, New York, New York
| | - Wendy McGahee
- NYC Health + Hospitals/Correctional Health Services, NYC Health + Hospitals, New York, New York
| | - Zachary Rosner
- Department of Medicine, NYU Grossman School of Medicine, New York, New York
- NYC Health + Hospitals/Correctional Health Services, NYC Health + Hospitals, New York, New York
| | - Patricia Yang
- NYC Health + Hospitals/Correctional Health Services, NYC Health + Hospitals, New York, New York
| | - Ross MacDonald
- Department of Medicine, NYU Grossman School of Medicine, New York, New York
- NYC Health + Hospitals/Woodhull, NYC Health + Hospitals, New York, New York
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3
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Wegener M, Brooks R, Speers S, Nichols L, Villanueva M. Implementing a Surveillance-Based Approach to Create a Statewide Viral Clearance Cascade for Hepatitis C Among People With HIV and HCV Coinfection in Connecticut. Public Health Rep 2024; 139:208-217. [PMID: 37232422 PMCID: PMC10851907 DOI: 10.1177/00333549231172173] [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] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVES Highly effective direct-acting antiviral medications have made it feasible to achieve elimination of hepatis C virus (HCV), including for people with HIV and HCV coinfection. The Centers for Disease Control and Prevention offers guidance for a laboratory surveillance-based HCV viral clearance cascade, which allows public health departments to track the outcomes of people with HCV based on the following steps: ever infected, virally tested, initial infection, and cured or cleared. We examined the feasibility of this approach among people with HIV and HCV coinfection in Connecticut. METHODS We matched an HIV surveillance database, which included cases from the enhanced HIV/AIDS Reporting System as of December 31, 2019, and the HCV surveillance database, the Connecticut Electronic Disease Surveillance System, to define a cohort of coinfected people. We used HCV laboratory results obtained from January 1, 2016, through August 3, 2020, to determine HCV status. RESULTS Of 1361 people who were ever infected with HCV as of December 31, 2019, 1256 (92.3%) received HCV viral testing, 865 of 1256 people tested (68.9%) were HCV infected, and 336 of 865 infected people (38.8%) were cleared or cured. People who had undetectable HIV viral loads at most recent HIV test (<200 copies/mL) were more likely than those with detectable HIV viral loads to achieve HCV cure (P = .02). CONCLUSIONS A surveillance-based approach that includes data based on the Centers for Disease Control and Prevention HCV viral clearance cascade is feasible to implement, can help track population-level outcomes longitudinally, and can help identify gaps to inform HCV elimination strategies.
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Affiliation(s)
| | - Ralph Brooks
- School of Medicine, Yale University, New Haven, CT, USA
| | - Suzanne Speers
- Connecticut Department of Public Health, Hartford, CT, USA
| | - Lisa Nichols
- School of Medicine, Yale University, New Haven, CT, USA
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4
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Montgomery MP, Randall LM, Morrison M, Gupta N, Doshani M, Teshale E. Hepatitis C Cascades: Data to Inform Hepatitis C Elimination in the United States. Public Health Rep 2023:333549231193508. [PMID: 37667621 DOI: 10.1177/00333549231193508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023] Open
Abstract
The United States has a goal to eliminate hepatitis C as a public health threat by 2030. To accomplish this goal, hepatitis C virus (HCV) care cascades (hereinafter, HCV cascades) can be used to measure progress toward HCV elimination and identify disparities in HCV testing and care. In this topical review of HCV cascades, we describe common definitions of cascade steps, review the application of HCV cascades in health care and public health settings, and discuss the strengths and limitations of data sources used. We use examples from the Massachusetts Department of Public Health as a case study to illustrate how multiple data sources can be leveraged to produce HCV cascades for public health purposes. HCV cascades in health care settings provide actionable data to improve health care quality and delivery of services in a single health system. In public health settings at jurisdictional and national levels, HCV cascades describe HCV diagnosis and treatment for populations, which can be challenging in the absence of a single data source containing complete, comprehensive, and timely data representing all steps of a cascade. Use of multiple data sources and strategies to improve interoperability of health care and public health data systems can advance the use of HCV cascades and speed progress toward HCV elimination.
