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Cunningham NE, Lamb J, Staller A, Krajden M, Hogg RS, Towle A, Lima VD, Salters K. Expanding access to healthcare for people who use drugs and sex workers: hepatitis C elimination implications from a qualitative study of healthcare experiences in British Columbia, Canada. Harm Reduct J 2024; 21:75. [PMID: 38575970 PMCID: PMC10996275 DOI: 10.1186/s12954-024-00991-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 03/22/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) is a major health threat in Canada. In British Columbia (BC) province, 1.6% of the population had been exposed to HCV by 2012. Prevalence and incidence of HCV are very high in populations of people who use drugs (PWUD) and sex workers (SW), who may experience unique barriers to healthcare. Consequently, they are less likely to be treated for HCV. Overcoming these barriers is critical for HCV elimination. This research sought to explore the healthcare experiences of PWUD and SW and how these experiences impact their willingness to engage in healthcare in the future, including HCV care. METHODS Interpretive Description guided this qualitative study of healthcare experiences in BC, underpinned by the Health Stigma and Discrimination framework. The study team included people with living/lived experience of drug use, sex work, and HCV. Twenty-five participants completed in-depth semi-structured interviews on their previous healthcare and HCV-related experiences. Thematic analysis was used to identify common themes. RESULTS Three major themes were identified in our analysis. First, participants reported common experiences of delay and refusal of care by healthcare providers, with many negative healthcare encounters perceived as rooted in institutional culture reflecting societal stigma. Second, participants discussed their choice to engage in or avoid healthcare. Many avoided all but emergency care following negative experiences in any kind of healthcare. Third, participants described the roles of respect, stigma, dignity, fear, and trust in communication in healthcare relationships. CONCLUSIONS Healthcare experiences shared by participants pointed to ways that better understanding and communication by healthcare providers could support positive change in healthcare encounters of PWUD and SW, who are at high risk of HCV infection. More positive healthcare encounters could lead to increased healthcare engagement which is essential for HCV elimination.
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Affiliation(s)
- Nance E Cunningham
- HIV/AIDS Drug Treatment Program, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Division of Infectious Diseases, Faculty of Medicine, University of British Columbia, 170-6371 Crescent Road, Vancouver, BC, V6T 1Z2, Canada
| | - Jessica Lamb
- AIDS Network Kootenay Outreach and Support Society, 209a 16 Ave N, Cranbrook, BC, V1C 5S8, Canada
- East Kootenays Network of People Who Use Drugs, 418-304 Street, Kimberley, BC, V1A 3H4, Canada
| | | | - Mel Krajden
- Division of Infectious Diseases, Faculty of Medicine, University of British Columbia, 170-6371 Crescent Road, Vancouver, BC, V6T 1Z2, Canada
- British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
| | - Robert S Hogg
- HIV/AIDS Drug Treatment Program, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Simon Fraser University, 8888 University Dr W, Burnaby, BC, V5A 1S6, Canada
| | - Angela Towle
- Division of Infectious Diseases, Faculty of Medicine, University of British Columbia, 170-6371 Crescent Road, Vancouver, BC, V6T 1Z2, Canada
| | - Viviane Dias Lima
- HIV/AIDS Drug Treatment Program, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
- Division of Infectious Diseases, Faculty of Medicine, University of British Columbia, 170-6371 Crescent Road, Vancouver, BC, V6T 1Z2, Canada.
| | - Kate Salters
- HIV/AIDS Drug Treatment Program, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Simon Fraser University, 8888 University Dr W, Burnaby, BC, V5A 1S6, Canada
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Gliddon HD, Ward Z, Heinsbroek E, Croxford S, Edmundson C, Hope VD, Simmons R, Mitchell H, Hickman M, Vickerman P, Stone J. Has the HCV cascade of care changed among people who inject drugs in England since the introduction of direct-acting antivirals? THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024:104324. [PMID: 38218700 DOI: 10.1016/j.drugpo.2024.104324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 12/31/2023] [Accepted: 01/03/2024] [Indexed: 01/15/2024]
Abstract
BACKGROUND In England, over 80 % of those with hepatitis C virus (HCV) infection have injected drugs. We quantified the HCV cascade of care (CoC) among people who inject drugs (PWID) in England and determined whether this improved after direct-acting antivirals (DAAs) were introduced. METHODS We analysed data from nine rounds of national annual cross-sectional surveys of PWID recruited from drug services (2011-2019; N = 12,320). Study rounds were grouped as: 'Pre-DAAs' (2011-2014), 'Prioritised DAAs' (2015-2016) and 'Unrestricted DAAs' (2017-2019). Participants were anonymously tested for HCV antibodies and RNA and completed a short survey. We assessed the proportion of PWID recently (current/previous year) tested for HCV. For participants ever HCV treatment eligible (past chronic infection with history of treatment or current chronic infection), we assessed the CoC as: HCV testing (ever), received a positive test result, seen a specialist nurse/doctor, and ever treated. We used logistic regression to determine if individuals progressed through the CoC differently depending on time-period, whether time-period was associated with recent testing (all participants) and lifetime HCV treatment (ever eligible participants), and predictors of HCV testing and treatment in the Unrestricted DAAs period. RESULTS The proportion of ever HCV treatment eligible PWID reporting lifetime HCV treatment increased from 12.5 % in the Pre-DAAs period to 25.6 % in the Unrestricted DAAs period (aOR:2.40, 95 %CI:1.95-2.96). There were also increases in seeing a specialist nurse/doctor. The largest loss in the CoC was at treatment for all time periods. During the Unrestricted DAAs period, recent (past year) homelessness (vs never, aOR:0.66, 95 %CI:0.45-0.97), duration of injecting (≤3 years vs >3 years; aOR:0.26, 95 %CI:0.12-0.60), never (vs current, aOR:0.31, 95 %CI:0.13-0.75) or previously being prescribed OAT (vs current, aOR:0.67, 95 %CI:0.47-0.95), and never using a NSP (vs past year, aOR:0.27, 95 %CI:0.08-0.89) were negatively associated with lifetime HCV treatment. The proportion of PWID reporting recent HCV testing was higher during Unrestricted DAAs (56 %) compared to Pre-DAAs (48 %; aOR:1.28, 95 %CI:1.06-1.54). CONCLUSION COC stages from seeing a specialist onwards improved after DAAs became widely available. Further improvements in HCV testing are needed to eliminate HCV in England.
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Affiliation(s)
- H D Gliddon
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; National Public Health Specialty Training Programme, South West, United Kingdom
| | - Z Ward
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol, United Kingdom
| | - E Heinsbroek
- Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Service, UK Health Security Agency, London, United Kingdom
| | - S Croxford
- National Public Health Speciality Training Programme, West Midlands, United Kingdom
| | - C Edmundson
- Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Service, UK Health Security Agency, London, United Kingdom
| | - V D Hope
- Public Health Institute, Liverpool John Moores University, Liverpool, United Kingdom
| | - R Simmons
- Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Service, UK Health Security Agency, London, United Kingdom
| | - H Mitchell
- Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Service, UK Health Security Agency, London, United Kingdom
| | - M Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol, United Kingdom
| | - P Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol, United Kingdom
| | - J Stone
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol, United Kingdom.
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Krekulová L, Damajka T, Krumphanslová Z, Řehák V. Pilot Outreach Program in Remedis-The Promising Step toward HCV Elimination among People Who Inject Drugs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:501. [PMID: 36612821 PMCID: PMC9819867 DOI: 10.3390/ijerph20010501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 06/17/2023]
Abstract
The global effort to eliminate HCV infection requires new approaches to accessing and testing the affected population in a setting with as low of a threshold as possible. The focus should be on socially marginalized people who inject drugs (PWIDs) and who are not willing or able to visit standard medical services. With this vision, we established an outreach service-a testing point in an ambulance in the park in front of the Main Railway Station of the capital city of Prague-to provide bloodborne disease testing and treatment. The service was available every week on Wednesday afternoon. Over the initial two years of our experience, 168 unique people were tested. Of them, 82 (49%) were diagnosed with chronic HCV infection and were eligible for treatment with antivirals. Of these, 24 (29%) initiated antiviral treatment over the study period, and 17 (71%) of these individuals achieved a documented sustained virological response. Offering medical services in PWIDs' neighborhoods helps overcome barriers and increase the chances that they will become patients and begin HCV treatment. The described outcomes appear promising for reaching the vision of linkage to the care of such a hard-to-reach population and can serve as a feasible model of care for further expansion.
