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Hobday S, Valerio H, Combo T, Monaghan R, Scott C, Silk D, Murray C, Read P, Henderson C, Degenhardt L, Treloar C, Dore GJ, Grebely J, Martinello M. Evaluating the prevalence of current hepatitis C infection and treatment among Aboriginal and Torres Strait Islander peoples who inject drugs in Australia: The ETHOS engage study. Drug Alcohol Rev 2023; 42:1617-1632. [PMID: 37556376 PMCID: PMC10946462 DOI: 10.1111/dar.13723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 06/21/2023] [Accepted: 06/26/2023] [Indexed: 08/11/2023]
Abstract
INTRODUCTION Evaluating progress towards hepatitis C virus (HCV) elimination among Aboriginal and Torres Strait Islander peoples is critical given the disproportionate burden of infection. We examined factors associated with current HCV infection and self-reported treatment among Aboriginal and Torres Strait Islander (hereafter referred to as Aboriginal peoples) and non-Aboriginal peoples who inject drugs (PWID) in Australia. METHODS ETHOS Engage is an observational cohort study of PWID attending drug treatment and needle and syringe programs in Australia. Participants underwent point-of-care HCV RNA testing (Xpert HCV RNA Viral Load Fingerstick) and completed a questionnaire including self-reported history of HCV treatment. RESULTS Between May 2018 and June 2021, 2395 participants were enrolled and 555 (23%) identified as Aboriginal (median age 42 years, 58% were men, 63% injected drugs in last month, 76% ever incarcerated). HCV RNA prevalence was 23% among Aboriginal PWID (24% in 2018-2019 and 21% in 2019-2021; p = 0.44), and 21% among non-Aboriginal PWID (24% in 2018-2019 and 16% in 2019-2021; p < 0.001). Self-reported HCV treatment was 65% among Aboriginal PWID (63% in 2018-2019 and 69% in 2019-2021; p = 0.30), and 70% among non-Aboriginal PWID (67% in 2018-2019 and 75% in 2019-2021; p < 0.001). Among Aboriginal PWID, current HCV infection was associated with recently injecting drugs and receiving opioid agonist treatment, and self-reported HCV treatment was negatively associated with younger age, homelessness and recently injecting drugs. DISCUSSION AND CONCLUSIONS Equitable access to HCV care and prevention is needed to ensure Australia meets its elimination targets among Aboriginal PWID.
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Affiliation(s)
- Steven Hobday
- The Kirby InstituteUniversity of New South WalesSydneyAustralia
| | - Heather Valerio
- The Kirby InstituteUniversity of New South WalesSydneyAustralia
| | - Troy Combo
- Infectious Disease Implementation Science GroupBurnet InstituteMelbourneAustralia
- Poche Centre for Indigenous Health, University of QueenslandBrisbaneAustralia
| | - Robert Monaghan
- The Kirby InstituteUniversity of New South WalesSydneyAustralia
| | - Clarke Scott
- Nepean Blue Mountains Local Health District, NSW HealthPenrithAustralia
| | - David Silk
- The Kirby InstituteUniversity of New South WalesSydneyAustralia
| | | | - Phillip Read
- The Kirby InstituteUniversity of New South WalesSydneyAustralia
- Kirketon Road CentreSydneyAustralia
| | | | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW SydneySydneyAustralia
| | - Carla Treloar
- Centre for Social Research in HealthUniversity of New South WalesSydneyAustralia
| | - Gregory J. Dore
- The Kirby InstituteUniversity of New South WalesSydneyAustralia
| | - Jason Grebely
- The Kirby InstituteUniversity of New South WalesSydneyAustralia
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Hudson-Buhagiar J, Carson J, Monaghan S, Collie P, Nelson R, Van Gessel H, Read P, Hanson J, Monaghan R, Matthews G, Dore GJ, Martinello M. Effectiveness of direct-acting antiviral therapy among Aboriginal and Torres Strait Islander peoples with HCV infection in Australia: A national real-world cohort (REACH-C). J Viral Hepat 2023; 30:386-396. [PMID: 36651627 DOI: 10.1111/jvh.13803] [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: 08/02/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 01/19/2023]
Abstract
Aboriginal and Torres Strait Islander peoples experience a disproportionate burden of hepatitis C virus (HCV) infection. This study assessed the effectiveness of direct-acting antiviral (DAA) therapy among Aboriginal peoples in the three years following universal access in Australia. REACH-C, a national multicentre prospective cohort study, evaluated HCV treatment outcomes from sequential DAA initiations across 33 health services between March 2016 and June 2019. DAA effectiveness was assessed by sustained virological response (SVR) in the total (full analysis set) and effectiveness (modified analysis set excluding those lost to follow-up) populations. Overall, 915 (10%) Aboriginal and 8095 (90%) non-Indigenous people commenced DAA therapy, of whom 30% and 16% reported current injecting drug use and 73% and 42% were treated in primary care, respectively. SVR in the total and effectiveness populations was 74% and 94% among Aboriginal people and 82% and 94% among non-Indigenous people, with loss to follow-up contributing to lower SVR in the total population analysis (22% Aboriginal, 13% non-Indigenous). Among Aboriginal people, returning for follow-up was positively associated with older age (aOR 1.20; 95% CI 1.04, 1.39) and SVR was negatively associated with cirrhosis (aOR 0.39; 95% CI 0.19, 0.80) and prior DAA treatment (aOR 0.14; 95% CI 0.04, 0.49). Factors reflecting higher vulnerability or inequity were not associated with returning for testing or SVR. DAA therapy was highly effective among Aboriginal peoples with HCV treated through primary and tertiary services. Tailored community-led interventions are necessary to optimize follow-up and engagement. Sustained DAA uptake and equitable access to care, treatment and prevention are required for HCV elimination.
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Affiliation(s)
| | - Joanne Carson
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Scott Monaghan
- Bulgarr Ngaru Medical Aboriginal Corporation, Grafton, New South Wales, Australia
| | - Patricia Collie
- Bulgarr Ngaru Medical Aboriginal Corporation, Grafton, New South Wales, Australia
| | - Renjy Nelson
- The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Helen Van Gessel
- Western Australia Country Health Service, Albany, Western Australia, Australia
| | - Phillip Read
- Kirketon Road Centre, Sydney, New South Wales, Australia
| | - Josh Hanson
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia.,Cairns Hinterland and Hospital Health Service, Cairns, Queensland, Australia
| | - Robert Monaghan
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Gail Matthews
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia.,St Vincent's Hospital, Sydney, Victoria, Australia
| | - Gregory J Dore
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia.,St Vincent's Hospital, Sydney, Victoria, Australia
| | - Marianne Martinello
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia.,Prince of Wales Hospital, Sydney, New South Wales, Australia
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Litwin AH, Lum PJ, Taylor LE, Mehta SH, Tsui JI, Feinberg J, Kim AY, Norton BL, Heo M, Arnsten J, Meissner P, Karasz A, Mckee MD, Ward JW, Johnson N, Pericot-Valverde I, Agyemang L, Stein ES, Thomas A, Borsuk C, Blalock KL, Wilkinson S, Wagner K, Roche J, Murray-Krezan C, Anderson J, Jacobsohn V, Luetkemeyer AF, Falade-Nwulia O, Page K. Patient-centred models of hepatitis C treatment for people who inject drugs: a multicentre, pragmatic randomised trial. Lancet Gastroenterol Hepatol 2022; 7:1112-1127. [PMID: 36370741 DOI: 10.1016/s2468-1253(22)00275-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND To achieve WHO targets for the elimination of hepatitis C virus (HCV) as a public threat, an increased uptake of HCV treatment among people who inject drugs (PWID) is urgently needed. Optimal HCV co-located treatment models for PWID have not yet been identified. We aimed to compare two patient-centred models of HCV care in PWID with active drug use. METHODS We did a pragmatic randomised controlled trial at eight US cities in eight opioid treatment programmes and 15 community health centres. PWID actively injecting within 90 days of study entry were randomly assigned (1:1) to either patient navigation or modified directly observed therapy (mDOT) using computer-generated variable block sizes of 2-6 stratified by city, clinical settings, and cirrhosis status. The randomisation code was concealed, in a centralised REDCap database platform, from all investigators and research staff except for an authorised data manager at the data coordinating centre. All participants received a fixed-dose combination tablet (sofosbuvir 400 mg plus velpatasvir 100 mg) orally once daily for 12 weeks. The primary outcome was sustained virological response (SVR; determined by chart review between 70 days and 365 days after end of treatment and if unavailable, by study blood draws), and secondary outcomes were treatment initiation, adherence (measured by electronic blister packs), and treatment completion. Analyses were conducted within the modified intention-to-treat (mITT; all who initiated treatment), intention-to-treat (all who were randomised), and per-protocol populations. This trial is registered with ClinicalTrials.gov, NCT02824640. FINDINGS Between Sept 15, 2016, and Aug 14, 2018, 1891 individuals were screened and 1136 were excluded (213 declined to participate and 923 did not meet the eligibility criteria). We randomly assigned 755 participants to patient navigation (n=379) or mDOT (n=376). In the mITT sample of participants who were randomised and initiated treatment (n=623), 226 (74% [95% CI 69-79]) of 306 participants in the mDOT group and 236 (76% [69-79]) of 317 in the patient navigation group had an SVR, with no significant difference between the groups (adjusted odds ratio [AOR] 0·97 [95% CI 0·66-1·42]; p=0·35). In the ITT sample (n=755), 226 (60% [95% CI 55-65]) of 376 participants in the mDOT group and 236 (62% [57-67]) of 379 in the patient navigation group had an SVR (AOR 0·92 [0·68-1·25]; p=0·61) and in the per-protocol sample (n=501), 226 (91% [87-94]) of 248 participants in the mDOT group and 235 (93% [89-96]) of 253 in the patient navigation group had an SVR (AOR 0·79 [0·41-1·55]; p=0·44). 306 (81%) of 376 participants in the mDOT group and 317 (84%) of 379 participants in the patient navigation group initiated treatment (AOR 0·86 [0·58-1·26]; p=0·44) and, among those, 251 (82%) participants in the mDOT group and 264 (83%) participants in the patient navigation group completed treatment (AOR 0·90 [0·58-1·39]; p=0·63). Mean daily adherence was higher in the mDOT group (78% [95% CI 75-81]) versus the patient navigation group (73% [70-77]), with a difference of 4·7% ([1·9-7·4]; p=0·0010). 421 serious adverse events were reported (217 in the mDOT group and 204 in the patient navigation group), with the most common being hospital admission (176 in the mDOT group vs 161 in the patient navigation group). INTERPRETATION In this trial of active PWID, both models resulted in high SVR. Although adherence was significantly higher in the mDOT group versus the patient navigation group, there was no significant difference in SVR between the groups. Increases in adherence and treatment completion were associated with an increased likelihood of SVR. These results suggest that active PWID can reach high SVRs in diverse settings with either mDOT or patient navigation support. FUNDING Patient-Centered Outcomes Research Institute, Gilead Sciences, Quest Diagnostics, Monogram Biosciences, and OraSure Technologies.
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Affiliation(s)
- Alain H Litwin
- School of Health Research, Clemson University, Clemson, SC, USA; Department of Medicine, University of South Carolina School of Medicine, Greenville, SC, USA; Department of Medicine, Prisma Health, Greenville, SC, USA.
| | - Paula J Lum
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Lynn E Taylor
- College of Pharmacy, University of Rhode Island, Providence, RI, USA; HIV and Viral Hepatitis Services, CODAC Behavioral Health, Providence, RI, USA
| | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Judith I Tsui
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Judith Feinberg
- Department of Behavioral Medicine and Psychiatry, and Department of Medicine, Section of Infectious Diseases, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Arthur Y Kim
- Division of Infectious Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Brianna L Norton
- Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, New York, NY, USA
| | - Moonseong Heo
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
| | - Julia Arnsten
- Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, New York, NY, USA
| | - Paul Meissner
- Department of Family and Social Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, New York, NY, USA
| | - Alison Karasz
- Department of Family Medicine & Community Health, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - M Diane Mckee
- Department of Family Medicine & Community Health, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - John W Ward
- Coalition for Global Hepatitis Elimination, The Task Force for Global Health, Decatur, GA, USA
| | - Nirah Johnson
- New York City Department of Health and Mental Hygiene, New York City, NY, USA
| | - Irene Pericot-Valverde
- Department of Psychology, Clemson University, Clemson, SC, USA; School of Health Research, Clemson University, Clemson, SC, USA
| | - Linda Agyemang
- Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, New York, NY, USA
| | - Ellen S Stein
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Aurielle Thomas
- College of Pharmacy, University of Rhode Island, Providence, RI, USA
| | - Courtney Borsuk
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kendra L Blalock
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Samuel Wilkinson
- Office of Research Program Management, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Katherine Wagner
- University of New Mexico Health Sciences Center, Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Jillian Roche
- Division of Infectious Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Jessica Anderson
- University of New Mexico Health Sciences Center, Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Vanessa Jacobsohn
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, USA
| | - Anne F Luetkemeyer
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Oluwaseun Falade-Nwulia
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kimberly Page
- University of New Mexico Health Sciences Center, Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
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Selfridge M, Barnett T, Lundgren K, Guarasci K, Milne R, Drost A, Fraser C. Treating people where they are: Nurse-led micro-elimination of hepatitis C in supported housing sites for networks of people who inject drugs in Victoria, Canada. Public Health Nurs 2022; 39:1009-1016. [PMID: 35537120 DOI: 10.1111/phn.13092] [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: 02/14/2022] [Revised: 04/19/2022] [Accepted: 04/21/2022] [Indexed: 11/28/2022]
Abstract
To achieve the World Health Organization's goal of eliminating hepatitis C (HCV) by 2030 requires enhanced HCV testing and treatment among people who use drugs (PWUD). Micro-elimination of HCV is a strategy to target HCV testing and treatment efforts to specific segments of the population. From February to December 2018 nurses initiated a "seek & treat" micro-elimination approach, increasing outreach and removing barriers to accessing HCV treatment in a clinic setting by testing and treating individuals, including PWUD, where they live. The aim of this study was to evaluate the proportion of clients with HCV antibodies and HCV RNA and the response to direct acting agent (DAA therapy) among people who live at or have social connections to local supportive housing sites through this nurse-led micro-elimination project in Victoria, Canada. A chart review of electronic medical records and case management documentation was used to collect relevant data of participants treated with DAA therapy, identified through specific housing site testing and outreach interventions. In total, 180 people were tested for HCV antibodies, 72 (40%) were antibody positive: 51 (28%) were RNA positive, 13 (7%) had spontaneously cleared and 8 (4%) had been previously treated. Of the 51 that were currently living with HCV, 43 people were started on treatment, 39 have achieved sustained virologic response (SVR). By providing treatment to clients in their homes and with their friends, clinicians have been able to treat clients, including those with limited contact with the health care system.
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Affiliation(s)
- Marion Selfridge
- Cool Aid Community Health Centre, Victoria, Canada.,University of Victoria, Victoria, Canada
| | | | | | | | | | - Anne Drost
- Cool Aid Community Health Centre, Victoria, Canada
| | - Chris Fraser
- Cool Aid Community Health Centre, Victoria, Canada.,University of British Columbia, Victoria, Canada
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5
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Kamis KF, Wyles DL, Minturn MS, Scott T, McEwen D, Hurley H, Prendergast SJ, Gunter J, Rowan SE. A retrospective, descriptive study of hepatitis C testing, prevalence, and care continuum among adults on probation. HEALTH & JUSTICE 2022; 10:26. [PMID: 35947313 PMCID: PMC9363270 DOI: 10.1186/s40352-022-00191-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/30/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Despite constituting the largest segment of the correctional population, individuals on court-ordered probation remain largely unstudied with respect to hepatitis C virus (HCV) testing and linkage-to-care. We conducted a retrospective, descriptive analysis to estimate prevalence of diagnosed HCV and the subsequent HCV care cascade among a cohort of individuals enrolled in an adult probation program over a 25-month period in Denver, Colorado. METHODS We utilized probabilistic matching with first and last name, sex, and birthdate to identify individuals enrolled in probation between July 1, 2016 and July 30, 2018 who had a medical record at the participating safety-net healthcare institution as of December 31, 2019. Electronic medical record data were queried for evidence of HCV testing and care through June 30, 2021. The state HCV registry was also queried for prevalence of reported HCV cases among the cohort. RESULTS This cohort included 8,903 individuals; 6,920 (78%) individuals had a medical record at the participating institution, and of these, 1,037 (15%) had ever been tested for HCV (Ab or RNA) and 308 (4% of those with a medical record, 30% of those tested) had detectable HCV RNA. Of these, 105 (34%) initiated HCV treatment, 89 (29%) had a subsequent undetectable HCV viral load, and 65 (21%) had documentation of HCV cure. Eleven percent of the total cohort had records of positive HCV Ab or RNA tests in the state HCV registry. CONCLUSIONS This study demonstrates the importance of HCV screening and linkage-to-care for individuals enrolled in probation programs. A focus on this population could enhance progress towards HCV elimination goals.
