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Schwarz C, Schubert R, Schwarz M, Schütz A, Jenke A, Bauer D, Steinwender B, Gutic E, Reiberger T, Haltmayer H, Gschwantler M. CHIME - A tailored HCV microelimination project in Viennese people who inject drugs at drug centralized substitution centers. J Virus Erad 2023; 9:100338. [PMID: 37663576 PMCID: PMC10474458 DOI: 10.1016/j.jve.2023.100338] [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: 03/01/2023] [Revised: 06/28/2023] [Accepted: 07/17/2023] [Indexed: 09/05/2023] Open
Abstract
Background Hepatitis C remains highly prevalent among people who inject drugs (PWIDs). We propose an integrated approach for screening/diagnostic testing and treatment in 6,665 Viennese PWIDs registered to access opioid agonist therapy (OAT). Methods OAT prescriptions were required monthly at one of nine approved authorities, making them ideal platforms for hepatitis C virus (HCV) screening. All PWIDs attending these authorities between January 2019 and March 2020 were offered on-site HCV screening, and consecutive HCV RNA PCR in case of positive HCV serology. In HCV viremic PWIDs, offsite referral to HCV care and treatment according to directly observed therapy (DOT) alongside OAT were performed. Results 4,327/6,665 (64.9%) individuals were contacted before the COVID-19-related project discontinuation. There were 1,538/4,327 (35.5%) individuals who had participated in the study. HCV serology was available in 1,510/1,538 (98.2%): 795/1,519 (52.6%) had a positive serology, among whom 632 (79.5%) were followed-up with a PCR test. In 8/1,538 (0.5%) additional study participants HCV RNA PCR was assessed without prior serological screening. 239/640 (37.3%) individuals were HCV viremic with 51 (21.3%) having started on direct-acting antivirals (DAAs). 48/51 (94.1%) had completed treatment, among whom 42 (87.5% according to ITT) had achieved sustained virologic response at 12 weeks after completing treatment (SVR12) and 6 (12.5%) had been lost to follow-up after completion of therapy (SVR12 according to mITT: 42/42, 100%). No treatment failures had occurred. Conclusion Providing integrated point-of-care HCV screening/diagnostic testing at central OAT approved centers, followed by DOT with DAAs, represents an effective HCV microelimination strategy. While some PWIDs were lost in the cascade to cure and the absolute number of SVR was limited by the COVID-19 pandemic, our approach will allow linkage to care in a large proportion of Viennese PWIDs.
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Affiliation(s)
- Caroline Schwarz
- Klinik Ottakring, Department of Internal Medicine IV, Vienna, Austria
- Medical University of Vienna, Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Vienna, Austria
- Vienna HIV & Liver Study Group, Vienna, Austria
| | - Raphael Schubert
- Suchthilfe Wien gGmbH, Ambulatorium Suchthilfe Wien, Vienna, Austria
| | - Michael Schwarz
- Klinik Ottakring, Department of Internal Medicine IV, Vienna, Austria
- Medical University of Vienna, Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Vienna, Austria
- Vienna HIV & Liver Study Group, Vienna, Austria
| | - Angelika Schütz
- Suchthilfe Wien gGmbH, Ambulatorium Suchthilfe Wien, Vienna, Austria
| | - Anika Jenke
- Suchthilfe Wien gGmbH, Ambulatorium Suchthilfe Wien, Vienna, Austria
| | - David Bauer
- Klinik Ottakring, Department of Internal Medicine IV, Vienna, Austria
- Medical University of Vienna, Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Vienna, Austria
- Vienna HIV & Liver Study Group, Vienna, Austria
| | | | - Enisa Gutic
- Klinik Ottakring, Department of Internal Medicine IV, Vienna, Austria
| | - Thomas Reiberger
- Medical University of Vienna, Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Vienna, Austria
- Vienna HIV & Liver Study Group, Vienna, Austria
| | - Hans Haltmayer
- Suchthilfe Wien gGmbH, Ambulatorium Suchthilfe Wien, Vienna, Austria
| | - Michael Gschwantler
- Klinik Ottakring, Department of Internal Medicine IV, Vienna, Austria
- Sigmund Freud University, Vienna, Austria
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Bhattacharya D, Aronsohn A, Price J, Lo Re V. Hepatitis C Guidance 2023 Update: AASLD-IDSA Recommendations for Testing, Managing, and Treating Hepatitis C Virus Infection. Clin Infect Dis 2023:ciad319. [PMID: 37229695 DOI: 10.1093/cid/ciad319] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 05/11/2023] [Accepted: 05/23/2023] [Indexed: 05/27/2023] Open
Abstract
The Infectious Diseases Society of America and the American Association for the Study of Liver Diseases have collaboratively developed evidence-based guidance regarding the diagnosis, management, and treatment of hepatitis C virus (HCV) infection since 2013. A panel of clinicians and investigators with extensive infectious diseases or hepatology expertise specific to HCV infection periodically review evidence from the field and update existing recommendations or introduce new recommendations as evidence warrants. This update focuses on changes to the guidance since the previous 2020 published update, including ongoing emphasis on recommended universal screening; management recommendations for incomplete treatment adherence; expanded eligibility for simplified chronic HCV infection treatment in adults with minimal monitoring; updated treatment and retreatment recommendations for children as young as 3 years old; management and treatment recommendations in the transplantation setting; and screening, treatment, and management recommendations for unique and key populations.
