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Doyle JS, Heath K, Elsum I, Douglass C, Wade A, Kasza J, Allardice K, Von Bibra S, Chan K, Camesella B, Guzman R, Bryant M, Thompson AJ, Stoové MA, Snelling TL, Scott N, Spelman T, Anderson D, Richmond J, Howell J, Andric N, Dietze PM, Higgs P, Sacks-Davis R, Forbes AB, Hellard ME, Pedrana AE. Same-visit hepatitis C testing and treatment to accelerate cure among people who inject drugs (the QuickStart Study): a cluster randomised cross-over trial protocol. BMJ Open 2024; 14:e083502. [PMID: 38960465 PMCID: PMC11227801 DOI: 10.1136/bmjopen-2023-083502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/28/2024] [Indexed: 07/05/2024] Open
Abstract
INTRODUCTION Despite universal access to government-funded direct-acting antivirals (DAAs) in 2016, the rate of hepatitis C treatment uptake in Australia has declined substantially. Most hepatitis C is related to injecting drug use; reducing the hepatitis C burden among people who inject drugs (PWID) is, therefore, paramount to reach hepatitis C elimination targets. Increasing DAA uptake by PWID is important for interrupting transmission and reducing incidence, as well as reducing morbidity and mortality and improving quality of life of PWID and meeting Australia's hepatitis C elimination targets. METHODS AND ANALYSIS A cluster randomised cross-over trial will be conducted with three intervention arms and a control arm. Arm A will receive rapid hepatitis C virus (HCV) antibody testing; arm B will receive rapid HCV antibody and rapid RNA testing; arm C will receive rapid HCV antibody testing and same-day treatment initiation for HCV antibody-positive participants; the control arm will receive standard of care. The primary outcomes will be (a) the proportion of participants with HCV commencing treatment and (b) the proportion of participants with HCV achieving cure. Analyses will be conducted on an intention-to-treat basis with mixed-effects logistic regression models. ETHICS AND DISSEMINATION The study has been approved by the Alfred Ethics Committee (number HREC/64731/Alfred-2020-217547). Each participant will provide written informed consent. Reportable adverse events will be reported to the reviewing ethics committee. The findings will be presented at scientific conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT05016609. TRIAL PROGRESSION The study commenced recruitment on 9 March 2022 and is expected to complete recruitment in December 2024.
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Affiliation(s)
- Joseph S Doyle
- Infectious Diseases, Monash University, Melbourne, Victoria, Australia
- Burnet Institute, Melbourne, Victoria, Australia
| | | | - Imogen Elsum
- Burnet Institute, Melbourne, Victoria, Australia
| | | | - Amanda Wade
- Burnet Institute, Melbourne, Victoria, Australia
| | - Jessica Kasza
- Population Health, Monash University, Melbourne, Victoria, Australia
| | | | | | - Kico Chan
- Burnet Institute, Melbourne, Victoria, Australia
| | | | | | | | - Alexander J Thompson
- Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia
- Department of Medicine at St Vincent's Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Thomas L Snelling
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Nick Scott
- Burnet Institute, Melbourne, Victoria, Australia
| | | | | | | | - Jessica Howell
- Burnet Institute, Melbourne, Victoria, Australia
- Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Nada Andric
- HepatitisWA, Perth, Western Australia, Australia
| | - Paul M Dietze
- Burnet Institute, Melbourne, Victoria, Australia
- Population Health, Monash University, Melbourne, Victoria, Australia
| | - Peter Higgs
- Burnet Institute, Melbourne, Victoria, Australia
- Public Health, La Trobe University, Bundoora, Victoria, Australia
| | | | - Andrew B Forbes
- Population Health, Monash University, Melbourne, Victoria, Australia
| | - Margaret E Hellard
- Burnet Institute, Melbourne, Victoria, Australia
- Population Health, Monash University, Melbourne, Victoria, Australia
| | - Alisa E Pedrana
- Burnet Institute, Melbourne, Victoria, Australia
- Population Health, Monash University, Melbourne, Victoria, Australia
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Fontaine G, Presseau J, Bruneau J, Etherington C, Thomas IM, Hung JHC, van Allen Z, Patey AM, Kareem A, Mortazhejri S, Høj SB, Boyer-Legault G, Grimshaw JM. Using an intersectionality lens to explore barriers and enablers to hepatitis C point-of-care testing: a qualitative study among people who inject drugs and service providers. Int J Equity Health 2024; 23:124. [PMID: 38886803 PMCID: PMC11184812 DOI: 10.1186/s12939-024-02209-0] [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: 04/23/2024] [Accepted: 05/31/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) infection is a significant global health burden, particularly among people who inject drugs. Rapid point-of-care HCV testing has emerged as a promising approach to improve HCV detection and linkage to care in harm reduction organizations such as needle and syringe programs. The objective of this study was to use an intersectionality lens to explore the barriers and enablers to point-of-care HCV testing in a needle and syringe program. METHODS A qualitative study was conducted using semi-structured interviews with clients (people who inject drugs) and service providers in a large community organization focused on the prevention of sexually transmitted and blood borne infections and harm reduction in Montreal, Canada. An intersectionality lens was used alongside the Theoretical Domains Framework to guide the formulation of research questions as well as data collection, analysis, and interpretation. RESULTS We interviewed 27 participants (15 clients, 12 providers). For clients, four themes emerged: (1) understanding and perceptions of HCV testing, (2) the role of an accessible and inclusive environment, (3) the interplay of emotions and motivations in decision-making, and (4) the impact of intersectional stigma related to HCV, behaviors, and identities. For providers, five themes emerged: (1) knowledge, skills, and confidence for HCV testing, (2) professional roles and their intersection with identity and lived experience, (3) resources and integration of services, (4) social and emotional factors, and (5) behavioral regulation and incentives for HCV testing. Intersectional stigma amplified access, emotional and informational barriers to HCV care for clients. In contrast, identity and lived experience acted as powerful enablers for providers in the provision of HCV care. CONCLUSION The application of an intersectionality lens provides a nuanced understanding of multilevel barriers and enablers to point-of-care HCV testing. Findings underscore the need for tailored strategies that address stigma, improve provider roles and communication, and foster an inclusive environment for equitable HCV care. Using an intersectionality lens in implementation research can offer valuable insights, guiding the design of equity-focused implementation strategies.
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Affiliation(s)
- Guillaume Fontaine
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, 680 Rue Sherbrooke O #1800, Montréal, QC, H3A 2M7, Canada.
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Sir Mortimer B. Davis Jewish General Hospital, CIUSSS West-Central Montreal, 3755 Chem. de La Côte-Sainte-Catherine, Montréal, QC, H3T 1E2, Canada.
- Viral Hepatitis Clinical Research Program, Kirby Institute, UNSW Sydney, UNSW, Wallace Wurth Building (C27), Cnr High St & Botany St, Kensington, NSW, 2052, Australia.
| | - Justin Presseau
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier, Vanier Hall, Ottawa, ON, K1N 6N5, Canada
| | - Julie Bruneau
- Research Centre, Université de Montréal Hospital Centre, 900 Saint Denis St, Montreal, QC, H2X 0A9, Canada
- Department of Family and Emergency Medicine, Université de Montréal, 2900, Boulevard Édouard-Montpetit, Montréal, QC, H3T 1J4, Canada
| | - Cole Etherington
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | - Isabella M Thomas
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | - Jui-Hsia Cleo Hung
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
| | - Zack van Allen
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier, Vanier Hall, Ottawa, ON, K1N 6N5, Canada
| | - Andrea M Patey
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
- School of Rehabilitation Therapy, Queen's University, Louise D Acton Building, 31 George St, Kingston, ON, K7L 3N6, Canada
| | - Ayesha Kareem
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | - Sameh Mortazhejri
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
| | - Stine Bordier Høj
- Research Centre, Université de Montréal Hospital Centre, 900 Saint Denis St, Montreal, QC, H2X 0A9, Canada
| | - Geneviève Boyer-Legault
- Direction of Community Services, CACTUS Montréal, 1300 Rue Sanguinet, Montréal, QC, H2X 3E7, Canada
| | - Jeremy M Grimshaw
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
- Department of Medicine, University of Ottawa, 45 Smyth Road, Ottawa, ON, K1H8M5, Canada
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Winter RJ, Griffin S, Sheehan Y, Nguyen W, Stoové M, Lloyd AR, Thompson AJ. People in community corrections are a population with unmet need for viral hepatitis care. EClinicalMedicine 2024; 70:102548. [PMID: 38516104 PMCID: PMC10955648 DOI: 10.1016/j.eclinm.2024.102548] [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: 10/30/2023] [Revised: 02/29/2024] [Accepted: 02/29/2024] [Indexed: 03/23/2024] Open
Abstract
To reach World Health Organization elimination targets for hepatitis C, different strategies are needed to reach people who have not yet been diagnosed and treated. In the context of declining treatment initiation rates, innovation in service design and delivery is necessary: testing and treatment needs to be offered to people in non-traditional settings. The community corrections (probation and parole) population is larger than the prison population, which has high prevalence of hepatitis C and-in some countries-established diagnosis and treatment programs. In this Viewpoint we identify a gap in hepatitis C care for people under community correctional supervision, a group who have either never been imprisoned or need continuity of healthcare provided in prison. We propose that offering hepatitis C screening and treatment would benefit this population, and accelerate progress to hepatitis C elimination.
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Affiliation(s)
- Rebecca J. Winter
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Samara Griffin
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Yumi Sheehan
- Viral Immunology Systems Program, The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | | | - Mark Stoové
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, VIC, Australia
| | - Andrew R. Lloyd
- Viral Immunology Systems Program, The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Alexander J. Thompson
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - National Prisons Hepatitis Network
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Viral Immunology Systems Program, The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
- Hepatitis Queensland, Brisbane, QLD, Australia
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, VIC, Australia
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
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MacIsaac MB, Whitton B, Anderson J, Cogger S, Vella-Horne D, Penn M, Weeks A, Elmore K, Pemberton D, Winter RJ, Papaluca T, Howell J, Hellard M, Stoové M, Wilson D, Pedrana A, Doyle JS, Clark N, Holmes JA, Thompson AJ. Point-of-care HCV RNA testing improves hepatitis C testing rates and allows rapid treatment initiation among people who inject drugs attending a medically supervised injecting facility. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 125:104317. [PMID: 38281385 DOI: 10.1016/j.drugpo.2024.104317] [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: 09/24/2023] [Revised: 12/27/2023] [Accepted: 01/01/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND To achieve hepatitis C virus (HCV) elimination targets, simplified care engaging people who inject drugs is required. We evaluated whether fingerstick HCV RNA point-of-care testing (PoCT) increased the proportion of clients attending a supervised injecting facility who were tested for hepatitis C. METHODS Prospective single-arm study with recruitment between 9 November 2020 and 28 January 2021 and follow-up to 31 July 2021. Clients attending the supervised injecting facility were offered HCV RNA testing using the Xpert® HCV Viral Load Fingerstick (Cepheid, Sunnyvale, CA) PoCT. Participants with a positive HCV RNA test were prescribed direct acting antiviral (DAA) therapy. The primary endpoint was the proportion of clients who engaged in HCV RNA PoCT, compared to a historical comparator group when venepuncture-based hepatitis C testing was standard of care. RESULTS Among 1618 clients who attended the supervised injecting facility during the study period, 228 (14%) engaged in PoCT. This was significantly higher than that observed in the historical comparator group (61/1,775, 3%; p < 0.001). Sixty-five (28%) participants were HCV RNA positive, with 40/65 (62%) receiving their result on the same day as testing. Sixty-one (94%) HCV RNA positive participants were commenced on DAA therapy; 14/61 (23%) started treatment on the same day as diagnosis. There was no difference in the proportion of HCV RNA positive participants commenced on treatment with DAA therapy when compared to the historical comparator group (61/65, 94% vs 22/26, 85%; p = 0.153). However, the median time to treatment initiation was significantly shorter in the PoCT cohort (2 days (IQR 1-20) vs 41 days (IQR 22-76), p < 0.001). Among participants who commenced treatment and had complete follow-up data available, 27/36 (75%) achieved hepatitis C cure. CONCLUSIONS HCV RNA PoCT led to a significantly higher proportion of clients attending a supervised injecting facility engaging in hepatitis C testing, whilst also reducing the time to treatment initiation.