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Affiliation(s)
- Kevin F Kamis
- Public Health Institute at Denver Health, Denver Health and Hospital Authority, 601 Broadway, 8th floor, MC 2800, Denver, CO, 80203-3407, USA.
| | - David L Wyles
- Division of Infectious Diseases, Denver Health Medical Center and University of Colorado School of Medicine, Aurora, CO, USA
| | - Matthew S Minturn
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Tracy Scott
- LGBTQ+ Health Services, Denver Health and Hospital Authority, Denver, CO, USA
| | - Dean McEwen
- Public Health Institute at Denver Health, Denver Health and Hospital Authority, 601 Broadway, 8th floor, MC 2800, Denver, CO, 80203-3407, USA
| | - Hermione Hurley
- Public Health Institute at Denver Health, Denver Health and Hospital Authority, 601 Broadway, 8th floor, MC 2800, Denver, CO, 80203-3407, USA
- Division of Infectious Diseases, Denver Health Medical Center and University of Colorado School of Medicine, Aurora, CO, USA
- Center for Addiction Medicine, Denver Health and Hospital Authority, Denver, CO, USA
| | | | - Jessie Gunter
- Colorado Department of Public Health & Environment, Denver, CO, USA
| | - Sarah E Rowan
- Public Health Institute at Denver Health, Denver Health and Hospital Authority, 601 Broadway, 8th floor, MC 2800, Denver, CO, 80203-3407, USA.
- Division of Infectious Diseases, Denver Health Medical Center and University of Colorado School of Medicine, Aurora, CO, USA.
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Jones AT, Briones C, Tran T, Moreno-Walton L, Kissinger PJ. Closing the hepatitis C treatment gap: United States strategies to improve retention in care. J Viral Hepat 2022; 29:588-595. [PMID: 35545901 PMCID: PMC9276641 DOI: 10.1111/jvh.13685] [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: 12/18/2021] [Revised: 03/10/2022] [Accepted: 04/05/2022] [Indexed: 12/09/2022]
Abstract
The hepatitis C virus (HCV) treatment landscape is shifting given the advent of direct-acting antivirals and a global call to action by the World Health Organization. Eliminating HCV is now an issue of healthcare delivery. Treatment is limited by the complexity of the HCV care continuum, expensive therapy and competing health burdens experienced by an underserved HCV population. The objective of this literature review was to assess strategies to improve retention in HCV care, with particular focus on those implemented in the United States. We identified barriers in HCV care retention and propose solutions to increase HCV treatment delivery. The following recommendations are herein described: improving the cohesion of health services through localized care and integrated case management, expanding the supply of non-specialist HCV treatment providers, leveraging patient navigators and care coordinators, improving adherence through directly observed therapy and reducing cost barriers through value-based payment and pharmaceutical subscription models.
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Affiliation(s)
- Austin T. Jones
- Department of Emergency Medicine, Denver Health Medical Center, Denver, CO, USA
| | - Christopher Briones
- Department of Emergency Medicine, University of California Los Angeles Medical Center, Los Angeles, CA, USA
| | - Torrence Tran
- Department of Emergency Medicine, University of California Los Angeles Medical Center, Los Angeles, CA, USA
| | - Lisa Moreno-Walton
- Section of Emergency Medicine, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Patricia J. Kissinger
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA
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Beer L, Inglis S, Malaguti A, Byrne C, Sharkey C, Robinson E, Gillings K, Radley A, Hapca A, Stephens B, Dillon J. Randomized clinical trial: Direct-acting antivirals as treatment for hepatitis C in people who inject drugs: Delivered in needle and syringe programs via directly observed therapy versus fortnightly collection. J Viral Hepat 2022; 29:646-653. [PMID: 35582875 PMCID: PMC9544056 DOI: 10.1111/jvh.13701] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/18/2022] [Accepted: 04/03/2022] [Indexed: 12/09/2022]
Abstract
Hepatitis C virus (HCV) treatment in people who inject drugs (PWID) is delivered within settings frequented by PWID, such as needle and syringe programs (NSP). The optimal direct-acting antiviral (DAA) dispensing regimen among NSP clients is unknown. This study compared cures (Sustained virologic response 12 weeks post-treatment, [SVR12 ]) across three dispensing schedules to establish non-inferiority of fortnightly dispensing versus directly observed therapy. The ADVANCE HCV study was a randomized, unblinded trial, recruiting PWID attending NSP in Tayside, Scotland, between January 2018 and November 2019. HCV-positive participants were randomized to receive DAAs via directly observed therapy, fortnightly provision or fortnightly provision with psychological intervention. A modified intention to treat analysis was used to identify differences in cures between the three treatment regimes. The study was registered with clinicaltrials.gov; NCT03236506. A total of 110 participants completed the study. 33 participants received directly observed therapy, with 90.91% SVR12 ; 37 received fortnightly provision, with 86.49% SVR12 and 40 received fortnightly provision and psychological intervention at treatment initiation, with 92.50% SVR12 . Analysis showed no significant difference in SVR12 (p = 0.67). This study did not demonstrate a statistically significant difference in cure rate between groups. This provides evidence of the non-inferiority of fortnightly dispensing of direct-acting antivirals (DAAs) compared to directly observed therapy among PWID. It suggests that tight control of adherence through directly observed therapy dispensing of DAAs among this population offers no therapeutic advantage. Therefore, less restrictive dispensing patterns can be used, tailored to patient convenience.
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Affiliation(s)
- Lewis Beer
- Tayside Clinical Trials UnitUniversity of DundeeDundeeUK
| | - Sarah Inglis
- Tayside Clinical Trials UnitUniversity of DundeeDundeeUK
| | - Amy Malaguti
- Tayside Drug & Alcohol Recovery Psychology ServiceNHS TaysideDundeeUK
| | - Christopher Byrne
- Tayside Clinical Trials UnitUniversity of DundeeDundeeUK,Department of Molecular and Clinical MedicineUniversity of DundeeDundeeUK
| | | | - Emma Robinson
- Department of Molecular and Clinical MedicineUniversity of DundeeDundeeUK,Ninewells Hospital and Medical SchoolNHS TaysideDundeeScotland
| | | | | | - Adrian Hapca
- Tayside Clinical Trials UnitUniversity of DundeeDundeeUK
| | - Brian Stephens
- Ninewells Hospital and Medical SchoolNHS TaysideDundeeScotland
| | - John Dillon
- Department of Molecular and Clinical MedicineUniversity of DundeeDundeeUK,Ninewells Hospital and Medical SchoolNHS TaysideDundeeScotland
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8
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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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O'Keefe D, Gunn J, Ryan K, Djordjevic F, Kerr P, Gold J, Elsum I, Layton C, Chan K, Dietze P, Higgs P, Doyle J, Stoové MA, Hellard M, Pedrana AE. Exploring hepatitis C virus testing and treatment engagement over time in Melbourne, Australia: a study protocol for a longitudinal cohort study (EC-Experience Cohort study). BMJ Open 2022; 12:e057618. [PMID: 34983773 PMCID: PMC8728403 DOI: 10.1136/bmjopen-2021-057618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/16/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The advent of direct acting antiviral therapy for hepatitis C virus (HCV) means the elimination of HCV is possible but requires sustained effort to achieve. Between 2016 and 2019, 44% of those living with HCV were treated in Australia. However, treatment uptake has declined significantly. In Australia, people who inject drugs (PWID) are the population most at risk of HCV acquisition. Eliminating HCV in Australia will require nuanced understanding of the barriers to HCV treatment experienced by PWID and tailored interventions to address these barriers. The EC-Experience Cohort study aims to explore the barriers and enablers reported by PWID to engagement in HCV care. METHODS AND ANALYSIS The EC-Experience Cohort study is a prospective cohort of PWID, established in Melbourne, Australia in 2018. Participants are assigned into three study groups: (1) those not currently engaged in HCV testing; (2) those diagnosed with HCV but not currently engaged in treatment and (3) those completed treatment. Participants complete a total of four interviews every 6 months across an 18-month study period. Predictors of experience of key outcome events along the HCV care cascade will be explored over time. ETHICS AND DISSEMINATION Ethical approval for the EC-Experience Cohort study was obtained by the Alfred Hospital Ethics Committee in Melbourne, Australia (Project Number: HREC/16/Alfred/164). All eligible participants are assessed for capacity to consent and partake in a thorough informed consent process. Results from the EC-Experience Cohort study will be disseminated via national and international scientific and public health conferences and peer-reviewed journal publications. Data from the EC-Experience Cohort study will improve the current understanding of the barriers to HCV care for PWID and guide the tailoring of service provision for specific subgroups. Understanding the barriers and how to increase engagement in care of PWID is critical to achieve HCV elimination goals.
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Affiliation(s)
- Daniel O'Keefe
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - J Gunn
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Kathleen Ryan
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Filip Djordjevic
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Phoebe Kerr
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Judy Gold
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Imogen Elsum
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Chloe Layton
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- Department of Infectious Diseases, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Kico Chan
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Paul Dietze
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- National Drug Research Institute, Curtin University, Perth, Western Australia, Australia
| | - Peter Higgs
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- National Drug Research Institute, Curtin University, Perth, Western Australia, Australia
- Department of Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Joseph Doyle
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- Department of Infectious Diseases, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Mark A Stoové
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Margaret Hellard
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- Department of Infectious Diseases, The Alfred Hospital, Melbourne, Victoria, Australia
- Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - A E Pedrana
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia
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10
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Anderson NC, Kesten JM, Ayres R, Hickman M, Amlôt R, Michie S, Lorencatto F. Acceptability of, and barriers and facilitators to, a pilot physical health service for people who inject drugs: A qualitative study with service users and providers. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 99:103437. [PMID: 34600415 DOI: 10.1016/j.drugpo.2021.103437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 07/27/2021] [Accepted: 08/25/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND People who inject drugs may experience difficulty accessing or maintaining involvement with traditional healthcare services. This is associated with increased health inequalities and bio-psychosocial difficulties. Embedding physical healthcare services within community-based drug services may provide a practical and feasible approach to increase access and delivery of healthcare. This study explored the acceptability of, and barriers and facilitators to, embedding a pilot physical healthcare service within a community-based drug service in the United Kingdom (Bristol, England). METHODS Semi-structured interviews were conducted with service users (people who inject drugs) (n = 13), and a focus group was conducted with service providers (n = 11: nine harm reduction workers, two nurses, one service manager). Topic guides included questions to explore barriers and facilitators to using and delivering the service (based on the COM-B Model), and acceptability of the service (using the Theoretical Framework of Acceptability). Transcripts were analysed using a combined deductive framework and inductive thematic analysis approach. RESULTS The service was viewed as highly acceptable. Service users and providers were confident they could access and provide the service respectively, and perceived it to be effective. Barriers included competing priorities of service users (e.g. drug use) and the wider service (e.g. equipment), and the potential impact of the service being removed in future was viewed as a barrier to overall healthcare access. Both service users and providers viewed embedding the physical health service within an existing community-based drug service as facilitating accessible and holistic care which reduced stigma and discrimination. CONCLUSIONS The current study demonstrated embedding a physical health service within an existing community-drug based and alcohol service was acceptable and beneficial. Future studies are required to demonstrate cost-effectiveness and ensure long-term sustainability, and to determine transferability of findings to other settings, organisations and countries.
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Affiliation(s)
- Niall C Anderson
- Centre for Behaviour Change, University College London, London, WC1E 7HB, UK; National Institute for Health Research (NIHR) Health Protection Research Unit in Behavioural Science and Evaluation, Bristol, BS8 2BN, UK.
| | - Joanna M Kesten
- National Institute for Health Research (NIHR) Health Protection Research Unit in Behavioural Science and Evaluation, Bristol, BS8 2BN, UK; Population Health Sciences, University of Bristol, BS8 1QU, UK; NIHR Applied Research Collaboration West (ARC West), Bristol, BS1 2NT, UK
| | | | - Matthew Hickman
- National Institute for Health Research (NIHR) Health Protection Research Unit in Behavioural Science and Evaluation, Bristol, BS8 2BN, UK; Population Health Sciences, University of Bristol, BS8 1QU, UK
| | - Richard Amlôt
- National Institute for Health Research (NIHR) Health Protection Research Unit in Behavioural Science and Evaluation, Bristol, BS8 2BN, UK; Health Protection Agency, Public Health England, Bristol, BS1 6EH, UK; Health Protection Research Unit in Emergency Preparedness and Response, Public Health England, Salisbury, SP4 0JG, UK
| | - Susan Michie
- Centre for Behaviour Change, University College London, London, WC1E 7HB, UK
| | - Fabiana Lorencatto
- Centre for Behaviour Change, University College London, London, WC1E 7HB, UK
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11
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Reported Barriers to Hepatitis C Treatment among Pregnant and Early-Parenting Mothers Undergoing Substance Use Disorder Treatment in One U.S. State. Infect Dis Rep 2021; 14:1-11. [PMID: 35076528 PMCID: PMC8788261 DOI: 10.3390/idr14010001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/15/2021] [Accepted: 12/15/2021] [Indexed: 11/16/2022] Open
Abstract
Nationwide, the prevalence of the hepatitis C virus (HCV) has risen in recent years. At least 90% of infected persons must be treated to achieve global elimination targets. The current study aimed to explore barriers to, and facilitators of, direct-acting antiviral (DAA) HCV treatment uptake amongst pregnant and early-parenting women undergoing comprehensive substance use treatment. Twenty participants with documented HCV antibody positivity were recruited from two substance use treatment centers in central Kentucky. Semi-structured interviews were conducted to explore knowledge about HCV, previous experiences, and intentions to seek care. Themes were extracted using an inductive analytical approach. Most participants were aware of the dangers posed by HCV infection. However, there was a high degree of misinformation about transmission mechanisms and treatment eligibility requirements. Low priority for HCV treatment also surfaced as a barrier to treatment uptake. Participants reported being unable to seek care due to time and resource limitations in the presence of a highly demanding treatment process. Findings from the current study suggest that more work is needed to eliminate residual barriers that limit access to HCV treatment among pregnant and early-parenting women in treatment for substance use disorder.
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12
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Kamis KF, Wyles DL, Minturn MS, Scott T, McEwen D, Hurley H, Prendergast SJ, Rowan SE. Hepatitis C Testing and Linkage to Care Among Adults on Probation in a Large US City. Open Forum Infect Dis 2021; 9:ofab636. [PMID: 35111867 PMCID: PMC8802802 DOI: 10.1093/ofid/ofab636] [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] [Received: 09/23/2021] [Accepted: 12/15/2021] [Indexed: 12/09/2022] Open
Abstract
Background Despite constituting the largest segment of the correctional population, individuals on probation remain largely unstudied with respect to hepatitis C virus (HCV) testing and linkage to care. We implemented an HCV testing and patient navigation program at an adult probation department. Methods Adults were tested at a local probation department with a rapid point-of-care HCV antibody (Ab) assay followed by a laboratory-based HCV ribonucleic acid (RNA) assay if anti-HCV positive. All individuals received counseling rooted in harm reduction principles. Individuals testing positive for HCV Ab were immediately linked to a patient navigator in person or via telephone. The patient navigator assisted patients through cure unless the patient was lost to follow-up. Study participation involved an optional survey and optional point-of-care human immunodeficiency virus test. Results Of 417 individuals tested, 13% were HCV Ab positive and 65% of those tested for HCV RNA (34 of 52) had detectable HCV RNA. Of the 14 individuals who linked to an HCV treatment provider, 4 completed treatment, as measured by pharmacy fill documentation in the electronic medical record, and 1 obtained sustained virologic response. One hundred ninety-three individuals tested for HIV; none tested positive. Conclusions The study cohort had a higher HCV seroprevalence than the general population (13% vs 2%), but linkage to care, completion of HCV treatment, and successful test-of-cure rates were all low. This study indicates that HCV disproportionately impacts adults on probation and prioritizing support for testing and linkage to care could improve health in this population. Colocalization of HCV treatment within probation programs would reduce the barrier of attending a new institution and could be highly impactful.