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Affiliation(s)
- Debika Bhattacharya
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA
| | - Andrew Aronsohn
- Department of Medicine, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago
| | - Jennifer Price
- Division of Medicine, Department of Gastroenterology and Hepatology, University of California, San Francisco
| | - Vincent Lo Re
- Department of Medicine, Division of Infectious Diseases and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine
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Spaderna M, Kattakuzhy S, Kang SJ, George N, Bijole P, Ebah E, Eyasu R, Ogbumbadiugha O, Silk R, Gannon C, Davis A, Cover A, Gayle B, Narayanan S, Pao M, Kottilil S, Rosenthal E. Hepatitis C cure and medications for opioid use disorder improve health-related quality of life in patients with opioid use disorder actively engaged in substance use. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 111:103906. [PMID: 36384062 PMCID: PMC9868066 DOI: 10.1016/j.drugpo.2022.103906] [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: 05/13/2022] [Revised: 11/02/2022] [Accepted: 11/04/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND This study aims to determine whether Hepatitis C (HCV) treatment improves health-related quality of life (HRQL) in patients with opioid use disorder (OUD) actively engaged in substance use, and which variables are associated with improving HRQL in patients with OUD during HCV treatment. METHODS Data are from a prospective, open-label, observational study of 198 patients with OUD or opioid misuse within 1 year of study enrollment who received HCV treatment with the primary endpoint of Sustained Virologic Response (SVR). HRQL was assessed using the Hepatitis C Virus Patient Reported Outcomes (HCV-PRO) survey, with higher scores denoting better HRQL. HCV-PRO surveys were conducted at Day 0, Week 12, and Week 24. A mixed-effects model investigated which variables were associated with changing HCV-PRO scores from Day 0 to Week 24. RESULTS Patients had a median age of 57 and were predominantly male (68.2%) and Black (83.3%). Most reported daily-or-more drug use (58.6%) and injection drug use (IDU) (75.8%). Mean HCV-PRO scores at Day 0 and Week 24 were 64.0 and 72.9, respectively. HCV-PRO scores at Week 24 improved compared with scores at Day 0 (8.7; p<0.001). Achieving SVR (10.4; p<0.001) and receiving medications for OUD (MOUD) at Week 24 (9.5; p<0.001) were associated with improving HCV-PRO scores. HCV-PRO scores increased at Week 24 for patients who experienced no decline in IDU frequency (8.1; p<0.001) or had a UDS positive for opioids (8.0; p<0.001) or cocaine (7.5; p=0.003) at Week 24. CONCLUSION Patients with OUD actively engaged in substance use experience improvement in HRQL from HCV cure unaffected by ongoing substance use. Interventions to promote HCV cure and MOUD engagement could improve HRQL for patients with OUD.
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Affiliation(s)
- Max Spaderna
- Department of Psychiatry, University of Maryland School of Medicine, 110 South Paca Street 4(th) Floor, Baltimore, Maryland 21201, United States.
| | - Sarah Kattakuzhy
- Department of Psychiatry, University of Maryland School of Medicine, 110 South Paca Street 4(th) Floor, Baltimore, Maryland 21201, United States; Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, 725 West Lombard Street, Baltimore, Maryland 21201, United States; DC Partnership for HIV/AIDS Progress, Clinical Research Program, Washington, District of Columbia, United States
| | - Sun Jung Kang
- Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, 35 Convent Drive, MSC 3720, Bldg 35A, Room 2E422A, Bethesda, Maryland 20892, United States
| | - Nivya George
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, 725 West Lombard Street, Baltimore, Maryland 21201, United States
| | - Phyllis Bijole
- HIPS, 906 H Street NE, Washington, District of Columbia 20002, United States
| | - Emade Ebah
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, 725 West Lombard Street, Baltimore, Maryland 21201, United States; DC Partnership for HIV/AIDS Progress, Clinical Research Program, Washington, District of Columbia, United States
| | - Rahwa Eyasu
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, 725 West Lombard Street, Baltimore, Maryland 21201, United States; DC Partnership for HIV/AIDS Progress, Clinical Research Program, Washington, District of Columbia, United States
| | - Onyinyechi Ogbumbadiugha
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, 725 West Lombard Street, Baltimore, Maryland 21201, United States; DC Partnership for HIV/AIDS Progress, Clinical Research Program, Washington, District of Columbia, United States
| | - Rachel Silk
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, 725 West Lombard Street, Baltimore, Maryland 21201, United States; DC Partnership for HIV/AIDS Progress, Clinical Research Program, Washington, District of Columbia, United States
| | - Catherine Gannon
- DC Partnership for HIV/AIDS Progress, Clinical Research Program, Washington, District of Columbia, United States; Critical Care Medicine Department, Clinical Center, National Institutes of Health, 10 Center Drive, Bethesda, Maryland 20892, United States
| | - Ashley Davis
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, 725 West Lombard Street, Baltimore, Maryland 21201, United States; DC Partnership for HIV/AIDS Progress, Clinical Research Program, Washington, District of Columbia, United States
| | - Amelia Cover
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, 725 West Lombard Street, Baltimore, Maryland 21201, United States; DC Partnership for HIV/AIDS Progress, Clinical Research Program, Washington, District of Columbia, United States
| | - Britt Gayle
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, 725 West Lombard Street, Baltimore, Maryland 21201, United States; DC Partnership for HIV/AIDS Progress, Clinical Research Program, Washington, District of Columbia, United States
| | - Shivakumar Narayanan
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, 725 West Lombard Street, Baltimore, Maryland 21201, United States
| | - Maryland Pao
- Office of the Clinical Director, National Institute of Mental Health, National Institutes of Health, 6001 Executive Boulevard, Room 6200, Bethesda, Maryland 20892, United States
| | - Shayamasundaran Kottilil
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, 725 West Lombard Street, Baltimore, Maryland 21201, United States; DC Partnership for HIV/AIDS Progress, Clinical Research Program, Washington, District of Columbia, United States
| | - Elana Rosenthal
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, 725 West Lombard Street, Baltimore, Maryland 21201, United States; DC Partnership for HIV/AIDS Progress, Clinical Research Program, Washington, District of Columbia, United States
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Primary Care Associated With Follow Up Viral Load Testing in Patients Cured of Hepatitis C Infection With Direct Acting Antivirals at a Multidisciplinary Addiction Treatment Program: Insights From a Real-World Setting. J Addict Med 2022; 16:333-339. [PMID: 34483278 PMCID: PMC9033626 DOI: 10.1097/adm.0000000000000910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Treatment of hepatitis C virus infection (HCV) with direct acting antiviral therapy is encouraged regardless of substance use status. Patients with substance use disorder are at risk of HCV reinfection after cure. Follow up viral load testing (FUVL) with HCV RNA is recommended. We investigated factors associated with adoption of FUVL in real-world clinical settings. METHODS Medical records of all patients with SUD who achieved HCV cure with direct acting antivirals at a multidisciplinary addiction treatment program between 2014 and 2019 were reviewed as part of a quality improvement initiative. Demographic and clinical characteristics including SUD treatment, urine toxicology results, and medical service use were collected. Factors associated with FUVL were analyzed and the rate of HCV reinfection was determined. RESULTS Among 149 patients, 58.4% received FUVL. Receipt of FUVL was associated with engagement in ongoing primary medical care after cure (AOR 4.39, 95% CI [1.67, 11.49]). The HCV reinfection rate among those who received FUVL was 1.95 per 100 person-years of follow up (95% CI [0.64, 5.98]). There was no significant difference in the percentage of negative urine toxicology results before and after cure. CONCLUSIONS Over half of a cohort of patients with substance use disorder cured of HCV received FUVL. The relationship between FUVL and engagement in primary medical and substance use treatment highlights the importance of integrated systems in providing longitudinal care for patients cured of HCV. Standardized interventions that facilitate FUVL testing and management of infectious complications of SUD in addiction treatment settings are needed.