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Affiliation(s)
- Michael B MacIsaac
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Faculty of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Bradley Whitton
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Jenine Anderson
- Medically Supervised Injecting Room, North Richmond Community Health, Richmond, Victoria, Australia
| | - Shelley Cogger
- Medically Supervised Injecting Room, North Richmond Community Health, Richmond, Victoria, Australia
| | - Dylan Vella-Horne
- Medically Supervised Injecting Room, North Richmond Community Health, Richmond, Victoria, Australia
| | - Matthew Penn
- Medically Supervised Injecting Room, North Richmond Community Health, Richmond, Victoria, Australia
| | - Anthony Weeks
- Medically Supervised Injecting Room, North Richmond Community Health, Richmond, Victoria, Australia
| | - Kasey Elmore
- Medically Supervised Injecting Room, North Richmond Community Health, Richmond, Victoria, Australia
| | - David Pemberton
- Medically Supervised Injecting Room, North Richmond Community Health, Richmond, Victoria, Australia
| | - Rebecca J Winter
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Timothy Papaluca
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Faculty of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Jessica Howell
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Faculty of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Margaret Hellard
- Faculty of Medicine, University of Melbourne, Parkville, Victoria, Australia; Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia
| | - Mark Stoové
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia
| | - David Wilson
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Alisa Pedrana
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Victoria, Australia
| | - Joseph S Doyle
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Victoria, Australia
| | - Nicolas Clark
- Medically Supervised Injecting Room, North Richmond Community Health, Richmond, Victoria, Australia; Department of Addiction Medicine, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Jacinta A Holmes
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Faculty of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Alexander J Thompson
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Faculty of Medicine, University of Melbourne, Parkville, Victoria, Australia.
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Chiew BA, Fong AYP, Cosgrove LT, Mohajerani SA, Ramji A, Lee SS. Pharmacy-based screening program to detect hepatitis C in 'baby-boomer' cohorts in western Canada. CANADIAN LIVER JOURNAL 2023; 6:388-394. [PMID: 38152322 PMCID: PMC10751003 DOI: 10.3138/canlivj-2023-0005] [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: 02/26/2023] [Accepted: 03/28/2023] [Indexed: 12/29/2023]
Abstract
Background The estimated prevalence of hepatitis C virus (HCV) in Canada is approximately 1.0%. However, the number of individuals living with HCV but unaware of it is estimated to be 30%-44%. Increased screening programs that are accessible, effective, and feasible are important to ensure treatment and meet WHO elimination goals. We implemented an HCV point of care test (POCT) program in community pharmacies to examine the effectiveness and feasibility in screening. Methods Twenty two London Drugs pharmacies in British Columbia and Alberta implemented an HCV POC screening program using OraQuick rapid antibody tests. Consenting patients filled out a 10-question screening questionnaire to examine risk factors. The participants then were tested using the POCT. While waiting for the test (20 minutes), patients were educated on HCV and treatment options. Results Three hundred seventy-one participants underwent HCV screening. The most common HCV risk factor was being born between 1945 and 1975 (baby boomer) (93% of cohort), while the second most common was having a tattoo or body piercing (22%). Seven people (2%) tested positive; four were HCV-RNA PCR-positive and were treated, whereas the PCR status of three was unknown as they were lost to follow-up or not tested. Conclusions Pharmacy-based POCT was shown to be effective and feasible in the western Canadian context, especially for baby boomers. Sustainable funding for pharmacy screening programs may be considered nationwide to identify HCV-infected persons and help meet elimination goals.
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Affiliation(s)
- Brandon A Chiew
- Liver Unit, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Anita YP Fong
- London Drugs, 12831 Horseshoe Place, Richmond, British Columbia, Canada
| | - Linh T Cosgrove
- London Drugs, 12831 Horseshoe Place, Richmond, British Columbia, Canada
| | - Seyed Amir Mohajerani
- Division of Gastroenterology, St Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Alnoor Ramji
- Division of Gastroenterology, St Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Samuel S Lee
- Liver Unit, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
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Tao Y, Tang W, Fajardo E, Cheng M, He S, Bissram JS, Hiebert L, Ward JW, Chou R, Rodríguez-Frías F, Easterbrook P, Tucker JD. Reflex Hepatitis C Virus Viral Load Testing Following an Initial Positive Hepatitis C Virus Antibody Test: A Global Systematic Review and Meta-analysis. Clin Infect Dis 2023; 77:1137-1156. [PMID: 37648655 DOI: 10.1093/cid/ciad126] [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: 10/26/2022] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Many people who have a positive hepatitis C virus (HCV) antibody (Ab) test never receive a confirmatory HCV RNA viral load (VL) test. Reflex VL testing may help address this problem. We undertook a systematic review to evaluate the effectiveness of reflex VL testing compared with standard nonreflex approaches on outcomes across the HCV care cascade. METHODS We searched 4 databases for studies that examined laboratory-based reflex or clinic-based reflex VL testing approaches, with or without a nonreflex comparator, and had data on the uptake of HCV RNA VL test and treatment initiation and turnaround time between Ab and VL testing. Both laboratory- and clinic-based reflex VL testing involve only a single clinic visit. Summary estimates were calculated using random-effects meta-analyses. RESULTS Fifty-one studies were included (32 laboratory-based and 19 clinic-based reflex VL testing). Laboratory-based reflex VL testing increased HCV VL test uptake versus nonreflex testing (RR: 1.35; 95% CI: 1.16-1.58) and may improve linkage to care among people with a positive HCV RNA test (RR: 1.47; 95% CI: .81-2.67) and HCV treatment initiation (RR: 1.03; 95% CI: .46-2.32). The median time between Ab and VL test was <1 day for all laboratory-based reflex studies and 0-5 days for 13 clinic-based reflex testing. CONCLUSIONS Laboratory-based and clinic-based HCV reflex VL testing increased uptake and reduced time to HCV VL testing and may increase HCV linkage to care. The World Health Organization now recommends reflex VL testing as an additional strategy to promote access to HCV VL testing and treatment. CLINICAL TRIALS REGISTRATION PROSPERO CRD42021283822.
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Affiliation(s)
- Yusha Tao
- Dermatology Hospital of South Medical University, Guangzhou, China
- University of North Carolina Project-China, Guangzhou, China
| | - Weiming Tang
- Dermatology Hospital of South Medical University, Guangzhou, China
- University of North Carolina Project-China, Guangzhou, China
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Emmanuel Fajardo
- Department of Global HIV, Hepatitis, and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Mengyuan Cheng
- Dermatology Hospital of South Medical University, Guangzhou, China
- University of North Carolina Project-China, Guangzhou, China
| | - Shiyi He
- China-Australia Joint Research Centre for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, China
| | - Jennifer S Bissram
- Health Sciences Library, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lindsey Hiebert
- Coalition for Global Hepatitis Elimination, Task Force for Global Health, Decatur, Georgia, USA
| | - John W Ward
- Coalition for Global Hepatitis Elimination, Task Force for Global Health, Decatur, Georgia, USA
| | - Roger Chou
- Departments of Medicine and Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Francisco Rodríguez-Frías
- Liver Pathology Unit, Biochemistry and Microbiology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- CIBER Hepatic and Digestive Diseases (CIBERehd), Instituto Carlos III, Madrid, Spain
| | - Philippa Easterbrook
- Department of Global HIV, Hepatitis, and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Joseph D Tucker
- University of North Carolina Project-China, Guangzhou, China
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
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7
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Howell J, Van H, Pham MD, Sawhney R, Li F, Bhat P, Lubel J, Kemp W, Bloom S, Majumdar A, McCaughan GW, Hall S, Spelman T, Doyle JS, Hellard M, Visvanathan K, Thompson A, Drummer HE, Anderson D. Validation of a novel point-of-care test for alanine aminotransferase measurement: A pilot cohort study. Liver Int 2023; 43:989-999. [PMID: 36719055 DOI: 10.1111/liv.15531] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 01/15/2023] [Accepted: 01/23/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND Alanine aminotransferase (ALT) measurement is essential for evaluation of liver disease. We validated a novel rapid point-of-care (POC) test for ALT1 against laboratory ALT. METHODS Stored plasma samples from adults with chronic liver disease (Test cohort n = 240; Validation cohort n = 491) were analysed using the BioPoint® antigen immunoassay POC ALT1 lateral flow test, which provides quantitative ALT results (Axxin handheld reader) or semi-quantitative results (visual read, cut off 40 IU/ml). The accuracy of POC ALT1 to detect ALT > 40 IU/L was determined by ROC analysis. In patients with chronic hepatitis B, treatment eligibility (EASL criteria) was determined using POC ALT1 and compared to laboratory ALT. RESULTS POC ALT1 test had good accuracy for laboratory ALT > 40 IU/L: AUROC 0.93 (95% CI: 0.89-0.96) in the Test cohort and AUROC 0.92 (95% CI: 0.88-0.95) in the Validation cohort. POC ALT1 cut off of 0.8 for ALT > 40 IU/L maximised sensitivity (97%) and specificity (71%) in the Test cohort (42% laboratory ALT > 40 IU/L) and yielded PPV 84% and NPV 91% in the Validation cohort (19% laboratory ALT > 40 IU/L). Semi-quantitative POC ALT1 had good accuracy for laboratory ALT in the Validation cohort (AUROC 0.85, 95% CI: 0.81-0.99; sensitivity 77% and specificity 93%). Combined with HBV DNA and transient elastography, both quantitative and semi-quantitative POC ALT1 tests had good accuracy for excluding hepatitis B treatment needs (sensitivity 96%, specificity 78% and NPV 99%). CONCLUSION The POC ALT1 test had good accuracy for elevated ALT levels and for determining treatment eligibility among people with chronic hepatitis B.