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Affiliation(s)
- Kevin F Kamis
- Public Health Institute at Denver Health, Denver Health and Hospital Authority, Denver, Colorado, USA
| | - David L Wyles
- Division of Infectious Diseases, Denver Health Medical Center and University of Colorado School of Medicine, Denver, Colorado, USA
| | - Matthew S Minturn
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Tracy Scott
- LGBTQ+ Health Services, Denver Health and Hospital Authority, Denver, Colorado, USA
| | - Dean McEwen
- Public Health Institute at Denver Health, Denver Health and Hospital Authority, Denver, Colorado, USA
| | - Hermione Hurley
- Public Health Institute at Denver Health, Denver Health and Hospital Authority, Denver, Colorado, USA
- Division of Infectious Diseases, Denver Health Medical Center and University of Colorado School of Medicine, Denver, Colorado, USA
- Center for Addiction Medicine, Denver Health and Hospital Authority, Denver, Colorado, USA
| | | | - Sarah E Rowan
- Public Health Institute at Denver Health, Denver Health and Hospital Authority, Denver, Colorado, USA
- Division of Infectious Diseases, Denver Health Medical Center and University of Colorado School of Medicine, Denver, Colorado, USA
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13
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Dhiman RK, Grover GS, Premkumar M, Roy A, Taneja S, Duseja A, Arora S. Outcomes of Real-World Integrated HCV Microelimination for People Who Inject Drugs: An expansion of the Punjab Model. EClinicalMedicine 2021; 41:101148. [PMID: 34712928 PMCID: PMC8529203 DOI: 10.1016/j.eclinm.2021.101148] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 09/03/2021] [Accepted: 09/15/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The prevalence of chronic hepatitis C (CHC) in People Who Inject Drugs (PWID) is 8-10% as compared to 3·6% in the general population in Punjab, India. We assessed the real-world efficacy and safety of free-of-charge generic direct-acting antivirals (DAAs), sofosbuvir with an NS5A inhibitor (ledipasvir, daclatasvir or velpatasvir)±ribavirin in the microelimination of CHC in PWID in a public health setting. METHODS An integrated care team at 25 sites provided algorithm based DAAs treatment to PWID supervised by telemedicine clinics between 18th June 2016 and 31st July 2019. The primary endpoint was sustained virological response at 12 weeks (SVR-12); the secondary endpoints were treatment completion, adherence, safety, and adverse events. ClinicalTrials.gov number: NCT01110447. FINDINGS We enrolled 3477 PWID (87·2% men; mean age 33·6±12·5 years; 83·8% rural; 6·8% compensated cirrhosis). While 2280 (65·5%) patients completed treatment, 1978 patients completed 12 weeks of follow up for SVR-12. SVR-12 was achieved in 91·1% of patients per protocol, 49.5% as per intention to treat (ITT) and 90·1% in a modified ITT analysis. Of 546 (15·7%) patients with treatment interruptions, 99 (19·7%) could be traced to test for SVR-12 with a cure rate of 77·8%. There were no major adverse events or consequent treatment discontinuation. INTERPRETATION Integrated care of PWID with CHC with DAAs is safe and effective. Measures for reducing treatment interruptions will further improve outcomes. FUNDING The Government of the state of Punjab, India under the Mukh Mantri Punjab Hepatitis C Relief Fund (MMPHCRF) project, funds the project.
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Key Words
- ALT, alanine aminotransferase
- CHC, chronic hepatitis C
- CI, confidence interval
- DAAs, direct-acting antiviral agents
- DCV, Daclatasvir
- DH, District Hospital
- ECHO, Extension for Community healthcare Outcome
- G, Genotype
- HBV, hepatitis B virus
- HCC, hepatocellular carcinoma
- HCV
- HCV, hepatitis C virus
- IDU, injection drug use
- INASL, Indian National Association for study of the Liver
- India
- LDV, ledipasvir
- MMPHCRF, Mukh Mantri Punjab Hepatitis C Relief Fund
- NVHCP, National Viral Hepatitis Control Programme
- OST, opioid substitution therapy peg-interferon
- PWID, People Who Inject Drugs
- RBV, ribavirin
- SOF, sofosbuvir
- SVR, sustained virologic response
- VEL, Velpatasvir
- hepatitis C virus
- injection drug use
- microelimination
- people who inject drugs
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Affiliation(s)
- Radha K Dhiman
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
- Mukh-Mantri Punjab Hepatitis C Relief Fund (MMPHCRF), Punjab Government, Punjab, India
- Technical Resource Group - National Viral Hepatitis Control Program (NVHCP), Government of India, India
- Injection Safety Project, Punjab Government, Punjab, India
| | | | - Madhumita Premkumar
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Akash Roy
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Sunil Taneja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Ajay Duseja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Sanjeev Arora
- ECHO Institute University of New Mexico, USA, New Mexico, United States
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14
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Grebely J, Collins AB, Artenie AA, Sutherland R, Meyer JP, Barocas JA, Falade-Nwulia O, Cepeda JA, Cunningham EB, Hajarizadeh B, Lafferty L, Lazarus JV, Bonn M, Marshall AD, Treloar C. Progress and remaining challenges to address hepatitis C, other infectious diseases, and drug-related harms to improve the health of people who use drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 96:103469. [PMID: 34610884 DOI: 10.1016/j.drugpo.2021.103469] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/08/2021] [Accepted: 09/09/2021] [Indexed: 12/31/2022]
Affiliation(s)
- Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, Australia.
| | | | | | - Rachel Sutherland
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Jaimie P Meyer
- AIDS Program, Yale School of Medicine, New Haven, United States; Chronic Disease Epidemiology, Yale School of Public Health, New Haven, United States
| | - Joshua A Barocas
- Divisions of General Internal Medicine and Infectious Diseases, University of Colorado School of Medicine, Aurora, United States
| | - Oluwaseun Falade-Nwulia
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, United States
| | - Javier A Cepeda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health,Baltimore, United States
| | | | | | - Lise Lafferty
- The Kirby Institute, UNSW Sydney, Sydney, Australia; Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Matthew Bonn
- Canadian Association of People Who Use Drugs, Dartmouth, Canada
| | - Alison D Marshall
- The Kirby Institute, UNSW Sydney, Sydney, Australia; Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
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15
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Stewart AC, Cossar RD, Wilkinson AL, Quinn B, Dietze P, Walker S, Butler T, Curtis M, Aitken C, Kirwan A, Winter R, Ogloff J, Kinner S, Stoové M. The Prison and Transition Health (PATH) cohort study: Prevalence of health, social, and crime characteristics after release from prison for men reporting a history of injecting drug use in Victoria, Australia. Drug Alcohol Depend 2021; 227:108970. [PMID: 34488074 DOI: 10.1016/j.drugalcdep.2021.108970] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/22/2021] [Accepted: 07/24/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND People who inject drugs are overrepresented in prison and have diverse and complex health needs. However, outcomes after release from prison are poorly understood, limiting effective interventions supporting community reintegration. We describe the prevalence of socio-demographics, physical and mental health, alcohol and other drug use, and crime characteristics of men with histories of injecting drug use after their release from prison in Victoria, Australia. METHODS Data come from the Prison and Transition Health (PATH) prospective cohort study. Interviews were undertaken approximately three, 12, and 24 months after release from their index prison episode and were completed in the community, or in prison for those reimprisoned during the study. We present cross-sectional descriptive statistics for each follow-up wave of the PATH study. RESULTS Among 400 men recruited into PATH, 85 % (n = 336) completed at least one follow-up interview; 162 (42 %) completed all three interviews. Participants reported social disadvantage and health inequity, including high rates of unemployment, homelessness, and physical and mental health morbidities at each follow-up time point. Rapid return to illicit substance use was common, as was overdose (ranging 9 %-13 %), receptive syringe sharing (ranging 20 %-29 %), involvement in crime-related activities (ranging 49 %-58 %), and reimprisonment (ranging 22 %-50 %) over the duration of follow-up. CONCLUSION Men in this study experienced substantial health and social challenges across a 24-month prospective follow-up period. Improved understanding of characteristics and experiences of this group after release from prison can inform more coordinated and continued care between prison and the community.
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Affiliation(s)
- Ashleigh C Stewart
- Behaviours and Health Risks, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Reece D Cossar
- Behaviours and Health Risks, Burnet Institute, Melbourne, Australia; Centre for Forensic Behavioural Science, Swinburne University of Technology and Forensicare, Australia.
| | - Anna L Wilkinson
- Behaviours and Health Risks, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Brendan Quinn
- Behaviours and Health Risks, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Paul Dietze
- Behaviours and Health Risks, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; National Drug Research Institute, Curtin University, Perth, Australia
| | - Shelley Walker
- Behaviours and Health Risks, Burnet Institute, Melbourne, Australia
| | - Tony Butler
- School of Public Health and Community Medicine, University of Sydney, Sydney, Australia
| | - Michael Curtis
- Behaviours and Health Risks, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Campbell Aitken
- Behaviours and Health Risks, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Amy Kirwan
- Behaviours and Health Risks, Burnet Institute, Melbourne, Australia
| | - Rebecca Winter
- Behaviours and Health Risks, Burnet Institute, Melbourne, Australia; Department of Gastroenterology, St Vincent's Hospital, Melbourne, Australia
| | - James Ogloff
- Centre for Forensic Behavioural Science, Swinburne University of Technology and Forensicare, Australia
| | - Stuart Kinner
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Justice Health Unit, School of Population and Global Health, University of Melbourne, Melbourne, Australia; Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Australia; Griffith Criminology Institute, Griffith University, Brisbane, Australia; Mater Research Institute-UQ, University of Queensland, Brisbane, Australia
| | - Mark Stoové
- Behaviours and Health Risks, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Corcorran MA, Ludwig-Baron N, Cheng DM, Lioznov D, Gnatienko N, Patts G, So-Armah K, Blokhina E, Bendiks S, Krupitsky E, Samet JH, Tsui JI. The Hepatitis C Continuum of Care Among HIV-Positive Persons with Heavy Alcohol Use in St. Petersburg, Russia. AIDS Behav 2021; 25:2533-2541. [PMID: 33730255 DOI: 10.1007/s10461-021-03214-y] [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] [Accepted: 02/26/2021] [Indexed: 11/28/2022]
Abstract
This study describes the self-reported prevalence of hepatitis C virus (HCV) coinfection and the HCV care continuum among persons enrolled in the St PETER HIV Study, a randomized controlled trial of medications for smoking and alcohol cessation in HIV-positive heavy drinkers and smokers in St. Petersburg, Russia. Baseline health questionnaire data were used to calculate proportions and 95% confidence intervals for self-reported steps along the HCV continuum of care. The cohort included 399 HIV-positive persons, of whom 387 [97.0% (95% CI 95.3-98.7%)] reported a prior HCV test and 315 [78.9% (95% CI 74.9-82.9%)] reported a prior diagnosis of HCV. Among those reporting a diagnosis of HCV, 43 [13.7% (95% CI 9.9-17.4%)] had received treatment for HCV, and 31 [9.8% (95% CI 6.6-13.1%)] had been cured. Despite frequent HCV testing in this HIV-positive Russian cohort, the proportion reporting prior effective HCV treatment was strikingly low. Increased efforts are needed to scale-up HCV treatment among HIV-positive Russians in St. Petersburg.
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Affiliation(s)
- Maria A Corcorran
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA.
- Division of Allergy and Infectious Diseases, Department of Medicine, Harborview Medical Center, University of Washington School of Medicine, 325 9th Ave, Box 359782, Seattle, WA, 98104, USA.
| | | | - Debbie M Cheng
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Dmitry Lioznov
- First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russian Federation
- Smorodintsev Research Institute of Influenza, St. Petersburg, Russian Federation
| | - Natalia Gnatienko
- Department of Medicine, Section of General Internal Medicine, Boston Medical Center, Clinical Addiction Research and Education (CARE) Unit, Boston, MA, USA
| | - Gregory Patts
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA, USA
| | - Kaku So-Armah
- Department of Medicine, Section of General Internal Medicine, Boston University School of Medicine/Boston Medical Center, Clinical Addiction Research and Education (CARE) Unit, Boston, MA, USA
| | - Elena Blokhina
- First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russian Federation
| | - Sally Bendiks
- Department of Medicine, Section of General Internal Medicine, Boston Medical Center, Clinical Addiction Research and Education (CARE) Unit, Boston, MA, USA
| | - Evgeny Krupitsky
- First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russian Federation
- Department of Addictions, V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology, St. Petersburg, Russian Federation
| | - Jeffrey H Samet
- Department of Medicine, Section of General Internal Medicine, Boston University School of Medicine/Boston Medical Center, Clinical Addiction Research and Education (CARE) Unit, Boston, MA, USA
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Judith I Tsui
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
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Gunn J, McNally S, Ryan J, Layton C, Bryant M, Walker S, O'Mahony C, Pedrana A. Barriers to hepatitis C treatment among secondary needle and syringe program clients and opportunities to intervene. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 96:103387. [PMID: 34330571 DOI: 10.1016/j.drugpo.2021.103387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 07/02/2021] [Accepted: 07/08/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND At least 160,000 Australians are living with hepatitis C (HCV), many of whom are people who inject drugs and access needle and syringe programs (NSP). Secondary NSPs provide injecting equipment via health services that are not dedicated to the provision of services to people who inject drugs; these sites could be a suitable space to increase engagement of people who inject drugs in HCV treatment. Drawing on data from a pilot study exploring the potential of upscaling linkage to HCV care in secondary NSPs, the aim of this research was to explore barriers and enablers to HCV treatment for clients who use these services. METHODS We interviewed 34 people who inject drugs (who self-reported HCV positivity) from six secondary NSPs in urban and regional Victoria, Australia in 2018. Fifty per cent were male, with ages ranging from 33 to 58. Twenty-two (65%) had never received HCV treatment and none had experience with direct-acting antiviral (DAA) treatment. Interviews were transcribed and analysed thematically. Field notes from a program evaluation with feedback from secondary NSP staff was also used as a secondary data source. RESULTS Five themes encompassing a set of contrasting barriers and enablers to accessing HCV care through secondary NSPs were uncovered. Themes included 'misinformation' vs. 'multiple trusted information sources; 'lack of symptoms and motivation' vs. 'benefits of cure'; 'competing priorities' vs. 'willingness and readiness to be cured'; 'unsupportive relationships with staff' vs. 'supportive relationships with staff'; and 'inaccessibility and stigma in health services' vs. 'enhanced support'. Secondary program evaluation data also highlighted that secondary NSP staff were under-resourced and had limited capacity to implement HCV care linkage and information. CONCLUSION We identified contrasting barriers and opportunities for accessing DAAs among a sample of secondary NSP clients and staff. Interventions that consider individual, provider and health system level factors are needed if secondary NSP services are to become a suitable setting to initiate conversations with clients around HCV treatment and provide linkages to care.
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Affiliation(s)
- Jack Gunn
- Disease Elimination Program, Burnet Institute, Melbourne, Melbourne, Australia.
| | | | - John Ryan
- Penington Institute, Melbourne, Victoria, Australia
| | - Chloe Layton
- Disease Elimination Program, Burnet Institute, Melbourne, Melbourne, Australia
| | - Mellissa Bryant
- Disease Elimination Program, Burnet Institute, Melbourne, Melbourne, Australia
| | - Shelley Walker
- Disease Elimination Program, Burnet Institute, Melbourne, Melbourne, Australia
| | | | - Alisa Pedrana
- Disease Elimination Program, Burnet Institute, Melbourne, Melbourne, Australia; Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
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18
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Yang X, Tang Y, Xu D, Zhang G, Xu P, Tang H, Pang L. Efficacy and safety of ledipasvir/sofosbuvir for hepatitis C among drug users: a systematic review and meta-analysis. Virol J 2021; 18:156. [PMID: 34315488 PMCID: PMC8314543 DOI: 10.1186/s12985-021-01625-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 07/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND AIMS Limited data is available on the efficacy of direct acting anti-viral drugs on hepatitis C in drug users. The aim of this meta-analysis was to comprehensively analyze the efficacy and safety of LDV/SOF in drug users infected with the hepatitis C virus (HCV). METHODS The PubMed, Cochrane library, Embase and Web of Science databases were searched for articles published till April 2021 on HCV-positive drug users who were treated with ledipasvir/sofosbuvir (LDV/SOF). The primary endpoint was pooled sustained virological response at 12 weeks (SVR12) with 95% confidence interval (95% CI). Funnel plots and Egger's test were used to assess the publication bias. RESULTS A total of 12 studies and 711 subjects treated with LDV/SOF-based regimen for HCV were included, and the pooled SVR12 rate was 89.8% (95% CI 85.9-92.7). The pooled SVR12 rate of genotype 1 drug users was 92.4% (95% CI 88.6-95.0). Subgroup analysis showed that pooled SVR12 rates of patients treated with LDV/SOF and LDV/SOF ± RBV were 89.2% (95% CI 83.4-93.1), 90.4% (95% CI 83.6-94.5) respectively. In addition, the SVR12 rates were 88% (95% CI 70.7-95.7) for 8 weeks, 89.9% (95% CI 81.0-94.9) for 12 weeks and 82.2% (95% CI 24.9-98.5) for 24 weeks of treatment. CONCLUSION LDV/SOF is a safe and relatively effective treatment for hepatitis C in drug users.