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Affiliation(s)
- Martha P Montgomery
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Now with Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Liisa M Randall
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Jamaica Plain, MA, USA
| | - Monica Morrison
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Jamaica Plain, MA, USA
| | - Neil Gupta
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mona Doshani
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Eyasu Teshale
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
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5
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Bositis CM, Tana MM. Timely Treatment Translates: A Vision for Eradicating HCV. NAM Perspect 2023; 2023:202307b. [PMID: 37916069 PMCID: PMC10617995 DOI: 10.31478/202307b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
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6
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Lloyd AR, Franco RA. Sexual Transmission of Viral Hepatitis. Infect Dis Clin North Am 2023; 37:335-349. [PMID: 37105646 DOI: 10.1016/j.idc.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Ongoing sexual transmission presents a significant barrier to viral hepatitis control. Endemic transmission of hepatitis A virus continues through communities of men with male sex partners, despite vaccine availability. Increased incidence of hepatitis B virus from 2014-2018 prompted expanded vaccination guidelines, but uptake and physician awareness remain poor. Hepatitis C virus while strongly associated with injection drug use, is also transmitted by high-risk sexual contact. Despite universal screening recommendations and curative treatment, incidence continues to increase. Even with safe and highly effective vaccinations or treatments, sexual transmission of viral hepatitides must be addressed to achieve disease elimination.
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Affiliation(s)
- Audrey R Lloyd
- Division of Infectious Diseases, Department of Medicine and Pediatrics, University of Alabama at Birmingham Heersink School of Medicine, Children's Harbor Building, 1600 7th Avenue South, Room 308, Birmingham, AL 35223, USA
| | - Ricardo A Franco
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham Heersink School of Medicine, 1917 Clinic Dewberry, 3220 5th Avenue South, Room 1044A, Birmingham, AL 35222, USA.
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7
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Cheema JS, Mathews WC, Wynn A, Bamford LB, Torriani FJ, Hill LA, Rajagopal AV, Yin J, Jain S, Garfein RS, Cachay ER, Martin NK. Hepatitis C Virus Micro-elimination Among People With HIV in San Diego: Are We on Track? Open Forum Infect Dis 2023; 10:ofad153. [PMID: 37065984 PMCID: PMC10099471 DOI: 10.1093/ofid/ofad153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 03/20/2023] [Indexed: 04/18/2023] Open
Abstract
Background Rising incidence of hepatitis C virus (HCV) among people with HIV (PWH) in San Diego County (SDC) was reported. In 2018, the University of California San Diego (UCSD) launched a micro-elimination initiative among PWH, and in 2020 SDC launched an initiative to reduce HCV incidence by 80% across 2015-2030. We model the impact of observed treatment scale-up on HCV micro-elimination among PWH in SDC. Methods A model of HCV transmission among people who inject drugs (PWID) and men who have sex with men (MSM) was calibrated to SDC. The model was additionally stratified by age, gender, and HIV status. The model was calibrated to HCV viremia prevalence among PWH in 2010, 2018, and 2021 (42.1%, 18.5%, and 8.5%, respectively), and HCV seroprevalence among PWID aged 18-39 years, MSM, and MSM with HIV in 2015. We simulate treatment among PWH, weighted by UCSD Owen Clinic (reaching 26% of HCV-infected PWH) and non-UCSD treatment, calibrated to achieve the observed HCV viremia prevalence. We simulated HCV incidence with observed and further treatment scale-up (+/- risk reductions) among PWH. Results Observed treatment scale-up from 2018 to 2021 will reduce HCV incidence among PWH in SDC from a mean of 429 infections/year in 2015 to 159 infections/year in 2030. County-wide scale-up to the maximum treatment rate achieved at UCSD Owen Clinic (in 2021) will reduce incidence by 69%, missing the 80% incidence reduction target by 2030 unless accompanied by behavioral risk reductions. Conclusions As SDC progresses toward HCV micro-elimination among PWH, a comprehensive treatment and risk reduction approach is necessary to reach 2030 targets.