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Affiliation(s)
- Jessica Howell
- Burnet Institute, Melbourne, Australia
- St Vincent's Hospital and University of Melbourne, Melbourne, Australia
| | - Huy Van
- Burnet Institute, Melbourne, Australia
| | - Minh D Pham
- Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Rohit Sawhney
- St Vincent's Hospital and University of Melbourne, Melbourne, Australia
- Department of Gastroenterology, Eastern Health, Box Hill, Victoria, Australia
- Department of Medicine, Monash University, Melbourne, Australia
| | - Fan Li
- Burnet Institute, Melbourne, Australia
| | | | - John Lubel
- Central Clinical School, Monash University, Melbourne, Australia
| | - William Kemp
- Central Clinical School, Monash University, Melbourne, Australia
| | - Stephen Bloom
- Department of Gastroenterology, Eastern Health, Box Hill, Victoria, Australia
- Department of Medicine, Monash University, Melbourne, Australia
| | - Avik Majumdar
- A.W.Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia
| | - Geoffrey W McCaughan
- A.W.Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia
- Centenary Institute, Sydney, Australia
| | - Samuel Hall
- St Vincent's Hospital and University of Melbourne, Melbourne, Australia
| | | | - Joseph S Doyle
- Burnet Institute, Melbourne, Australia
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Australia
| | - Margaret Hellard
- Burnet Institute, Melbourne, Australia
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Australia
| | - Kumar Visvanathan
- St Vincent's Hospital and University of Melbourne, Melbourne, Australia
| | | | - Heidi E Drummer
- Burnet Institute, Melbourne, Australia
- Department of Microbiology, Monash University, Clayton, Victoria, Australia
- Department of Microbiology at The Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Parkville, Australia
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Byrne CJ, Malaguti A, Inglis SK, Dillon JF. Mixed-methods evaluation of point-of-care hepatitis C virus RNA testing in a Scottish prison. BMJ Open 2023; 13:e068604. [PMID: 37037621 DOI: 10.1136/bmjopen-2022-068604] [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] [Indexed: 04/12/2023] Open
Abstract
OBJECTIVES Hepatitis C virus (HCV) poses a global public health threat. Prisons are a focus of prevention efforts due to high infection burdens. Expedition of treatment for incarcerated people is critical, as many are short-term sentenced. We evaluated point-of-care (PoC) HCV RNA testing in a maximum-security Scottish prison and assessed its impact on transition to treatment. We also evaluated costs and determinants of implementation. DESIGN Mixed-methods evaluation of a single-centre care pathway pilot using National Health Service (NHS) data from 2018 to 2021. Descriptive statistics and survival analysis were undertaken. Cost analysis was assessed from a provider perspective. Healthcare staff participated in semistructured interviews and thematic analysis with a deductive approach was undertaken to identify implementation determinants. SETTING A large maximum-security Scottish prison health centre administered by the NHS. PARTICIPANTS 296 incarcerated NHS patients (all men) and six NHS staff members (two men and four women). INTERVENTIONS HCV testing using the Cepheid GeneXpert platform with Xpert HCV VL Fingerstick assay. OUTCOME MEASURES The main outcome was survival (in days) from HCV test to treatment initiation. Secondary outcomes were cost-per-cure obtained and implementation determinants. RESULTS During the pilot, 167 Xpert tests were administered, with an 84% completion rate, and treatment transition was superior for those who received it (p=0.014). Where PoC tests were administered, shorter survival to treatment was observed (19 vs 33 days: adjusted HR (aHR) 1.91 (1.03-3.55), p=0.040; 19 vs 50 days; aHR 3.76 (1.67-8.46), p=0.001). PoC was costlier than conventional testing. In qualitative analysis, most facilitators were observed among characteristics of individual domain while most barriers were noted in the inner setting. CONCLUSIONS Integrating PoC HCV RNA diagnosis into nurse-led HCV care in a maximum-security prison health centre shortens survival to HCV treatment. However, there are cost implications to this approach and multiple determinants that impact on implementation should be addressed.
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Affiliation(s)
- Christopher J Byrne
- Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
- Directorate of Public Health, NHS Tayside, Dundee, UK
| | - Amy Malaguti
- Tayside Drug and Alcohol Recovery Psychology Service, NHS Tayside, Dundee, UK
- Department of Psychology, University of Dundee, Dundee, UK
| | | | - John F Dillon
- Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
- Department of Gastroenterology, NHS Tayside, Dundee, UK
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Howell J, Van H, Pham MD, Sawhney R, Li F, Bhat P, Lubel J, Kemp W, Bloom S, Majumdar A, McCaughan G, Spelman T, Doyle JS, Hellard M, Visvanathan K, Thompson A, Anderson D. A novel point-of-care test for cirrhosis based on dimeric to monomeric IgA ratio in blood: a pilot cohort study. Hepatol Commun 2023; 7:e0106. [PMID: 36995999 PMCID: PMC10069834 DOI: 10.1097/hc9.0000000000000106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/19/2022] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND AND AIMS Dimeric IgA to monomeric IgA ratio (dIgA ratio) is a biomarker of gut mucosal leakage in liver cirrhosis. We evaluated the diagnostic performance of a novel point-of-care (POC) dIgA ratio test for cirrhosis. METHODS Plasma samples from people with chronic liver disease were analyzed using the BioPoint POC dIgA ratio antigen immunoassay lateral flow test. Cirrhosis was defined by Fibroscan>12.5 kPa, clinical evidence of cirrhosis or liver histopathology. POC dIgA test diagnostic accuracy was determined in a test cohort using receiver operating characteristic curve analysis; optimal cutoffs for sensitivity and specificity were then applied to a validation cohort. RESULTS A total of 1478 plasma samples from 866 patients with chronic liver disease were included (test cohort n = 260, validation cohort n = 606). In all, 32% had cirrhosis; 44% Child-Pugh A, 26% Child-Pugh B, and 29% Child-Pugh C. Median POC dIgA ratio was higher in cirrhosis (0.9) compared with no cirrhosis (0.4, p < 0.001), and in Child-Pugh class B/C compared with A cirrhosis (1.4 Child-Pugh B/C vs. 0.6 Child-Pugh A, p < 0.001). POC dIgA ratio test had good diagnostic accuracy for liver cirrhosis in the test cohort (area under the receiver operating characteristic curve=0.80); a dIgA ratio cutoff of 0.6 had a sensitivity of 74% and specificity of 86%. POC dIgA test accuracy was moderate in the validation cohort (area under the receiver operating characteristic curve=0.75; positive predictive value 64%, negative predictive value 83%). Using a dual cutoff approach, 79% of cirrhosis cases were correctly diagnosed and further testing was avoided in 57%. CONCLUSIONS POC dIgA ratio test had moderate accuracy for cirrhosis. Further studies evaluating the accuracy of POC dIgA ratio testing for cirrhosis screening are warranted.
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Affiliation(s)
- Jessica Howell
- Burnet Institute, Melbourne, Victoria, Australia
- St Vincent’s Hospital and University of Melbourne, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Huy Van
- Burnet Institute, Melbourne, Victoria, Australia
| | - Minh D. Pham
- Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rohit Sawhney
- St Vincent’s Hospital and University of Melbourne, Melbourne, Victoria, Australia
- Eastern Health, Box Hill, Victoria, Australia
| | - Fan Li
- Burnet Institute, Melbourne, Victoria, Australia
| | | | - John Lubel
- Department of Gastroenterology, The Alfred Hospital and Monash Central Clinical School, Melbourne, Victoria, Australia
| | - William Kemp
- Department of Gastroenterology, The Alfred Hospital and Monash Central Clinical School, Melbourne, Victoria, Australia
| | | | - Avik Majumdar
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Geoff McCaughan
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Centenary Institute, Sydney, New South Wales, Australia
| | | | - Joseph S. Doyle
- Burnet Institute, Melbourne, Victoria, Australia
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Victoria, Australia
| | - Margaret Hellard
- Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Victoria, Australia
| | - Kumar Visvanathan
- St Vincent’s Hospital and University of Melbourne, Melbourne, Victoria, Australia
| | - Alexander Thompson
- St Vincent’s Hospital and University of Melbourne, Melbourne, Victoria, Australia
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Moussa D, Wallace J, Manski-Nankervis JA, Doyle JS, Nguyen L, Boyle D, Stoové MA, Asselin J, Valaydon Z, Ahad M, Glasgow S, New K, Hocking JS, Sanci L, Thompson A, Hellard M, Howell J. Assessment of a primary care e-support package of automated case finding, simplified treatment algorithm and decision support to increase hepatitis B treatment uptake in primary care clinics in Australia (SIMPLY-B Study): protocol for a pilot evaluation. BMJ Open 2023; 13:e070663. [PMID: 36927591 PMCID: PMC10030932 DOI: 10.1136/bmjopen-2022-070663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
INTRODUCTION Despite the availability of effective, subsidised hepatitis B treatment, linkage to care and treatment rates remain very low globally. In Australia, specially trained primary care physicians (general practitioner, GPs) can prescribe hepatitis B treatment, however, most hepatitis B care occurs in specialist clinics. Increasing hepatitis B management by GPs in primary care clinics is essential to achieve national hepatitis B linkage to care and treatment targets by 2030.This pilot study determines the feasibility, acceptability and effectiveness of Simply B, a novel GP hepatitis B e-support package designed to increase hepatitis B management by GPs in primary care clinics. METHODS AND ANALYSIS This study will be conducted in three parts:Part A: A prospective open-label pilot intervention study, comparing the proportion of people with hepatitis B who are managed by their GP in primary care clinics before, 12 months and 24 months after implementation of the Simply B electronic hepatitis B support package.Part B: A nested qualitative health services feasibility study using semistructured interviews and thematic analysisPart C: Cost-effectiveness analysis. ETHICS AND DISSEMINATION This study has received ethics approval by St Vincent's Hospital. Data management and analysis will be centralised through the Department of Gastroenterology, St Vincent's Hospital. TRIAL REGISTRATION NUMBER NCT05614466.
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Affiliation(s)
- Dina Moussa
- The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia
- Burnet Institute, Melbourne, Victoria, Australia
- St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Jack Wallace
- Burnet Institute, Melbourne, Victoria, Australia
| | - Jo-Anne Manski-Nankervis
- The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia
| | - Joseph S Doyle
- Burnet Institute, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | - Long Nguyen
- Burnet Institute, Melbourne, Victoria, Australia
| | - Douglas Boyle
- The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia
| | | | | | - Zina Valaydon
- The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia
| | - Marvad Ahad
- Burnet Institute, Melbourne, Victoria, Australia
| | - Susanne Glasgow
- St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Kate New
- St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Jane S Hocking
- School of Population and Global Health, Univerisy of Melbourne, Melbourne, Victoria, Australia
| | - Lena Sanci
- The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia
| | - Alexander Thompson
- The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia
- St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Margaret Hellard
- Burnet Institute, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | - Jess Howell
- The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia
- Burnet Institute, Melbourne, Victoria, Australia
- St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
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11
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Ydreborg M, Lundström E, Kolleby R, Lexén S, Pizarro E, Lindgren J, Wejstål R, Larsson SB. Linkage to hepatitis C treatment in two opioid substitution treatment units in Gothenburg, Sweden: a retrospective cohort study. Subst Abuse Treat Prev Policy 2023; 18:17. [PMID: 36907872 PMCID: PMC10009929 DOI: 10.1186/s13011-023-00527-0] [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: 12/22/2022] [Accepted: 03/07/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Chronic infection with the hepatitis C virus (HCV) is common in people with former or current injection drug use. Among the patients in the opioid substitution treatment (OST) program in Gothenburg, Sweden, more than 50% had been infected with HCV. However, many patients did not have any follow-up for their infection and the linkage to treatment could be improved. METHODS A model of care for HCV was introduced at an OST unit in Gothenburg, Sweden, in 2017. The aim was to increase testing and linkage to HCV treatment. A nurse and a medical doctor, both specialized in infectious diseases, performed on-site testing at the OST unit with transient liver elastography (Fibroscan) to evaluate the fibrosis stage and initiated HCV treatment. This study retrospectively reviewed the patients' medical records to assess information regarding participation in the model of care, hepatitis C status, linkage to treatment and treatment outcome. RESULTS Among the 225 patients enrolled in OST at baseline, 181 were still in the OST program at the end of study (December 31st, 2018). In total, 29 patients, most of whom did not attend the Clinic of Infectious Diseases, were referred to the model of care. By the end of study, 17 patients (100% of those treated) reached sustained virologic response. In parallel, an additional 19 patients got treatment directly at the Clinic of Infectious Diseases. CONCLUSION Integrating HCV screening and examination in an OST unit successfully linked patients to treatment. However, not all patients received treatment. To reach the goal of eliminating HCV, different models of care are needed.