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Affiliation(s)
- Xue Yang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yang Tang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Di Xu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Guang Zhang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Peng Xu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Houlin Tang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
| | - Lin Pang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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19
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Grebely J, Tran L, Degenhardt L, Dowell-Day A, Santo T, Larney S, Hickman M, Vickerman P, French C, Butler K, Gibbs D, Valerio H, Read P, Dore GJ, Hajarizadeh B. Association Between Opioid Agonist Therapy and Testing, Treatment Uptake, and Treatment Outcomes for Hepatitis C Infection Among People Who Inject Drugs: A Systematic Review and Meta-analysis. Clin Infect Dis 2021; 73:e107-e118. [PMID: 32447375 PMCID: PMC8246796 DOI: 10.1093/cid/ciaa612] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 05/20/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND People who inject drugs (PWID) experience barriers to accessing testing and treatment for hepatitis C virus (HCV) infection. Opioid agonist therapy (OAT) may provide an opportunity to improve access to HCV care. This systematic review assessed the association of OAT and HCV testing, treatment, and treatment outcomes among PWID. METHODS Bibliographic databases and conference presentations were searched for studies that assessed the association between OAT and HCV testing, treatment, and treatment outcomes (direct-acting antiviral [DAA] therapy only) among PWID (in the past year). Meta-analysis was used to pool estimates. RESULTS Of 9877 articles identified, 22 studies conducted in Australia, Europe, North America, and Thailand were eligible and included. Risk of bias was serious in 21 studies and moderate in 1 study. Current/recent OAT was associated with an increased odds of recent HCV antibody testing (4 studies; odds ratio (OR), 1.80; 95% confidence interval [CI], 1.36-2.39), HCV RNA testing among those who were HCV antibody-positive (2 studies; OR, 1.83; 95% CI, 1.27-2.62), and DAA treatment uptake among those who were HCV RNA-positive (7 studies; OR, 1.53; 95% CI, 1.07-2.20). There was insufficient evidence of an association between OAT and treatment completion (9 studies) or sustained virologic response following DAA therapy (9 studies). CONCLUSIONS OAT can increase linkage to HCV care, including uptake of HCV testing and treatment among PWID. This supports the scale-up of OAT as part of strategies to enhance HCV treatment to further HCV elimination efforts.
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Affiliation(s)
- Jason Grebely
- The Kirby Institute, Sydney, New South Wales, Australia
| | - Lucy Tran
- National Drug and Alcohol Research Centre, Sydney, New South Wales, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, Sydney, New South Wales, Australia
| | | | - Thomas Santo
- National Drug and Alcohol Research Centre, Sydney, New South Wales, Australia
| | - Sarah Larney
- National Drug and Alcohol Research Centre, Sydney, New South Wales, Australia
| | - Matthew Hickman
- Population Health Sciences, University of Bristol, Bristol, England
| | - Peter Vickerman
- Population Health Sciences, University of Bristol, Bristol, England
| | - Clare French
- Population Health Sciences, University of Bristol, Bristol, England
| | - Kerryn Butler
- National Drug and Alcohol Research Centre, Sydney, New South Wales, Australia
- Discipline of Addiction Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Daisy Gibbs
- National Drug and Alcohol Research Centre, Sydney, New South Wales, Australia
| | | | - Phillip Read
- Kirketon Road Centre, Sydney, New South Wales, Australia
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20
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Heard E, Smirnov A, Massi L, Selvey LA. Personal, provider and system level barriers and enablers for hepatitis C treatment in the era of direct-acting antivirals: Experiences of patients who inject drugs accessing treatment in general practice settings in Australia. J Subst Abuse Treat 2021; 127:108460. [PMID: 34134878 DOI: 10.1016/j.jsat.2021.108460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 04/23/2021] [Accepted: 05/04/2021] [Indexed: 12/28/2022]
Abstract
Direct acting antiviral (DAA) treatment has made the elimination of hepatitis C virus (HCV) a realisable global public health goal and people who inject drugs are a key target population. This study investigates barriers and enablers to DAA treatment of HCV in general practice settings in Australia, from the patient perspective. Semi-structured interviews were conducted with 28 patients; of these patients, seventeen participants were currently on opioid agonist therapy, and four were currently injecting drugs. Thematic data analysis was undertaken and a personal, provider and systems framework was used to describe the barriers and enablers to DAA treatment. Results suggest a range of initiatives are required to support the uptake of DAA in general practice settings. These include the provision of formalised peer information and support, and increasing the accessibility of blood tests and liver assessment on-site. Further, there remains a need to address stigma and discrimination affecting people who inject drugs in community healthcare settings.
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Affiliation(s)
- Emma Heard
- School of Public Health, The University of Queensland, 288 Herston Road, Herston 4006, QLD, Australia.
| | - Andrew Smirnov
- School of Public Health, The University of Queensland, 288 Herston Road, Herston 4006, QLD, Australia.
| | - Luciana Massi
- School of Public Health, The University of Queensland, 288 Herston Road, Herston 4006, QLD, Australia.
| | - Linda A Selvey
- School of Public Health, The University of Queensland, 288 Herston Road, Herston 4006, QLD, Australia.
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21
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Age and gender-specific hepatitis C continuum of care and predictors of direct acting antiviral treatment among persons who inject drugs in Seattle, Washington. Drug Alcohol Depend 2021; 220:108525. [PMID: 33461152 PMCID: PMC7938869 DOI: 10.1016/j.drugalcdep.2021.108525] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 12/11/2020] [Accepted: 12/23/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Direct acting antivirals (DAAs) have revolutionized management of hepatitis C virus (HCV), but treatment uptake remains low among persons who inject drugs (PWID). We report the continuum of care for HCV and describe predictors of treatment with DAAs among PWID in Seattle. METHODS We analyzed data from the 2018 Seattle area National HIV Behavioral Surveillance (NHBS) survey of PWID. Persons ≥18 years of age who injected drugs in the past year and completed the core NHBS survey, a local survey supplement, and rapid HCV antibody testing were included. Among those who screened HCV antibody positive, we calculated proportions and 95 % confidence intervals for self-reported steps along the HCV care continuum. Multivariable logistic regression was used to calculate the adjusted odds (AOR) of having received DAA therapy. RESULTS The sample included 533 PWID, 376 (71 %) of whom tested positive for antibodies to HCV. Among those who were HCV antibody positive, 94 % reported any prior HCV test, 81 % reported a prior confirmatory test, and 68 % reported a prior HCV diagnosis. Of those diagnosed, 26 % had undergone treatment and 18 % had been cured. In a multivariate model, being one year older (AOR 1.05 per year, 1.01-1.08) was predictive of DAA treatment, while homelessness (AOR 0.39, 0.19-0.80) and female gender (AOR 0.36, 0.16-0.78) were associated with a lower odds of DAA therapy. CONCLUSIONS Despite widespread HCV testing among PWID in Seattle, treatment uptake remains low in the DAA era. In particular, treatment of women, younger adults and persons living homeless is lagging behind.
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22
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Graf C, Mücke MM, Dultz G, Peiffer KH, Kubesch A, Ingiliz P, Zeuzem S, Herrmann E, Vermehren J. Efficacy of Direct-acting Antivirals for Chronic Hepatitis C Virus Infection in People Who Inject Drugs or Receive Opioid Substitution Therapy: A Systematic Review and Meta-analysis. Clin Infect Dis 2021; 70:2355-2365. [PMID: 31513710 DOI: 10.1093/cid/ciz696] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 07/23/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Treatment uptake for hepatitis C virus (HCV) infection in people who inject drugs (PWID) and patients on opioid substitution therapy (OST) is still low despite treatment guidelines that advocate the use of direct-acting antivirals (DAAs) in all patients. Our aim in this review was to investigate treatment outcomes among PWID and patients on OST in comparison to control cohorts. METHODS A search of Embase, Medline, PubMed, and Web of Science (from October 2010 to March 2018) was conducted to assess sustained virologic response (SVR), discontinuation rates, adherence, and HCV reinfection in PWID and patients on OST. RESULTS We identified 11 primary articles and 12 conference abstracts comprising 1702 patients on OST, 538 PWID, and 19 723 patients who served as controls. Among patients on OST, the pooled SVR was 90% (95% confidence interval [CI], 87% to 93%) and pooled treatment discontinuation rate was 7% (95% CI, 4% to 11%). Similarly, the pooled SVR was 88% (95% CI, 80% to 93%) in PWID and the pooled treatment discontinuation rate was 9% (95% CI, 5% to 15%). There was no significant difference regarding pooled rates of SVR, adherence, and discontinuation between patients on OST and controls as well as between PWID and controls. HCV reinfection rates among patients on OST ranged from 0.0 to 12.5 per 100 person-years. CONCLUSIONS HCV treatment outcomes in PWID and patients on OST are similar to those in patients without a history of injecting drugs, supporting current guideline recommendations to treat HCV in these patient populations.
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Affiliation(s)
- Christiana Graf
- Department of Internal Medicine, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Marcus M Mücke
- Department of Internal Medicine, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Georg Dultz
- Department of Internal Medicine, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Kai-Henrik Peiffer
- Department of Internal Medicine, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Alica Kubesch
- Department of Internal Medicine, University Hospital Frankfurt, Frankfurt am Main, Germany
| | | | - Stefan Zeuzem
- Department of Internal Medicine, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Eva Herrmann
- Institute of Biostatistics and Mathematical Modeling, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Johannes Vermehren
- Department of Internal Medicine, University Hospital Frankfurt, Frankfurt am Main, Germany
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23
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Morris L, Selvey L, Williams O, Gilks C, Smirnov A. Reasons for Not Seeking Hepatitis C Treatment among People Who Inject Drugs. Subst Use Misuse 2021; 56:175-184. [PMID: 33208025 DOI: 10.1080/10826084.2020.1846198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Despite increases in treatment uptake for hepatitis C viral infection (HCV) in Australia since the introduction of direct acting antiviral (DAA) therapy, a large proportion of HCV-infected people who inject drugs (PWID) have not sought treatment. Purpose/Objectives: To examine predictors of treatment uptake and reasons for not seeking treatment among PWID. Methods: PWID (n = 404) recruited through five needle and syringe programs in South East Queensland were interviewed about HCV testing, status and treatment, recent injecting drug use, mental health and reasons for not taking up treatment. Predictors of treatment uptake were examined using unadjusted and adjusted logistic regression analyses. Proportions were calculated for participants reporting each reason for not taking up treatment. Results: We recruited 404 PWID. Of those tested for HCV (94%), 55% were HCV antibody positive and 31% with active infection. Approximately 36% of eligible participants had begun or completed DAA treatment. In adjusted analyses, injecting drugs three or more times per day was associated with not taking up HCV treatment (p = 0.005). Common reasons for not seeking treatment ("applied a lot") included experiencing no HCV-related symptoms (25%), HCV treatment not being a priority (23%), fear of treatment side effects (18%), and no knowledge of DAA treatments (15%). Conclusions/Importance: HCV education efforts for PWID should target misperceptions and lack of awareness of DAA therapy, and highlight the likely benefits of treatment even when asymptomatic. The use of peer workers and increased investment in integrated treatment facilities will likely aid treatment uptake.
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Affiliation(s)
- Leith Morris
- School of Public Health, The University of Queensland, Herston, Australia
| | - Linda Selvey
- School of Public Health, The University of Queensland, Herston, Australia
| | - Owain Williams
- School of Public Health, The University of Queensland, Herston, Australia
| | - Charles Gilks
- School of Public Health, The University of Queensland, Herston, Australia
| | - Andrew Smirnov
- School of Public Health, The University of Queensland, Herston, Australia.,Queensland Alcohol and Drug Research and Education Centre, The University of Queensland, Herston, Australia
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24
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Falade-Nwulia O, Sulkowski MS. Hepatitis C Virus Treatment: Simplifying the Simple and Optimizing the Difficult. J Infect Dis 2020; 222:S745-S757. [PMID: 33245350 PMCID: PMC8171802 DOI: 10.1093/infdis/jiaa534] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The availability of safe, efficacious, oral direct-acting antivirals (DAAs) have ushered in a new era of hepatitis C treatment with potential to eliminate hepatitis C as a public health threat. To achieve population-level effectiveness of these oral DAAs, hepatitis C treatment by a wide range of providers in different settings will be essential to increase the number of persons treated. We provide a clinical review of hepatitis C treatment with a focus on practical tools for management of hepatitis C in majority of currently infected individuals who can be easily cured and optimization of treatment for those in whom treatment may not be as simple.
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Affiliation(s)
| | - Mark S Sulkowski
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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25
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Tofighi B, Lee JD, Sindhu SS, Chemi C, Leonard NR. Engagement in the Hepatitis C care continuum among people who use drugs. JOURNAL OF SUBSTANCE USE 2020; 25:343-349. [PMID: 33041652 DOI: 10.1080/14659891.2019.1704076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Despite high rates of Hepatitis C virus (HCV) infection among people who use drugs (PWUDs), access to the HCV care continuum combined with the receipt of medications for addiction treatment in primary care settings remains suboptimal. A qualitative study was conducted among adults admitted for inpatient detoxification for opioid use disorder (OUD) in New York City (n=23) to assess barriers and facilitators with HCV prevention, screening, treatment, interactions with primary care providers, and experiences with integrated care approaches. Study findings yielded six major themes related to HCV care. Major gaps persist in knowledge regarding HCV harm reduction strategies, voluntary HCV testing services, and eligibility for HCV treatment. Treatment coordination challenges reinforce the importance of enhancing linkages to HCV care in key access-points utilized by PWUDs (e.g., emergency rooms, specialty addiction treatment settings). Peer networks combined with frequent patient-physician communication were elicited as important factors in facilitating linkage to HCV care. Additional care coordination needs in primary care settings included access to integrated treatment of HCV and OUD, and administrative support for enrollment in Medicaid, subsidized housing, and access to transportation vouchers.
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Affiliation(s)
- Babak Tofighi
- New York University School of Medicine, Department of Population Health.,New York University School of Medicine, Division of General Internal Medicine.,Center for Drug Use and HIV Research, NYU College of Global Public Health
| | - Joshua D Lee
- New York University School of Medicine, Department of Population Health.,New York University School of Medicine, Division of General Internal Medicine.,Center for Drug Use and HIV Research, NYU College of Global Public Health
| | - Selena S Sindhu
- New York University School of Medicine, Department of Population Health
| | - Chemi Chemi
- New York University School of Medicine, Department of Population Health
| | - Noelle R Leonard
- Center for Drug Use and HIV Research, NYU College of Global Public Health.,NYU Silver School of Social Work
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26
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Chan J, Kaba F, Schwartz J, Bocour A, Akiyama MJ, Rosner Z, Winters A, Yang P, MacDonald R. The hepatitis C virus care cascade in the New York City jail system during the direct acting antiviral treatment era, 2014-2017. EClinicalMedicine 2020; 27:100567. [PMID: 33150329 PMCID: PMC7599312 DOI: 10.1016/j.eclinm.2020.100567] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/13/2020] [Accepted: 09/11/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND High patient turnover presents challenges and opportunity to provide hepatitis C virus (HCV) care in US jails (remand facilities). This study describes the HCV care cascade in the New York City (NYC) jail system during the direct-acting antiviral (DAA) treatment era. METHODS Patients admitted to the NYC jail system from January 2014 through December 2017 were included in this retrospective cohort analysis. We describe rates of screening, diagnosis, linkage to jail-based care, and treatment among the overall cohort, and among subgroups with long jail stays (≥120 days) or frequent stays (≥10 admissions). The study protocol was approved by a third-party institutional review board (BRANY, Lake Success, NY). FINDINGS Among the 121,371 patients in our analysis, HCV screening was performed in 40,219 (33%), 4665 (12%) of whom were viremic, 1813 (39%) seen by an HCV clinician in jail, and 248 (5% of viremic patients) started on treatment in jail. Having a long stay (adjusted risk ratio [aRR] 8·11, 95% confidence interval [CI] 6·98, 9·42) or frequent stays (aRR 1·51, 95% CI 1·04, 2·18) were significantly associated with being seen by an HCV clinician. Patients with long stays had a higher rate of treatment (14% of viremic patients). Sustained virologic response at 12 weeks was achieved in 147/164 (90%) of patients with available virologic data. INTERPRETATION Jail health systems can reach large numbers of HCV-infected individuals. The high burden of HCV argues for universal screening in jail settings. Length of stay was strongly associated with being seen by an HCV clinician in jail. Treatment is feasible among those with longer lengths of stay. FUNDING None.