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Affiliation(s)
- Laura Krekulová
- Remedis, s.r.o., Vladimírova 10, 140 00 Prague 4, Czech Republic
- 4th Department of Internal Medicine, First Faculty of Medicine, Charles University in Prague, Kateřinská 32, 128 00 Prague 2, Czech Republic
| | - Tomáš Damajka
- Remedis, s.r.o., Vladimírova 10, 140 00 Prague 4, Czech Republic
| | | | - Vratislav Řehák
- Remedis, s.r.o., Vladimírova 10, 140 00 Prague 4, Czech Republic
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Seear K, Lenton E. Becoming posthuman: hepatitis C, the race to elimination and the politics of remaking the subject. HEALTH SOCIOLOGY REVIEW : THE JOURNAL OF THE HEALTH SECTION OF THE AUSTRALIAN SOCIOLOGICAL ASSOCIATION 2021; 30:229-243. [PMID: 34448668 DOI: 10.1080/14461242.2021.1971102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 08/16/2021] [Indexed: 05/22/2023]
Abstract
Hepatitis C has long been a public health problem in Australia. 'Revolutionary' new drugs with the potential to cure hepatitis C have now emerged. The Australian government has invested heavily in them, and has an ambitious goal to eliminate hepatitis C by 2030. Numerous shifts in policy and practice are required if the elimination agenda is to be realised. This paper explores the significance of these shifts. We ask: what is the race to elimination doing with the subject? We argue that the race to elimination can be understood, simultaneously, as a product of posthuman forces, capable of being analysed using the theoretical tools made available via the posthuman turn; producing an intervention in what it means to be human; and generating a dilemma for people who use (or used) drugs, people with hepatitis C, and posthuman scholarship. In drawing out these issues, we aim to: trace the significant developments underway in hepatitis C medicine and raise awareness of them; encourage reflection on the consequences of these developments; and invite reflections on what might be lost when the human is remade by hepatitis C medicine.
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Affiliation(s)
- Kate Seear
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, Australia
| | - Emily Lenton
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, Australia
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Krekulova L, Honzák R, Riley LW. Viral hepatitis C pandemic: Challenges and threats to its elimination. J Viral Hepat 2021; 28:694-698. [PMID: 33550694 DOI: 10.1111/jvh.13480] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 01/18/2021] [Indexed: 01/13/2023]
Abstract
Under the WHO plan, the global elimination of the HCV pandemic is scheduled for 2030. The burden of HCV infection in developed countries is largely borne by people who inject drugs (PWID): new infections and reinfections are related to their risky behaviour. Although safe and sensitive hepatitis C diagnostic tools and directly acting antiviral medication are widely used, major challenges to disease elimination still remain in developed countries, where the WHO plan is in progress. The challenge is in the involvement and engagement of infected PWID. There is a strong need to change our uptake and treatment strategies to address all patients from the risk groups, connect them with the healthcare system and cure them with the vision to eliminate this HCV pandemic.
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Affiliation(s)
- Laura Krekulova
- Remedis s.r.o., Prague, Czech Republic.,4th Department of Internal Medicine, 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Radkin Honzák
- Remedis s.r.o., Prague, Czech Republic.,Institute of Clinical and Experimental Medicine, Prague, Czech Republic
| | - Lee W Riley
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, CA, USA
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6
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Artenie AA, Fortier E, Sylvestre MP, Høj SB, Minoyan N, Gauvin L, Jutras-Aswad D, Bruneau J. Socioeconomic stability is associated with lower injection frequency among people with distinct trajectories of injection drug use. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 94:103205. [PMID: 33839598 DOI: 10.1016/j.drugpo.2021.103205] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 02/16/2021] [Accepted: 03/05/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Little is known about how socioeconomic circumstances relate to injection frequencies among people who inject drugs (PWID) with diverse trajectories of injection. We aimed to characterize trajectories of injection drug use in a community-based sample of PWID over 7.5 years and to investigate the extent to which two modifiable factors reflecting socioeconomic stability-stable housing and stable income-relate to injection frequencies across distinct trajectories. METHODS HEPCO is an open, prospective cohort study of PWID living in Montréal with repeated follow-up at three-month or one-year intervals. Self-reported data on injection frequency, housing and income are collected at each visit. Injection frequency was defined as the number of injection days (0-30), reported for each of the past three months. Using group-based trajectory modeling, we first estimated average trajectories of injection frequency. Then, we estimated the trajectory group-specific average shift upward or downward associated with periods of stable housing and stable income relative to periods when these conditions were unstable. RESULTS Based on 19,527 injection frequency observations accrued by 529 participants followed over 2011-2019 (18.3% female, median age: 41), we identified five trajectories of injection frequency: three characterized by sustained injection at different frequencies (28% infrequent; 19% fluctuating; 19% frequent), one by a gradual decline (12%), and another by cessation (28%). Periods of stable housing and stable income were each independently associated with a lower injection frequency, on average, in all five trajectory groups (2.2-7.5 fewer injection days/month, depending on the factor and trajectory group). CONCLUSION Trajectories of injection drug use frequency were diverse and long-lasting for many PWID. Despite this diversity, socioeconomic stability was consistently associated with a lower injection frequency, emphasizing the close relationship between access to fundamental necessities and injection patterns in all PWID, irrespective of whether they are on a path to cessation or sustained injecting.
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Affiliation(s)
- Andreea Adelina Artenie
- Population Health Sciences, University of Bristol, Oakfield Grove, Clifton, Bristol BS8 2BN, UK
| | - Emmanuel Fortier
- Research Centre, Centre Hospitalier de l'Université de Montréal, 900 St Denis Street, Montréal, Québec H2X 3H8, Canada; Department of Family and Emergency Medicine, Université de Montréal, 2900, Édouard-Montpetit Boulevard, Montréal, Québec H3T 1J4, Canada
| | - Marie-Pierre Sylvestre
- Research Centre, Centre Hospitalier de l'Université de Montréal, 900 St Denis Street, Montréal, Québec H2X 3H8, Canada; Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, 7101 Park Ave, Montréal, Québec H3N 1X9, Canada
| | - Stine Bordier Høj
- Research Centre, Centre Hospitalier de l'Université de Montréal, 900 St Denis Street, Montréal, Québec H2X 3H8, Canada
| | - Nanor Minoyan
- Research Centre, Centre Hospitalier de l'Université de Montréal, 900 St Denis Street, Montréal, Québec H2X 3H8, Canada; Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, 7101 Park Ave, Montréal, Québec H3N 1X9, Canada
| | - Lise Gauvin
- Research Centre, Centre Hospitalier de l'Université de Montréal, 900 St Denis Street, Montréal, Québec H2X 3H8, Canada; Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, 7101 Park Ave, Montréal, Québec H3N 1X9, Canada
| | - Didier Jutras-Aswad
- Research Centre, Centre Hospitalier de l'Université de Montréal, 900 St Denis Street, Montréal, Québec H2X 3H8, Canada; Department of Psychiatry, Université de Montréal, 2900, Édouard-Montpetit Boulevard, Montréal, Québec H3T 1J4, Canada
| | - Julie Bruneau
- Research Centre, Centre Hospitalier de l'Université de Montréal, 900 St Denis Street, Montréal, Québec H2X 3H8, Canada; Department of Family and Emergency Medicine, Université de Montréal, 2900, Édouard-Montpetit Boulevard, Montréal, Québec H3T 1J4, Canada.