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Affiliation(s)
- Magdalena Ydreborg
- Department of Infectious Diseases, Sahlgrenska Academy, University of Gothenburg, Box 480, 405 30, Gothenburg, Sweden
- Clinic of Infectious Diseases, Sahlgrenska University Hospital, Region Västra Götaland, Journalvägen, 10 416 50, Gothenburg, Sweden
| | - Emil Lundström
- Department of Addiction and Dependency, Sahlgrenska University Hospital, Region Västra Götaland, Journalvägen, 5 416 85, Gothenburg, Sweden
| | - Rosanna Kolleby
- Clinic of Infectious Diseases, Sahlgrenska University Hospital, Region Västra Götaland, Journalvägen, 10 416 50, Gothenburg, Sweden
| | - Sofia Lexén
- Department of Addiction and Dependency, Sahlgrenska University Hospital, Region Västra Götaland, Journalvägen, 5 416 85, Gothenburg, Sweden
| | - Elena Pizarro
- Department of Addiction and Dependency, Sahlgrenska University Hospital, Region Västra Götaland, Journalvägen, 5 416 85, Gothenburg, Sweden
| | - Jessica Lindgren
- Department of Addiction and Dependency, Sahlgrenska University Hospital, Region Västra Götaland, Journalvägen, 5 416 85, Gothenburg, Sweden
| | - Rune Wejstål
- Department of Infectious Diseases, Sahlgrenska Academy, University of Gothenburg, Box 480, 405 30, Gothenburg, Sweden
- Clinic of Infectious Diseases, Sahlgrenska University Hospital, Region Västra Götaland, Journalvägen, 10 416 50, Gothenburg, Sweden
| | - Simon B Larsson
- Department of Infectious Diseases, Sahlgrenska Academy, University of Gothenburg, Box 480, 405 30, Gothenburg, Sweden.
- Department of Addiction and Dependency, Sahlgrenska University Hospital, Region Västra Götaland, Journalvägen, 5 416 85, Gothenburg, Sweden.
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Trickey A, Fajardo E, Alemu D, Artenie AA, Easterbrook P. Impact of hepatitis C virus point-of-care RNA viral load testing compared with laboratory-based testing on uptake of RNA testing and treatment, and turnaround times: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2023; 8:253-270. [PMID: 36706775 DOI: 10.1016/s2468-1253(22)00346-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 10/06/2022] [Accepted: 10/12/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Point-of-care (POC) hepatitis C virus (HCV) RNA nucleic acid test viral load assays are being used increasingly as an alternative to centralised, laboratory-based standard-of-care (SOC) viral load assays to reduce loss to follow-up. We aimed to evaluate the impact of using POC compared with SOC approaches on uptake of HCV RNA viral load testing and treatment, and turnaround times from testing to treatment along the HCV care cascade. METHODS We searched PubMed, Embase, and Web of Science for studies published in English between Jan 1, 2016, and April 13, 2022. We additionally searched for accepted conference abstracts (2016-20) not identified in the main search. The contacts directory of the WHO Global Hepatitis Programme was also used to solicit additional studies on use of POC RNA assays. We included studies if they evaluated use of POC HCV RNA viral load with or without a comparator laboratory-based SOC assay, and had data on uptake of viral load testing and treatment, and turnaround times between these steps in cascade. We excluded studies with a sample size of ten or fewer participants. The POC studies were categorised according to whether the POC assay was based onsite at the clinic, in a mobile unit, or in a laboratory. Studies using the POC assay or comparator SOC assays were further stratified according to four models of care: whether HCV testing and treatment initiation were performed in the same or different site, and on the same or a different visit. The comparator was centralised, laboratory-based HCV RNA SOC assays. For turnaround times, we calculated the weighted median of medians with 95% CIs. We analysed viral load testing and treatment uptake using random-effects meta-analysis. The quality of evidence was rated using the GRADE framework. This study is registered with PROSPERO, CRD42020218239. FINDINGS We included 45 studies with 64 within-study arms: 28 studies were in people who inject drugs, were homeless, or both; four were in people incarcerated in prison; nine were in the general or mixed (ie, includes high-risk groups) populations; and four were in people living with HIV. All were observational studies. The pooled median turnaround times between HCV antibody test and treatment initiation was shorter with onsite POC assays (19 days [95% CI 14-53], ten arms) than with either laboratory-based POC assays (64 days [64-64], one arm) or laboratory-based SOC assays (67 days [50-67], two arms). Treatment uptake was higher with onsite POC assays (77% [95% CI 72-83], 34 arms) or mobile POC assays (81% [60-97], five arms) than with SOC assays (53% [31-75], 12 arms); onsite and mobile POC assay vs SOC assay p=0·029). For POC and SOC arms, higher RNA viral load testing uptake was seen with the same-site models for testing and treatment than with different-site models (all within-category p≤0·0001). For onsite and mobile POC arms, there was higher treatment uptake for same-site than different-site models (within-category p<0·0001). Four studies had direct within-study POC versus SOC comparisons for RNA viral load testing uptake (pooled relative risk 1·11 [95% CI 0·89-1·38]), and there were ten studies on treatment uptake (1·32 [1·06-1·64]). Overall, the quality of evidence was rated as low. INTERPRETATION Compared with use of laboratory-based SOC HCV viral load testing, the use of POC assays was associated with reduced time from antibody test to treatment initiation and increased treatment uptake. The effect of POC viral load testing is greatest when positioned within a simplified care model in which testing and treatment are provided at the same site, and, where possible, on the same day. POC HCV RNA viral load testing is now recommended in WHO guidelines as an alternative strategy to laboratory-based viral load testing. FUNDING Unitaid.
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Affiliation(s)
- Adam Trickey
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Emmanuel Fajardo
- Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Daniel Alemu
- Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | | | - Philippa Easterbrook
- Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland.
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13
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Microneedles as a momentous platform for psoriasis therapy and diagnosis: A state-of-the-art review. Int J Pharm 2023; 632:122591. [PMID: 36626973 DOI: 10.1016/j.ijpharm.2023.122591] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 12/20/2022] [Accepted: 01/04/2023] [Indexed: 01/09/2023]
Abstract
Psoriasis is a chronic, autoimmune, and non-communicable skin disease with a worldwide prevalence rate of 2-3%, creating an economic burden on global health. Some significant risk factors associated with psoriasis include genetic predisposition, pathogens, stress, medications, etc. In addition, most patients with psoriasis should also deal with comorbidities such as psoriatic arthritis, inflammatory bowel diseases, cardiovascular diseases, and psychological conditions, including suicidal thoughts. Based on its severity, the treatment approach for psoriasis is categorised into three types, i.e., topical therapy, systemic therapy, and phototherapy. Topical therapy for mild-to-moderate psoriasis faces several issues, such as poor skin permeability, low skin retention of drug formulation, greasy texture of topical vehicle, lack of controlled release, and so on. On the other arrow, systemic therapy via an oral or parenteral route of drug administration involves numerous drawbacks, including first-pass hepatic metabolism, hepatotoxicity, gastrointestinal disturbances, needle pain and phobia, and requirement of healthcare professional to administer the drug. To overcome these limitations, researchers devised a microneedle-based drug delivery system for treating mild-to-moderate and moderate-to-severe psoriasis. A single microneedle system can deliver the anti-psoriatic drugs either locally (topical) or systemically (transdermal) by adjusting the needle height without involving any pain. In this contemplate, the current review provides concise information on the pathophysiology, risk factors, and comorbidities of psoriasis, followed by their current treatment approaches and limitations. Further, it meticulously discusses the potential of microneedles in psoriasis therapy and diagnosis, along with descriptions of their patents and clinical trials.
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Crespo J, Cabezas J, Aguilera A, Berenguer M, Buti M, Forns X, García F, García-Samaniego J, Hernández-Guerra M, Jorquera F, Lazarus JV, Lens S, Martró E, Pineda JA, Prieto M, Rodríguez-Frías F, Rodríguez M, Serra MÁ, Turnes J, Domínguez-Hernández R, Casado MÁ, Calleja JL. Recommendations for the integral diagnosis of chronic viral hepatitis in a single analytical extraction. GASTROENTEROLOGIA Y HEPATOLOGIA 2023; 46:150-162. [PMID: 36257502 DOI: 10.1016/j.gastrohep.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/08/2022] [Accepted: 09/28/2022] [Indexed: 11/11/2022]
Abstract
The Spanish Society of Digestive Pathology (SEPD), the Spanish Association for the Study of the Liver (AEEH), the Spanish Society of Infections and Clinical Microbiology (SEIMC) and its Viral Hepatitis Study Group (GEHEP), and with the endorsement of the Alliance for the Elimination of Viral Hepatitis in Spain (AEHVE), have agreed on a document to carry out a comprehensive diagnosis of viral hepatitis (B, C and D), from a single blood sample; that is, a comprehensive diagnosis, in the hospital and/or at the point of care of the patient. We propose an algorithm, so that the positive result in a viral hepatitis serology (B, C and D), as well as human immunodeficiency virus (HIV), would trigger the analysis of the rest of the virus, including the viral load when necessary, in the same blood draw. In addition, we make two additional recommendations. First, the need to rule out a previous hepatitis A virus (VHA) infection, to proceed with its vaccination in cases where IgG-type studies against this virus are negative and the vaccine is indicated. Second, the determination of the HIV serology. Finally, in case of a positive result for any of the viruses analyzed, there must be an automated alerts and initiate epidemiological monitoring.
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Affiliation(s)
- Javier Crespo
- Servicio de Gastroenterología y Hepatología, Grupo de Investigación Clínica y Traslacional en Enfermedades Digestivas, Instituto de Investigación Valdecilla (IDIVAL), Hospital Universitario Marqués de Valdecilla, Santander, España.