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Affiliation(s)
- Justin Chan
- Correctional Health Services, NYC Health + Hospitals, 55 Water Street, 18th floor, New York, NY 10041, United States
- Corresponding authors.
| | - Fatos Kaba
- Correctional Health Services, NYC Health + Hospitals, 55 Water Street, 18th floor, New York, NY 10041, United States
| | - Jessie Schwartz
- Bureau of Communicable Diseases, Viral Hepatitis Program, New York City Department of Health and Mental Hygiene, Long Island City, NY 11101, United States
| | - Angelica Bocour
- Bureau of Communicable Diseases, Viral Hepatitis Program, New York City Department of Health and Mental Hygiene, Long Island City, NY 11101, United States
| | - Matthew J Akiyama
- Montefiore Medical Center, Albert Einstein College of Medicine, 1621 Eastchester Road, Bronx, NY 10461, United States
| | - Zachary Rosner
- Correctional Health Services, NYC Health + Hospitals, 55 Water Street, 18th floor, New York, NY 10041, United States
| | - Ann Winters
- Bureau of Communicable Diseases, Viral Hepatitis Program, New York City Department of Health and Mental Hygiene, Long Island City, NY 11101, United States
| | - Patricia Yang
- Correctional Health Services, NYC Health + Hospitals, 55 Water Street, 18th floor, New York, NY 10041, United States
| | - Ross MacDonald
- Correctional Health Services, NYC Health + Hospitals, 55 Water Street, 18th floor, New York, NY 10041, United States
- Corresponding authors.
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27
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Iversen J, Dore GJ, Starr M, Catlett B, Cunningham P, Geddes L, Maher L. Estimating the Consensus hepatitis C Cascade of Care among people who inject drugs in Australia: Pre and post availability of direct acting antiviral therapy. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 83:102837. [PMID: 32645585 DOI: 10.1016/j.drugpo.2020.102837] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 06/04/2020] [Accepted: 06/13/2020] [Indexed: 12/21/2022]
Abstract
Background Monitoring the hepatitis C virus (HCV) cascade of care (CoC) among people who inject drugs (PWID) is an essential component of the response to World Health Organisation's (WHO) hepatitis elimination goals. This study aimed to estimate the Consensus hepatitis C CoC among PWID using data collected in Australia prior to and after the introduction of unrestricted direct-acting antiviral (DAA) therapy in March 2016. Methods The Australian Needle Syringe Program Survey is a cross-sectional bio-behavioural surveillance system that recruits >2000 PWID annually. Using data from 2015 and 2019, HCV antibody and ribonucleic acid (RNA) test results from dried blood spots were combined with self-reported data on HCV diagnostic testing and treatment to project HCV Consensus CoC indicators at a population-level among Australian PWID. Results Among an estimated 75,000 people who inject drugs on a regular basis in Australia, the number with active HCV infection declined from 32,619 (44%) in October 2015 to 12,679 (17%) in October 2019. The majority (78% in 2015 and 2019) of PWID reported HCV diagnosis, while the proportion of those diagnosed who were treated increased from 3% in 2015 to 47% in 2019. Among those treated, the proportion who were HCV RNA negative and assumed to have been successfully treated (cured), increased from 27% in 2015 to 88% in 2019. Conclusion This study demonstrates remarkable HCV CoC progress among PWID in Australia following availability of DAA therapy. There was a substantial increase in the proportion of HCV diagnosed PWID who initiated treatment and were cured, while the number of PWID with active HCV infection more than halved over a 3.5 year period. Estimates of the Consensus hepatitis C CoC among PWID is required to monitor progress toward WHO HCV elimination goals.
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Affiliation(s)
- Jenny Iversen
- The Kirby Institute, UNSW Sydney, Sydney, Australia.
| | | | - Mitchell Starr
- NSW State Reference Laboratory for HIV, St Vincent's Centre for Applied Medical Research, St Vincent's Hospital Sydney, Australia
| | - Beth Catlett
- The Kirby Institute, UNSW Sydney, Sydney, Australia; NSW State Reference Laboratory for HIV, St Vincent's Centre for Applied Medical Research, St Vincent's Hospital Sydney, Australia
| | - Philip Cunningham
- NSW State Reference Laboratory for HIV, St Vincent's Centre for Applied Medical Research, St Vincent's Hospital Sydney, Australia
| | | | - Lisa Maher
- The Kirby Institute, UNSW Sydney, Sydney, Australia
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28
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Chan J, Schwartz J, Kaba F, Bocour A, Akiyama MJ, Hobstetter L, Rosner Z, Winters A, Yang P, MacDonald R. Outcomes of Hepatitis C Virus Treatment in the New York City Jail Population: Successes and Challenges Facing Scale up of Care. Open Forum Infect Dis 2020; 7:ofaa263. [PMID: 33123613 PMCID: PMC7580175 DOI: 10.1093/ofid/ofaa263] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/23/2020] [Indexed: 12/19/2022] Open
Abstract
Background The population detained in the New York City (NYC) jail system bears a high burden of hepatitis C virus (HCV) infection. Challenges to scaling up treatment include short and unpredictable lengths of stay. We report on the clinical outcomes of direct-acting antiviral (DAA) treatment delivered by NYC Health + Hospitals/Correctional Health Services in NYC jails from 2014 to 2017. Methods We performed a retrospective observational cohort study of HCV patients with detectable HCV ribonucleic acid treated with DAA therapy while in NYC jails. Some patients initiated treatment in jail, whereas others initiated treatment in the community and were later incarcerated. Our primary outcome was sustained virologic response at 12 weeks (SVR12). Results There were 269 patients included in our cohort, with 181 (67%) initiating treatment in jail and 88 (33%) continuing treatment started in the community. The SVR12 virologic outcome data were available for 195 (72%) individuals. Of these, 172 (88%) achieved SVR12. Patients who completed treatment in jail were more likely to achieve SVR12 relative to those who were released on treatment (adjusted risk ratio, 2.93; 95% confidence interval, 1.35-6.34). Of those who achieved SVR12, 114 (66%) had a subsequent viral load checked. We detected recurrent viremia in 18 (16%) of these individuals, which corresponded to 10.6 cases per 100 person-years of follow-up. Conclusions Hepatitis C virus treatment with DAA therapy is effective in a jail environment. Future work should address challenges related to discharging patients while they are on treatment, loss to follow-up, and a high incidence of probable reinfection.
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Affiliation(s)
- Justin Chan
- Correctional Health Services, NYC Health + Hospitals, New York, New York, USA
| | - Jessie Schwartz
- Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Fatos Kaba
- Correctional Health Services, NYC Health + Hospitals, New York, New York, USA
| | - Angelica Bocour
- Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Matthew J Akiyama
- Correctional Health Services, NYC Health + Hospitals, New York, New York, USA.,Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Laura Hobstetter
- Correctional Health Services, NYC Health + Hospitals, New York, New York, USA
| | - Zachary Rosner
- Correctional Health Services, NYC Health + Hospitals, New York, New York, USA
| | - Ann Winters
- Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Patricia Yang
- Correctional Health Services, NYC Health + Hospitals, New York, New York, USA
| | - Ross MacDonald
- Correctional Health Services, NYC Health + Hospitals, New York, New York, USA
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Biondi MJ, Feld JJ. Hepatitis C models of care: approaches to elimination. CANADIAN LIVER JOURNAL 2020; 3:165-176. [PMID: 35991853 PMCID: PMC9202783 DOI: 10.3138/canlivj.2019-0002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 01/27/2019] [Indexed: 07/29/2023]
Abstract
Hepatitis C direct-acting antivirals (DAAs) have an efficacy of 95% or greater, with pangenotypic options. Many regions in Canada have recently abolished the need to demonstrate fibrosis before treatment with DAAs, and several combination therapies are available under public and private insurance coverage. As a result, efforts to increase treatment are largely focused on engaging specific populations and providers. With minimal side effects and decreased need for monitoring, hepatitis C screening, linkage, and treatment can largely be done in a single setting. In this article, we highlight both Canadian and international examples of the specialist's ongoing role and discuss the task shifting of hepatitis C treatment to primary care; specialized community clinics; and mental health, corrections, addictions, and opioid substitution therapy settings. Although specialists continue to support most models of care described in the literature, we highlight the potential for non-specialist care in working toward the elimination of hepatitis C in Canada.
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Affiliation(s)
- Mia J Biondi
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario
- Arthur Labatt Family School of Nursing, Western University, London, Ontario
| | - Jordan J Feld
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario
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30
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Lepage C, Garber G, Corrin R, Galanakis C, Leonard L, Cooper C. Telemedicine successfully engages marginalized rural hepatitis C patients in curative care. JOURNAL OF THE ASSOCIATION OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASE CANADA = JOURNAL OFFICIEL DE L'ASSOCIATION POUR LA MICROBIOLOGIE MEDICALE ET L'INFECTIOLOGIE CANADA 2020; 5:87-97. [PMID: 36338186 PMCID: PMC9602883 DOI: 10.3138/jammi-2019-0025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 02/04/2020] [Indexed: 04/16/2023]
Abstract
BACKGROUND Rurally located individuals living with hepatitis C virus (HCV) face barriers to engagement and retention in care. Telemedicine technologies coupled with highly curative direct acting antiviral (DAA) treatments may increase accessibility to HCV care while achieving high sustained virologic response (SVR) rates. We compared clinical and socio-economic characteristics, SVR, and loss to follow-up among telemedicine (TM), mixed delivery (MD), and outpatient clinic (OPC) patients receiving care through The Ottawa Hospital Viral Hepatitis Program (TOHVHP). METHODS TOHVHP clinical database was used to evaluate patients engaging HCV care between January 1, 2012, and December 31, 2016. SVR rates by HCV care delivery method (TM versus OPC versus MD) were calculated. RESULTS Analysis included 1,454 patients who engaged with TOHVHP at least once. Patients were aged almost 50 years on average and were predominately male and Caucasian. A greater proportion of TM patients were rurally based, were Indigenous, had a history of substance use, and had previously been incarcerated. Per-protocol DAA SVR rates for TM, OPC, and MD patients were 100% (26/26), 93% (440/472), and 94% (44/47), respectively. Loss-to-follow-up rates for HCV-treated TM and MD patients were higher (27% [10/37], 95% CI 0.58 to 0.88, and 11% [7/62], 95% CI 0.81 to 0.97, respectively) than for those followed exclusively in the OPC (5% [39/800], 95% CI 0.94 to 0.97). CONCLUSIONS TM can successfully engage, retain, and cure rurally based HCV patients facing barriers to care. Strategies to improve TM retention of patients initiating HCV antiviral treatment are key to optimizing the impact of this model of care.
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Affiliation(s)
- Candis Lepage
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Gary Garber
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Division of Infectious Diseases, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Raymond Corrin
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Lynne Leonard
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Curtis Cooper
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Division of Infectious Diseases, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Correspondence: Curtis Cooper, Department of Medicine, University of Ottawa, 501 Smyth Road, Box 223, Ottawa, Ontario K1H 8L6 Canada. Telephone: 613-737-8899 ext. 72296. E-mail:
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31
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Biondi MJ, Feld JJ. Hepatitis C models of care: approaches to elimination. CANADIAN LIVER JOURNAL 2020. [DOI: 10.3138/canlivj-2019-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Hepatitis C direct-acting antivirals (DAAs) have an efficacy of 95% or greater, with pangenotypic options. Many regions in Canada have recently abolished the need to demonstrate fibrosis before treatment with DAAs, and several combination therapies are available under public and private insurance coverage. As a result, efforts to increase treatment are largely focused on engaging specific populations and providers. With minimal side effects and decreased need for monitoring, hepatitis C screening, linkage, and treatment can largely be done in a single setting. In this article, we highlight both Canadian and international examples of the specialist’s ongoing role and discuss the task shifting of hepatitis C treatment to primary care; specialized community clinics; and mental health, corrections, addictions, and opioid substitution therapy settings. Although specialists continue to support most models of care described in the literature, we highlight the potential for non-specialist care in working toward the elimination of hepatitis C in Canada.
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Affiliation(s)
- Mia J Biondi
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario
- Arthur Labatt Family School of Nursing, Western University, London, Ontario
| | - Jordan J Feld
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario
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32
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Hepatitis C cascade of care at an integrated community facility for people who inject drugs. J Subst Abuse Treat 2020; 114:108025. [PMID: 32527512 DOI: 10.1016/j.jsat.2020.108025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 04/15/2020] [Accepted: 05/01/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To examine the hepatitis C virus (HCV) cascade of care at a community-based integrated harm reduction and treatment facility for people who inject drugs (PWID). METHODS Queensland Injectors' Health Network is a community-based agency providing integrated harm reduction and treatment services, including HCV treatment. Program data were analyzed from program commencement (early 2015) up to December 2017. RESULTS By December 2017, 476 participants with confirmed HCV infection had enrolled in treatment, of whom 72% had commenced treatment, 65% had completed treatment, and 44% had a confirmed sustained virologic response at 12-weeks post-treatment. Participants who commenced treatment tended to be older (ref 18-34 years; 35-49 years OR = 1.84, p = 0.037, 50+ years OR = 3.19, p = 0.002) and to feel safe and stable in their housing (OR = 2.36, p = 0.021). Participants who completed treatment were less likely to report legal issues (OR = 0.23, p = 0.009). CONCLUSIONS Integrated community-based services can successfully engage PWID throughout the HCV treatment journey. Additional social support, including linkage with housing and legal navigation services, may improve treatment uptake and completion. Point-of-care testing, including same-day scripting, could improve treatment uptake.
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Koustenis KR, Anagnostou O, Kranidioti H, Vasileiadi S, Antonakaki P, Koutli E, Pantsas P, Deutsch M, Manolakopoulos S. Direct-acting antiviral treatment for chronic hepatitis C in people who use drugs in a real-world setting. Ann Gastroenterol 2020; 33:195-201. [PMID: 32127741 PMCID: PMC7049240 DOI: 10.20524/aog.2020.0449] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 12/09/2019] [Indexed: 12/15/2022] Open
Abstract
Background Direct-acting antivirals (DAAs) offer high cure rates in people who inject drugs (PWID) with hepatitis C virus (HCV) infection. There are concerns regarding lower response rates among PWID in real life. We evaluated the outcome of DAA therapy in PWID in a real-world setting and the factors that affect it. Methods We performed a retrospective analysis of 174 PWID with chronic hepatitis C who started DAAs in a Greek liver clinic in collaboration with an addiction program. Patients who did not return for reassessment were considered as lost to follow up (LTFU). A logistic regression model was used to assess factors associated with a sustained virological response 12 weeks after treatment completion (SVR12) and LTFU. Results Patients' mean age was 48±9.2 years and 91/174 (52.3%) were attending opioid substitution treatment programs. Overall, 144/174 (82.8%) patients completed therapy and presented for SVR12 testing, 8/174 (4.6%) did not complete treatment and 22/174 (12.6%) were LTFU. Overall SVR12 was 79.9% (139/174). For those with an available SVR12 test the response rate reached 96.5% (139/144). Regression analysis did not indicate any significant association between patient characteristics and SVR12. Age <45 years and genotype 3 were independent predictors of LTFU. Parallel use was found to have a trend towards LTFU. Conclusions HCV treatment by hepatologists and addiction specialists is feasible, effective and safe in a real-world setting. However, as 12% of patients appear to be LTFU, more emphasis should be placed on interventions guaranteeing follow up for SVR testing and general care.