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Falcato L, Bernardini C, Bruggmann P. Hepatitis C reinfection following successful direct-acting antiviral therapy among patients attending a multidisciplinary treatment centre for people who use drugs in Zurich, Switzerland. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 96:103434. [PMID: 34511311 DOI: 10.1016/j.drugpo.2021.103434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 08/18/2021] [Accepted: 08/20/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND AIM On-going risk-exposure followed by reinfection may jeopardize hepatitis C elimination efforts among people who use drugs. We estimated the HCV reinfection incidence in patients who successfully completed HCV therapy and attended a low-threshold access centre for comprehensive addiction medicine. METHODS Retrospective chart review was undertaken, in a convenience sample of patients with opioid/cocaine use disorders who achieved sustained viral response (SVR) after direct-acting antiviral (DAA) therapy in Zurich, Switzerland between April 2015 and July 2019 (n = 153). HCV reinfection incidence in patients with and without on-going drug use was calculated. RESULTS 79% of the patients were in opioid agonist treatment, and 19% were being managed for other medical or psychiatric conditions. 58% used drugs after SVR, of whom 49% injected. The follow-up period totalled 346 (median 2.1) person-years (py). Overall HCV reinfection incidence was 1.2 (CI-95: 0.3 to 3.0) per 100 py and 1.6 (0.2 to 5.8) in patients with drug use after SVR. CONCLUSION The risk of HCV reinfection after DAA therapy in persons who use drugs can be low if, after SVR, patients remain in care in a well developed comprehensive harm reduction setting.
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Affiliation(s)
- Luis Falcato
- Arud Centre for Addiction Medicine, Schützengasse 31, CH-8001 Zürich, Switzerland.
| | - Claudia Bernardini
- Arud Centre for Addiction Medicine, Schützengasse 31, CH-8001 Zürich, Switzerland
| | - Philip Bruggmann
- Arud Centre for Addiction Medicine, Schützengasse 31, CH-8001 Zürich, Switzerland; Institute of Primary Care (IHAMZ), University Hospital Zurich, Switzerland
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Tsui JI, Barry MP, Austin EJ, Sweek EW, Tung E, Hansen RN, Ninburg M, Scott JD, Glick SN, Williams EC. 'Treat my whole person, not just my condition': qualitative explorations of hepatitis C care delivery preferences among people who inject drugs. Addict Sci Clin Pract 2021; 16:52. [PMID: 34384494 PMCID: PMC8358259 DOI: 10.1186/s13722-021-00260-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 08/03/2021] [Indexed: 12/20/2022] Open
Abstract
Background The advent of direct-acting antivirals (DAAs)—a form of hepatitis C (HCV) treatment associated with shorter treatment course and greater efficacy—offers an unprecedented opportunity to eliminate HCV, but only if care delivery systems are developed to extend treatment to people who inject drugs (PWID). To support the design of a community-pharmacy program, we explored perspectives of PWID with chronic HCV with regard to barriers, motivators, preferences, and prior experiences related to HCV treatment and pharmacists. Methods We conducted semi-structured interviews with people living with HCV who reported active injection drug use. Participants were recruited from local community service and clinical organizations in the Seattle, Washington region, and focus groups and interviews were conducted in-person or via phone/video-conference. Rapid Assessment Process was used to analyze qualitative data. Dual coders used structured templates to summarize findings and engaged in iterative review to identify themes. Results Among the 40 participants, 65% were male, 52.5% were white, and 80% were not stably housed. On average, participants had been injecting drugs for 14 years and living with HCV for 6 years. Analyses revealed 3 themes: (1) limited knowledge regarding HCV and DAA treatments; (2) barriers/motivators for receiving treatment included fear of side effects, prior stigmatizing behaviors from physicians, and desire to protect relatives and the PWID community from HCV transmission; and (3) preferences for HCV care delivery, including a need for person-centered, low-barrier, and collaborative treatment integrated with other care (e.g. primary care and addiction treatment) for PWID. Participants were generally receptive to a community-pharmacy model for HCV treatment, but prior interactions with pharmacists were mixed and there were some concerns expressed that care delivered by pharmacists would not be equivalent to that of physicians. Conclusions Even in the direct-acting antivirals era, people who inject drugs still face major barriers to hepatitis C treatment which may be reduced by providing low-barrier points of access for care through pharmacists. Key recommendations for community-pharmacy design included providing care team training to reduce stigma and ensuring care team structures and culture target PWID-specific needs for education and engagement. Supplementary Information The online version contains supplementary material available at 10.1186/s13722-021-00260-8.