| | - Joaquín Cabezas
- Servicio de Gastroenterología y Hepatología, Grupo de Investigación Clínica y Traslacional en Enfermedades Digestivas, Instituto de Investigación Valdecilla (IDIVAL), Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Antonio Aguilera
- Servicio de Microbiología, Hospital Clínico Universitario de Santiago de Compostela, Departamento de Microbioloxía y Parasitoloxía, Universidade de Santiago de Compostela, A Coruña, España
| | - Marina Berenguer
- Unidad de Hepatología y Trasplante Hepático y CIBEREHD, Hospital Universitario y Politécnico La Fe; IIS La Fe y Universidad de Valencia, Valencia, España
| | - María Buti
- Servicio de Hepatología, Hospital Universitario Valle Hebrón y CIBEREHD del Instituto Carlos III, Barcelona, España
| | - Xavier Forns
- Servicio de Hepatología, Hospital Clínic, Universidad de Barcelona, IDIBAPS, CIBEREHD, Barcelona, España
| | - Federico García
- Servicio de Microbiología, Hospital Universitario Clínico San Cecilio, Instituto de Investigación IBS, Ciber de Enfermedades Infecciosas (CIBERINFEC), Granada, España
| | | | - Manuel Hernández-Guerra
- Servicio de Aparato Digestivo, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife, España
| | - Francisco Jorquera
- Servicio de Aparato Digestivo, Complejo Asistencial Universitario de León, IBIOMED y CIBEREHD, León, España
| | - Jeffrey V Lazarus
- Instituto de Salud Global de Barcelona (ISGlobal), Hospital Clínic, Universidad de Barcelona, Barcelona, España
| | - Sabela Lens
- Servicio de Hepatología, Hospital Clínic de Barcelona, IDIBAPS, CIBEREHD, Universidad de Barcelona, Barcelona, España
| | - Elisa Martró
- Servicio de Microbiología, Laboratori Clínic Metropolitana Nord (LCMN), Hospital Universitario Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol (IGTP), Badalona (Barcelona), España, Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, España
| | - Juan Antonio Pineda
- Departamento de Medicina, Universidad de Sevilla, Hospital Universitario de Valme, Ciber de Enfermedades Infecciosas (CIBERINFEC), Sevilla, España
| | - Martín Prieto
- Unidad de Hepatología y Trasplante Hepático, Hospital Universitario y Politécnico La Fe, Valencia, CIBEREHD, Instituto de Salud Carlos III, Madrid, España
| | - Francisco Rodríguez-Frías
- Servicios de Microbiología y Bioquímica, Laboratorios Clínicos Hospital Universitario Vall d'Hebron, CIBEREHD, Instituto de investigación Vall d'Hebron (VHIR), Barcelona, España
| | - Manuel Rodríguez
- Sección de Hepatología, Servicio de Digestivo, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Universidad de Oviedo, Oviedo, España
| | - Miguel Ángel Serra
- Catedrático Jubilado de Medicina, Universidad de Valencia, Valencia, España
| | - Juan Turnes
- Servicio de Digestivo, Hospital Universitario de Pontevedra, Pontevedra, España
| | | | | | - José Luis Calleja
- Servicio de Gastroenterología y Hepatología, Hospital Universitario Puerta de Hierro, Instituto de Investigación Puerta de Hierro Majadahonda (IDIPHIM), Universidad Autónoma de Madrid, Madrid, España
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15
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Nicolás Pérez D, Morales Arráez DE, Castilla Rodríguez I, Gutiérrez Nicolás F, Díaz-Flores Estévez F, de Vera González A, Nazco Casariego GJ, Hernández Guerra M. Hepatitis C virus infection screening reduces mortality and is cost-effective independently of the intervention test. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS : ORGANO OFICIAL DE LA SOCIEDAD ESPANOLA DE PATOLOGIA DIGESTIVA 2022; 114:731-737. [PMID: 35285662 DOI: 10.17235/reed.2022.8609/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Chronic infection due to hepatitis C virus (HCV) is frequently asymptomatic even in advanced stages of liver disease. Implementation of a screening program based on different HCV tests may enable an earlier diagnosis of HCV liver disease and subsequent application of highly effective treatment. PATIENTS AND METHODS A Markov model which compares three different screening strategies for hepatitis C versus no screening in low-risk prevalence (general population) and high-risk prevalence population (people who inject drugs or prison population) was designed, taking into account age at the start of screening and participation. The three strategies were: 1) serological detection of antibodies against the HCV, 2) dried blood spot test (DBS) to detect antibodies against HCV and 3) detection of RNA from HCV. Quality-adjusted life-years (QALY) were taken as a measurement of effectiveness. The incremental cost-effectiveness ratio (ICER) was calculated and a deterministic and probabilistic sensitivity analysis was performed. RESULTS All three screening strategies were found to be cost-effective with an ICER of €13,633, €12,015 and €12,328/QALY for AntiHCV, DBS-AntiHCV and DBS-RNA HCV, respectively. There was a decrease in mortality due to liver disease in comparison to no screening for AntiHCV (40.7% and 52%), DBS-AntiHCV (45% and 80%) and DBS-RNA HCV (45.2% and 80%) for low-prevalence and high-prevalence populations, respectively. CONCLUSION All test interventions for HCV screening are cost-effective for the early detection of HCV infection, also achieving a reduction in mortality. Thus, implementation of screening programs for HCV should not be halted by decisions on monetary policy.
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Awareness of HCV Status and Preferences for Testing and Treatment among People with Recent Injecting Drug Use at a Peer-Led Needle and Syringe Program: The TEMPO Pilot Study. Viruses 2022; 14:v14112463. [PMID: 36366561 PMCID: PMC9696805 DOI: 10.3390/v14112463] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/26/2022] [Accepted: 11/02/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND New technologies and therapies allow the possibility of a single-visit test and treat model for hepatitis C virus (HCV), addressing some of the barriers to care faced by people who inject drugs. METHODS The TEMPO Pilot Study was an interventional cohort study evaluating a single-visit test and treat intervention among people with recent injecting drug use at a one peer-led needle and syringe program (NSP) in Sydney, Australia between September 2019 and February 2021. This analysis evaluated awareness of HCV status and agreement of self-report with HCV RNA test results. The analysis also assessed acceptability of: modality of result delivery, modality of blood sampling, site of treatment, and duration of treatment. RESULTS Among 101 participants (median age 43; 31% female), 100 had a valid HCV RNA test result and 27% (27/100) were HCV RNA detectable. Overall, 65% (65/100) were aware of their status. Among people with a positive HCV RNA result, 48% (13/27) were aware of their status. People preferred same-day HCV test results (95%, 96/101), and preferred to receive results in person (69%, 70/101). Receiving treatment at an NSP was acceptable (100%, 101/101) and 78% (79/101) were willing to discuss their health with a peer NSP worker. CONCLUSION Half of people with current HCV infection were aware of their status. The high acceptability of simplified testing and treatment pathways delivered at NSPs indicates that this is an appropriate strategy to improve HCV awareness and treatment uptake in this population.
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17
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Brener L, Horwitz R, Rance J, Caruana T, Bryant J. Health worker perceptions of the impact of COVID-19 on harm reduction services for people who inject drugs. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:2320-2329. [PMID: 35293054 PMCID: PMC9111390 DOI: 10.1111/hsc.13782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/19/2021] [Accepted: 03/02/2022] [Indexed: 06/14/2023]
Abstract
The COVID-19 pandemic has affected entire systems of health service provision globally, including health service closure, redeployment of staff and resources and implementation of infection prevention protocols. Harm reduction facilities face particular challenges responding to COVID-19, attempting to continue service provision to people who inject drugs with minimal service disruption whilst protecting their staff. This research assessed the impact of COVID-19 on staff working at harm reduction and alcohol and other drug (AOD) services in Australia in the first 9 months of the pandemic. The research employed mixed methods, using survey data to inform in-depth interviews. Surveys were completed by 207 participants working in the AOD sector and the harm reduction sector nationally. Interviews were conducted with 16 staff at three harm reduction sites in metropolitan Sydney and one regional NSW service. Staff felt able to respond to the trying circumstances of this pandemic, especially as practical messages around the COVID-19 response were similar to those already in place for clients in relation to blood-borne virus prevention. Staff felt that they were still able to provide core services to clients with some modifications in delivery. They were willing to take on additional responsibilities to ensure their own safety and that of clients, including conducting temperature checks and screening questions, whilst also adopting novel service provision strategies to reach clients during lockdowns such as postal services, outreach work and telehealth. NSP and AOD services were able to implement COVID-19 infection control strategies, whilst maintaining and expanding service access through remote and innovative strategies in a manner which supported both clients and service providers, during the first wave of the pandemic in 2020.
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Affiliation(s)
- Loren Brener
- Centre for Social Research in HealthUniversity of New South WalesSydneyAustralia
| | - Robyn Horwitz
- Centre for Social Research in HealthUniversity of New South WalesSydneyAustralia
| | - Jake Rance
- Centre for Social Research in HealthUniversity of New South WalesSydneyAustralia
| | - Theresa Caruana
- Centre for Social Research in HealthUniversity of New South WalesSydneyAustralia
| | - Joanne Bryant
- Centre for Social Research in HealthUniversity of New South WalesSydneyAustralia
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18
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Raja SS, Edwards S, Stewart J, Huynh D. Missed opportunities for hepatitis C treatment at a tertiary care hospital in South Australia. World J Hepatol 2022; 14:1576-1583. [PMID: 36157868 PMCID: PMC9453456 DOI: 10.4254/wjh.v14.i8.1576] [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: 08/01/2021] [Revised: 11/01/2021] [Accepted: 07/11/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatitis C is a global epidemic and an estimated 230 000 Australians were living with chronic hepatitis C in 2016. Through effective public health policy and state commitment, Australia has utilised the advent of direct acting antiviral (DAA) therapy to transform the therapeutic landscape for hepatitis C virus (HCV). However, treatment rates are falling and novel public health approaches are required to maintain momentum for HCV elimination. Contemporary discourse in cascades of care have focused on expanding testing capabilities but less attention has been given to linking previously diagnosed patients back to care. Our simple and focused study rests on the premise that hospital admissions are an excellent opportunity to identify and refer previously diagnosed patients for HCV treatment.
AIM To assess whether inpatients with HCV are appropriately referred on for treatment.
METHODS We conducted a retrospective single centre cohort study that examined all patients with HCV presenting to The Queen Elizabeth Hospital (QEH) inpatient service between January 1 and December 31, 2017. QEH is a tertiary care hospital in South Australia. The main inclusion criteria were patients with active HCV infection who were eligible for DAA therapy. Our study cohort was identified using a comprehensive list of diagnosis based on international classification of diseases-10 AM codes for chronic viral hepatitis. Patients were excluded from the analysis if they had previously received DAA therapy or spontaneously cleared HCV. Patients presenting with decompensated liver cirrhosis or other systemic medical conditions conferring poor short-term prognosis were also excluded from the analysis. The primary outcome of our study was referral of patients for HCV treatment. Secondary outcomes included assessment of factors predicting treatment referral.
RESULTS There were 309 inpatients identified with hepatitis C as a principal or additional diagnosis between January 1 and December 31, 2017. Of these patients, 148 had active HCV infection without prior treatment or spontaneous clearance. Overall, 131 patients were deemed eligible for DAA treatment and included in the main analysis. Mean patient age was 47.75 ± 1.08 years, and 69% of the cohort were male and 13% identified as Aboriginal or Torres Strait Islander. Liver cirrhosis was a complication of hepatitis C in 7% of the study cohort. Only 10 patients were newly diagnosed with HCV infection during the study period with the remainder having been diagnosed prior to the study.
CONCLUSION Under 25% of hepatitis C patients presenting to an Australian tertiary hospital were appropriately referred for treatment. Advanced age, cirrhosis and admission under medical specialties were predictors of treatment referral.
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Affiliation(s)
- Sreecanth Sibhi Raja
- Department of Gastroenterology, The Queen Elizabeth Hospital, Woodville 5011, South Australia, Australia
| | - Suzanne Edwards
- Department of Statistician, School of Public Health, University of Adelaide, Adelaide 5000, South Australia, Australia
| | - Jeffrey Stewart
- Department of Gastroenterology, The Queen Elizabeth Hospital, Woodville 5011, South Australia, Australia
| | - Dep Huynh
- Department of Gastroenterology, The Queen Elizabeth Hospital, Woodville 5011, South Australia, Australia
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19
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Howell J, Traeger MW, Williams B, Layton C, Doyle JS, Latham N, Draper B, Bramwell F, Membrey D, McPherson M, Roney J, Stoové M, Thompson AJ, Hellard ME, Pedrana A. The impact of point-of-care hepatitis C testing in needle and syringe exchange programs on linkage to care and treatment uptake among people who inject drugs: An Australian pilot study. J Viral Hepat 2022; 29:375-384. [PMID: 35274403 DOI: 10.1111/jvh.13664] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/20/2022] [Indexed: 12/13/2022]
Abstract
Point-of-care (POC) diagnostics overcome barriers to conventional hepatitis C (HCV) testing in people who inject drugs. This study assessed impact on hepatitis C treatment uptake of POC HCV testing in needle and syringe exchange programs (NSPs). Rapid EC was a single-arm interventional pilot study of HCV POC testing conducted in three inner-city community clinics with NSPs. Twelve months after the POC testing, a retrospective medical record and Pharmaceutical Benefits Scheme audit was performed to determine the number of HCV RNA-positive participants who were prescribed HCV treatment. 70 HCV RNA-positive Rapid EC study participants were included. 44 (63%) were prescribed DAAs; 26 (59%) completed treatment and 15 (34%) had SVR testing, all of whom were cured. Age ≥ 40 years (aOR 3.45, 95% CI 1.10-11.05, p = .03) and secondary school education (aOR 5.8, 95% CI 1.54-21.80, p = .009) had higher likelihood of being prescribed DAAs, whereas homelessness was inversely associated with prescription of DAAs (aOR 0.30, 95% CI 0.09-1.04, p = .057). Median time to receive a DAA script from date of diagnosis was seven days (IQR 0 to 14 days), and time to filling the DAA prescription was 2 days (IQR 0-12 days). In conclusion, provision of POC testing through NSPs was effective for linking new clients to HCV treatment and reduced the time to treatment. Further studies are needed to define the most cost-effective use of POC testing in models of care for people who inject drugs to increase HCV treatment uptake.