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Affiliation(s)
- Kanellos Rafail Koustenis
- Gastroenterology-Liver Unit, 2 Academic Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, Hippokration General Hospital, (Kanellos Rafail Koustenis, Olga Anagnostou, Hariklia Kranidioti, Sofia Vasileiadi, Pinelopi Antonakaki, Evangelia Koutli, Paris Pantsas, Melanie Deutsch, Spilios Manolakopoulos)
| | - Olga Anagnostou
- Gastroenterology-Liver Unit, 2 Academic Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, Hippokration General Hospital, (Kanellos Rafail Koustenis, Olga Anagnostou, Hariklia Kranidioti, Sofia Vasileiadi, Pinelopi Antonakaki, Evangelia Koutli, Paris Pantsas, Melanie Deutsch, Spilios Manolakopoulos)
| | - Hariklia Kranidioti
- Gastroenterology-Liver Unit, 2 Academic Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, Hippokration General Hospital, (Kanellos Rafail Koustenis, Olga Anagnostou, Hariklia Kranidioti, Sofia Vasileiadi, Pinelopi Antonakaki, Evangelia Koutli, Paris Pantsas, Melanie Deutsch, Spilios Manolakopoulos)
| | - Sofia Vasileiadi
- Gastroenterology-Liver Unit, 2 Academic Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, Hippokration General Hospital, (Kanellos Rafail Koustenis, Olga Anagnostou, Hariklia Kranidioti, Sofia Vasileiadi, Pinelopi Antonakaki, Evangelia Koutli, Paris Pantsas, Melanie Deutsch, Spilios Manolakopoulos)
| | - Pinelopi Antonakaki
- Gastroenterology-Liver Unit, 2 Academic Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, Hippokration General Hospital, (Kanellos Rafail Koustenis, Olga Anagnostou, Hariklia Kranidioti, Sofia Vasileiadi, Pinelopi Antonakaki, Evangelia Koutli, Paris Pantsas, Melanie Deutsch, Spilios Manolakopoulos)
| | - Evangelia Koutli
- Gastroenterology-Liver Unit, 2 Academic Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, Hippokration General Hospital, (Kanellos Rafail Koustenis, Olga Anagnostou, Hariklia Kranidioti, Sofia Vasileiadi, Pinelopi Antonakaki, Evangelia Koutli, Paris Pantsas, Melanie Deutsch, Spilios Manolakopoulos)
| | - Paris Pantsas
- Gastroenterology-Liver Unit, 2 Academic Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, Hippokration General Hospital, (Kanellos Rafail Koustenis, Olga Anagnostou, Hariklia Kranidioti, Sofia Vasileiadi, Pinelopi Antonakaki, Evangelia Koutli, Paris Pantsas, Melanie Deutsch, Spilios Manolakopoulos)
| | - Melanie Deutsch
- Gastroenterology-Liver Unit, 2 Academic Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, Hippokration General Hospital, (Kanellos Rafail Koustenis, Olga Anagnostou, Hariklia Kranidioti, Sofia Vasileiadi, Pinelopi Antonakaki, Evangelia Koutli, Paris Pantsas, Melanie Deutsch, Spilios Manolakopoulos)
| | - Spilios Manolakopoulos
- Gastroenterology-Liver Unit, 2 Academic Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, Hippokration General Hospital, (Kanellos Rafail Koustenis, Olga Anagnostou, Hariklia Kranidioti, Sofia Vasileiadi, Pinelopi Antonakaki, Evangelia Koutli, Paris Pantsas, Melanie Deutsch, Spilios Manolakopoulos).,Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital (Spilios Manolakopoulos), Athens, Greece
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Pourmarzi D, Hall L, Smirnov A, Hepworth J, Rahman T, FitzGerald G. Framework for community-based models for treating hepatitis C virus. AUST HEALTH REV 2020; 44:459-469. [DOI: 10.1071/ah18220] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 05/01/2019] [Indexed: 12/16/2022]
Abstract
Objective
Although community-based models for treating hepatitis C virus (HCV) are widely recognised for reaching more people who require treatment, little is known about their organisational and operational elements. This study aimed to address this gap and develop a framework for designing, implementing and evaluating community-based models for treating HCV.
Methods
This study was a systematic review in which 17 databases were searched for published and unpublished studies. The final search of databases was performed in September 2017. A qualitative inductive thematic approach was used to extract and categorise organisational and operational elements of community-based models for treating HCV.
Results
Data analysis yielded 13 organisational and operational elements that were categorised into three domains: support for patients, support for healthcare providers and service delivery facilitation. In the support for patients domain, support was categorised into four elements: peer support, psychological assessment and support, social assessment and support and adherence support. In the support for healthcare providers domain, the elements included the provision of educational opportunities for HCV care providers, specialist mentoring, decision making support and rewarding and recognition for HCV care providers. Finally, the service delivery facilitation domain included seven elements that target service-level enablers for community-based HCV treatment, including essential infrastructure, policy implementation and collocation and collaboration with other related services.
Conclusion
This framework for understanding the components of models of community-based HCV treatment may be used as a guide for designing, implementing and evaluating models of care in support of HCV elimination. HCV care providers and patients need to be supported to improve their engagement with the provision of community-based treatment. In addition, evidence-based strategies to facilitate service delivery need to be included.
What is known about the topic?
Community-based models for treating HCV are widely recognised as having the advantage of reaching more people who require treatment. These types of models aim to remove barriers related to accessibility and acceptability associated with tertiary centre-based HCV treatment.
What does this paper add?
Community-based models for treating HCV use various organisational and operational elements to improve the accessibility, effectiveness and acceptability of these services. The elements we identified target three main domains: support for patients with HCV, support for HCV care providers and service delivery facilitation. The importance of these organisational and operational elements designed to improve health and health services outcomes of community-based models for treating HCV is strongly influenced by context, and dependent on both the setting and target population.
What are the implications for practitioners?
Health policy makers and practitioners need to consider a patient’s psychosocial and economic status and provide support when needed. To successfully deliver HCV treatment in community settings, HCV care providers need to be trained and supported, and need to establish linkages, collaborations or colocations with other related services.
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Latham NH, Doyle JS, Palmer AY, Vanhommerig JW, Agius P, Goutzamanis S, Li Z, Pedrana A, Gottfredsson M, Bouscaillou J, Luhmann N, Mazhnaya A, Altice FL, Saeed S, Klein M, Falade-Nwulia OO, Aspinall E, Hutchinson S, Hellard ME, Sacks-Davis R. Staying hepatitis C negative: A systematic review and meta-analysis of cure and reinfection in people who inject drugs. Liver Int 2019; 39:2244-2260. [PMID: 31125496 DOI: 10.1111/liv.14152] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 05/16/2019] [Accepted: 05/19/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIMS Direct-acting antivirals (DAAs) are highly effective in treating hepatitis C. However, there is concern that cure rates may be lower, and reinfection rates higher, among people who inject drugs. We conducted a systematic review of treatment outcomes achieved with DAAs in people who inject drugs (PWID). METHODS A search strategy was used to identify studies that reported sustained viral response (SVR), treatment discontinuation, adherence or reinfection in recent PWID and/or opioid substitution therapy (OST) recipients. Study quality was assessed using the Newcastle-Ottawa Scale. Meta-analysis of proportions was used to estimate pooled SVR and treatment discontinuation rates. The pooled relative risk of achieving SVR and pooled reinfection rate were calculated using generalized mixed effects linear models. RESULTS The search identified 8075 references; 26 were eligible for inclusion. The pooled SVR for recent PWID was 88% (95% CI, 83%-92%) and 91% (95% CI 88%-95%) for OST recipients. The relative risk of achieving SVR for recent PWID compared to non-recent PWID was 0.99 (95% CI, 0.94-1.06). The pooled treatment discontinuation was 2% (95% CI, 1%-4%) for both recent PWID and OST recipients. Amongst recent PWID, the pooled incidence of reinfection was 1.94 per 100 person years (95% CI, 0.87-4.32). In OST recipients, the incidence of reinfection was 0.55 per 100 person years (95% CI, 0.17-1.76). CONCLUSIONS Treatment outcomes were similar in recent PWID compared to non-PWID treated with DAAs. People who report recent injecting or OST recipients should not be excluded from hepatitis C treatment.
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Affiliation(s)
- Ned H Latham
- Disease Elimination Program, Burnet Institute, Melbourne, Australia.,School of Medicine, Monash University, Melbourne, Australia
| | - Joseph S Doyle
- Disease Elimination Program, Burnet Institute, Melbourne, Australia.,Department of Infectious Diseases, The Alfred Hospital and Monash University, Melbourne, Australia
| | - Anna Y Palmer
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
| | | | - Paul Agius
- Disease Elimination Program, Burnet Institute, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Stelliana Goutzamanis
- Disease Elimination Program, Burnet Institute, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Zinia Li
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
| | - Alisa Pedrana
- Disease Elimination Program, Burnet Institute, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Magnus Gottfredsson
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland.,Division of Infectious Diseases, Landspitali University Hospital, Reykjavik, Iceland.,Department of Science, Landspitali University Hospital, Reykjavik, Iceland
| | | | | | - Alyona Mazhnaya
- The International Charitable Foundation Alliance for Public Health, Kyiv, Ukraine.,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore
| | - Frederick L Altice
- Section of Infectious Diseases, Yale University School of Medicine, New Haven.,Division of Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven
| | - Sahar Saeed
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Marina Klein
- Department of Medicine, McGill University Health Centre, Montreal, Canada
| | | | - Esther Aspinall
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom.,Health Protection Scotland, National Services Scotland, Glasgow, United Kingdom
| | - Sharon Hutchinson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom.,Health Protection Scotland, National Services Scotland, Glasgow, United Kingdom
| | - Margaret E Hellard
- Disease Elimination Program, Burnet Institute, Melbourne, Australia.,Department of Infectious Diseases, The Alfred Hospital and Monash University, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Doherty Institute, University of Melbourne, Melbourne, Australia
| | - Rachel Sacks-Davis
- Disease Elimination Program, Burnet Institute, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.,Department of Medicine, University of Melbourne, Australia
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Radley A, Robinson E, Aspinall EJ, Angus K, Tan L, Dillon JF. A systematic review and meta-analysis of community and primary-care-based hepatitis C testing and treatment services that employ direct acting antiviral drug treatments. BMC Health Serv Res 2019; 19:765. [PMID: 31660966 PMCID: PMC6819346 DOI: 10.1186/s12913-019-4635-7] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 10/14/2019] [Indexed: 12/23/2022] Open
Abstract
Background Direct Acting Antiviral (DAAs) drugs have a much lower burden of treatment and monitoring requirements than regimens containing interferon and ribavirin, and a much higher efficacy in treating hepatitis C (HCV). These characteristics mean that initiating treatment and obtaining a virological cure (Sustained Viral response, SVR) on completion of treatment, in non-specialist environments should be feasible. We investigated the English-language literature evaluating community and primary care-based pathways using DAAs to treat HCV infection. Methods Databases (Cinahl; Embase; Medline; PsycINFO; PubMed) were searched for studies of treatment with DAAs in non-specialist settings to achieve SVR. Relevant studies were identified including those containing a comparison between a community and specialist services where available. A narrative synthesis and linked meta-analysis were performed on suitable studies with a strength of evidence assessment (GRADE). Results Seventeen studies fulfilled the inclusion criteria: five from Australia; two from Canada; two from UK and eight from USA. Seven studies demonstrated use of DAAs in primary care environments; four studies evaluated integrated systems linking specialists with primary care providers; three studies evaluated services in locations providing care to people who inject drugs; two studies evaluated delivery in pharmacies; and one evaluated delivery through telemedicine. Sixteen studies recorded treatment uptake. Patient numbers varied from around 60 participants with pathway studies to several thousand in two large database studies. Most studies recruited less than 500 patients. Five studies reported reduced SVR rates from an intention-to-treat analysis perspective because of loss to follow-up before the final confirmatory SVR test. GRADE assessments were made for uptake of HCV treatment (medium); completion of HCV treatment (low) and achievement of SVR at 12 weeks (medium). Conclusion Services sited in community settings are feasible and can deliver increased uptake of treatment. Such clinics are able to demonstrate similar SVR rates to published studies and real-world clinics in secondary care. Stronger study designs are needed to confirm the precision of effect size seen in current studies. Prospero: CRD42017069873.
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Affiliation(s)
- Andrew Radley
- NHS Tayside, Directorate of Public Health, Kings Cross Hospital, Clepington Road, Dundee, DD3 8EA, UK. .,University of Dundee, Division of Cardiovascular Medicines and Diabetes Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK.
| | - Emma Robinson
- University of Dundee, Division of Cardiovascular Medicines and Diabetes Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK
| | - Esther J Aspinall
- School of Health and Life Sciences, Glasgow Caledonian University Glasgow and Health Protection Scotland, NHS National Services, Scotland, UK
| | - Kathryn Angus
- Institute for Social Marketing, Faculty of Health Sciences and Sport University of Stirling, Stirling, FK9 4LA, UK
| | - Lex Tan
- University of Dundee, Division of Cardiovascular Medicines and Diabetes Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK
| | - John F Dillon
- University of Dundee, Division of Cardiovascular Medicines and Diabetes Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK
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Verna EC, Schluger A, Brown RS. Opioid epidemic and liver disease. JHEP Rep 2019; 1:240-255. [PMID: 32039374 PMCID: PMC7001546 DOI: 10.1016/j.jhepr.2019.06.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 06/27/2019] [Accepted: 06/29/2019] [Indexed: 12/12/2022] Open
Abstract
Opioid use in the United States and in many parts of the world has reached epidemic proportions. This has led to excess mortality as well as significant changes in the epidemiology of liver disease. Herein, we review the impact of the opioid epidemic on liver disease, focusing on the multifaceted impact this epidemic has had on liver disease and liver transplantation. In particular, the opioid crisis has led to a significant shift in incident hepatitis C virus infection to younger populations and to women, leading to changes in screening recommendations. Less well characterized are the potential direct and indirect hepatotoxic effects of opioids, as well as the changes in the incidence of hepatitis B virus infection and alcohol abuse that are likely rising in this population as well. Finally, the opioid epidemic has led to a significant rise in the proportion of organ donors who died due to overdose. These donors have led to an overall increase in donor numbers, but also to new considerations about the better use of donors with perceived or actual risk of disease transmission, especially hepatitis C. Clearly, additional efforts are needed to combat the opioid epidemic. Moreover, better understanding of the epidemiology and underlying pathophysiology will help to identify and treat liver disease in this high-risk population.
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Affiliation(s)
- Elizabeth C. Verna
- Center for Liver Disease and Transplantation, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Aaron Schluger
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Robert S. Brown
- Center for Liver Disease and Transplantation, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, NY
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Alavi M, Poustchi H, Merat S, Kaveh-Ei S, Rahimi-Movaghar A, Shadloo B, Hajarizadeh B, Grebely J, Dore GJ, Malekzadeh R. An intervention to improve HCV testing, linkage to care, and treatment among people who use drugs in Tehran, Iran: The ENHANCE study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 72:99-105. [PMID: 31303262 DOI: 10.1016/j.drugpo.2019.07.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/21/2019] [Accepted: 07/02/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Globally, HCV testing, linkage to care and treatment is sub-optimal among people who use drugs (PWUD). This study aimed to evaluate the impact of an innovative intervention to enhance HCV testing, linkage to care, and treatment initiation among PWUD in Tehran, Iran. METHODS ENHANCE is a non-randomized trial evaluating the effect of on-site rapid HCV antibody testing, venepuncture for HCV RNA testing (HCV antibody positive only), liver fibrosis assessment, and linkage to care to enhance direct-acting antiviral (DAA) therapy (sofosbuvir/daclatasvir) initiation for HCV among people with a history of drug use. Recruitment was from April 2018 and will continue to July 2019, through three opioid substitution treatment (OST) clinics, five community-based drop-in centres, and one homeless reception centre. Participants initiated DAA therapy at a specialist clinic (OST clinics) or on-site (other sites), with monitoring provided on-site or at the specialist clinic (for those with cirrhosis attending OST clinics). RESULTS Among 632 participants enrolled (median age, 44 years), 97% were male, 28% had a history of injecting drug use, and 58% had used drugs within the previous year. HCV antibody prevalence was 27%; 62% and 15% among those with and without a history of injecting drug use. Among 170 HCV antibody positive participants, 168 had HCV RNA testing (99%), of whom 134 (80%) were positive. Among HCV RNA positive participants, treatment initiation was 84%: 100% (45/45), 96% (46/48) and 54% (22/41) in OST clinics, drop-in centres, and homeless reception settings, respectively. CONCLUSION Following on-site HCV testing and linkage to care, HCV treatment uptake was extremely high among PWUD, apart from the homeless reception population. This intervention could be explored in other settings globally to enhance HCV scale-up and elimination efforts.
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Affiliation(s)
- Maryam Alavi
- Viral Hepatitis Clinical Research Program, The Kirby Institute, UNSW Sydney, Sydney, NSW 2052, Australia; Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Hossein Poustchi
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahin Merat
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Soudeh Kaveh-Ei
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Afarin Rahimi-Movaghar
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Behrang Shadloo
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Behzad Hajarizadeh
- Viral Hepatitis Clinical Research Program, The Kirby Institute, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Jason Grebely
- Viral Hepatitis Clinical Research Program, The Kirby Institute, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Gregory J Dore
- Viral Hepatitis Clinical Research Program, The Kirby Institute, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Reza Malekzadeh
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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White L, Azzam A, Burrage L, Orme C, Kay B, Higgins S, Kaye S, Sloss A, Broom J, Weston N, Mitchell J, O’Beirne J. Facilitating treatment of HCV in primary care in regional Australia: closing the access gap. Frontline Gastroenterol 2019; 10:210-216. [PMID: 31288252 PMCID: PMC6583569 DOI: 10.1136/flgastro-2018-101049] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/14/2018] [Accepted: 09/29/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Australia has unrestricted access to direct-acting antivirals (DAA) for hepatitis C virus (HCV) treatment. In order to increase access to treatment, primary care providers are able to prescribe DAA after fibrosis assessment and specialist consultation. Transient elastography (TE) is recommended prior to commencement of HCV treatment; however, TE is rarely available outside secondary care centres in Australia and therefore a requirement for TE could represent a barrier to access to HCV treatment in primary care. OBJECTIVES In order to bridge this access gap, we developed a community-based TE service across the Sunshine Coast and Wide Bay areas of Queensland. DESIGN Retrospective analysis of a prospectively recorded HCV treatment database. INTERVENTIONS A nurse-led service equipped with two mobile Fibroscan units assesses patients in eight locations across regional Queensland. Patients are referred into the service via primary care and undergo nurse-led TE at a location convenient to the patient. Patients are discussed at a weekly multidisciplinary team meeting and a treatment recommendation made to the referring GP. Treatment is initiated and monitored in primary care. Patients with cirrhosis are offered follow-up in secondary care. RESULTS 327 patients have undergone assessment and commenced treatment in primary care. Median age 48 years (IQR 38-56), 66% male. 57% genotype 1, 40% genotype 3; 82% treatment naïve; 10% had cirrhosis (liver stiffness >12.5 kPa). The majority were treated with sofosbuvir-based regimens. 26% treated with 8-week regimens. All patients had treatment prescribed and monitored in primary care. Telephone follow-up to confirm sustained virological response (SVR) was performed by clinic nurses. 147 patients remain on treatment. 180 patients have completed treatment. SVR data were not available for 19 patients (lost to follow-up). Intention-to-treat SVR rate was 85.5%. In patients with complete data SVR rate was 95.6%. CONCLUSION Community-based TE assessment facilitates access to HCV treatment in primary care with excellent SVR rates.