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Affiliation(s)
- Judith I Tsui
- Department of Medicine, Division of General Internal Medicine, University of Washington, Box 359780 - 325 9th Avenue, Seattle, WA, 98104, USA.
| | - Michael P Barry
- Department of Epidemiology, University of Washington, Seattle, WA, USA.,HIV/STD Program, Public Health - Seattle & King County, Seattle, WA, USA
| | - Elizabeth J Austin
- Department of Surgery, University of Washington, Seattle, WA, USA.,Department of Health Services, University of Washington, Seattle, WA, USA
| | - Elsa W Sweek
- Department of Surgery, University of Washington, Seattle, WA, USA.,Department of Health Services, University of Washington, Seattle, WA, USA.,Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, VA Puget Sound, Seattle, WA, USA
| | - Elyse Tung
- Department of Pharmacy, University of Washington, Seattle, WA, USA.,Kelley-Ross Pharmacy Group, Seattle, WA, USA
| | - Ryan N Hansen
- Department of Pharmacy, University of Washington, Seattle, WA, USA.,Kelley-Ross Pharmacy Group, Seattle, WA, USA
| | | | - John D Scott
- Department of Medicine, Division of General Internal Medicine, University of Washington, Box 359780 - 325 9th Avenue, Seattle, WA, 98104, USA
| | - Sara N Glick
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA.,HIV/STD Program, Public Health - Seattle & King County, Seattle, WA, USA
| | - Emily C Williams
- Department of Health Services, University of Washington, Seattle, WA, USA.,Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, VA Puget Sound, Seattle, WA, USA
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Brunner N, Bruggmann P. Trends of the Global Hepatitis C Disease Burden: Strategies to Achieve Elimination. J Prev Med Public Health 2021; 54:251-258. [PMID: 34370938 PMCID: PMC8357539 DOI: 10.3961/jpmph.21.151] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/10/2021] [Indexed: 12/19/2022] Open
Abstract
Hepatitis C infection is responsible for high morbidity and mortality rates globally as well as for significant indirect costs. The disease burden caused by the hepatitis C virus (HCV) is comparable to the one caused by human immunodeficiency virus or tuberculosis. Today, simple detection methods, highly effective and easy to administer therapies and efficient preventative measures are available to combat hepatitis C. Nevertheless, in most countries around the world, the World Health Organization target of eliminating this infectious disease and its consequences by 2030 are not being met. Significant gaps in care for hepatitis C sufferers still exist, the shortcomings ranging from education and treatment to aftercare. Hepatitis C infection was and still is not on the radar of most politicians and health authorities. National programmes and strategies to combat the disease exist or are being developed in many countries. However, for these to be implemented efficiently and successfully, clear political commitment, strong civil society actors, well-functioning public health structures and the relevant support from global donors are needed.
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Affiliation(s)
| | - Philip Bruggmann
- Swiss Hepatitis, Zurich, Switzerland.,Arud Centre for Addiction Medicine, Zurich, Switzerland
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8
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Haines M, O'Byrne P. Injectable opioid agonist treatment: An evolutionary concept analysis. Res Nurs Health 2021; 44:664-671. [PMID: 33993526 DOI: 10.1002/nur.22140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 04/05/2021] [Accepted: 05/01/2021] [Indexed: 11/09/2022]
Abstract
Canada is currently in the midst of an overdose crisis. With new and innovative approaches desperately needed, injectable opioid agonist treatment (iOAT) should be considered as an integral treatment option to prevent even more fatalities. These programs provide injectable diacetylmorphine or hydromorphone to clients with severe opioid use disorders. Currently, they remain an under-executed and under-studied treatment modality. To better understand why this may be, we performed an evolutionary concept analysis as described by Rodgers. The attributes, antecedents, consequences, and surrogate terms of iOAT were unpacked and explored. Further, four themes were identified within the literature: (1) physical and mental health, (2) illicit drug use, (3) criminal behavior, and (4) ethical considerations. Recommendations surrounding the need for additional studies that focus on the perspectives of people who use opioids (PWUO), the necessity of nursing advocacy in iOAT, and the consideration of a changing illicit drug supply were explored. Further, theoretical analysis coupled with direct input from PWUO was discussed as a necessity to move forward with iOAT.
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Affiliation(s)
- Marlene Haines
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Patrick O'Byrne
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
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9
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An intervention to increase hepatitis C virus diagnosis and treatment uptake among people in custody in Iran. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 95:103269. [PMID: 33991887 DOI: 10.1016/j.drugpo.2021.103269] [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: 06/10/2020] [Revised: 04/01/2021] [Accepted: 04/14/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Iran is among countries with high opioid agonist therapy (OAT) coverage in prisons, which provides an infrastructure to increase feasibility of HCV programs. We aimed to evaluate the impact of an intervention to improve HCV screening, diagnosis, and treatment, including alongside the provision of OAT, in an Iranian prison. METHODS During July-December 2018, in the Gorgan prison, all incarcerated adults (>18 years) received HCV antibody rapid testing and, if positive, provided a venepuncture sample for HCV RNA testing. Participants with positive RNA received direct-acting antiviral (DAA) therapy [(Sofosbuvir/Daclatasvir) for 24 or 12 weeks, respectively, for those with and without cirrhosis]. Response to treatment was measured by the sustained virological response at 12 weeks post-treatment (SVR12). RESULTS Among 2015 incarcerated people with a median age of 35 years (IQR:29-41), the majority were male (97%), had not finished high school (68%), and had a history of drug use (71%), of whom 15% had ever injected drugs. A third of participants were receiving OAT, including 54% of those who had ever injected. HCV antibody prevalence was 6.7%, and RNA was detected in 4.6% of all participants; this prevalence was 32.6% and 24.7% among those with a history of injection, respectively. Treatment uptake was 82% (75/92) and was similar among people on OAT and those with a history of injection (81%). The majority completed treatment in prison and were available for SVR12 assessment (71%, 53/75). Achieved SVR12 was 100% (53/53) based on the available case analysis; those who did not have available SVR12 were released either prior to treatment initiation or completion (n = 39). CONCLUSION The availability of OAT infrastructure should be considered as an opportunity for enhancing HCV care in prisons. Where resources are limited, the prison harm reduction network could be used to design targeted HCV programs among people who are at higher risk of infection.