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Affiliation(s)
- Jessica Howell
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Michael W Traeger
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Bridget Williams
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Chloe Layton
- Cohealth, General Practice, Melbourne, Victoria, Australia
| | - Joseph S Doyle
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia.,Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Victoria, Australia
| | - Ned Latham
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia.,Department of Infectious Diseases, Monash University, Melbourne, Victoria, Australia
| | - Bridget Draper
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | | | - Dean Membrey
- Cohealth, General Practice, Melbourne, Victoria, Australia
| | - Maggie McPherson
- North Richmond Community Health, General Practice, Melbourne, Victoria, Australia
| | - Janine Roney
- Department of Infectious Diseases, The Alfred, Melbourne, Victoria, Australia
| | - Mark Stoové
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Alexander J Thompson
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Margaret E Hellard
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Cohealth, General Practice, Melbourne, Victoria, Australia.,Department of Infectious Diseases, The Alfred, Melbourne, Victoria, Australia.,Doherty Institute and School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Alisa Pedrana
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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20
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Harney BL, Whitton B, Paige E, Brereton R, Weiss R, Membrey D, Wade AJ, Iser D, Kemp W, Roberts SK, Spelman T, Sacks-Davis R, Hellard ME, Doyle JS. A multi-site, nurse-coordinated hepatitis C model of care in primary care and community services in Melbourne, Australia. Liver Int 2022; 42:522-531. [PMID: 34821021 DOI: 10.1111/liv.15107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/10/2021] [Accepted: 11/18/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Hepatitis C virus (HCV) treatment through primary care and community-based services will be a critical component of HCV elimination. We evaluated a nurse-coordinated programme providing care across eight sites and analysed progression through the HCV care cascade. METHODS People-accessing services from six primary care clinics, a homeless crisis accommodation provider and a mental health service were directly referred to nurses or engaged by nurses during regular clinic visits. Nurses supported HCV testing, treatment and follow-up. The prescription was provided by affiliated clinicians. Logistic regression was used to examine factors associated with treatment commencement and sustained virological response (SVR) testing. RESULTS Of 640 people referred to and/or engaged by the nurses from January 2017 to July 2019, 518 had an HCV RNA test of whom 381 (74%) were HCV RNA positive. Treatment was commenced by 281 (74%) people of whom 161 had an SVR test, 157 (97.5%) were cured. Opioid agonist therapy was associated with treatment commencement (aOR 2.68, 95% CI 1.48-4.88). People who were homeless/unstably housed were less likely to commence treatment (aOR 0.45, 95% CI 0.23-0.87). Treatment prescription from a specialist (aOR 2.39, 95% CI 1.20-4.74) and recent injection drug use (<6 months) (aOR 2.15, 95% CI 1.07-4.31) was associated with SVR testing. CONCLUSION A nurse-coordinated model of care led to high levels of HCV treatment uptake and cure amongst people attending primary care and community services. More tailored models of care may be beneficial for people who are homeless or have unstable housing. These results support primary care and community-based hepatitis C treatment.
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Affiliation(s)
- Brendan L Harney
- Department of Infectious Diseases, Alfred Health & Monash University, Melbourne, Australia.,Disease Elimination Program, Burnet Institute, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Bradley Whitton
- Department of Infectious Diseases, Alfred Health & Monash University, Melbourne, Australia
| | - Emma Paige
- Department of Infectious Diseases, Alfred Health & Monash University, Melbourne, Australia
| | - Rebecca Brereton
- St Kilda Road Clinic & South City Clinic, Alfred Community Mental & Addiction Health, Melbourne, Australia
| | | | | | - Amanda J Wade
- Disease Elimination Program, Burnet Institute, Melbourne, Australia.,Department of Infectious Diseases, Barwon Health, Geelong, Australia
| | - David Iser
- Department of Infectious Diseases, Alfred Health & Monash University, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
| | - William Kemp
- Department of Gastroenterology, Alfred Health, Melbourne, Australia.,Department of Medicine, Monash University, Melbourne, Australia
| | - Stuart K Roberts
- Department of Gastroenterology, Alfred Health, Melbourne, Australia.,Department of Medicine, Monash University, Melbourne, Australia
| | - Tim Spelman
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
| | - Rachel Sacks-Davis
- Disease Elimination Program, Burnet Institute, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Margaret E Hellard
- Department of Infectious Diseases, Alfred Health & Monash University, Melbourne, Australia.,Disease Elimination Program, Burnet Institute, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Doherty Institute and School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Joseph S Doyle
- Department of Infectious Diseases, Alfred Health & Monash University, Melbourne, Australia.,Disease Elimination Program, Burnet Institute, Melbourne, Australia
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21
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Yee J, Carson JM, Hajarizadeh B, Hanson J, O'Beirne J, Iser D, Read P, Balcomb A, Doyle JS, Davies J, Martinello M, Marks P, Dore GJ, Matthews GV. High Effectiveness of Broad Access Direct-Acting Antiviral Therapy for Hepatitis C in an Australian Real-World Cohort: The REACH-C Study. Hepatol Commun 2022; 6:496-512. [PMID: 34729957 PMCID: PMC8870316 DOI: 10.1002/hep4.1826] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/29/2021] [Accepted: 08/24/2021] [Indexed: 12/15/2022] Open
Abstract
Australia was one of the first countries with unrestricted access to government subsidized direct-acting antiviral (DAA) therapy for adults with chronic hepatitis C virus. This study assessed real-world DAA treatment outcomes across a diverse range of Australian clinical services and evaluated factors associated with successful treatment and loss to follow-up. Real-world Effectiveness of Antiviral therapy in Chronic Hepatitis C (REACH-C) consisted a national observational cohort of 96 clinical services including specialist clinics and less traditional settings such as general practice. Data were obtained on consecutive individuals who commenced DAAs from March 2016 to June 2019. Effectiveness was assessed by sustained virological response ≥12 weeks following treatment (SVR) using intention-to-treat (ITT) and per-protocol (PP) analyses. Within REACH-C, 10,843 individuals initiated DAAs (male 69%; ≥50 years 52%; cirrhosis 22%). SVR data were available in 85% (9,174 of 10,843). SVR was 81% (8,750 of 10,843) by ITT and 95% (8,750 of 9,174) by PP. High SVR (≥92%) was observed across all service types and participant characteristics. Male gender (adjusted odds ratio [aOR] 0.56, 95% confidence interval [CI] 0.43-0.72), cirrhosis (aOR 0.52, 95% CI 0.41-0.64), recent injecting drug use (IDU; aOR 0.64, 95% CI 0.46-0.91) and previous DAA treatment (aOR 0.50, 95% CI 0.28-0.90) decreased the likelihood of achieving SVR. Multiple factors modified the likelihood of loss to follow-up including IDU ± opioid agonist therapy (OAT; IDU only: aOR 1.75, 95% CI 1.44-2.11; IDU + OAT: aOR 1.39, 95% CI 1.11-1.74; OAT only, aOR 1.36; 95% CI 1.13-1.68) and age (aOR 0.97, 95% CI 0.97-0.98). Conclusion: Treatment response was high in a diverse population and through a broad range of services following universal access to DAA therapy. Loss to follow-up presents a real-world challenge. Younger people who inject drugs were more likely to disengage from care, requiring innovative strategies to retain them in follow-up.
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Affiliation(s)
- Jasmine Yee
- The Kirby InstituteUNSW AustraliaSydneyNSWAustralia
| | | | | | - Joshua Hanson
- The Kirby InstituteUNSW AustraliaSydneyNSWAustralia.,Cairns HospitalCairnsQLDAustralia
| | - James O'Beirne
- Sunshine Coast University HospitalSunshine CoastQLDAustralia
| | - David Iser
- Scope GastroenterologyMelbourneVICAustralia
| | | | | | - Joseph S Doyle
- Burnet InstituteMelbourneVICAustralia.,The Alfred and Monash UniversityDepartment of Infectious DiseasesMelbourneVICAustralia
| | - Jane Davies
- Royal Darwin HospitalDarwinAustralia.,Menzies School of Health ResearchDarwinAustralia
| | - Marianne Martinello
- The Kirby InstituteUNSW AustraliaSydneyNSWAustralia.,Blacktown Mount Druitt HospitalBlacktownNSWAustralia.,St Vincent's HospitalSydneyNSWAustralia
| | | | - Gregory J Dore
- The Kirby InstituteUNSW AustraliaSydneyNSWAustralia.,St Vincent's HospitalSydneyNSWAustralia
| | - Gail V Matthews
- The Kirby InstituteUNSW AustraliaSydneyNSWAustralia.,St Vincent's HospitalSydneyNSWAustralia
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Draper BL, Htay H, Pedrana A, Yee WL, Howell J, Pyone Kyi K, Naing W, Sanda Aung K, Markby J, Easterbrook P, Bowring A, Aung W, Sein YY, Nwe N, Myint KT, Shilton S, Hellard M. Outcomes of the CT2 study: A 'one-stop-shop' for community-based hepatitis C testing and treatment in Yangon, Myanmar. Liver Int 2021; 41:2578-2589. [PMID: 34153155 PMCID: PMC8596916 DOI: 10.1111/liv.14983] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/28/2021] [Accepted: 06/14/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND With the advent of low-cost generic direct-acting antivirals (DAA), hepatitis C (HCV) elimination is now achievable even in low-/middle-income settings. We assessed the feasibility and effectiveness of a simplified clinical pathway using point-of-care diagnostic testing and non-specialist-led care in a decentralized, community-based setting. METHODS This feasibility study was conducted at two sites in Yangon, Myanmar: one for people who inject drugs (PWID), and the other for people with liver disease. Participants underwent on-site rapid anti-HCV testing and HCV RNA testing using GeneXpert(R) . General practitioners determined whether participants started DAA therapy immediately or required specialist evaluation. Primary outcome measures were progression through the HCV care cascade, including uptake of RNA testing and treatment, and treatment outcomes. FINDINGS All 633 participants underwent anti-HCV testing; 606 (96%) were anti-HCV positive and had HCV RNA testing. Of 606 tested, 535 (88%) were RNA positive and had pre-treatment assessments; 30 (6%) completed specialist evaluation. Of 535 RNA positive participants, 489 (91%) were eligible to initiate DAAs, 477 (98%) completed DAA therapy and 421 achieved SVR12 (92%; 421/456). Outcomes were similar by site: PWID site: 91% [146/161], and liver disease site: 93% [275/295]). Compensated cirrhotic patients were treated in the community; they achieved an SVR12 of 83% (19/23). Median time from RNA test to DAA initiation was 3 days (IQR 2-5). CONCLUSIONS Delivering a simplified, non-specialist-led HCV treatment pathway in a decentralized community setting was feasible in Yangon, Myanmar; retention in care and treatment success rates were very high. This care model could be integral in scaling up HCV services in Myanmar and other low- and middle-income settings.