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Affiliation(s)
- Jaskaran S Cheema
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, USA
| | - William C Mathews
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, USA
| | - Adriane Wynn
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, USA
| | - Laura B Bamford
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, USA
| | - Francesca J Torriani
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, USA
| | - Lucas A Hill
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, USA
| | - Amutha V Rajagopal
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, USA
| | - Jeffrey Yin
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, USA
| | - Sonia Jain
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, California, USA
| | - Richard S Garfein
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, USA
| | - Edward R Cachay
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, USA
| | - Natasha K Martin
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, USA
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
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Finbråten AK, Eckhardt BJ, Kapadia SN, Marks KM. Rapid Treatment Initiation for Hepatitis C Virus Infection: Potential Benefits, Current Limitations, and Real-World Examples. Gastroenterol Hepatol (N Y) 2022; 18:628-638. [PMID: 36866028 PMCID: PMC9972665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
The science for rapid treatment initiation for hepatitis C virus infection is in place. Easy and quick diagnostic tools can provide results within an hour. Necessary assessment before treatment initiation is now minimal and manageable. Treatment has a low dose burden and high tolerability. Although the critical components for rapid treatment are accessible, certain barriers prevent wider utilization, including insurance restrictions and delays in the health care system. Rapid treatment initiation can improve linkage to care by addressing many barriers to care at once, which is essential for achieving a care plateau. Young people with low health care engagement, finitely engaged people (eg, those who are incarcerated), or people with high-risk injection drug behavior, and thereby high risk for transmission of hepatitis C virus, can benefit the most from rapid treatment. Several innovative care models have demonstrated the potential for rapid treatment initiation by overcoming barriers to care with rapid diagnostic testing, decentralization, and simplification. Expanding these models is likely to be an important component for the elimination of hepatitis C virus infection. This article reviews the current motivation for rapid treatment initiation for hepatitis C virus infection and published literature describing rapid treatment initiation models.
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Affiliation(s)
- Ane-Kristine Finbråten
- 1Commonwealth Fund, New York, New York,2Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - Benjamin J. Eckhardt
- 3Division of Infectious Disease and Immunology, NYU Grossman School of Medicine, New York, New York
| | - Shashi N. Kapadia
- 2Department of Population Health Sciences, Weill Cornell Medicine, New York, New York,4Division of Infectious Diseases, Weill Cornell Medicine, New York, New York
| | - Kristen M. Marks
- 4Division of Infectious Diseases, Weill Cornell Medicine, New York, New York
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Hegazy GE, Abu-Serie MM, Abou-Elela GM, Ghozlan H, Sabry SA, Soliman NA, Teleb M, Abdel-Fattah YR. Bioprocess development for biosurfactant production by Natrialba sp. M6 with effective direct virucidal and anti-replicative potential against HCV and HSV. Sci Rep 2022; 12:16577. [PMID: 36195643 PMCID: PMC9531635 DOI: 10.1038/s41598-022-20091-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 09/08/2022] [Indexed: 11/09/2022] Open
Abstract
Halophilic archaea is considered an promising natural source of many important metabolites. This study focused on one of the surface-active biomolecules named biosurfactants produced by haloarchaeon Natrialba sp. M6. The production trend was optimized and the product was partially purified and identified using GC-Mass spectrometry. Sequential optimization approaches, Plackett-Burman (PB) and Box-Behnken Designs (BBD) were applied to maximize the biosurfactants production from M6 strain by using 14 factors; pH, NaCl, agitation and glycerol; the most significant factors that influenced the biosurfactant production were used for Response Surface Methodology (RSM). The final optimal production conditions were agitation (150 rpm), glycerol (3%), NaCl (20.8%), pH (12) and cultivation temperature (37°C). GC-Mass spectrometry for the recovered extract revealed the presence of a diverse group of bipolar nature, hydrophobic hydrocarbon chain and charged function group. The majority of these compounds are fatty acids. Based on results of GC-MS, compositional analysis content and Zetasizer, it was proposed that the extracted biosurfactant produced by haloarchaeon Natrialba sp. M6 could be a cationic lipoprotein. The antiviral activity of such biosurfactant was investigated against hepatitis C (HCV) and herpes simplex (HSV1) viruses at its maximum safe doses (20 μg/mL and 8 μg/mL, respectively). Its mode of antiviral action was declared to be primarily via deactivating viral envelopes thus preventing viral entry. Moreover, this biosurfactant inhibited RNA polymerase- and DNA polymerase-mediated viral replication at IC50 of 2.28 and 4.39 μg/mL, respectively also. Molecular docking studies showed that surfactin resided well and was bound to the specified motif with low and accepted binding energies (ΔG = - 5.629, - 6.997 kcal/mol) respectively. Therefore, such biosurfactant could be presented as a natural safe and effective novel antiviral agent.