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10
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Hepatitis C treatment outcomes among patients treated in co-located primary care and addiction treatment settings. J Subst Abuse Treat 2021; 131:108438. [PMID: 34098298 DOI: 10.1016/j.jsat.2021.108438] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 01/22/2021] [Accepted: 04/21/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND Persons with substance use disorders face major barriers to hepatitis C virus (HCV) treatment. Co-location of addiction and HCV treatment is appealing, yet there are limited data on outcomes using this model. This study evaluated HCV outcomes of patients treated with direct-acting antivirals (DAAs) by primary care providers in two sites of co-located addiction/HCV care. METHODS The study conducted a retrospective chart review for all patients receiving DAA treatment from 2016 to 2018 at 1) a hospital-based primary care clinic with an office-based buprenorphine program, and 2) a primary care clinic within an opioid treatment program (i.e. methadone clinic). The study classified patients into 3 groups according to treatment status: buprenorphine maintenance, methadone maintenance, or neither. Descriptive analyses compared patient demographics, clinical characteristics, adherence to monitoring and treatment, and the primary outcome of sustained virologic response at 12 weeks (SVR12), defined as an undetectable HCV viral load at least 12 weeks after completing treatment. RESULTS This study included 50 patients who initiated DAA treatment. The majority of patients were unemployed (74.0%), did not smoke tobacco (54.0%), and had psychiatric comorbidities (80.0%). Many also experienced homelessness during treatment (22.0%) and experienced previous incarceration (36.0%). Only a few had recently injected drugs (4.0%). Seven of 7 (100%) patients were treated with buprenorphine, 21 of 24 (87.5%) patients were treated with methadone, and 17 of 19 (89.5%) patients receiving no opioid addiction treatment fully completed HCV DAA treatment. When including patients with missing SVR12 data with the cohort that did not achieve cure, we observe that 44 of 50 patients (88.0%) achieved SVR12. Excluding patients missing SVR12 data, we observed that 44 of 46 patients (95.7%) achieved SVR12. CONCLUSION Persons with substance use disorders treated with DAAs in co-located primary care and addiction treatment settings can achieve high rates of cure despite significant comorbidities and barriers. DAA treatment should be expanded to co-located HCV and addiction settings.
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Messina V, Onorato L, Di Caprio G, Claar E, Iovinella V, Russo A, Rosato V, Salzillo A, Nevola R, Simeone F, Curcio F, Pisaturo M, Coppola N. Directly Acting Antiviral-Based Treatment for HCV-Infected Persons Who Inject Drugs: A Multicenter Real-Life Study. Life (Basel) 2020; 11:17. [PMID: 33396802 PMCID: PMC7824069 DOI: 10.3390/life11010017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 12/13/2020] [Accepted: 12/26/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND We aimed to evaluate the factors associated with a virological response in a cohort of Hepatitis C virus (HCV)-infected people who inject drugs (PWID) treated with direct acting antivirals (DAAs). METHODS We conducted a multicenter retrospective cohort study enrolling HCV-infected PWID treated with DAAs. The primary outcome evaluated was the sustained virological response (SVR12) rate. RESULTS Five hundred and twenty HCV-infected PWID treated with all-oral DAA-based regimens were enrolled; a total of 168 (32.3%) patients presented genotype 1a, 109 (21.0%) genotype 1b, and 174 (33.5%) genotype 3; a total 152 of the 520 subjects (29.2%) were cirrhotics; a total 118 (22.7%) and 373 (71.7%) were treated with DAA regimens of second and third generation, respectively; a total 169 (33.6%) patients were receiving an opioid agonist at the start of antiviral therapy. Only 11 subjects (2.1%) did not show an SVR12. A significant correlation was found between treatment with opioid substitution therapy (p < 0.001), Human Immunodeficiency Virus (HIV) coinfection (p = 0.002), and treatment with first- or second-generation regimens (p = 0.0015) and HCV failure. Upon multivariate analysis, treatment with a first- or second-generation DAA was the only factor independently associated with failure (OR 10.4, 95% CI: 1.43 to 76.1, p = 0.02). CONCLUSIONS Treatment with DAAs led to a high SVR12 rate (97.9%) in a large cohort of HCV-infected PWID. The only predictor of viral failure found in our analysis was treatment with first- and second-generation DAA.
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Affiliation(s)
- Vincenzo Messina
- Infectious Diseases Unit, AORN Sant’Anna e San Sebastiano, 81100 Caserta, Italy; (V.M.); (L.O.); (G.D.C.); (A.R.); (A.S.); (F.S.); (M.P.)
| | - Lorenzo Onorato
- Infectious Diseases Unit, AORN Sant’Anna e San Sebastiano, 81100 Caserta, Italy; (V.M.); (L.O.); (G.D.C.); (A.R.); (A.S.); (F.S.); (M.P.)
| | - Giovanni Di Caprio
- Infectious Diseases Unit, AORN Sant’Anna e San Sebastiano, 81100 Caserta, Italy; (V.M.); (L.O.); (G.D.C.); (A.R.); (A.S.); (F.S.); (M.P.)
| | - Ernesto Claar
- Hepatology Unit, Evangelical Hospital Betania, 80147 Naples, Italy; (E.C.); (V.R.); (R.N.)
| | - Vincenzo Iovinella
- Department of Internal Medicine, San Paolo Hospital, ASL Napoli 1 Centro, 80145 Naples, Italy;
| | - Antonio Russo
- Infectious Diseases Unit, AORN Sant’Anna e San Sebastiano, 81100 Caserta, Italy; (V.M.); (L.O.); (G.D.C.); (A.R.); (A.S.); (F.S.); (M.P.)
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, Second University of Naples, 80131 Naples, Italy
| | - Valerio Rosato
- Hepatology Unit, Evangelical Hospital Betania, 80147 Naples, Italy; (E.C.); (V.R.); (R.N.)
| | - Angela Salzillo
- Infectious Diseases Unit, AORN Sant’Anna e San Sebastiano, 81100 Caserta, Italy; (V.M.); (L.O.); (G.D.C.); (A.R.); (A.S.); (F.S.); (M.P.)
| | - Riccardo Nevola
- Hepatology Unit, Evangelical Hospital Betania, 80147 Naples, Italy; (E.C.); (V.R.); (R.N.)
| | - Filomena Simeone
- Infectious Diseases Unit, AORN Sant’Anna e San Sebastiano, 81100 Caserta, Italy; (V.M.); (L.O.); (G.D.C.); (A.R.); (A.S.); (F.S.); (M.P.)
| | - Fabio Curcio
- UOC Dipendenze Ovest, ASL Napoli 1 Centro, 80145 Naples, Italy;
| | - Mariantonietta Pisaturo
- Infectious Diseases Unit, AORN Sant’Anna e San Sebastiano, 81100 Caserta, Italy; (V.M.); (L.O.); (G.D.C.); (A.R.); (A.S.); (F.S.); (M.P.)