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Affiliation(s)
- Bridget Louise Draper
- Disease Elimination ProgramBurnet InstituteMelbourneAustralia,School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
| | | | - Alisa Pedrana
- Disease Elimination ProgramBurnet InstituteMelbourneAustralia,School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia,Health Services Research and ImplementationMonash PartnersMelbourneAustralia
| | | | - Jessica Howell
- Disease Elimination ProgramBurnet InstituteMelbourneAustralia,School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia,St Vincent’s Hospital MelbourneAustralia,Department of MedicineUniversity of MelbourneMelbourneAustralia
| | | | - Win Naing
- Myanmar Liver FoundationMyanmar,Yangon Specialty HospitalMyanmar
| | - Khin Sanda Aung
- National Hepatitis Control Program, Ministry of Health and SportsMyanmar
| | - Jessica Markby
- Foundation for Innovative New DiagnosticsGenevaSwitzerland
| | - Philippa Easterbrook
- Department of Global HIV, Hepatitis, and STI ProgrammesWorld Health OrganizationGenevaSwitzerland
| | - Anna Bowring
- Disease Elimination ProgramBurnet InstituteMelbourneAustralia
| | | | | | - Nwe Nwe
- Foundation for Innovative New DiagnosticsGenevaSwitzerland
| | | | | | - Margaret Hellard
- Disease Elimination ProgramBurnet InstituteMelbourneAustralia,School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia,Hepatitis Service, Department of Infectious DiseasesAlfred HospitalMelbourneAustralia,Doherty InstituteMelbourneAustralia,School of Population and Global HealthUniversity of MelbourneMelbourneAustralia
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23
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Lazarus JV, Herranz A, Picchio CA, Villota-Rivas M, Rodríguez A, Alonso JM, Moratinos A, Perrotta A, Tegeo E, Bibiloni F, Buti M, Vilella À. Eliminating hepatitis C on the Balearic Islands, Spain: a protocol for an intervention study to test and link people who use drugs to treatment and care. BMJ Open 2021; 11:e053394. [PMID: 34675021 PMCID: PMC8532552 DOI: 10.1136/bmjopen-2021-053394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION The hepatitis C virus (HCV) is a highly infectious and deadly disease, affecting some 58 million people worldwide. Of the 1.13 million people living in the Balearic Islands, Spain, about 1350 individuals have untreated HCV. Of these, about 1120 (83%) are estimated to be people who use drugs (PWUD), who are one of the key at-risk groups for HCV infection globally. Carrying out micro-elimination approaches focused on this population is crucial to achieve the WHO goal of eliminating HCV by 2030. Thus, the primary objective of this study is to validate a model of care that simplifies the screening and linkage to HCV care pathways for PWUD on the Balearic Islands. METHODS AND ANALYSIS This intervention study will be implemented across 17 sites, in 4 different settings: addiction service centres (n=12), non-governmental organisation centres (n=3), a mobile methadone unit and a prison, with an estimated 3725 participants. Together with the healthcare staff at each centre, the intervention protocols will be adapted, focusing on four phases: recruitment and testing; linkage to care; treatment for those who test positive; and monitoring of sustained virological response 12 weeks after treatment and reinfection. The primary outcomes will be the number of tested and treated individuals and the secondary outcomes will include individuals lost at each step in the cascade of care. Descriptive analysis and multivariable logistic regression of the data will be undertaken. ETHICS AND DISSEMINATION The Hospital Clínic Barcelona, Spain, Ethics Committee approved this study on 18 February 2021 (HCB/2020/2018). Findings will be disseminated through peer-reviewed publications, conference presentations and social media. The results of this study could provide a model for targeting PWUD for HCV testing and treatment in the rest of Spain and in other settings, helping to achieve the WHO HCV elimination goal.
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Affiliation(s)
- Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Andrea Herranz
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Camila A Picchio
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Marcela Villota-Rivas
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Antonia Rodríguez
- Servicio médico, Centro Penitenciario de Mallorca, Palma de Mallorca, Spain
| | | | - Albert Moratinos
- Unitat de Conductes Addictives, Institut d'Afers Socials Mallorquí (IMAS), Palma de Mallorca, Spain
| | | | - Elisabet Tegeo
- Sector mèdic, Projecte Home Balears, Illes Balears, Spain
| | - Francisca Bibiloni
- Pla d'addiccions i drogodependències de les Illes Balears (PADIB), Conselleria de Salut i Consum, Govern de les Illes Balears, Spain
| | - Maria Buti
- Liver Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- CIBER-EHD, Instituto de Salud Carlos III, Madrid, Spain
| | - Àngels Vilella
- Department of Gastroenterology, Hospital Universitari Son Llàtzer, Palma de Mallorca, Spain
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Seaman A, King CA, Kaser T, Geduldig A, Ronan W, Cook R, Chan B, Levander XA, Priest KC, Korthuis PT. A hepatitis C elimination model in healthcare for the homeless organization: A novel reflexive laboratory algorithm and equity assessment. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 96:103359. [PMID: 34325969 PMCID: PMC8720290 DOI: 10.1016/j.drugpo.2021.103359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 06/16/2021] [Accepted: 06/18/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Reaching World Health Organization hepatitis C (HCV) elimination targets requires diagnosis and treatment of people who use drugs (PWUD) with direct acting antivirals (DAAs). PWUD experience challenges engaging in HCV treatment, including needing multiple provider and laboratory appointments. Women, minoritized racial communities, and homeless individuals are less likely to complete treatment. METHODS We implemented a streamlined opt-out HCV screening and linkage-to-care program in two healthcare for the homeless clinics and a medically supported withdrawal center. Front-line staff initiated a single-order reflex laboratory bundle combining screening, confirmation, and pre-treatment laboratory evaluation from a single blood draw. Multinomial logistic regression models identified characteristics influencing movement through each stage of the HCV treatment cascade. Multiple logistic regression models identified patient characteristics associated with HCV care cascade progression and Cox proportional hazards models assessed time to initiation of DAAs. RESULTS Of 11,035 clients engaged in services between May 2017 and March 2020, 3,607 (32.7%) were screened. Of those screened, 1,020 (28.3%) were HCV PCR positive. Of those with detectable RNA, 712 (69.8%) initiated treatment and 670 (94.1%) completed treatment. Of those initiating treatment, 407 (57.2%) achieved SVR12. There were eight treatment failures and six reinfections. In the unadjusted model, the bundle intervention was associated with increased care cascade progression, and in the survival analysis, decreased time to initiation; these differences were attenuated in the adjusted model. Women were less likely to complete treatment and SVR12 labs than men. Homelessness increased likelihood of screening and diagnosis but was negatively associated with completing SVR12 labs. Presence of opioid and stimulant use disorder diagnoses predicted increased care cascade progression. CONCLUSIONS The laboratory bundle and referral pathways improved treatment initiation, time to initiation, and movement across the cascade. Despite overall population improvements, women and homeless individuals experienced important gaps across the HCV care cascade.
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Affiliation(s)
- A Seaman
- Department of Medicine, Section of Addiction Medicine, Oregon Health & Science University, Portland, Oregon, United States; Hepatitis C Elimination Program, Central City Concern, Portland, Oregon, United States.
| | - C A King
- Dept. of Biomedical Engineering, School of Medicine, Oregon Health & Science University, Portland, Oregon, United States
| | - T Kaser
- Hepatitis C Elimination Program, Central City Concern, Portland, Oregon, United States
| | - A Geduldig
- Hepatitis C Elimination Program, Central City Concern, Portland, Oregon, United States
| | - W Ronan
- Hepatitis C Elimination Program, Central City Concern, Portland, Oregon, United States
| | - R Cook
- Department of Medicine, Section of Addiction Medicine, Oregon Health & Science University, Portland, Oregon, United States
| | - B Chan
- Department of Medicine, Section of Addiction Medicine, Oregon Health & Science University, Portland, Oregon, United States; Hepatitis C Elimination Program, Central City Concern, Portland, Oregon, United States
| | - X A Levander
- Department of Medicine, Section of Addiction Medicine, Oregon Health & Science University, Portland, Oregon, United States
| | - K C Priest
- School of Medicine, MD/PhD Program, Oregon Health & Science University, Portland, Oregon, United States
| | - P T Korthuis
- Department of Medicine, Section of Addiction Medicine, Oregon Health & Science University, Portland, Oregon, United States
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Ryan P, Valencia J, Cuevas G, Torres-Macho J, Troya J, Pueyo Á, José Muñoz-Gómez M, Muñoz-Rivas N, Vázquez-Morón S, Martinez I, Lazarus JV, Resino S. Detection of active hepatitis C in a single visit and linkage to care among marginalized people using a mobile unit in Madrid, Spain. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 96:103424. [PMID: 34429222 DOI: 10.1016/j.drugpo.2021.103424] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 07/22/2021] [Accepted: 08/11/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND The burden of hepatitis C virus (HCV) infection among marginalized people in Spain is high, despite the fact that HCV prevalence has decreased in recent years. We aimed to assess the effectiveness of a simplified point-of-care (PoC) model for screening for active HCV infection via a mobile unit and subsequent linkage to care with the assistance of navigators. METHODS We carried out a prospective study on 2001 participants from Madrid, Spain. A nurse and a navigator/educator screened for hepatitis C in a mobile unit, using the OraQuick HCV Rapid Antibody Test and Xpert HCV VL Fingerstick assay. Participants with active HCV were referred to the hospital the same day with a navigator for evaluation and treatment of HCV. RESULTS Overall, 1621 (81%) participants had not been exposed to HCV, 380 (18.9%) were positive for HCV antibodies, and 136 (6.8%) had active hepatitis C. Among the latter, 134 (98.5%) received the HCV screening results, 133 (97.8%) had an appointment at the hospital, 126 (92.8%) were seen by a physician once they were at the hospital, and 105 (77.2%) started HCV treatment. Being over 50 years old and a person who uses drugs, particularly people who inject drugs (PWID), was directly associated with active hepatitis C (p<0.05). PWID were the only patients with HCV reinfection (4.3% in people without recent injecting drug use and 5.9% in people with recent injecting drug use). Among PWID, no income and daily alcohol intake were also directly associated with active hepatitis C. People with recent injecting drug use showed the lowest rates of attendance at the hospital (91.8%) and starting HCV treatment (70.4%). CONCLUSION HCV screening using a two-step PoC-based strategy and its linkage to care was extremely efficient for identifying and treating marginalized people with active hepatitis C, thanks to the use of a mobile unit with personnel and technical equipment, an interdisciplinary team, and collaboration between institutions.
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Affiliation(s)
- Pablo Ryan
- University Hospital Infanta Leonor, Madrid, Spain; Complutense University of Madrid (UCM), Madrid, Spain; Gregorio Marañón Health Research Institute (IiSGM), Madrid, Spain
| | - Jorge Valencia
- University Hospital Infanta Leonor, Madrid, Spain; Harm Reduction Unit "SMASD", Madrid, Spain
| | | | - Juan Torres-Macho
- University Hospital Infanta Leonor, Madrid, Spain; Complutense University of Madrid (UCM), Madrid, Spain
| | - Jesús Troya
- University Hospital Infanta Leonor, Madrid, Spain
| | - Ángel Pueyo
- Foundation for Biomedical Research and Innovation of University Hospital Infanta Leonor and University Hospital Southeast, Madrid, Spain; Heath Science PhD Program. UCAM Universidad Católica San Antonio de Murcia. 30107 Guadalupe de Maciascoque, Murcia, Spain
| | - María José Muñoz-Gómez
- Viral Infection and Immunity Unit, National Centre for Microbiology, Health Institute Carlos III, Majadahonda, Madrid, Spain
| | | | - Sonia Vázquez-Morón
- Viral Infection and Immunity Unit, National Centre for Microbiology, Health Institute Carlos III, Majadahonda, Madrid, Spain
| | - Isidoro Martinez
- Viral Infection and Immunity Unit, National Centre for Microbiology, Health Institute Carlos III, Majadahonda, Madrid, Spain
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Salvador Resino
- Viral Infection and Immunity Unit, National Centre for Microbiology, Health Institute Carlos III, Majadahonda, Madrid, Spain.