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Affiliation(s)
- Lauren White
- Sunshine Coast University Hospital, Birtinya, Queensland, Australia
| | - Ali Azzam
- Sunshine Coast University Hospital, Birtinya, Queensland, Australia
| | - Lauren Burrage
- Sunshine Coast University Hospital, Birtinya, Queensland, Australia
| | - Clare Orme
- Sunshine Coast University Hospital, Birtinya, Queensland, Australia
| | - Barbara Kay
- Sunshine Coast University Hospital, Birtinya, Queensland, Australia
| | - Sarah Higgins
- Sunshine Coast University Hospital, Birtinya, Queensland, Australia
| | - Simone Kaye
- Sunshine Coast University Hospital, Birtinya, Queensland, Australia
| | - Andrew Sloss
- Sunshine Coast University Hospital, Birtinya, Queensland, Australia
| | - Jennifer Broom
- Sunshine Coast University Hospital, Birtinya, Queensland, Australia,University of Queensland, Brisbane, Queensland, Australia
| | - Nicola Weston
- Sunshine Coast University Hospital, Birtinya, Queensland, Australia
| | | | - James O’Beirne
- Sunshine Coast University Hospital, Birtinya, Queensland, Australia,University of the Sunshine Coast, Sippy Downs, Queensland, Australia
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Wade AJ, Doyle JS, Gane E, Stedman C, Draper B, Iser D, Roberts SK, Kemp W, Petrie D, Scott N, Higgs P, Agius PA, Roney J, Stothers L, Thompson AJ, Hellard ME. Outcomes of Treatment for Hepatitis C in Primary Care, Compared to Hospital-based Care: A Randomized, Controlled Trial in People Who Inject Drugs. Clin Infect Dis 2019; 70:1900-1906. [DOI: 10.1093/cid/ciz546] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 06/20/2019] [Indexed: 12/18/2022] Open
Abstract
Abstract
Background
To achieve the World Health Organization hepatitis C virus (HCV) elimination targets, it is essential to increase access to direct-acting antivirals (DAAs), especially among people who inject drugs (PWID). We aimed to determine the effectiveness of providing DAAs in primary care, compared with hospital-based specialist care.
Methods
We randomized PWID with HCV attending primary care sites in Australia or New Zealand to receive DAAs at their primary care site or local hospital (standard of care [SOC]). The primary outcome was to determine whether people treated in primary care had a noninferior rate of sustained virologic response at Week 12 (SVR12), compared to historical controls (consistent with DAA trials at the time of the study design); secondary outcomes included comparisons of treatment initiation, SVR12 rates, and the care cascade by study arm.
Results
We recruited 140 participants and randomized 136: 70 to the primary care arm and 66 to the SOC arm. The SVR12 rate (100%, 95% confidence interval [CI] 87.7–100) of people treated in primary care was noninferior when compared to historical controls (85% assumed). An intention-to-treat analysis revealed that the proportion of participants commencing treatment in the primary care arm (75%, 43/57) was significantly higher than in the SOC arm (34%, 18/53; P < .001; relative risk [RR] 2.48, 95% CI 1.54–3.95), and the proportion of participants with SVR12 was significantly higher in the primary care arm, compared to in the SOC arm (49% [28/57] and 30% [16/53], respectively; P = .043; RR 1.63, 95% CI 1.0–2.65).
Conclusions
Providing HCV treatment in primary care increases treatment uptake and cure rates. Approaches that increase treatment uptake among PWID will accelerate elimination strategies.
Clinical Trials Registration
NCT02555475.
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Affiliation(s)
- Amanda J Wade
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
| | - Joseph S Doyle
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
- Department of Infectious Diseases, The Alfred, Melbourne, Australia
| | - Edward Gane
- New Zealand Liver Transplant Unit, Auckland City Hospital, Christchurch, New Zealand
| | - Catherine Stedman
- Department of Gastroenterology, Christchurch Hospital, Christchurch, New Zealand
- University of Otago, Christchurch, New Zealand
| | - Bridget Draper
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
| | - David Iser
- Department of Infectious Diseases, The Alfred, Melbourne, Australia
| | - Stuart K Roberts
- Department of Gastroenterology, The Alfred
- Department of Medicine, Monash University
| | - William Kemp
- Department of Gastroenterology, The Alfred
- Department of Medicine, Monash University
| | | | - Nick Scott
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne
| | - Peter Higgs
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne
- Department of Public Health, La Trobe University, Bundoora
| | - Paul A Agius
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne
- Judith Lumley Centre, La Trobe University
| | - Janine Roney
- Department of Infectious Diseases, The Alfred, Melbourne, Australia
| | - Lisa Stothers
- Department of Gastroenterology, St Vincent’s Hospital
| | - Alexander J Thompson
- Department of Gastroenterology, St Vincent’s Hospital
- Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Margaret E Hellard
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
- Department of Infectious Diseases, The Alfred, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne
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Bryant J, Rance J, Hull P, Mao L, Treloar C. Making sense of 'side effects': Counterpublic health in the era of direct-acting antivirals. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 72:77-83. [PMID: 31221475 DOI: 10.1016/j.drugpo.2019.06.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 05/30/2019] [Accepted: 06/05/2019] [Indexed: 01/25/2023]
Abstract
Direct-Acting Antiviral (DAA) treatments for hepatitis C have been widely promoted by health promotion professionals and medical clinicians as being 'side-effect free'. In this paper, we draw on data that troubles this approach. We used a mixed method design to collect data from people who inject drugs, and who were DAA treatment naïve, in New South Wales, Australia. We describe knowledge about and perceptions of DAA treatment. We found that concerns about side effects were commonplace - for example, one-third (37%) of participants who had not taken up treatment worried "a lot" about 'side effects' - and that these concerns were underpinned by a general distrust and suspicion of medical institutions and their technologies, including widespread negative associations linked to interferon treatment. In trying to make sense of this, we draw on the concept of counterpublic health and its recognition that the everyday health needs, knowledges and aspirations of subordinated citizens frequently contradict the normative frameworks governing public health interventions. We suggest that failing to engage with concerns about 'side effects' could hinder elimination efforts. Our analysis suggests that addressing the issue of 'side effects' within the 'public' discourse of DAAs will not dampen or damage elimination efforts, as some might fear, but rather it will legitimate the concerns of people who inject, decrease their suspicion of medical interventions, and better support the uptake of DAA treatments.
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Affiliation(s)
- Joanne Bryant
- Centre for Social Research in Health, University of New South Wales, Sydney, 2052, Australia.
| | - Jake Rance
- Centre for Social Research in Health, University of New South Wales, Sydney, 2052, Australia.
| | - Peter Hull
- Centre for Social Research in Health, University of New South Wales, Sydney, 2052, Australia.
| | - Limin Mao
- Centre for Social Research in Health, University of New South Wales, Sydney, 2052, Australia.
| | - Carla Treloar
- Centre for Social Research in Health, University of New South Wales, Sydney, 2052, Australia.
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Selfridge M, Cunningham EB, Milne R, Drost A, Barnett T, Lundgren K, Guarasci K, Grebely J, Fraser C. Direct-acting antiviral treatment for hepatitis C, reinfection and mortality among people attending an inner-city community health centre in Victoria, Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 72:106-113. [PMID: 31178254 DOI: 10.1016/j.drugpo.2019.03.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 03/08/2019] [Accepted: 03/13/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Direct-acting antiviral (DAA) treatment for hepatitis C virus (HCV) has been shown to be effective among PWID, but more real-world data on treatment outcomes is needed. The aim of this analysis was to assess the efficacy of DAA therapy, and the rate of reinfection and mortality among people attending an inner-city community health centre in Victoria, Canada. METHODS In this retrospective study, patients treated with DAA therapy between November 2014 and Dec 31, 2017 were included. Retrospective chart review was performed to assess recent injecting drug use (IDU, previous six months) or receipt of opioid agonist treatment (OAT). The primary endpoint was Sustained Virologic Response (SVR12). Secondary endpoints included HCV reinfection and mortality. RESULTS Of 270 patients who initiated DAA treatment (31% female), 20% (n=54) had HIV/HCV coinfection, 32% (n=84) had cirrhosis, 67% (n=181) had genotype 1, 6% (n=15) had genotype 2, 26% (n=69) had genotype 3. 46% (n=125) of patients were receiving OAT and 49% (n=132) reported recent IDU. 98% (n=265) completed treatment; two people stopped due to mental health, two people died, and one was non-adherent. 92% (249 of 270) achieved SVR12. 16 patients with End of Treatment (EOT) response did not have a SVR12; 7 were lost to follow-up; 2 people refused bloodwork; 2 people died; 1 had reinfection; and 4 had viral relapse. There was no difference in SVR12 by OAT (OAT, 93% vs. no OAT, 91%, P=0.435), recent injecting drug use (yes, 92% vs. no, 92%, P=0.904), or HIV status (HIV, 92% vs. no HIV, 94%, P=0.498). Eight cases of HCV reinfection were observed over 253 person-years of follow up (3.2 cases per 100 person-years; 95% CI 1.6-6.3). Twenty people died (6.3 per 100 person-years; 95% CI 3.9-10.3), including two during therapy (drug overdose, n=2) and 18 following therapy completion (drug overdose, n=7). CONCLUSION This study demonstrates that DAA treatment is effective among a marginalized population receiving care in an inner-city community health centre. The high mortality in this study highlights the importance of integrating HCV care within a framework addressing drug-related harms, preventing overdose mortality, addressing social inequalities, and improving the health of PWID.
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Affiliation(s)
| | | | | | - Anne Drost
- Cool Aid Community Health Centre, Victoria, Canada
| | | | | | | | | | - Chris Fraser
- Cool Aid Community Health Centre, Victoria, Canada
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Socías ME, Karamouzian M, Parent S, Barletta J, Bird K, Ti L. Integrated models of care for people who inject drugs and live with hepatitis C virus: A systematic review. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 72:146-159. [PMID: 31147142 DOI: 10.1016/j.drugpo.2019.05.023] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 05/16/2019] [Accepted: 05/21/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Despite the key role that people who inject drugs (PWID) play in the hepatitis C virus (HCV) epidemic, HCV treatment rates among this population have been historically low. Integrated models of HCV and substance use care have the potential to overcome some barriers to access; however, the evidence base is uncertain. This systematic review assesses the impacts of integrated HCV and substance use services on engagement in HCV care among PWID. METHODS We searched five databases up to December 2018 to identify original quantitative studies evaluating the impacts of co-location of HCV and substance use services on engagement in the HCV cascade of care among adult PWID. We conducted a narrative synthesis, categorizing models based on patient entry point (a: HCV facility, b: substance use disorder (SUD) facility, and c: other facilities), and levels of integrated services offered (a: HCV/substance use testing only, b: HCV/substance use treatment, and c: testing/treatment + other services). RESULTS A total of 46 articles corresponding to 44 original studies were included. Almost all studies (n = 42) were conducted in high-income countries and only six studies in the Direct-Acting Antiviral (DAA) era. Twenty-six studies discussed the integration of services at SUD facilities, one at HCV facilities, and seventeen at other facilities. Analysis of included studies indicated that overall integrated care resulted in improved engagement in HCV care (e.g., testing, treatment uptake and cure). However, the quality of evidence was predominantly low to moderate. CONCLUSIONS Available evidence suggests that integration of HCV and substance use services may improve engagement along the continuum of HCV care among PWID. Given limitations in data quality, and very few studies conducted in the DAA era and in low- and middle-income settings, further research is urgently needed to inform strategies to optimize HCV care access and outcomes among PWID globally.
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Affiliation(s)
- M Eugenia Socías
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
| | - Mohammad Karamouzian
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; HIV/STI Surveillance Research Center, WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, 7616911320, Iran
| | - Stephanie Parent
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - José Barletta
- Infectious Diseases Division, Hospital Juan A. Fernández, Cerviño 3356, Buenos Aires, C1425AGP, Argentina
| | - Kathleen Bird
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | - Lianping Ti
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
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Gayam V, Tiongson B, Mandal AK, Garlapati P, Pan C, Mohanty S. Real-world study of hepatitis C treatment with direct-acting antivirals in patients with drug abuse and opioid agonist therapy. Scand J Gastroenterol 2019; 54:646-655. [PMID: 31120776 DOI: 10.1080/00365521.2019.1617893] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background: Limited data exist evaluating the treatment outcomes with direct-acting antivirals (DAAs) in patients with drug use in the community setting. We aim to assess the treatment response of DAAs in this subset of patients with or without the opioid agonist therapy (OAT). Methods: All the hepatitis C virus (HCV) infected patients treated with DAAs were retrospectively analyzed. Patients were stratified into two groups by the presence or absence of abusing alcohol, cocaine and heroin. All the patients who were assigned to the abuser group had positive urine toxicology with one of the drugs during the DAA treatment. The primary assessment was the sustained virologic response (SVR12) at 12 weeks post-treatment (SVR12). Results: Among the 314 patients, 152, 128 and 58 were patients with drug use, non-drug use and receiving OAT. Among the patients with injectable or non-injectable drug use treatment, completion rate was 99% (151/152) and SVR12 was 93.4%. Among the patients with no drug use treatment, completion rate was 95% (122/128) and SVR12 was 88.3%. Among patients receiving OAT alone, SVR12 was 100%, and in patients with OAT + other drug use, SVR12 was 96.5%. None of the patients included in this study discontinued the treatment due to adverse events associated with treatment medications. Conclusions: In this community-based study, DAAs are safe, effective with high overall SVR12 in patients with active drug use (injectable and non-injectable) and OAT enrolled patients. These results support the removal of drug use as a barrier to DAA therapy.
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Affiliation(s)
- Vijay Gayam
- a Department of Medicine and Gastroenterology , Interfaith Medical Center , Brooklyn , NY , USA
| | - Benjamin Tiongson
- a Department of Medicine and Gastroenterology , Interfaith Medical Center , Brooklyn , NY , USA
| | - Amrendra Kumar Mandal
- a Department of Medicine and Gastroenterology , Interfaith Medical Center , Brooklyn , NY , USA
| | - Pavani Garlapati
- a Department of Medicine and Gastroenterology , Interfaith Medical Center , Brooklyn , NY , USA
| | - Calvin Pan
- b Department of Medicine, Division of Gastroenterology and Hepatology , NYU Langone Health, New York University School of Medicine , New York , NY , USA
| | - Smruti Mohanty
- c Department of Medicine and Division of Gastroenterology and Hepatology , New York-Presbyterian Brooklyn Methodist Hospital , Brooklyn , NY , USA
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Harney BL, Whitton B, Lim C, Paige E, McDonald B, Nolan S, Pemberton D, Hellard ME, Doyle JS. Quantitative evaluation of an integrated nurse model of care providing hepatitis C treatment to people attending homeless services in Melbourne, Australia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 72:195-198. [PMID: 30981613 DOI: 10.1016/j.drugpo.2019.02.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/27/2019] [Accepted: 02/28/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND The prevalence of hepatitis C virus (HCV) has been reported to be high among people experiencing homelessness. People who are homeless often have multiple needs that may take precedence over HCV testing and treatment. We quantitatively evaluated the outcomes of a service providing HCV treatment to people attending homeless services. METHODS Clients attending homeless services were referred to a nurse specialising in HCV-related care. The nurse provided HCV testing, education and case-management while prescriptions were provided by an affiliated doctor. Logistic regression was used to explore factors associated with treatment commencement. RESULTS Fifty-two clients referred (78%) underwent testing, thirty-nine were HCV-RNA positive among whom 18 (46%) reported sleeping rough and 29 (74%) reported injecting drug use; 66% had injected less than three months ago. Twenty-four (62%) clients commenced treatment, of whom thirteen (54%) had a sustained virological response test; all were cured. Treatment commencement was lower among people who reported sleeping rough (aOR 0.15, 95%CI 0.029-0.73). There was no difference in treatment commencement based on injecting drugs (aOR 1.06, 95%CI 0.21-5.2). CONCLUSION Most clients' commenced treatment and the majority were successfully cured using a dedicated nursing service. Clients who reported sleeping rough may still face personal and/or system level barriers to HCV treatment.