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, Second University of Naples, 80131 Naples, Italy
| | - Nicola Coppola
- Infectious Diseases Unit, AORN Sant’Anna e San Sebastiano, 81100 Caserta, Italy; (V.M.); (L.O.); (G.D.C.); (A.R.); (A.S.); (F.S.); (M.P.)
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, Second University of Naples, 80131 Naples, Italy
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12
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Byrne C, Robinson E, Rae N, Dillon JF. Toward microelimination of hepatitis C and HIV coinfection in NHS Tayside, Scotland: Real-world outcomes. Health Sci Rep 2020; 3:e191. [PMID: 33033752 PMCID: PMC7534516 DOI: 10.1002/hsr2.191] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/30/2020] [Accepted: 08/18/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND AIMS NHS Tayside is a health board in Scotland which serves around 400 000 residents. Approximately, 2761 are estimated to be persons who inject drugs (PWID), and therefore at risk of infections such as hepatitis C (HCV) and HIV. There are few studies exploring mechanisms and success of eliminating HCV in HIV co-infected PWID using real-world data. This study aims to empirically assess HCV treatment outcomes in people living with HIV (PLHIV) to evaluate progress toward microelimination of HCV in the HIV-positive population in Tayside. METHODS HCV testing and treatment details for PLHIV stored on clinical databases dating from 2001 were extracted and anonymized. HCV treatment uptake among co-infected patients eligible for HCV treatment was calculated. Reinfection incidence was calculated in person years. Confidence intervals were calculated assuming Poisson distribution. Caldicott Guardian approval was obtained to access patient data (ref: IGTCAL 5677). RESULTS Ninety-six percent of PLHIV were tested for HCV across nine services and aware of their HCV status. From 2001 to 2019, 58 PLHIV were HCV co-infected. Four left the area and five died prior to HCV treatment. Forty-nine were eligible for HCV treatment. Thirty were treated with PEGylated interferon (Peg-IFN); 18 with direct acting antivirals (DAA). One is yet to be treated. Twelve treated with Peg-IFN did not achieve sustained viral response (SVR12); 10 were retreated, two died prior to re-treatment. Injecting drug use was the mode of HCV transmission for 39 of 49 patients. Proportion who achieved SVR12 is 75%; 92% if treated with DAAs. Annual proportions of PLHIV treated for HCV increased from 3.57% in the Peg-IFN era to 66.67% in the DAA era. Reinfection incidence is 0.2 per 100 person years (CI -0.3 to 0.7). CONCLUSIONS NHS Tayside has made progress toward microelimination of HCV among PLHIV. The most common mode of HCV transmission in PLHIV in NHS Tayside is injecting drug use. DAAs increased the proportion of co-infected PLHIV treated for HCV and produced superior SVR12 results compared to Peg-IFN.
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Affiliation(s)
- Christopher Byrne
- Molecular and Clinical MedicineUniversity of Dundee School of MedicineDundeeUK
| | - Emma Robinson
- Molecular and Clinical MedicineUniversity of Dundee School of MedicineDundeeUK
- Department of GastroenterologyNinewells Hospital & Medical SchoolDundeeUK
| | - Nikolas Rae
- Infection and Immunodeficiency UnitNinewells Hospital & Medical SchoolDundeeUK
| | - John F. Dillon
- Molecular and Clinical MedicineUniversity of Dundee School of MedicineDundeeUK
- Department of GastroenterologyNinewells Hospital & Medical SchoolDundeeUK
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13
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Pawlotsky JM, Ramers CB, Dillon JF, Feld JJ, Lazarus JV. Simplification of Care for Chronic Hepatitis C Virus Infection. Semin Liver Dis 2020; 40:392-402. [PMID: 32725611 DOI: 10.1055/s-0040-1713657] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
In 2016, the World Health Organization (WHO) set a target for eliminating viral hepatitis as a major public health threat by 2030. However, while today's highly effective and well-tolerated pangenotypic direct-acting antiviral regimens have maximized simplification of hepatitis C virus (HCV) treatment, there remain a plethora of barriers to HCV screening, diagnosis, and linkage to care. As of 2017, only 19% of the estimated 71 million individuals living with chronic HCV worldwide were diagnosed and in 2015 to 2016, only 21% of diagnosed individuals had accessed treatment. Simplification and decentralization of the HCV care cascade would bolster patient engagement and support the considerable scale-up needed to achieve WHO targets. Recent developments in HCV screening and diagnosis, together with reduced pretreatment assessment and on-treatment monitoring requirements, can further streamline the care continuum, ensuring patients are linked to care quickly and earlier in the disease course, and minimize clinic visits.