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Affiliation(s)
- Ghada E Hegazy
- National Institute of Oceanography & Fisheries, NIOF-Egypt, Qaitbay Sq, El-Anfousy, Alexandria, 11865, Egypt.
| | - Marwa M Abu-Serie
- Medical Biotechnology Department, Genetic Engineering & Biotechnology Research Institute (GEBRI), City of Scientific Research & Technological Applications, Alexandria, Egypt
| | - G M Abou-Elela
- National Institute of Oceanography & Fisheries, NIOF-Egypt, Qaitbay Sq, El-Anfousy, Alexandria, 11865, Egypt
| | - Hanan Ghozlan
- Botany & Microbiology Department, Faculty of Science, Alexandria University, Alexandria, Egypt
| | - Soraya A Sabry
- Botany & Microbiology Department, Faculty of Science, Alexandria University, Alexandria, Egypt
| | - Nadia A Soliman
- Bioprocess Development Department, Genetic Engineering & Biotechnology Research Institute (GEBRI), City of Scientific Research & Technological Applications, New Borg El-Arab City, Universities & Research Institutes Zone, Alexandria, 21934, Egypt
| | - Mohamed Teleb
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Alexandria University, Alexandria, Egypt
| | - Yasser R Abdel-Fattah
- Bioprocess Development Department, Genetic Engineering & Biotechnology Research Institute (GEBRI), City of Scientific Research & Technological Applications, New Borg El-Arab City, Universities & Research Institutes Zone, Alexandria, 21934, Egypt.
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Ivanova Reipold E, Fajardo E, Juma E, Bukusi D, Bermudez Aza E, Jamil MS, Johnson CC, Farquhar C, Easterbrook P, Monroe-Wise A. Usability and acceptability of oral fluid hepatitis C self-testing among people who inject drugs in Coastal Kenya: a cross-sectional pilot study. BMC Infect Dis 2022; 22:738. [PMID: 36109704 PMCID: PMC9479404 DOI: 10.1186/s12879-022-07712-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 08/22/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND People who inject drugs (PWID) are disproportionally affected by hepatitis C virus (HCV) infection and many remain undiagnosed. HCV self-testing (HCVST) may be an effective approach to increase testing uptake, but has rarely been used among PWID. We assessed the usability and acceptability of HCVST among PWID in Kenya. METHODS We conducted a cross-sectional study nested within a cohort study between August and December 2020 on Kenya's North Coast region. Participants were handed a prototype oral fluid HCVST kit and asked to conduct the test relying on the instructions for use. Usability was assessed by documenting errors made and difficulties faced by participants. Acceptability was assessed using an interviewer-administered semi-structured questionnaire. RESULTS Among 150 participants, 19% were female and 65.3% had primary level education or lower. 71.3% made at least one error, 56.7% experienced some difficulty during at least one step, and the majority of participants (78%) required assistance during at least one step of the procedure. Most common errors occurred when placing the tube into the stand (18%), collecting the oral fluid sample (24%) and timing of reading results (53%). There was a strong association between presence of symptoms of opiate withdrawals and observed errors (94% vs 62%; p = 0.016) in a sub-group of 74 participants assessed. Inter-reader and inter-operator concordance were 97.7% (kappa: 0.92) and 99.2% (kappa: 0.95), respectively. Acceptability assessed by asking whether participants would choose to use HCVST prior to and after conducting HCVST was 98% and 95%, respectively. CONCLUSIONS We found a high acceptability of oral fluid HCVST among PWID. User errors were common and were associated with the presence of withdrawal symptoms among users. Despite errors, most participants were able to obtain and interpret results correctly. These findings suggest that this group of users may benefit from greater messaging and education including options to receive direct assistance when self-testing for HCV.