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Abadie R, Dombrowski K. "Caballo": risk environments, drug sharing and the emergence of a hepatitis C virus epidemic among people who inject drugs in Puerto Rico. Harm Reduct J 2020; 17:85. [PMID: 33097062 PMCID: PMC7582446 DOI: 10.1186/s12954-020-00421-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 10/06/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sharing drug injection equipment has been associated with the transmission of HCV among PWID through blood contained in the cooker and cotton used to prepare and divide up the drug solution. While epidemiologists often subsume this practice under the sharing of "ancillary equipment," more attention should be paid to the fact that indirect sharing takes place within the process of joint drug acquisition and preparation. METHODS We employed an ethnographic approach observing active PWID (N = 33) in four rural towns in Puerto Rico in order to document drug sharing arrangements involved in "caballo", as this practice is locally known. We explored partners' motivation to engage in drug sharing, as well as its social organization, social roles and existing norms. FINDINGS Findings suggest that drug sharing, is one of the main drivers of the HCV epidemic in this population. Lack of financial resources, drug packaging, drug of choice and the desire to avoid the painful effects of heroin withdrawal motivates participants' decision to partner with somebody else, sharing injection equipment-and risk-in the process. Roles are not fixed, changing not only according to caballo partners, but also, power dynamics. CONCLUSION In order to curb the HCV epidemic, harm reduction policies should recognize the particular sociocultural contexts in which people inject drugs and make decisions about risk. Avoiding sharing of injection equipment within an arrangement between PWID to acquire and use drugs is more complex than assumed by harm reduction interventions. Moving beyond individual risk behaviors, a risk environment approach suggest that poverty, and a strict drug policy that encourage users to carry small amounts of illicit substances, and a lack of HCV treatment among other factors, contribute to HCV transmission.
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Affiliation(s)
- R Abadie
- Department of Anthropology, University of Nebraska-Lincoln, 839 Oldfather Hall, Lincoln, NE, 68588, USA.
| | - K Dombrowski
- Department of Anthropology, University of Vermont, 72 University Place, Burlington, VE, 05405, USA
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Hickman M, Dillon JF, Elliott L, De Angelis D, Vickerman P, Foster G, Donnan P, Eriksen A, Flowers P, Goldberg D, Hollingworth W, Ijaz S, Liddell D, Mandal S, Martin N, Beer LJZ, Drysdale K, Fraser H, Glass R, Graham L, Gunson RN, Hamilton E, Harris H, Harris M, Harris R, Heinsbroek E, Hope V, Horwood J, Inglis SK, Innes H, Lane A, Meadows J, McAuley A, Metcalfe C, Migchelsen S, Murray A, Myring G, Palmateer NE, Presanis A, Radley A, Ramsay M, Samartsidis P, Simmons R, Sinka K, Vojt G, Ward Z, Whiteley D, Yeung A, Hutchinson SJ. Evaluating the population impact of hepatitis C direct acting antiviral treatment as prevention for people who inject drugs (EPIToPe) - a natural experiment (protocol). BMJ Open 2019; 9:e029538. [PMID: 31551376 PMCID: PMC6773339 DOI: 10.1136/bmjopen-2019-029538] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 07/25/2019] [Accepted: 07/29/2019] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Hepatitis C virus (HCV) is the second largest contributor to liver disease in the UK, with injecting drug use as the main risk factor among the estimated 200 000 people currently infected. Despite effective prevention interventions, chronic HCV prevalence remains around 40% among people who inject drugs (PWID). New direct-acting antiviral (DAA) HCV therapies combine high cure rates (>90%) and short treatment duration (8 to 12 weeks). Theoretical mathematical modelling evidence suggests HCV treatment scale-up can prevent transmission and substantially reduce HCV prevalence/incidence among PWID. Our primary aim is to generate empirical evidence on the effectiveness of HCV 'Treatment as Prevention' (TasP) in PWID. METHODS AND ANALYSIS We plan to establish a natural experiment with Tayside, Scotland, as a single intervention site where HCV care pathways are being expanded (including specialist drug treatment clinics, needle and syringe programmes (NSPs), pharmacies and prison) and HCV treatment for PWID is being rapidly scaled-up. Other sites in Scotland and England will act as potential controls. Over 2 years from 2017/2018, at least 500 PWID will be treated in Tayside, which simulation studies project will reduce chronic HCV prevalence among PWID by 62% (from 26% to 10%) and HCV incidence will fall by approximately 2/3 (from 4.2 per 100 person-years (p100py) to 1.4 p100py). Treatment response and re-infection rates will be monitored. We will conduct focus groups and interviews with service providers and patients that accept and decline treatment to identify barriers and facilitators in implementing TasP. We will conduct longitudinal interviews with up to 40 PWID to assess whether successful HCV treatment alters their perspectives on and engagement with drug treatment and recovery. Trained peer researchers will be involved in data collection and dissemination. The primary outcome - chronic HCV prevalence in PWID - is measured using information from the Needle Exchange Surveillance Initiative survey in Scotland and the Unlinked Anonymous Monitoring Programme in England, conducted at least four times before and three times during and after the intervention. We will adapt Bayesian synthetic control methods (specifically the Causal Impact Method) to generate the cumulative impact of the intervention on chronic HCV prevalence and incidence. We will use a dynamic HCV transmission and economic model to evaluate the cost-effectiveness of the HCV TasP intervention, and to estimate the contribution of the scale-up in HCV treatment to observe changes in HCV prevalence. Through the qualitative data we will systematically explore key mechanisms of TasP real world implementation from provider and patient perspectives to develop a manual for scaling up HCV treatment in other settings. We will compare qualitative accounts of drug treatment and recovery with a 'virtual cohort' of PWID linking information on HCV treatment with Scottish Drug treatment databases to test whether DAA treatment improves drug treatment outcomes. ETHICS AND DISSEMINATION Extending HCV community care pathways is covered by ethics (ERADICATE C, ISRCTN27564683, Super DOT C Trial clinicaltrials.gov: NCT02706223). Ethical approval for extra data collection from patients including health utilities and qualitative interviews has been granted (REC ref: 18/ES/0128) and ISCRCTN registration has been completed (ISRCTN72038467). Our findings will have direct National Health Service and patient relevance; informing prioritisation given to early HCV treatment for PWID. We will present findings to practitioners and policymakers, and support design of an evaluation of HCV TasP in England.