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Affiliation(s)
- Jean-Michel Pawlotsky
- Department of Virology, National Reference Center for Viral Hepatitis B, C and D, Henri Mondor Hospital, University of Paris-Est-INSERM U955, Créteil, France
| | - Christian B Ramers
- Division of Infectious Diseases, Department of Medicine, UC San Diego School of Medicine, La Jolla, California
| | - John F Dillon
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Jordan J Feld
- Toronto Centre for Liver Disease, University Health Network, Sandra Rotman Centre for Global Health, Toronto, ON, Canada
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
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14
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Hariri S, Sharafi H, Sheikh M, Merat S, Hashemi F, Azimian F, Tamadoni B, Ramazani R, Gouya MM, Abbasi B, Tashakorian M, Alasvand R, Alavian SM, Poustchi H, Malekzadeh R. Continuum of hepatitis C care cascade in prison and following release in the direct-acting antivirals era. Harm Reduct J 2020; 17:80. [PMID: 33081794 PMCID: PMC7576794 DOI: 10.1186/s12954-020-00431-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/13/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND People with criminal justice involvement contribute remarkably to the rising hepatitis C virus (HCV) burden; however, the continuum of care is a major barrier to prison-based programs. We aimed to evaluate a comprehensive HCV care model in an Iranian provincial prison. METHODS Between 2017-2018, in the Karaj Central Prison, newly admitted male inmates received HCV antibody testing and venipuncture for RNA testing (antibody-positive only). Participants with positive RNA underwent direct-acting antiviral (DAA) therapy (Sofosbuvir/Daclatasvir). Sustained virological response was evaluated at 12 weeks post-treatment (SVR12). RESULTS Overall, from 3485 participants, 182 (5.2%) and 117 (3.4%) tested positive for HCV antibody and RNA, respectively. Among 116 patients who were eligible for treatment, 24% (n = 28) were released before treatment and 72% (n = 83) initiated DAA therapy, of whom 81% (n = 67/83) completed treatment in prison, and the rest were released. Of total released patients, 68% (n = 30/44) were linked to care in community, and 70% (n = 21/30) completed treatment, including 60% (n = 12/20) and 90% (n = 9/10) among those who were released before and during treatment, respectively. The overall HCV treatment uptake and completion were 89% (n = 103/116) and 85% (n = 88/103), respectively. From people who completed treatment, 43% (n = 38/88) attended for response assessment and all were cured (SVR12 = 100%). CONCLUSIONS Integrated HCV care models are highly effective and can be significantly strengthened by post-release interventions. The close collaboration of community and prison healthcare systems is crucial to promote high levels of treatment adherence. Future studies should investigate the predictors of engagement with HCV care following release.
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Affiliation(s)
- Sanam Hariri
- Liver and Pancreatobiliary Diseases Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, N. Kargar St., 14117, Tehran, Iran
| | | | - Mahdi Sheikh
- Liver and Pancreatobiliary Diseases Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, N. Kargar St., 14117, Tehran, Iran
- Section of Genetics, International Agency for Research on Cancer, Lyon, France
| | - Shahin Merat
- Liver and Pancreatobiliary Diseases Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, N. Kargar St., 14117, Tehran, Iran
| | - Farnaz Hashemi
- Liver and Pancreatobiliary Diseases Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, N. Kargar St., 14117, Tehran, Iran
| | - Fatemeh Azimian
- Centre for Communicable Diseases Control, Ministry of Health and Medical Education, Tehran, Iran
| | - Babak Tamadoni
- Health and Treatment Directorate of Prisons and Security and Corrective Measures Organization, Tehran, Iran
| | - Rashid Ramazani
- Centre for Communicable Diseases Control, Ministry of Health and Medical Education, Tehran, Iran
| | - Mohammad Mehdi Gouya
- Centre for Communicable Diseases Control, Ministry of Health and Medical Education, Tehran, Iran
| | - Behzad Abbasi
- Liver and Pancreatobiliary Diseases Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, N. Kargar St., 14117, Tehran, Iran
| | - Mehrzad Tashakorian
- Health and Treatment Directorate of Prisons and Security and Corrective Measures Organization, Tehran, Iran
| | - Ramin Alasvand
- Health and Treatment Directorate of Prisons and Security and Corrective Measures Organization, Tehran, Iran
| | | | - Hossein Poustchi
- Liver and Pancreatobiliary Diseases Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, N. Kargar St., 14117, Tehran, Iran.
| | - Reza Malekzadeh
- Liver and Pancreatobiliary Diseases Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, N. Kargar St., 14117, Tehran, Iran
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15
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Schulte B, Schmidt CS, Manthey J, Strada L, Christensen S, Cimander K, Görne H, Khaykin P, Scherbaum N, Walcher S, Mauss S, Schäfer I, Verthein U, Rehm J, Reimer J. Clinical and Patient-Reported Outcomes of Direct-Acting Antivirals for the Treatment of Chronic Hepatitis C Among Patients on Opioid Agonist Treatment: A Real-world Prospective Cohort Study. Open Forum Infect Dis 2020; 7:ofaa317. [PMID: 32875003 PMCID: PMC7452367 DOI: 10.1093/ofid/ofaa317] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 08/07/2020] [Indexed: 12/15/2022] Open
Abstract
Background Patient-reported outcomes (PROs) can help to reduce uncertainties about hepatitis C virus (HCV) treatment with direct-acting antivirals (DAAs) among people who inject drugs and increase treatment uptake in this high-risk group. Besides clinical data, this study analyzed for the first time PROs in a real-world sample of patients on opioid agonist treatment (OAT) and HCV treatment with DAAs. Methods HCV treatment data including virological response, adherence, safety, and PROs of 328 German patients on OAT were analyzed in a pragmatic prospective cohort study conducted from 2016 to 2018. Clinical effectiveness was defined as sustained virological response (SVR) at week 12 after end of treatment and calculated in per-protocol (PP) and intention-to-treat (ITT) analyses. Changes over time in PROs on health-related quality of life, physical and mental health, functioning, medication tolerability, fatigue, concentration, and memory were analyzed by repeated-measures analyses of variances (ANOVAs). Results We found high adherence and treatment completion rates, a low number of mainly mild adverse events, and high SVR rates (PP: 97.5% [n = 285]; ITT: 84.5% [n = 328]). Missing SVR data in the ITT sample were mainly caused by patients lost to follow-up after treatment completion. Most PROs showed statistically significant but modest improvements over time, with more pronounced improvements in highly impaired patients. Conclusions This real-world study confirms that DAA treatment among OAT patients is feasible, safe, and effective. PROs show that all patients, but particularly those with higher somatic, mental, and social burden, benefit from DAA treatment.