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Affiliation(s)
| | - Emmanuel Fajardo
- FIND, Campus Biotech, Chemin des Mines 9, 1202, Geneva, Switzerland
| | - Emily Juma
- VCT and HIV Prevention Unit, Kenyatta National Hospital, Nairobi, Kenya
| | - David Bukusi
- VCT and HIV Prevention Unit, Kenyatta National Hospital, Nairobi, Kenya
| | | | - Muhammad S Jamil
- Department of Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
| | - Cheryl Case Johnson
- Department of Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
| | - Carey Farquhar
- Departments of Global Health, Epidemiology and Medicine, University of Washington, Seattle, WA, USA
| | - Philippa Easterbrook
- Department of Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
| | - Aliza Monroe-Wise
- Department of Global Health, University of Washington, Seattle, WA, USA
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11
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Marshall AD, Rance J, Grebely J, Treloar C. 'Not just one box that you tick off' - Deconstructing the hepatitis C care cascade in the interferon-free direct acting antiviral era from the client perspective. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 102:103610. [PMID: 35151085 DOI: 10.1016/j.drugpo.2022.103610] [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: 10/28/2021] [Revised: 01/30/2022] [Accepted: 01/31/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND To achieve hepatitis C viral (HCV) elimination targets set by the World Health Organisation, pillars of the HCV care cascade are often referenced to track progress. The aim of this qualitative study was to explore the limitations of the care cascade framework through the real-world accounts of 'HCV journeys' among people who inject drugs (PWID), with particular attention to the intersection of PWID agency and structural determinants in the healthcare system. METHODS An in-depth analysis was conducted on five case studies to better understand participant experiences 'behind the cascade pillars'. The five case studies were drawn from the ETHOS Engage cohort as exemplars of the real-world complexities of people's HCV cascade journeys. Inclusion criteria for the qualitative study were participant has voluntarily signed the informed consent form, aged ≥18 years, HCV antibody positive by self-report, clients of selected sites participating in the ETHOS Engage cohort, and sufficiently proficient in English to participate in an interview. Thirty-four semi-structured interviews were conducted with participants who had received or had not received HCV treatment to identify barriers and facilitators to HCV care. RESULTS Participants 'housed' at the 'HCV RNA diagnosed pillar' (n = 2; Will; Julie) reported withholding their HCV serostatus in certain healthcare settings for fear that disclosure would lead to discriminatory decision-making from their treating physician. among participants who had completed treatment (n = 3; Corey; John; Nora) two reported still being unsure of their HCV status >6 months post-treatment. Ongoing feelings of frustration and shame were expressed in this 'post-cure care pillar' due to a perceived lack of quality care from clinic services and continued uneasiness when discussing drug use and reinfection while receiving opioid agonist treatment (OAT). Both case 'categories' described often tenuous therapeutic relationships with their physicians and recommended task-shifting to nurses and trusted case workers for ongoing care. CONCLUSION The care cascade provides a linear, two dimensional snapshot of clinical targets. Our findings illuminate structural barriers not visible behind its 'static' pillars, presenting insights into experiences among PWID otherwise dismissed as 'disengaged' or 'lost to follow-up'.
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Affiliation(s)
- A D Marshall
- The Kirby Institute, UNSW Sydney, Australia; Centre for Social Research in Health, UNSW Sydney, Australia.
| | - J Rance
- Centre for Social Research in Health, UNSW Sydney, Australia
| | - J Grebely
- The Kirby Institute, UNSW Sydney, Australia
| | - C Treloar
- Centre for Social Research in Health, UNSW Sydney, Australia
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Micro-Elimination of Hepatitis C among Patients with Kidney Disease by Using Electronic Reminder System-A Hospital-Based Experience. J Clin Med 2022; 11:jcm11020423. [PMID: 35054120 PMCID: PMC8778896 DOI: 10.3390/jcm11020423] [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] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 12/31/2021] [Accepted: 01/11/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Little is known about the use of an electronic reminder system for HCV screening among patients with kidney disease. In this study, we tried to determine whether reminder systems could improve the HCV screening rate in patients with kidney disease. Methods: Patients with kidney disease were enrolled from August 2019 to December 2020 to automatically screen and order HCV antibody and RNA testing in outpatient departments. Results: A total of 19,316 outpatients with kidney disease were included, and the mean age was 66.5 years. The assessment rate of HCV antibody increased from 53.1% prior to the reminder system to 79.8% after the reminder system (p < 0.001), and the assessment rate of HCV RNA increased from 71% to 82.9%. The anti-HCV seropositivity rate decreased from 7.3% at baseline to 2.5% after the implementation of the reminder system (p < 0.001), and the percentage of patients with detectable HCV RNA among those with anti-HCV seropositivity decreased from 69.1% at baseline to 46.8% (p < 0.001). Conclusions: The feasibility of an electronic reminder system for HCV screening among patients with kidney disease in a hospital-based setting was demonstrated.