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Affiliation(s)
- Brendan L Harney
- Department of Infectious Diseases, Alfred Health & Monash University, 85 Commercial Road, Melbourne, Victoria, 3004, Australia; Disease Elimination Program, Burnet Institute, 85 Commercial Road, Melbourne, Victoria, 3004, Melbourne, Australia.
| | - Bradley Whitton
- Department of Infectious Diseases, Alfred Health & Monash University, 85 Commercial Road, Melbourne, Victoria, 3004, Australia
| | - Cheryl Lim
- Department of Infectious Diseases, Alfred Health & Monash University, 85 Commercial Road, Melbourne, Victoria, 3004, Australia; Star Health, 341 Coventry St, South Melbourne, Victoria, 3205, Australia
| | - Emma Paige
- Department of Infectious Diseases, Alfred Health & Monash University, 85 Commercial Road, Melbourne, Victoria, 3004, Australia
| | - Belinda McDonald
- Star Health, 341 Coventry St, South Melbourne, Victoria, 3205, Australia
| | - Sarah Nolan
- Star Health, 341 Coventry St, South Melbourne, Victoria, 3205, Australia; Launch Housing, 52 Haig St, Southbank, Victoria, 3205, Australia
| | - David Pemberton
- Star Health, 341 Coventry St, South Melbourne, Victoria, 3205, Australia; Launch Housing, 52 Haig St, Southbank, Victoria, 3205, Australia
| | - Margaret E Hellard
- Department of Infectious Diseases, Alfred Health & Monash University, 85 Commercial Road, Melbourne, Victoria, 3004, Australia; Disease Elimination Program, Burnet Institute, 85 Commercial Road, Melbourne, Victoria, 3004, Melbourne, Australia
| | - Joseph S Doyle
- Department of Infectious Diseases, Alfred Health & Monash University, 85 Commercial Road, Melbourne, Victoria, 3004, Australia; Disease Elimination Program, Burnet Institute, 85 Commercial Road, Melbourne, Victoria, 3004, Melbourne, Australia
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Janjua NZ, Darvishian M, Wong S, Yu A, Rossi C, Ramji A, Yoshida EM, Butt ZA, Samji H, Chong M, Chapinal N, Cook D, Alvarez M, Tyndall M, Krajden M. Effectiveness of Ledipasvir/Sofosbuvir and Sofosbuvir/Velpatasvir in People Who Inject Drugs and/or Those in Opioid Agonist Therapy. Hepatol Commun 2019; 3:478-492. [PMID: 30976739 PMCID: PMC6442698 DOI: 10.1002/hep4.1307] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 12/14/2018] [Indexed: 12/12/2022] Open
Abstract
We evaluated the effectiveness of ledipasvir/sofosbuvir (LDV/SOF) in treating hepatitis C virus (HCV) genotype 1 and SOF/velpatasvir (SOF/VEL) for all genotypes among people who inject drugs (PWID) and those not injecting drugs and who were on or off opioid agonist therapy (OAT). Study participants comprised a population-based cohort in British Columbia, Canada. The British Columbia Hepatitis Testers Cohort includes data on individuals tested for HCV from 1990 to 2016 that are integrated with medical visits, hospitalization, and prescription drug data. We classified study participants as off OAT/recent injection drug use (off-OAT/RIDU), off OAT/past IDU (off-OAT/PIDU), off OAT/no IDU (off-OAT/NIDU), on OAT/IDU (on-OAT/IDU), and on OAT/no IDU (on-OAT/NIDU). We assessed sustained virologic response (SVR) 10 weeks after HCV treatment among study groups treated with LDV/SOF or SOF/VEL until January 13, 2018. Analysis included 5,283 eligible participants: 390 off-OAT/RIDU, 598 off-OAT/PIDU, 3,515 off-OAT/NIDU, 609 on-OAT/IDU, and 171 on-OAT/NIDU. The majority were male patients (64%-74%) and aged ≥50 years (58%-85%). The SVRs for off-OAT/RIDU, off-OAT/PIDU, off-OAT/NIDU, on-OAT/IDU, and on-OAT/NIDU were 91% (355/390), 95% (570/598), 96% (3,360/3,515), 93% (567/609), and 95% (163/171), respectively. Among those with no SVR, 14 individuals died while on treatment or before SVR assessment, including 4 from illicit drug overdose. In the overall multivariable model, off-OAT/RIDU, on-OAT/IDU, male sex, cirrhosis, treatment duration <8 weeks, treatment duration 8 weeks, and treatment with SOF/VEL were associated with not achieving SVR. Conclusion: In this large real-world cohort, PWID and/or those on OAT achieved high SVRs, although slightly lower than people not injecting drugs. This finding also highlights the need for additional measures to prevent loss to follow-up and overdose-related deaths among PWID.
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Affiliation(s)
- Naveed Z. Janjua
- British Columbia Centre for Disease ControlVancouverCanada
- School of Population and Public HealthUniversity of British ColumbiaVancouverCanada
| | - Maryam Darvishian
- British Columbia Centre for Disease ControlVancouverCanada
- School of Population and Public HealthUniversity of British ColumbiaVancouverCanada
| | - Stanley Wong
- British Columbia Centre for Disease ControlVancouverCanada
| | - Amanda Yu
- British Columbia Centre for Disease ControlVancouverCanada
| | - Carmine Rossi
- British Columbia Centre for Disease ControlVancouverCanada
- School of Population and Public HealthUniversity of British ColumbiaVancouverCanada
| | - Alnoor Ramji
- Division of Gastroenterology of the Department of MedicineUniversity of British ColumbiaVancouverCanada
| | - Eric M. Yoshida
- Division of Gastroenterology of the Department of MedicineUniversity of British ColumbiaVancouverCanada
| | - Zahid A. Butt
- British Columbia Centre for Disease ControlVancouverCanada
- School of Population and Public HealthUniversity of British ColumbiaVancouverCanada
| | - Hasina Samji
- British Columbia Centre for Disease ControlVancouverCanada
- Faculty of Health SciencesSimon Fraser UniversityBurnabyCanada
| | - Mei Chong
- British Columbia Centre for Disease ControlVancouverCanada
| | - Nuria Chapinal
- British Columbia Centre for Disease ControlVancouverCanada
| | - Darrel Cook
- British Columbia Centre for Disease ControlVancouverCanada
| | - Maria Alvarez
- British Columbia Centre for Disease ControlVancouverCanada
| | - Mark Tyndall
- British Columbia Centre for Disease ControlVancouverCanada
- School of Population and Public HealthUniversity of British ColumbiaVancouverCanada
| | - Mel Krajden
- British Columbia Centre for Disease ControlVancouverCanada
- Department of Pathology and Laboratory MedicineUniversity of British ColumbiaVancouverCanada
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47
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Pourmarzi D, Hall L, Hepworth J, Smirnov A, Rahman T, FitzGerald G. Clinical effectiveness, cost effectiveness and acceptability of community-based treatment of hepatitis C virus infection: A mixed method systematic review. J Viral Hepat 2019; 26:432-453. [PMID: 30516874 DOI: 10.1111/jvh.13045] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 11/05/2018] [Accepted: 11/07/2018] [Indexed: 12/11/2022]
Abstract
Several community-based models for treating hepatitis C virus (HCV) infection have been implemented to improve treatment accessibility and health outcomes. However, there is a lack of knowledge regarding how well these models achieve the desired goals. We conducted a mixed-method systematic review of quantitative and qualitative evidence about clinical effectiveness, cost effectiveness and acceptability of community-based HCV treatment models. Seventeen databases were researched for published and unpublished studies. Methodological quality was assessed using The Joanna Briggs Institute Critical Appraisal tools. Quantitative findings were synthesized in narrative form and qualitative findings were synthesized using meta-synthesis. Forty-two quantitative and six qualitative studies were included. No relevant cost effectiveness studies were found. Five categories of community-based models were identified: telehealth, integration of HCV and addiction services, integration of HCV and HIV services, integration of HCV and primary care, and implementation by a home care and health care management company. The range of reported outcomes included; end of treatment response: 48.7% to 96%, serious side effects: 3.3% to 27.8%, sustained virological response: 22.3% to 95.5%, relapse: 2.2% to 16.7%, and treatment completion: 33.4% to 100%. Inconsistent measures of uptake and adherence were used; uptake ranged from 8.3% to 92%, and 68.4% to 100% of patients received ≥80% of prescribed doses. Patient reported experiences included trusted and supportive care providers, safe and trusted services, easily accessible care, and positive psychological and behavioural changes. The clinical effectiveness and acceptability reported from the included studies are similar to or better than reported outcomes from systematic reviews of studies in tertiary settings. Studies of the cost effectiveness of community-based models for treating HCV are needed.
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Affiliation(s)
- Davoud Pourmarzi
- School of Public Health and Social Work, Faculty of Health, Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology, Brisbane, Queensland, Australia
| | - Lisa Hall
- School of Public Health and Social Work, Faculty of Health, Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology, Brisbane, Queensland, Australia.,School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Julie Hepworth
- Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Andrew Smirnov
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Tony Rahman
- School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Gastroenterology and Hepatology, The Prince Charles Hospital, Brisbane, Australia
| | - Gerrard FitzGerald
- School of Public Health and Social Work, Faculty of Health, Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology, Brisbane, Queensland, Australia
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48
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Lakhan P, Askew D, Hayman N, Pokino LA, Sendall C, Clark PJ. Optimising Hepatitis C care in an urban Aboriginal and Torres Strait Islander primary health care clinic. Aust N Z J Public Health 2019; 43:228-235. [PMID: 30908846 DOI: 10.1111/1753-6405.12888] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 02/01/2018] [Accepted: 02/01/2019] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE Describe the sociodemographic and clinical characteristics of patients with Hepatitis C Virus (HCV) attending an urban Indigenous primary health clinic (IPHC) in Brisbane, Australia. METHODS A retrospective chart review of sociodemographic characteristics, presence of liver disease and treatments, lifestyle behaviours and comorbidities in patients with a HCV infection was conducted between October 2015 and March 2016. RESULTS One hundred and thirteen patients with confirmed HCV infection were aged between seven and 63 years; 66% were male, and 84% were Indigenous. Sixty-nine per cent had been incarcerated; 41% had experienced conflict or domestic violence; 47% were injecting drugs; 72% had depression; and 61% had anxiety. Cirrhosis was present in 7/95 patients with adequate data and associated with age (p=0.02). Eleven patients had commenced direct acting antiviral (DAA) therapy in the 18 months that it had been available. CONCLUSIONS The study highlights the opportunities for enhancing treatment of patients with HCV infection. Opportunities to improve treatment rates in an Indigenous primary healthcare include optimising diagnostic pathways, improving patient engagement, and general practitioner and peer worker participation. Implications for public health: HCV poses a serious threat to public health in Australia and IPHCs are key sites to addressing this for Indigenous people. Optimising care of patients with HCV attending IPHC requires recognition of the complex health needs and social context, to reduce the incidence and consequences of HCV infection.
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Affiliation(s)
- Prabha Lakhan
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland
| | - Deborah Askew
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland.,The University of Queensland, Primary Care Clinical Unit, Royal Brisbane and Women's Hospital, Queensland
| | - Noel Hayman
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland
| | - Leigh-Anne Pokino
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland
| | - Cheryl Sendall
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland
| | - Paul J Clark
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland.,Faculty of Medicine, The University of Queensland.,Department of Gastroenterology, The Princess Alexandra and Mater Hospitals, Queensland
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49
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Pourmarzi D, Smirnov A, Hepworth J, Rahman T, FitzGerald G, Hall L. Elements of community-based models for treating hepatitis C virus in supporting HCV elimination in Australia: A Delphi study. Int J Health Plann Manage 2019; 34:e1247-e1256. [PMID: 30901129 DOI: 10.1002/hpm.2770] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 02/14/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND A key to achieving the goal of hepatitis C virus (HCV) elimination is the provision of its treatment in community settings. This study aimed to identify the important organisational and operational elements of community-based models for treating HCV and their feasibility in the Australian context. METHODS A Delphi study was conducted with 33 experts from Australia. The questionnaire included 13 elements drawn from the literature. Participants rated each element on a five-point Likert scale for importance and feasibility and suggested additional elements. Consensus was identified when the sum of categories 1 and 2 or 4 and 5 of the five-point Likert scale reached greater than or equal to 70%. RESULTS Eight elements reached consensus in regard to importance including "Safe and enabling environment," "Training and support for healthcare providers," "Open referral policy," "Linkage with or providing outreach services," "Person-centred approach," "On-site screening and assessment," "Linkage or co-location with harm reduction services," and "Linkage or co-location with drug and alcohol services." At least 65% of participants agreed implementing elements of open referral policy, Training and support for healthcare providers, and Person-centred approach are usually or always/very feasible. For the other five elements, this was agreed to by a range of 15.2%-57.6% of participants. CONCLUSION Successful community-based models for treating HCV in Australia are dependent on the integration and coordination of care and the support provided for both patients and healthcare providers. Substantial work is required across policy and health service planning to integrate these highly rated elements into Australian primary health care.
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Affiliation(s)
- Davoud Pourmarzi
- School of Public Health and Social Work, Faculty of Health, Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology, Brisbane, Australia
| | - Andrew Smirnov
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Julie Hepworth
- Mater Research Institute, The University of Queensland, Brisbane, Australia
| | - Tony Rahman
- School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Australia.,Department of Gastroenterology and Hepatology, The Prince Charles Hospital, Brisbane, Australia
| | - Gerrard FitzGerald
- School of Public Health and Social Work, Faculty of Health, Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology, Brisbane, Australia
| | - Lisa Hall
- School of Public Health and Social Work, Faculty of Health, Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology, Brisbane, Australia.,School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
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50
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Pericàs JM, Bromberg DJ, Ocampo D, Schatz E, Wawer I, Wysocki P, Safreed-Harmon K, Lazarus JV. Hepatitis C services at harm reduction centres in the European Union: a 28-country survey. Harm Reduct J 2019; 16:20. [PMID: 30898122 PMCID: PMC6429787 DOI: 10.1186/s12954-019-0290-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 03/06/2019] [Indexed: 12/21/2022] Open
Abstract
Background In the context of the WHO’s 2016 Viral Hepatitis Strategy and the introduction of treatment that can cure more than 95% of cases with hepatitis C virus (HCV) infection, the European Joint Action on HIV and Co-infection Prevention and Harm Reduction (HA-REACT) undertook a study in the member states of the European Union (EU). It aimed to determine service providers’ understanding of the current services in their respective countries and the barriers experienced by PWID in accessing HCV testing, care and treatment services in their country. Methods In 2017, 38 purposively selected harm reduction service providers completed a 26-item English-language online survey addressing the availability, accessibility and funding of HCV services at harm reduction centres. HCV-related data and reported findings were extracted by country or by responding organization. Results Responses were received from all EU member states. Respondents from 23 countries reported that HCV tests are offered by harm reduction services in their countries, and eight countries reported that addiction specialists in their countries are able to prescribe HCV therapy. Almost half of the respondents (45%) said that their respective organizations had established referral systems with centres providing HCV treatment. Conclusions Not all EU member states have harm reduction services that provide HCV tests, and many do not have established referral systems with treatment providers. Moreover, the inability of addiction specialists to prescribe HCV treatment points to missed opportunities to make treatment more accessible. Further, discrepancies were noted between the available HCV services and stakeholders’ knowledge about their availability.
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Affiliation(s)
- Juan M Pericàs
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Carrer Rosselló, 132, 4th floor, ES-08036, Barcelona, Spain
| | - Daniel J Bromberg
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Carrer Rosselló, 132, 4th floor, ES-08036, Barcelona, Spain
| | - Denise Ocampo
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Carrer Rosselló, 132, 4th floor, ES-08036, Barcelona, Spain
| | - Eberhard Schatz
- Correlation Network, De Regenboog Groep, Amsterdam, The Netherlands
| | - Iwona Wawer
- National AIDS Centre, Ministry of Health of Poland, Warsaw, Poland
| | - Piotr Wysocki
- National AIDS Centre, Ministry of Health of Poland, Warsaw, Poland
| | - Kelly Safreed-Harmon
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Carrer Rosselló, 132, 4th floor, ES-08036, Barcelona, Spain
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Carrer Rosselló, 132, 4th floor, ES-08036, Barcelona, Spain. .,CHIP, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
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