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Affiliation(s)
- Matthew Hickman
- Population Health Sciences, Bristol Medical School, Bristol, Bristol, UK
| | - John F Dillon
- Hepatology & Gastroenterology, Clinical & Molecular Medicine, School of Medicine, University of Dundee, Dundee, UK
| | | | - Daniela De Angelis
- MRC Biostatistics Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, Bristol, Bristol, UK
| | - Graham Foster
- Blizard Institute, Queen Mary University of London, London, UK
- Barts Health NHS Trust, London, UK
| | - Peter Donnan
- Dundee Epidemiology and Biostatistics Unit, University of Dundee, Dundee, UK
| | | | | | - David Goldberg
- Glasgow Caledonian University, Glasgow, UK
- Health Protection Scotland, Glasgow, UK
| | | | - Samreen Ijaz
- National Infection Service, Public Health England, London, UK
| | | | - Sema Mandal
- National Infection Service, Public Health England, London, UK
| | - Natasha Martin
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, UK
| | - Lewis J Z Beer
- Tayside Clinical Trials Unit, Tayside Medical Science Centre, University of Dundee, Dundee, UK
| | - Kate Drysdale
- Blizard Institute, Queen Mary University of London, London, UK
- Barts Health NHS Trust, London, UK
| | - Hannah Fraser
- Population Health Sciences, Bristol Medical School, Bristol, Bristol, UK
| | - Rachel Glass
- National Infection Service, Public Health England, London, UK
| | | | - Rory N Gunson
- West Of Scotland Specialist Virology Centre, NHS Greater Glasgow & Clyde Board, Glasgow, UK
| | | | - Helen Harris
- National Infection Service, Public Health England, London, UK
| | | | - Ross Harris
- National Infection Service, Public Health England, London, UK
| | | | - Vivian Hope
- Liverpool John Moores University, Liverpool, UK
| | - Jeremy Horwood
- Population Health Sciences, Bristol Medical School, Bristol, Bristol, UK
| | - Sarah Karen Inglis
- Tayside Clinical Trials Unit, Tayside Medical Science Centre, University of Dundee, Dundee, UK
| | - Hamish Innes
- Glasgow Caledonian University, Glasgow, UK
- Health Protection Scotland, Glasgow, UK
| | - Athene Lane
- Population Health Sciences, Bristol Medical School, Bristol, Bristol, UK
| | - Jade Meadows
- Population Health Sciences, Bristol Medical School, Bristol, Bristol, UK
| | - Andrew McAuley
- Glasgow Caledonian University, Glasgow, UK
- Health Protection Scotland, Glasgow, UK
| | - Chris Metcalfe
- Population Health Sciences, Bristol Medical School, Bristol, Bristol, UK
| | | | | | - Gareth Myring
- Population Health Sciences, Bristol Medical School, Bristol, Bristol, UK
| | - Norah E Palmateer
- Glasgow Caledonian University, Glasgow, UK
- Health Protection Scotland, Glasgow, UK
| | - Anne Presanis
- MRC Biostatistics Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Andrew Radley
- Hepatology & Gastroenterology, Clinical & Molecular Medicine, School of Medicine, University of Dundee, Dundee, UK
- Directorate of Public Health, NHS Tayside, Dundee, UK
| | - Mary Ramsay
- National Infection Service, Public Health England, London, UK
| | - Pantelis Samartsidis
- MRC Biostatistics Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Ruth Simmons
- National Infection Service, Public Health England, London, UK
| | - Katy Sinka
- National Infection Service, Public Health England, London, UK
| | | | - Zoe Ward
- Population Health Sciences, Bristol Medical School, Bristol, Bristol, UK
| | | | - Alan Yeung
- Glasgow Caledonian University, Glasgow, UK
- Health Protection Scotland, Glasgow, UK
| | - Sharon J Hutchinson
- Glasgow Caledonian University, Glasgow, UK
- Health Protection Scotland, Glasgow, UK
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Bryant J, Brener L, Pepolim L, Harrod ME. Care, agency and criminality: Making sense of authorised extended distribution in the accounts of key stakeholders. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 71:56-61. [PMID: 31226504 DOI: 10.1016/j.drugpo.2019.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 05/10/2019] [Accepted: 06/06/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION One of the current harm reduction debates in Australia concerns the legalisation of the extended distribution of sterile needles and syringes, a practice that is currently unlawful in most Australian settings. METHODS We used data from a unique pilot program of authorised extended distribution to document the opinions held by 22 key stakeholders -service staff, drug users and police - about the risks and benefits of authorisation, and to analyse the ways in which drug users were understood within these. RESULTS Opinions were strongly in favour of authorising extended distribution, based on the belief that this would reduce the transmission of hepatitis C. However, stakeholders also identified that distributors risked attention from police and some noted that the consequences of this would be borne by distributors themselves and not the services that support them. These opinions rested on specific assumptions about people who inject, some of which reflect negative constructions of drug users as a source of danger to the public or as helpless 'addicts' with little control over their risk reduction. But there were other representations that positioned drug users more positively as responsible agents with a strong duty of care to themselves and others whose choices are often limited by inadequate service structures. Staff participants drew on these understandings in careful and strategic ways, arguing for the rationality and expertise of drug users, while also problematizing the individualised approach that any form of authorised extended distribution might take. CONCLUSION We argue that localised and incremental changes such as those that took place to support this pilot project, and the extensive support for extended distribution among stakeholders in this study including police, creates meaningful opportunities to think about extended distribution differently, which can in turn support conditions for future discussions about legislative change.
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Affiliation(s)
- Joanne Bryant
- Centre for Social Research in Health, UNSW Sydney, NSW, 2052, Australia.
| | - Loren Brener
- Centre for Social Research in Health, UNSW Sydney, NSW, 2052, Australia
| | - Lucy Pepolim
- New South Wales Users and AIDS Association (NUAA), 345 Crown St, Surry Hills, NSW, 2010, Australia
| | - Mary Ellen Harrod
- New South Wales Users and AIDS Association (NUAA), 345 Crown St, Surry Hills, NSW, 2010, Australia
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Makarenko I, Artenie A, Hoj S, Minoyan N, Jacka B, Zang G, Barlett G, Jutras-Aswad D, Martel-Laferriere V, Bruneau J. Transitioning from interferon-based to direct antiviral treatment options: A potential shift in barriers and facilitators of treatment initiation among people who use drugs? THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 72:69-76. [PMID: 31010749 DOI: 10.1016/j.drugpo.2019.04.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/31/2019] [Accepted: 04/04/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Multiple barriers for accessing hepatitis C virus (HCV) treatment were identified during the interferon-based (IFN) treatment era for people who inject drugs (PWID). Whether these barriers persist since the introduction of IFN-free direct-acting antiviral (DAA) agents in Canada remains to be documented. This study examined temporal trends in HCV treatment initiation and associated factors during the transition from INF-based to all-oral DAA regimens. METHODS The study population was drawn from a prospective cohort of PWID in Montreal, Canada. At three-month/one-year intervals between 2011 and 2017, participants with chronic HCV infection completed an interviewer-administered questionnaire on socio-demographic characteristics, drug use and health service utilisation, including HCV treatment. Time-updated Cox multivariate regression models, stratified by DAA + INF (2011-2013) and all-oral DAA (2014-2017) availability periods, were conducted to examine associations between time to HCV treatment initiation and associated barriers and facilitators. RESULTS Of 308 participants (85% male, median age 42 [IQR: 33, 50]), 80 (26%) initiated HCV treatment during 915 person-years (PY). Incidence rates increased from 1.6 /100 PY (95%CI:0.9-2.6) in 2011 to 12.7 (10.6-15.1) in 2017 (p-trend = 0.0012). In multivariate analyses, visiting a primary care physician (2011-2013: aHR = 3.63[1.21-10.9]; 2014-2017: 2.52[1.10-5.77]) and frequent injection (0.23[0.05-0.99] and 0.49[0.24-0.99]) were consistently associated with treatment initiation. Participants aged >40 (2.27[1.24-4.13]), receiving opioid agonist therapy (OAT) (2.17[1.19-3.94]), and reporting prior HCV treatment (3.00[1.75-5.15]) were more likely to initiate treatment in the all-oral DAA period. CONCLUSION Treatment initiation increased between 2011 and 2017, but still remains low among PWID. Primary care visiting was a key facilitator regardless of the period, while engagement in OAT and health services, indicated by prior HCV treatment, increased the likelihood of treatment initiation in the DAA era. These findings suggest that access to health services is essential but not enough to scale up treatment in this population.
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Affiliation(s)
- Iuliia Makarenko
- McGill University, Department of Family Medicine, Montreal, QC, Canada; Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Adelina Artenie
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Stine Hoj
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Nanor Minoyan
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Brendan Jacka
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Geng Zang
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Gillian Barlett
- McGill University, Department of Family Medicine, Montreal, QC, Canada
| | - Didier Jutras-Aswad
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada; Department of Psychiatry and Addiction, Université de Montréal, Montreal, QC, Canada
| | - Valerie Martel-Laferriere
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada; Department of Microbiology, Infectious Diseases and Immunology, Université de Montréal, Montreal, QC, Canada
| | - Julie Bruneau
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada; Department of Family and Emergency Medicine, Université de Montréal, Montreal, QC, Canada.
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11
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Høj SB, Jacka B, Minoyan N, Artenie AA, Bruneau J. Conceptualising access in the direct-acting antiviral era: An integrated framework to inform research and practice in HCV care for people who inject drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 72:11-23. [PMID: 31003825 DOI: 10.1016/j.drugpo.2019.04.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/22/2019] [Accepted: 04/01/2019] [Indexed: 12/17/2022]
Abstract
As direct-acting antiviral (DAA) therapy costs fall and eligibility criteria are relaxed, people who inject drugs (PWID) will increasingly become eligible for HCV treatment. Yet eligibility does not necessarily equate to access. Amidst efforts to expand treatment uptake in this population, we seek to synthesise and clarify the conceptual underpinnings of access to health care for PWID, with a view to informing research and practice. Integrating dominant frameworks of health service utilisation, care seeking processes, and ecological perspectives on health promotion, we present a comprehensive theoretical framework to understand, investigate and intervene upon barriers and facilitators to HCV care for PWID. Built upon the concept of Candidacy, the framework describes access to care as a continually negotiated product of the alignment between individuals, health professionals, and health systems. Individuals must identify themselves as candidates for services and then work to stake this claim; health professionals serve as gatekeepers, adjudicating asserted candidacies within the context of localised operating conditions; and repeated interactions build experiential knowledge and patient-practitioner relationships, influencing identification and assertion of candidacy over time. These processes occur within a complex social ecology of interdependent individual, service, system, and policy factors, on which other established theories provide guidance. There is a pressing need for a deliberate and nuanced theory of health care access to complement efforts to document the HCV 'cascade of care' among PWID. We offer this framework as an organising device for observational research, intervention, and implementation science to expand access to HCV care in this vulnerable population. Using practical examples from the HCV literature, we demonstrate its utility for specifying research questions and intervention targets across multiple levels of influence; describing and testing plausible effect mechanisms; and identifying potential threats to validity or barriers to research translation.