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Reau N, Sulkowski MS, Thomas E, Sundaram V, Xu Q, Cheng WH, Marx SE, Hayes OA, Manthena SR, Chirikov V, Dylla DE, Brooks H, Carabino JM, Saab S. Epidemiology and Clinical Characteristics of Individuals with Hepatitis C Virus Infection in the United States, 2017-2019. Adv Ther 2021; 38:5777-5790. [PMID: 34704194 PMCID: PMC8548268 DOI: 10.1007/s12325-021-01928-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/17/2021] [Indexed: 12/12/2022]
Abstract
Introduction Hepatitis C virus (HCV) is the most common bloodborne chronic infection in the US. Following approval of highly effective, direct-acting antivirals in 2014, the diagnostic and treatment rates for HCV infection in the US have evolved. This study assessed the number of individuals with HCV screening or diagnostic testing and the clinical characteristics and treatment of HCV-infected individuals between 2017 and 2019. Methods Individuals screened for HCV antibody and/or tested for HCV ribonucleic acid (RNA) from 2017 to 2019 by two large US laboratory companies were included in this analysis. Clinical characteristics, such as HCV genotype, fibrosis stage, HIV coinfection and demographics, were assessed in HCV RNA-positive individuals. HCV treatment and subsequent achievement of sustained virologic response were imputed using data-driven algorithms based on successive viral load decline and negativity. Results From 2017 to 2019, the number of individuals tested for HCV antibody increased by 5.7%, from 7,580,303 in 2017 to 8,009,081 in 2019. The percentage of individuals tested who were HCV antibody positive was stable, ranging from 5.0% in 2017 to 4.9% in 2018 and 2019. The number of HCV RNA-positive individuals decreased by 5.0% from 382,500 in 2017 to 363,532 in 2019. Of HCV RNA-positive individuals, the proportions with genotype (GT) 3 and minimal fibrosis increased over time; proportions of individuals aged < 40 years increased, while the proportion aged 50 to 59 years decreased. Treatment rates increased from 23.4% in 2017 to 26.8% in 2019. Conclusions The percentage of HCV antibody-positive individuals remained stable from 2017 to 2019. The number of individuals tested HCV RNA positive decreased over the years. Demographics shifted toward a younger population with less fibrosis and higher rates of GT3. More than 70% of diagnosed individuals were not treated during this interval, highlighting a need for unfettered access to treatment. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-021-01928-y.
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Affiliation(s)
- Nancy Reau
- Rush University Medical Center, Chicago, IL, USA
| | | | - Emmanuel Thomas
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Vinay Sundaram
- Department of Medicine and Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | | | | | | | | | | | | | | | | | - Sammy Saab
- UCLA Medical Center, 200 Medical Plaza Driveway, Los Angeles, CA, 90095, USA.