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Affiliation(s)
- Bernd Schulte
- Centre for Interdisciplinary Addiction Research, Department of Psychiatry, Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Christiane S Schmidt
- Centre for Interdisciplinary Addiction Research, Department of Psychiatry, Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Jakob Manthey
- Centre for Interdisciplinary Addiction Research, Department of Psychiatry, Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany
| | - Lisa Strada
- Centre for Interdisciplinary Addiction Research, Department of Psychiatry, Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Christensen
- Center for Interdisciplinary Medicine Infectious Diseases, Muenster, Germany.,Department of Gastroenterology and Hepatology, Muenster University Hospital, Muenster, Germany
| | - Konrad Cimander
- Kompetenzzentrum Suchtmedizin, Infektiologie und Cannabis-Therapie, Hannover, Germany
| | - Herbert Görne
- MediZentrum Hamburg, Praxis für Suchtmedizin, Hamburg, Germany
| | | | - Norbert Scherbaum
- LVR-Hospital Essen, Department of Addictive Behaviour and Addiction Medicine, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | | | - Stefan Mauss
- Center for HIV and Hepatogastroenterology, Düsseldorf, Germany
| | - Ingo Schäfer
- Centre for Interdisciplinary Addiction Research, Department of Psychiatry, Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Uwe Verthein
- Centre for Interdisciplinary Addiction Research, Department of Psychiatry, Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Jürgen Rehm
- Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Jens Reimer
- Centre for Interdisciplinary Addiction Research, Department of Psychiatry, Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,Gesundheit Nord, Bremen, Germany
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16
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Taylor LE. Colocalization in Hepatitis C Virus Infection Care: The Role of Opioid Agonist Therapy Clinics. Clin Liver Dis (Hoboken) 2020; 16:12-15. [PMID: 32714517 PMCID: PMC7373770 DOI: 10.1002/cld.921] [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] [Received: 12/10/2019] [Accepted: 01/12/2020] [Indexed: 02/04/2023] Open
Abstract
Watch an interview with the author.
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Affiliation(s)
- Lynn E. Taylor
- Research ProfessorUniversity of Rhode IslandProvidenceRI
- Director of HIV and Viral Hepatitis ServicesCODAC Behavioral HealthProvidenceRI
- Director, RI Defeats Hep CProvidenceRI
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17
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Hajarizadeh B, Cunningham EB, Valerio H, Martinello M, Law M, Janjua NZ, Midgard H, Dalgard O, Dillon J, Hickman M, Bruneau J, Dore GJ, Grebely J. Hepatitis C reinfection after successful antiviral treatment among people who inject drugs: A meta-analysis. J Hepatol 2020; 72:643-657. [PMID: 31785345 DOI: 10.1016/j.jhep.2019.11.012] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 10/30/2019] [Accepted: 11/05/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS HCV reinfection following successful treatment can compromise treatment outcomes. This systematic review assessed the rate of HCV reinfection following treatment among people with recent drug use and those receiving opioid agonist therapy (OAT). METHODS We searched bibliographic databases and conference abstracts for studies assessing post-treatment HCV reinfection rates among people with recent drug use (injecting or non-injecting) or those receiving OAT. Meta-analysis was used to cumulate reinfection rates and meta-regression was used to explore heterogeneity across studies. RESULTS Thirty-six studies were included (6,311 person-years of follow-up). The overall rate of HCV reinfection was 5.9/100 person-years (95% CI 4.1-8.5) among people with recent drug use (injecting or non-injecting), 6.2/100 person-years (95% CI 4.3-9.0) among people recently injecting drugs, and 3.8/100 person-years (95% CI 2.5-5.8) among those receiving OAT. Reinfection rates were comparable following interferon-based (5.4/100 person-years; 95% CI 3.1-9.5) and direct-acting antiviral (3.9/100 person-years; 95% CI 2.5-5.9) therapy. In stratified analysis, reinfection rates were 1.4/100 person-years (95% CI 0.8-2.6) among people receiving OAT with no recent drug use, 5.9/100 person-years (95% CI 4.0-8.6) among people receiving OAT with recent drug use, and 6.6/100 person-years (95% CI 3.4-12.7) among people with recent drug use not receiving OAT. In meta-regression analysis, longer follow-up was associated with lower reinfection rate (adjusted rate ratio [aRR] per year increase in mean/median follow-up 0.77; 95% CI 0.69-0.86). Compared with people receiving OAT with no recent drug use, those with recent drug use receiving OAT (aRR 3.50; 95% CI 1.62-7.53), and those with recent drug use not receiving OAT (aRR 3.96; 95% CI 1.82-8.59) had higher reinfection rates. CONCLUSION HCV reinfection risk following treatment was higher among people with recent drug use and lower among those receiving OAT. The lower rates of reinfection observed in studies with longer follow-up suggested higher reinfection risk early post-treatment. LAY SUMMARY Our findings demonstrate that although reinfection by hepatitis C virus occurs following successful treatment in people with recent drug use, the rate of hepatitis C reinfection is lower than the rates of primary infection reported in the literature for this population - reinfection should not be used as a reason to withhold therapy from people with ongoing injecting drug use. The rate of hepatitis C reinfection was lowest among people receiving opioid agonist therapy with no recent drug use. These data illustrate that harm reduction services are required to reduce the reinfection risk, while regular post-treatment hepatitis C assessment is required for early detection and retreatment.
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Affiliation(s)
| | | | | | | | - Matthew Law
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Naveed Z Janjua
- British Columbia Centre for Disease Control, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Håvard Midgard
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
| | | | - John Dillon
- Ninewells Hospital and Medical School, University of Dundee, Dundee, The United Kingdom
| | - Matthew Hickman
- Population Health Sciences, University of Bristol, Bristol, The United Kingdom
| | - Julie Bruneau
- Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Gregory J Dore
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
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18
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Morgan TR. Hepatitis C Guidance 2019 Update: American Association for the Study of Liver Diseases-Infectious Diseases Society of America Recommendations for Testing, Managing, and Treating Hepatitis C Virus Infection. Hepatology 2020; 71:686-721. [PMID: 31816111 PMCID: PMC9710295 DOI: 10.1002/hep.31060] [Citation(s) in RCA: 470] [Impact Index Per Article: 117.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 11/21/2019] [Indexed: 02/06/2023]
Affiliation(s)
| | - Timothy R. Morgan
- Chief of Hepatology Veterans Affairs Long Beach Healthcare System Long Beach CA
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19
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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: 53] [Impact Index Per Article: 10.6] [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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