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Affiliation(s)
- Stine Bordier Høj
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 rue St-Denis, Montréal, Québec, H2X 0A9, Canada.
| | - Brendan Jacka
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 rue St-Denis, Montréal, Québec, H2X 0A9, Canada
| | - Nanor Minoyan
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 rue St-Denis, Montréal, Québec, H2X 0A9, Canada; École de Santé Publique de l'Université de Montréal, 7101 Avenue du Parc, Montréal, Québec, H3N 1X9, Canada
| | - Andreea Adelina Artenie
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 rue St-Denis, Montréal, Québec, H2X 0A9, Canada; École de Santé Publique de l'Université de Montréal, 7101 Avenue du Parc, Montréal, Québec, H3N 1X9, Canada
| | - Julie Bruneau
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 rue St-Denis, Montréal, Québec, H2X 0A9, Canada; Département de Médicine Familiale et Médecine d'Urgence, Faculté de médecine, Université de Montréal, C.P. 6128, succursale Centre-ville, Montréal, Québec, H3C 3J7, Canada.
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12
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Barriers to Treatment of Hepatitis C Virus in the Direct-Acting Antiviral Era. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2019. [DOI: 10.1007/s40506-019-00184-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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13
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Heffernan A, Cooke GS, Nayagam S, Thursz M, Hallett TB. Scaling up prevention and treatment towards the elimination of hepatitis C: a global mathematical model. Lancet 2019; 393:1319-1329. [PMID: 30704789 PMCID: PMC6484702 DOI: 10.1016/s0140-6736(18)32277-3] [Citation(s) in RCA: 184] [Impact Index Per Article: 36.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 08/13/2018] [Accepted: 09/12/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND The revolution in hepatitis C virus (HCV) treatment through the development of direct-acting antivirals (DAAs) has generated international interest in the global elimination of the disease as a public health threat. In 2017, this led WHO to establish elimination targets for 2030. We evaluated the impact of public health interventions on the global HCV epidemic and investigated whether WHO's elimination targets could be met. METHODS We developed a dynamic transmission model of the global HCV epidemic, calibrated to 190 countries, which incorporates data on demography, people who inject drugs (PWID), current coverage of treatment and prevention programmes, natural history of the disease, HCV prevalence, and HCV-attributable mortality. We estimated the worldwide impact of scaling up interventions that reduce risk of transmission, improve access to treatment, and increase screening for HCV infection by considering six scenarios: no change made to existing levels of diagnosis or treatment; sequentially adding the following interventions: blood safety and infection control, PWID harm reduction, offering of DAAs at diagnosis, and outreach screening to increase the number diagnosed; and a scenario in which DAAs are not introduced (ie, treatment is only with pegylated interferon and oral ribavirin) to investigate the effect of DAA use. We explored the effect of varying the coverage or impact of these interventions in sensitivity analyses and also assessed the impact on the global epidemic of removing certain key countries from the package of interventions. FINDINGS By 2030, interventions that reduce risk of transmission in the non-PWID population by 80% and increase coverage of harm reduction services to 40% of PWID could avert 14·1 million (95% credible interval 13·0-15·2) new infections. Offering DAAs at time of diagnosis in all countries could prevent 640 000 deaths (620 000-670 000) from cirrhosis and liver cancer. A comprehensive package of prevention, screening, and treatment interventions could avert 15·1 million (13·8-16·1) new infections and 1·5 million (1·4-1·6) cirrhosis and liver cancer deaths, corresponding to an 81% (78-82) reduction in incidence and a 61% (60-62) reduction in mortality compared with 2015 baseline. This reaches the WHO HCV incidence reduction target of 80% but is just short of the mortality reduction target of 65%, which could be reached by 2032. Reducing global burden depends upon success of prevention interventions, implemention of outreach screening, and progress made in key high-burden countries including China, India, and Pakistan. INTERPRETATION Further improvements in blood safety and infection control, expansion or creation of PWID harm reduction services, and extensive screening for HCV with concomitant treatment for all are necessary to reduce the burden of HCV. These findings should inform the ongoing global action to eliminate the HCV epidemic. FUNDING Wellcome Trust.
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Affiliation(s)
- Alastair Heffernan
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, London, UK
| | - Graham S Cooke
- Division of Infectious Diseases, St Mary's Hospital, Imperial College London, London, UK
| | - Shevanthi Nayagam
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, London, UK; Division of Digestive Diseases, St Mary's Hospital, Imperial College London, London, UK
| | - Mark Thursz
- Division of Digestive Diseases, St Mary's Hospital, Imperial College London, London, UK
| | - Timothy B Hallett
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, London, UK.
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Rance J, Lafferty L, Treloar C. ‘Behind closed doors, no one sees, no one knows’: hepatitis C, stigma and treatment-as-prevention in prison. CRITICAL PUBLIC HEALTH 2018. [DOI: 10.1080/09581596.2018.1541225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Jake Rance
- Centre for Social Research in Health, UNSW, Sydney, Australia
| | - Lise Lafferty
- Centre for Social Research in Health, UNSW, Sydney, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW, Sydney, Australia
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15
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Harris M, Rhodes T. Caring and curing: Considering the effects of hepatitis C pharmaceuticalisation in relation to non-clinical treatment outcomes. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 60:24-32. [PMID: 30092546 DOI: 10.1016/j.drugpo.2018.07.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 07/18/2018] [Accepted: 07/20/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND The development of simplified and effective hepatitis C (HCV) pharmaceuticals enables treatment scale up among the most marginalised. This potentiates a promise of viral elimination at the population level but also individual level clinical and non-clinical benefits. Reports of transformative non-clinical outcomes, such as changes in self-worth and substance use, are primarily associated with arduous interferon-based treatments that necessitate intensive care relationships. We consider the implications of simplified treatment provision in the era of direct acting antivirals (DAAs) for the realisation of non-clinical benefits. METHODS We draw on qualitative data from ethnographic observations and longitudinal interviews with people receiving (n = 22) and providing (n = 10) HCV treatment in London during a transition in HCV biomedicine. First generation DAAs in conjunction with interferon were standard of care for most of this time, with the promise of simplified treatment provision on the horizon. FINDINGS Patient accounts of care accentuate the transformative value of interferon-based HCV treatment derived through non-clinical benefits linked to identity and lifestyle change. Such care is constituted as extending beyond the virus and its biomedical effects, with nurse specialists positioned as vital to this care being realised. Provider accounts emphasise the increased pharmaceuticalisation of HCV treatment; whereby care shifts from the facilitation of therapeutic relationships to pharmaceutical access. CONCLUSION HCV care in the interferon-era affords identity transformations for those receiving and providing treatment. Biomedical promise linked to the increasing pharmaceuticalisation of HCV treatment has disruptive potential, shifting how care is practised and potentially the realisation of non-clinical treatment outcomes.