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14
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Perkins M, Slevin A, Strand MA, Freisner D. Screening at a Federally Qualified Health Center in the Midwest for Hepatitis C Among People Who Inject Drugs, 2019-2020. Prev Chronic Dis 2021; 18:E69. [PMID: 34264813 PMCID: PMC8300540 DOI: 10.5888/pcd18.200604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Introduction Hepatitis C virus (HCV) infection is a public health epidemic. People who inject drugs (PWID) are at high risk for transmitting and contracting HCV. The objective of this study was to assess the effectiveness of a multifaceted intervention at a federally qualified health center in the US Midwest to improve HCV screening rates among PWID. Methods A prospective quality improvement initiative was conducted to increase the proportion of PWID screened for HCV. Inclusion criteria consisted of being seen by a primary care provider from April 16, 2019, through February 28, 2020, being aged 18 years or older, and confirmation of intravenous drug use. PWID status was confirmed by reviewing electronic health records. The multifaceted intervention consisted of educational sessions for the health care team and workflow changes. We analyzed the proportion of patients screened preintervention and postintervention by using χ2 tests. Results Of 742 patients who met the inclusion criteria, the proportion of PWID screened preintervention was 59.6% (n = 329) and the proportion of PWID screened postintervention was 65.1% (n = 283), increasing the screening rate by 5.5 percentage points. A χ2 test of homogeneity indicated a significant relationship between the preintervention and postintervention periods, and screening outcomes (P < .001). Conclusion This multifaceted intervention to increase HCV screening resulted in a modest increase in the proportion of PWID screened. Consistent and health care system–wide screening approaches are needed to optimize the potential of HCV treatment and cure options now available.
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Affiliation(s)
- Melissa Perkins
- North Dakota State University, Fargo, North Dakota.,817 S Whitford St, Fergus Falls, MN 56537.
| | - Amber Slevin
- Pharmacy Practice Department, North Dakota State University, Fargo, North Dakota.,Family HealthCare, Fargo, North Dakota
| | - Mark A Strand
- Department of Pharmacy Practice and Department of Public Health, North Dakota State University, Fargo, North Dakota
| | - Daniel Freisner
- Pharmacy Practice Department, North Dakota State University, Fargo, North Dakota
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15
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Baiano CX, Caven M, Robinson EM, Dillon JF. Evaluating and communicating hepatitis C cascades of care data in Tayside, Scotland: A journey towards elimination. J Viral Hepat 2021; 28:909-915. [PMID: 33759258 DOI: 10.1111/jvh.13505] [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: 12/14/2020] [Revised: 01/15/2021] [Accepted: 03/08/2021] [Indexed: 12/09/2022]
Abstract
Chronic hepatitis C virus (HCV) is one of the leading causes of liver cirrhosis and hepatocellular carcinoma. The WHO 2030 Elimination Goals require each country to evaluate their response to their epidemics. This can be achieved by visualization of cascades of care, depicting how infected cases move through disease control stages. However, methods of displaying data are debated and lack practical application. This project proposes a new way of codifying and displaying HCV data using Tayside as a case study. 1464 cases of active HCV infections in Tayside from 2015 to 2019 were analysed from NHS Tayside's HCV Database. Variables were evaluated to create a systematic coding framework that was then used to code each patient's diagnosis, treatment and cure status each year from 2015 to 2019. Graphical representation of the data in the form of a stacked clustered bar chart demonstrates general trends and conversion rates. For example, Tayside has seen an increase in diagnosis-to-cure rates from 18% to 49% (2015-2019). This method also demonstrates the portion of newly and previously diagnosed people accessing treatment, those with unsuccessful or incomplete treatments, completed treatments with unconfirmed cure, and the number of deaths and relocations. In conclusion, this project proposes a novel way of displaying cascades of care data that relays yearly snapshots of an epidemic, cumulative progression over time, nuanced information of each stage and progression towards elimination targets. This method can be meaningfully used to improve local service planning, knowledge exchange across health systems and reporting to bodies like the WHO.
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Affiliation(s)
- Cassandra X Baiano
- Ninewells Hospital, University of Dundee Medical School, Dundee, Scotland
| | - Madeleine Caven
- Gut Group, Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, Scotland
| | - Emma M Robinson
- Gut Group, Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, Scotland.,Department of Gastroenterology, NHS Tayside, Ninewells Hospital, Dundee, Scotland
| | - John F Dillon
- Gut Group, Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, Scotland.,Department of Gastroenterology, NHS Tayside, Ninewells Hospital, Dundee, Scotland
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Mintz CM, Hartz SM, Fisher SL, Ramsey AT, Geng EH, Grucza RA, Bierut LJ. A cascade of care for alcohol use disorder: Using 2015-2019 National Survey on Drug Use and Health data to identify gaps in past 12-month care. Alcohol Clin Exp Res 2021; 45:1276-1286. [PMID: 33993541 PMCID: PMC8254783 DOI: 10.1111/acer.14609] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 03/29/2021] [Accepted: 03/29/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Although effective treatments exist, alcohol use disorder (AUD) is undertreated. We used a cascade of care framework to understand gaps in care for persons with AUD. METHODS Using 2015-2019 National Survey on Drug Use and Health data, we evaluated the following steps in the cascade of care: (1) adult prevalence of AUD; (2) proportion of adults with AUD who utilized health care in the past 12 months; (3) proportion with AUD screened about their alcohol use; (4) proportion with AUD who received a brief intervention about their alcohol misuse; (5) proportion with AUD who received information about treatment for alcohol misuse; and (6) proportion with AUD who received treatment. Analyses were stratified by AUD severity. RESULTS Of the 214,505 persons included in the sample, the weighted prevalence of AUD was 7.8% (95% CI 7.6-8.0%). Cascades of care showed the majority of individuals with AUD utilized health care in the past 12 months [81.4% (95% CI 80.7-82.1%)] and were screened about alcohol use [69.9% (95% CI 68.9-70.8%)]. However, only a minority of individuals received subsequent steps of care, including 11.6% (95% CI 11.0-12.2%) who reported receiving a brief intervention, 5.1% (95% CI 4.6-5.6%) who were referred to treatment, and 5.8% (95% CI 5.4-6.3%) who received treatment. Similar patterns were observed when cascades of care were stratified by AUD severity. CONCLUSIONS Persons with AUD commonly utilize health care and are often screened about alcohol use, but few receive treatment. Healthcare settings-particularly primary care settings-represent a prime opportunity to implement AUD treatment to improve outcomes in this high-risk population.
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Affiliation(s)
- Carrie M. Mintz
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Sarah M. Hartz
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Sherri L. Fisher
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Alex T. Ramsey
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Elvin H. Geng
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Richard A. Grucza
- Family and Community Medicine, Center for Outcomes Research, Saint Louis University, St. Louis, MO, USA
| | - Laura J. Bierut
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
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Mintz CM, Hartz SM, Fisher SL, Ramsey AT, Geng EH, Grucza RA, Bierut LJ. A Cascade of Care for Alcohol Use Disorder: Using 2015-2018 National Survey on Drug Use and Health Data to Identify Gaps in Care. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.10.30.20222695. [PMID: 33173882 PMCID: PMC7654865 DOI: 10.1101/2020.10.30.20222695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Although effective treatments exist, alcohol use disorder (AUD) is undertreated. We used a cascade of care framework to understand gaps in care between diagnosis and treatment for persons with AUD. METHODS Using 2015-2018 National Survey on Drug Use and Health data, we evaluated the following steps in the cascade of care: 1) prevalence of adults with AUD; 2) proportion of adults who utilized health care in the past 12 months; 3) were screened about alcohol use; 4) received a brief intervention about alcohol misuse; 5) received information about treatment for alcohol misuse; and 6) proportion of persons with AUD who received treatment. Analyses were stratified by AUD severity. RESULTS Of the 171,766 persons included in the sample, weighted prevalence of AUD was 7.9% (95% CI 7.7-8.0%). Persons with AUD utilized health care settings at similar rates as those without AUD. Cascades of care showed the majority of individuals with AUD utilized health care and were screened about alcohol use, but the percent who received the subsequent steps of care decreased substantially. For those with severe AUD, 83.5% (CI: 78.3%-88.7%) utilized health care in the past 12 months, 73.5% (CI: 68.1%-78.9%) were screened for alcohol use, 22.7% (CI: 19.4%-26.0%) received a brief intervention, 12.4% (CI: 10%-14.7%) received information about treatment, and 20.5% (CI: 18%-23.1%) were treated for AUD. The greatest decrease in the care continuum occurred from screening to brief intervention and referral to treatment. More persons with severe AUD received treatment than were referred, indicating other pathways to treatment outside of the healthcare system. CONCLUSIONS Persons with AUD utilize health care at high rates and are frequently screened about alcohol use, but few receive treatment. Health care settings-particularly primary care settings-represent a prime opportunity to implement pharmacologic treatment for AUD to improve outcomes in this high-risk population.
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