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Affiliation(s)
- Magdalena Harris
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH, United Kingdom.
| | - Tim Rhodes
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH, United Kingdom
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16
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Quantifying potentially infectious sharing patterns among people who inject drugs in Baltimore, USA. Epidemiol Infect 2018; 146:1845-1853. [PMID: 30070187 DOI: 10.1017/s0950268818002042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Mixing matrices quantify how people with similar or different characteristics make contact with each other, creating potential for disease transmission. Little empirical data on mixing patterns among persons who inject drugs (PWID) are available to inform models of blood-borne disease such as HIV and hepatitis C virus. Egocentric drug network data provided by PWID in Baltimore, Maryland between 2005 and 2007 were used to characterise drug equipment-sharing patterns according to age, race and gender. Black PWID and PWID who were single (i.e. no stable sexual partner) self-reported larger equipment-sharing networks than their white and non-single counterparts. We also found evidence of assortative mixing according to age, gender and race, though to a slightly lesser degree in the case of gender. Highly assortative mixing according to race and gender highlights the existence of demographically isolated clusters, for whom generalised treatment interventions may have limited benefits unless targeted directly. These findings provide novel insights into mixing patterns of PWID for which little empirical data are available. The age-specific assortativity we observed is also significant in light of its role as a key driver of transmission for other pathogens such as influenza and tuberculosis.
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17
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Høj SB, Minoyan N, Artenie AA, Grebely J, Bruneau J. The role of prevention strategies in achieving HCV elimination in Canada: what are the remaining challenges? CANADIAN LIVER JOURNAL 2018; 1:4-13. [PMID: 35990720 PMCID: PMC9202798 DOI: 10.3138/canlivj.1.2.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 03/14/2018] [Indexed: 07/28/2023]
Abstract
BACKGROUND The worldwide economic, health, and social consequences of drug use disorders are devastating. Injection drug use is now a major factor contributing to hepatitis C virus (HCV) transmission globally, and it is an important public health concern. METHODS This article presents a narrative review of scientific evidence on public health strategies for HCV prevention among people who inject drugs (PWID) in Canada. RESULTS A combination of public health strategies including timely HCV detection and harm reduction (mostly needle and syringe programmes and opioid substitution therapy) have helped to reduce HCV transmission among PWID. The rising prevalence of pharmaceutical opioid and methamphetamine use and associated HCV risk in several Canadian settings has prompted further innovation in harm reduction, including supervised injection facilities and low-threshold opioid substitution therapies. Further significant decreases in HCV incidence and prevalence, and in corresponding disease burden, can only be accomplished by reducing transmission among high-risk persons and enhancing access to HCV treatment for those at the greatest risk of disease progression or viral transmission. Highly effective and tolerable direct-acting antiviral therapies have transformed the landscape for HCV-infected patients and are a valuable addition to the prevention toolkit. Curing HCV-infected persons, and thus eliminating new infections, is now a real possibility. CONCLUSIONS Prevention strategies have not yet ended HCV transmission, and sharing of injecting equipment among PWID continues to challenge the World Health Organization goal of eliminating HCV as a global public health threat by 2030. Future needs for research, intervention implementation, and uptake in Canada are discussed.
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Affiliation(s)
- Stine Bordier Høj
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, Québec, Canada
- Department of Family and Emergency Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Nanor Minoyan
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, Québec, Canada
- Department of Social and Preventive Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Andreea Adelina Artenie
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, Québec, Canada
- Department of Social and Preventive Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Jason Grebely
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Julie Bruneau
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, Québec, Canada
- Department of Family and Emergency Medicine, Université de Montréal, Montréal, Québec, Canada
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18
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Guise A, Witzel TC, Mandal S, Sabin C, Rhodes T, Nardone A, Harris M. A qualitative assessment of the acceptability of hepatitis C remote self-testing and self-sampling amongst people who use drugs in London, UK. BMC Infect Dis 2018; 18:281. [PMID: 29914381 PMCID: PMC6006927 DOI: 10.1186/s12879-018-3185-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 06/06/2018] [Indexed: 12/22/2022] Open
Abstract
Background Hepatitis C (HCV) diagnosis and care is a major challenge for people who use illicit drugs, and is characterised by low rates of testing and treatment engagement globally. New approaches to fostering engagement are needed. We explored the acceptability of remote forms of HCV testing including self-testing and self-sampling among people who use drugs in London, UK. Methods A qualitative rapid assessment was undertaken with people who use drugs and stakeholders in London, UK. Focus groups were held with men who have sex with men engaged in drug use, people who currently inject drugs and people who formerly injected drugs (22 participants across the 3 focus groups). Stakeholders participated in semi-structured interviews (n = 5). We used a thematic analysis to report significant themes in participants’ responses. Results We report an overarching theme of ‘tension’ in how participants responded to the acceptability of remote testing. This tension is evident across four separate sub-themes we explore. First, choice and control, with some valuing the autonomy and privacy remote testing could support. Second, the ease of use of self testing linked to its immediate result and saliva sample was preferred over the delayed result from a self administered blood sample tested in a laboratory. Third, many respondents described the need to embed remote testing within a supportive care pathway. Fourth, were concerns over managing a positive result, and its different meanings, in isolation. Conclusions The concept of remote HCV testing is acceptable to some people who use drugs in London, although tensions with lived experience of drug use and health system access limit its relevance. Future development of remote testing must respond to concerns raised in order for acceptable implementation to take place.
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Affiliation(s)
- Andy Guise
- London School of Hygiene and Tropical Medicine, London, UK. .,School of Population Health and Environmental Sciences, Guy's campus, King's College London, Addison House, London, UK.
| | - T Charles Witzel
- SIGMA Research, London School of Hygiene and Tropical Medicine, Tavistock Place, London, UK
| | - Sema Mandal
- Public Health England, Wellington House, Waterloo Road, London, UK.,National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in collaboration with Public Health England, London, UK
| | - Caroline Sabin
- National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in collaboration with Public Health England, London, UK. .,Institute for Global Health, UCL, London, UK.
| | - Tim Rhodes
- London School of Hygiene and Tropical Medicine, London, UK.,National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in collaboration with Public Health England, London, UK
| | - Anthony Nardone
- Public Health England, Wellington House, Waterloo Road, London, UK.,National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in collaboration with Public Health England, London, UK
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Grebely J, Bruneau J, Lazarus JV, Dalgard O, Bruggmann P, Treloar C, Hickman M, Hellard M, Roberts T, Crooks L, Midgard H, Larney S, Degenhardt L, Alho H, Byrne J, Dillon JF, Feld JJ, Foster G, Goldberg D, Lloyd AR, Reimer J, Robaeys G, Torrens M, Wright N, Maremmani I, Norton BL, Litwin AH, Dore GJ. Research priorities to achieve universal access to hepatitis C prevention, management and direct-acting antiviral treatment among people who inject drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 47:51-60. [PMID: 28683982 PMCID: PMC6049820 DOI: 10.1016/j.drugpo.2017.05.019] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 04/11/2017] [Accepted: 05/05/2017] [Indexed: 02/06/2023]
Abstract
Globally, it is estimated that 71.1 million people have chronic hepatitis C virus (HCV) infection, including an estimated 7.5 million people who have recently injected drugs (PWID). There is an additional large, but unquantified, burden among those PWID who have ceased injecting. The incidence of HCV infection among current PWID also remains high in many settings. Morbidity and mortality due to liver disease among PWID with HCV infection continues to increase, despite the advent of well-tolerated, simple interferon-free direct-acting antiviral (DAA) HCV regimens with cure rates >95%. As a result of this important clinical breakthrough, there is potential to reverse the rising burden of advanced liver disease with increased treatment and strive for HCV elimination among PWID. Unfortunately, there are many gaps in knowledge that represent barriers to effective prevention and management of HCV among PWID. The Kirby Institute, UNSW Sydney and the International Network on Hepatitis in Substance Users (INHSU) established an expert round table panel to assess current research gaps and establish future research priorities for the prevention and management of HCV among PWID. This round table consisted of a one-day workshop held on 6 September, 2016, in Oslo, Norway, prior to the International Symposium on Hepatitis in Substance Users (INHSU 2016). International experts in drug and alcohol, infectious diseases, and hepatology were brought together to discuss the available scientific evidence, gaps in research, and develop research priorities. Topics for discussion included the epidemiology of injecting drug use, HCV, and HIV among PWID, HCV prevention, HCV testing, linkage to HCV care and treatment, DAA treatment for HCV infection, and reinfection following successful treatment. This paper highlights the outcomes of the roundtable discussion focused on future research priorities for enhancing HCV prevention, testing, linkage to care and DAA treatment for PWID as we strive for global elimination of HCV infection.
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Affiliation(s)
- Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, Australia.
| | - Julie Bruneau
- CHUM Research Centre (CRCHUM), Centre Hospitalier de l'Université de Montréal, Montréal, Canada; Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montréal, Canada
| | - Jeffrey V Lazarus
- CHIP, Rigshospitalet, University of Copenhagen, Denmark; Barcelona Institute of Global Health (ISGlobal), Hospital Clínic, Barcelona, Spain
| | - Olav Dalgard
- Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway; University of Oslo, Oslo, Norway
| | | | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Matthew Hickman
- School of Social & Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Margaret Hellard
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
| | | | - Levinia Crooks
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia; Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine, Sydney, Australia
| | - Håvard Midgard
- Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway; Institute for Clinical Medicine, University of Oslo, Norway; Department of Gastroenterology, Oslo University Hospital, Norway
| | - Sarah Larney
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney, Australia
| | - Hannu Alho
- University of Helsinki, Helsinki, Finland; National Institute for Health and Welfare, Helsinki, Finland; Abdominal Center, Helsinki University Hospital, Helsinki, Finland
| | - Jude Byrne
- Australian Injecting & Illicit Drug Users League, Canberra, Australia
| | - John F Dillon
- Ninewells Hospital and Medical School, Dundee, United Kingdom
| | - Jordan J Feld
- Toronto Centre for Liver Disease, Sandra Rotman Centre for Global Health, University of Toronto, Toronto, Canada
| | - Graham Foster
- The Liver Unit, Queen Mary University of London, London, United Kingdom
| | - David Goldberg
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom; Health Protection Scotland, Glasgow, United Kingdom
| | | | - Jens Reimer
- Centre for Interdisciplinary Addiction Research, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Geert Robaeys
- Department of Gastroenterology and Hepatology, Ziekenhuis Oost Limburg, Genk, Belgium; Department of Hepatology, UZ Leuven, Leuven, Belgium; Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Marta Torrens
- Institute of Neuropsychiatry & Addictions-Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Icro Maremmani
- Santa Chiara University Hospital, University of Pisa, Italy
| | - Brianna L Norton
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, United States
| | - Alain H Litwin
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, United States
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Implementing and scaling up HCV treatment services for people who inject drugs and other high risk groups in Ukraine: An evaluation of programmatic and treatment outcomes. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 47:187-195. [PMID: 28811159 DOI: 10.1016/j.drugpo.2017.07.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 07/05/2017] [Accepted: 07/21/2017] [Indexed: 01/16/2023]
Abstract
BACKGROUND HCV prevalence estimates among people who inject drugs (PWID) in Ukraine is high (60-90%), yet barriers to HCV treatment and care remain substantial including limited access to direct acting antiviral (DAA) medications. A feasibility scale-up project implemented HCV treatment in community-based settings to improve access to DAA treatment for key populations in this context. METHODS Using program-level data and verified medical records, we describe the development, implementation processes and outcomes for HCV treatment for PWID and other risks groups. Most participants (76%) received a combination of sofosbuvir, pegylated interferon, and ribavirin for 12 weeks. Treatment enrollment started in June 2015; the first two waves are reported. Data on demographics, HIV characteristics, HCV genotype and RNA levels, including sustained virologic response (SVR) were obtained from verified medical records. We used logistic regression to examine the independent correlates of achieving a SVR. RESULTS The project was implemented in 19 healthcare institutions from 16 regions of Ukraine, mainly within AIDS specialty centers. Our analytical sample included 1126 participants who were mostly men (73%) and the majority were HIV co-infected (79%). Treatment retention was 97.7%; the proportions of participants who achieved SVR for the overall sample and for those with complete data (N=1029) were 86.2% (95% CI 84.08-88.19%) and 94.3% (95% CI 92.8-95.7%) respectively. The analysis of data restricted to only those with SVR data available showed that PWID who were currently injecting had comparable SVR rates (89.2%, 95% CI 81.5-94.5%) to PWID not injecting (94.4%, 95% CI 92.4-96.1), PWID on methadone (94.4%, 95%CI 92.4-96.1), and 'other' risk groups (95.2%, 95% CI 91.3-97.7). Independent factors associated with achieving a SVR were female sex (AOR: 3.44, 95% CI 1.45-8.14), HCV genotype 3 (AOR: 4.57, 95% CI 1.97-10.59) compared to genotype 1. SVR rates in PWID actively injecting did not differ significantly from any other group. CONCLUSION Both patient-level and structural factors influence HCV treatment scale-up in Ukraine, but patient-level outcomes confirm high levels of achieving SVR in PWID, irrespective of injection and treatment status.
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21
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Lazarus JV, Safreed-Harmon K, Stumo SR, Jauffret-Roustide M, Maticic M, Reic T, Schatz E, Tallada J, Harris M. Restrictions on access to direct-acting antivirals for people who inject drugs: The European Hep-CORE study and the role of patient groups in monitoring national HCV responses. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 47:47-50. [PMID: 28689856 DOI: 10.1016/j.drugpo.2017.05.054] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 05/24/2017] [Accepted: 05/30/2017] [Indexed: 01/27/2023]
Affiliation(s)
- J V Lazarus
- CHIP, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain.
| | - K Safreed-Harmon
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - S R Stumo
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - M Jauffret-Roustide
- Cermes3, Inserm U988/CNRS UMR 8211, EHESS, Paris Descartes University, Paris, France
| | - M Maticic
- Clinic for Infectious Diseases and Febrile Illnesses, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - T Reic
- European Liver Patients' Association, Brussels, Belgium
| | - E Schatz
- Correlation Network, Amsterdam, the Netherlands
| | - J Tallada
- European AIDS Treatment Group, Brussels, Belgium
| | - M Harris
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
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22
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Metzig C, Surey J, Francis M, Conneely J, Abubakar I, White PJ. Impact of Hepatitis C Treatment as Prevention for People Who Inject Drugs is sensitive to contact network structure. Sci Rep 2017; 7:1833. [PMID: 28500290 PMCID: PMC5431870 DOI: 10.1038/s41598-017-01862-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 03/17/2017] [Indexed: 12/14/2022] Open
Abstract
Treatment as Prevention (TasP) using directly-acting antivirals has been advocated for Hepatitis C Virus (HCV) in people who inject drugs (PWID), but treatment is expensive and TasP’s effectiveness is uncertain. Previous modelling has assumed a homogeneously-mixed population or a static network lacking turnover in the population and injecting partnerships. We developed a transmission-dynamic model on a dynamic network of injecting partnerships using data from survey of injecting behaviour carried out in London, UK. We studied transmission on a novel exponential-clustered network, as well as on two simpler networks for comparison, an exponential unclustered and a random network, and found that TasP’s effectiveness differs markedly. With respect to an exponential-clustered network, the random network (and homogeneously-mixed population) overestimate TasP’s effectiveness, whereas the exponential-unclustered network underestimates it. For all network types TasP’s effectiveness depends on whether treated patients change risk behaviour, and on treatment coverage: higher coverage requires fewer total treatments for the same health gain. Whilst TasP can greatly reduce HCV prevalence, incidence of infection, and incidence of reinfection in PWID, assessment of TasP’s effectiveness needs to take account of the injecting-partnership network structure and post-treatment behaviour change, and further empirical study is required.
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Affiliation(s)
- Cornelia Metzig
- MRC Centre for Outbreak Analysis and Modelling and NIHR Health Protection Research Unit in Modelling Methodology, Imperial College London School of Public Health, London, W2 1PG, UK. .,Department of Mathematics, Imperial College London, London, SW7 2AZ, UK.
| | - Julian Surey
- Research Department of Infection and Population Health, University College London, London, WC1E 6JB, UK
| | - Marie Francis
- Research Department of Infection and Population Health, University College London, London, WC1E 6JB, UK
| | - Jim Conneely
- Hepatitis C Trust, 27 Crosby Row, London, SE1 3YD, UK
| | - Ibrahim Abubakar
- Research Department of Infection and Population Health, University College London, London, WC1E 6JB, UK.,TB Section, National Infection Service, Public Health England, London, NW9 5EQ, UK.,MRC Clinical Trials Unit, University College London, London, WC2B 6NH, UK
| | - Peter J White
- MRC Centre for Outbreak Analysis and Modelling and NIHR Health Protection Research Unit in Modelling Methodology, Imperial College London School of Public Health, London, W2 1PG, UK. .,Modelling and Economics Unit, National Infection Service, Public Health England, London, NW9 5EQ, UK.
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23
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Daw MA, El-Bouzedi AA, Ahmed MO, Dau AA, Agnan MM, Drah AM. Geographic integration of hepatitis C virus: A global threat. World J Virol 2016; 5:170-182. [PMID: 27878104 PMCID: PMC5105050 DOI: 10.5501/wjv.v5.i4.170] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 06/05/2016] [Accepted: 07/13/2016] [Indexed: 02/05/2023] Open
Abstract
AIM To assess hepatitis C virus (HCV) geographic integration, evaluate the spatial and temporal evolution of HCV worldwide and propose how to diminish its burden.
METHODS A literature search of published articles was performed using PubMed, MEDLINE and other related databases up to December 2015. A critical data assessment and analysis regarding the epidemiological integration of HCV was carried out using the meta-analysis method.
RESULTS The data indicated that HCV has been integrated immensely over time and through various geographical regions worldwide. The history of HCV goes back to 1535 but between 1935 and 1965 it exhibited a rapid, exponential spread. This integration is clearly seen in the geo-epidemiology and phylogeography of HCV. HCV integration can be mirrored either as intra-continental or trans-continental. Migration, drug trafficking and HCV co-infection, together with other potential risk factors, have acted as a vehicle for this integration. Evidence shows that the geographic integration of HCV has been important in the global and regional distribution of HCV.
CONCLUSION HCV geographic integration is clearly evident and this should be reflected in the prevention and treatment of this ongoing pandemic.
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24
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Gilchrist G, Tirado-Munoz J, Taylor A, Fischer G, Moskalewicz J, Köchl B, Giammarchi C, Dabrowska K, Shaw A, Munro A, Di Furia L, Torrens M. An uncontrolled, feasibility study of a group intervention to reduce hepatitis C transmission risk behaviours and increase transmission knowledge among women who inject drugs. DRUGS-EDUCATION PREVENTION AND POLICY 2016. [DOI: 10.1080/09687637.2016.1197885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- G. Gilchrist
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK,
| | - J. Tirado-Munoz
- IMIM-Institut Hospital del Mar d'Investigacions Mèdiques and Institute of Neuropsychiatry and Addictions, Barcelona, Barcelona, Spain,
| | - A. Taylor
- School of Media, Culture and Society, University of the West of Scotland, Paisley, UK,
| | - G. Fischer
- Addiction Clinic, Medical University of Vienna, Vienna, Austria,
| | - J. Moskalewicz
- Department of Studies on Alcoholism and Drug Dependence, Institute of Psychiatry and Neurology, Warsaw, Poland,
| | - B. Köchl
- Addiction Clinic, Medical University of Vienna, Vienna, Austria,
| | | | - K. Dabrowska
- Department of Studies on Alcoholism and Drug Dependence, Institute of Psychiatry and Neurology, Warsaw, Poland,
| | - A. Shaw
- School of Media, Culture and Society, University of the West of Scotland, Paisley, UK,
| | - A. Munro
- School of Media, Culture and Society, University of the West of Scotland, Paisley, UK,
| | - L. Di Furia
- Servizio Salute Regione Marche, Ancona, Italy, and
| | - M. Torrens
- IMIM-Institut Hospital del Mar d'Investigacions Mèdiques and Institute of Neuropsychiatry and Addictions, Barcelona, Barcelona, Spain,
- Psychiatry Department, Universitat Autònoma de Barcelona, Barcelona, Spain
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25
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Grebely J, Bruggmann P, Treloar C, Byrne J, Rhodes T, Dore GJ. Strategies for achieving universal access to hepatitis C virus prevention and care for people who inject drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 26:1039-40. [PMID: 26254496 DOI: 10.1016/j.drugpo.2015.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Jason Grebely
- The Kirby Institute, UNSW Australia, Sydney, Australia.
| | | | - Carla Treloar
- Centre for Social Research in Health, UNSW Australia, Sydney, Australia
| | - Jude Byrne
- International Network of People Who Use Drugs, Canberra, Australia; Australian Injecting and Illicit Drug Users League, Canberra, Australia
| | - Tim Rhodes
- Centre for Research on Drugs and Health Behaviour, London School of Hygiene and Tropical Medicine, London, United Kingdom
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26
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Grebely J, Bruggmann P, Treloar C, Byrne J, Rhodes T, Dore GJ. Expanding access to prevention, care and treatment for hepatitis C virus infection among people who inject drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 26:893-8. [PMID: 26254497 DOI: 10.1016/j.drugpo.2015.07.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Jason Grebely
- The Kirby Institute, UNSW Australia, Sydney, Australia; Australian Injecting and Illicit Drug Users League, Canberra, Australia.
| | | | - Carla Treloar
- Centre for Social Research in Health, UNSW Australia, Sydney, Australia
| | - Jude Byrne
- International Network of People Who Use Drugs, Canberra, Australia
| | - Tim Rhodes
- Centre for Research on Drugs and Health Behaviour, London School of Hygiene and Tropical Medicine, London, United Kingdom
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27
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Wolfe D, Luhmann N, Harris M, Momenghalibaf A, Albers E, Byrne J, Swan T. Human rights and access to hepatitis C treatment for people who inject drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 26:1072-80. [PMID: 26232055 DOI: 10.1016/j.drugpo.2015.05.007] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 04/26/2015] [Accepted: 05/12/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND People who inject drugs (PWID) achieve adherence to and outcomes from hepatitis C virus (HCV) treatment comparable to other patients. Nonetheless, this population has been excluded from treatment by regulation or practice. Approval of safer and more effective oral HCV medicines should offer greater treatment options for PWID, although high medicine prices have led to continued treatment rationing and exclusion in developed countries. In middle-income countries (MICS), treatment is largely unavailable and unaffordable for most PWID. METHODS Human rights analysis, with its emphasis on the universal and interconnected nature of the economic, social and political spheres, offers a useful framework for HCV treatment reform. Using peer-reviewed and grey literature, as well as community case reports, we discuss barriers to treatment, correlate these barriers to rights violations, and highlight examples of community advocacy to increase treatment for PWID. RESULTS Structural drivers of lack of treatment access for PWID include stigma in health settings; drug use status as a criterion for treatment exclusion; requirements for fees or registration by name as a drug user prior to treatment initiation; and incarceration/detention in prisons and rehabilitation centers where treatment is unavailable. High medicine prices force further exclusion of PWID, with cost containment masked as concern about treatment adherence. These barriers correlate to multiple rights violations, including of the rights to privacy; non-discrimination; health; freedom of information; fair trial; and freedom from cruel, inhuman and degrading treatment. CONCLUSIONS Needed reforms include decriminalization of drug use, possession of drugs and drug injecting equipment; removal of exclusionary or discriminatory treatment protocols; approaches to strengthen links between health providers and increase participation of PWID in treatment design and implementation; and measures to increase transparency in government/pharmaceutical company negotiations and reduce treatment price.
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Affiliation(s)
- D Wolfe
- Open Society Foundations, 224 West 57th Street, New York, NY 10019, USA.
| | - N Luhmann
- Médecins Du Monde, 62 Rue Marcadet, Paris 75018, France
| | - M Harris
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom
| | - A Momenghalibaf
- Open Society Foundations, 224 West 57th Street, New York, NY 10019, USA
| | - E Albers
- International Network of People who Use Drugs, Unit 2C05, South Bank Technopark 90 London Road, London SE1 6LN, United Kingdom
| | - J Byrne
- Australian Injecting and Illicit Drug Users League, GPO Box 1552, Canberra ACT 2601, Australia
| | - T Swan
- Treatment Action Group, 261 5th Avenue #2110, New York, NY 10016, USA
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