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26
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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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Smookler D, Vanderhoff A, Biondi MJ, Valencia J, Ryan P, Karkada J, Hong R, Sattar I, Mandel E, Gjevori M, Casey J, Fletcher D, Shah H, Hansen BE, Capraru C, Janssen HLA, Lazarus JV, Feld JJ. Reducing Read Time of Point-of-Care Test Does Not Affect Detection of Hepatitis C Virus and Reduces Need for Reflex RNA. Clin Gastroenterol Hepatol 2021; 19:1451-1458.e4. [PMID: 32763480 DOI: 10.1016/j.cgh.2020.07.058] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/28/2020] [Accepted: 07/29/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Global elimination of hepatitis C virus (HCV) will require increases in diagnosis. Point of care (POC) tests that detect antibodies against HCV can be useful for testing large and difficult to reach populations. The most accurate POC test requires a 20 min read time to identify antibody-positive samples. We investigated whether viremic patients could be identified using a shorter read time, to increase efficiency and reduce the need for reflex tests (a follow-up test for HCV RNA on the same specimen to confirm viremia). METHODS Patients with past or current HCV infections provided samples at 2 clinics in Canada for evaluation by the OraQuick HCV Rapid antibody POC test. A community HCV-screening program in Madrid, Spain (real-world cohort) invited people to be tested for HCV with the same OraQuick test. Patients provided samples of whole blood, via finger prick. Fingerprick samples were tested immediately after collection. In the clinic cohort, photographs of the developing test were taken at 15 second intervals, and blinded readers recorded the time to positivity. In the real-world cohort, readers recorded the OraQuick result at 5 minutes, and each minute after, up to 10 minutes, and then again at 20 minutes; viremia was then evaluated using a POC HCV RNA test (GeneXpert HCV Viral Load Assay). Sera from viremic and non-viremic clinic patients were used to quantify antibody titers to investigate the relationship between the time of band appearance and antibody concentration. Fisher's exact test and exact logistic regression were used to determine factors associated with a positive result at 5 minutes. RESULTS Blood from all viremic patients produced a positive result in the antibody POC test by 5 min. Median time to a positive result for 171 viremic patients was 2.6 min (range, 1.8-4.6 min), vs 4.1 min (range, 2.3-14.4 min) for 108 patients with resolved infection (P < .001). The 5-min threshold identified all viremic cases among 176 HCV antibody-positive patients in the real-world cohort, confirmed by testing for HCV RNA. In the pooled cohorts, antibody positivity at 5 min identified viremic patients with 100% sensitivity (95% CI, 98.4%-100%); the negative predictive value was 100% (95% CI, 94.9%-100%). The positive predictive value at 5 min was 62.0% (95% CI, 56.7%-67.0%) and therefore insufficient alone to detect viremia; an HCV RNA test would still be necessary to confirm active infection. CONCLUSIONS The wait time for the OraQuick HCV Rapid antibody POC blood test can be reduced from 20 min to 5 min and continue to reliably identify patients with HCV infection. Shortening the test time could increase high-throughput screening, reduce loss to follow up, and reduce the need for reflex HCV RNA testing.
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Affiliation(s)
- David Smookler
- Viral Hepatitis Care Network (VIRCAN), Toronto, Ontario, Canada; Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Aaron Vanderhoff
- Viral Hepatitis Care Network (VIRCAN), Toronto, Ontario, Canada; Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Mia J Biondi
- Viral Hepatitis Care Network (VIRCAN), Toronto, Ontario, Canada; Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Jorge Valencia
- Harm Reduction Unit (SMASD), Subdireccion General de Adicciones, Madrid, Spain
| | - Pablo Ryan
- Internal Medicine/HIV Unit, Infanta Leonor Hospital, Madrid, Spain
| | - Joel Karkada
- Viral Hepatitis Care Network (VIRCAN), Toronto, Ontario, Canada; Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Rachel Hong
- Viral Hepatitis Care Network (VIRCAN), Toronto, Ontario, Canada; Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Izza Sattar
- Viral Hepatitis Care Network (VIRCAN), Toronto, Ontario, Canada; Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Erin Mandel
- Viral Hepatitis Care Network (VIRCAN), Toronto, Ontario, Canada; Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Martina Gjevori
- Viral Hepatitis Care Network (VIRCAN), Toronto, Ontario, Canada; Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Julia Casey
- Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | - Hemant Shah
- Viral Hepatitis Care Network (VIRCAN), Toronto, Ontario, Canada; Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Bettina E Hansen
- Viral Hepatitis Care Network (VIRCAN), Toronto, Ontario, Canada; Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Ontario, Canada; Institute of Health, Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Camelia Capraru
- Viral Hepatitis Care Network (VIRCAN), Toronto, Ontario, Canada; Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Harry L A Janssen
- Viral Hepatitis Care Network (VIRCAN), Toronto, Ontario, Canada; Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | - Jordan J Feld
- Viral Hepatitis Care Network (VIRCAN), Toronto, Ontario, Canada; Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Ontario, Canada.
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28
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A H, L M, Am J, M M, Gp A, S V. Community-Based Assessment and Treatment of Hepatitis C Virus-Related Liver Disease, Injecting Drug and Alcohol Use Amongst People Who Are Homeless: A Systematic Review and Meta-Analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 96:103342. [PMID: 34210551 DOI: 10.1016/j.drugpo.2021.103342] [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: 01/06/2021] [Revised: 05/19/2021] [Accepted: 06/02/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND/AIMS We performed a systematic review and meta-analysis addressing community-based assessment and treatment of hepatitis C virus (HCV)-related liver disease, injecting drug use (IDU) and alcohol use amongst people who are homeless (PWAH). METHODS Using systematic review methodology, databases were searched (MEDLINE/ EMBASE/CINAHL) for studies combining PWAH, HCV-related liver disease and community assessment until December 2019. Studies with a sample size ≥ 30, with PWAH constituting at least 30% of the cohort were included and a quality assessment performed. Pooled estimates of key indicators were analysed using meta-analysis. RESULTS We identified 39 studies (n = 13,918), 37 categorised as poor quality (Newcastle-Ottawa Scale). Prevalence of homelessness ranged between 30%-100% (37 studies). Eight studies provided all of the following: HCV screening, alcohol/substance use/liver fibrosis assessment and HCV treatment. No study provided interventions for alcohol use, with two providing opioid substitution treatment. Alcohol use prevalence (24 studies) was 4%-97%, being 59% (95% CI 20%-92%) in four studies that included only PWAH. Recent IDU prevalence (16 studies) was 7%-73%, being 21% (95% CI 17%-26%) in four studies that included only PWAH. HCV seroprevalence (25 studies) was 2.5% - 58%; in 13 studies that included only PWAH, this was 20% (95% CI 12%-30%). Prevalence of F4 fibrosis (nine studies) was 6%-28%, being 7% and 16% in two studies that included only PWAH. Direct acting antiviral-based intention-to-treat sustained virological response (SVR) rates (five studies) were 82%-92%, being 92% in the one study that included only PWAH. In the only two randomised controlled trials (RCT) identified, community-based interventions (mental health/peer mentor) significantly increased linkage to care (p = 0.04), HCV treatment (p = 0.005) and SVR rates (p = 0.018). CONCLUSION The burden from alcohol/IDU and HCV, and consequently liver disease in PWAH needs addressing. RCT trials assessing community-based interventions to improve liver health in PWAH are needed.
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Affiliation(s)
- Hashim A
- Department of Gastroenterology and Hepatology, University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom; Department of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Macken L
- Department of Gastroenterology and Hepatology, University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom; Department of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Jones Am
- Sussex Partnership Foundation Trust, Hove, United Kingdom
| | - McGeer M
- Department of Gastroenterology and Hepatology, University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom; Department of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Aithal Gp
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, United Kingdom; Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Verma S
- Department of Gastroenterology and Hepatology, University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom; Department of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, United Kingdom.
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29
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Valerio H, Alavi M, Law M, McManus H, Tillakeratne S, Bajis S, Martinello M, Matthews GV, Amin J, Janjua NZ, Krajden M, George J, Degenhardt L, Grebely J, Dore GJ. Opportunities to enhance linkage to hepatitis C care among hospitalised people with recent drug dependence in New South Wales, Australia: A population-based linkage study. Clin Infect Dis 2021; 73:2037-2044. [PMID: 34107022 DOI: 10.1093/cid/ciab526] [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: 02/23/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND People who inject drugs are at greater risk of hepatitis C virus (HCV) infection and hospitalisation, yet admissions are not utilised for HCV treatment initiation. We aimed to assess the extent to which people with HCV notification, including those with evidence of recent drug dependence, are hospitalised while eligible for direct-acting antiviral (DAA) therapy, and treatment uptake according to hospitalisation in the DAA era. METHODS We conducted a longitudinal, population-based cohort study of people living with HCV in the DAA era (March 2016-December 2018) through analysis of linked databases in New South Wales, Australia. Kaplan Meier estimates were used to report HCV treatment uptake by frequency, length, and cause-specific hospitalisation. RESULTS Among 57,467 people, 14,938 (26%) had evidence of recent drug dependence, 50% (n=7,506) of whom were hospitalised while DAA eligible. Incidence of selected cause-specific hospitalisation was highest for mental health-related (15.84 per 100 person-years [PY]), drug-related (15.20 per 100PY), and injection-related infectious disease (9.15 per 100PY) hospitalisations, and lowest for alcohol use disorder (4.58 per 100PY) and liver-related (3.13 per 100PY). 65% (n=4,898) of those hospitalised had been admitted >2 times and 46% (n=3,437) were hospitalised >7 days. By the end of 2018, DAA therapy was lowest for those hospitalised >2 times, for >7 days, and those whose first admission was for injection-related infectious disease, mental health disorders, and drug-related complications. CONCLUSIONS Among people who have evidence of recent drug dependence, frequent hospitalisation-particularly mental health, drug, and alcohol admissions-presents an opportunity for engagement in HCV care.
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Affiliation(s)
| | - Maryam Alavi
- The Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Matthew Law
- The Kirby Institute, UNSW Sydney, Sydney, Australia
| | | | | | - Sahar Bajis
- The Kirby Institute, UNSW Sydney, Sydney, Australia
| | | | | | - Janaki Amin
- The Kirby Institute, UNSW Sydney, Sydney, Australia.,Department of Health Systems and Populations, Maquarie University, Sydney, Australia
| | - Naveed Z Janjua
- British Columbia Centre for Disease Control, Vancouver, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Mel Krajden
- British Columbia Centre for Disease Control, Vancouver, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Jacob George
- Storr Liver Centre, Westmead Millennium Institute, University of Sydney and Westmead Hospital, Westmead, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
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30
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Ohata PJ, Su Lwin HM, Han WM, Khwairakpam G, Tangkijvanich P, Matthews GV, Avihingsanon A. Elimination of hepatitis C among HIV-positive population in Asia: old and new challenges. Future Virol 2021. [DOI: 10.2217/fvl-2021-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Hepatitis C virus (HCV) prevalence is high among people living with HIV co-infected with HCV, people who inject drugs, men who have sex with men and inmates in correctional settings. The barriers to eliminate HCV among these key populations include diagnosis challenges, lack of awareness, discrimination and stigmatization. In addition, scaling up of HCV treatment has been a challenge in Asia–Pacific with the lack of national policies, targets and unavailability of appropriate direct-acting antivirals regimens. In order to achieve HCV micro elimination within these high-risk populations, novel strategies to improve the cascade of care from diagnosis to treatment with direct-acting antivirals, complemented by behavioral change interventions, harm reduction services for people who inject drugs, civil society led advocacy and policies from the government, will be necessary.
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Affiliation(s)
- Pirapon June Ohata
- HIV-NAT, Thai Red Cross – AIDS Research Centre, 104 Ratchadamri Road, Pathumwan, Bangkok, 10330, Thailand
| | - Hay Mar Su Lwin
- HIV-NAT, Thai Red Cross – AIDS Research Centre, 104 Ratchadamri Road, Pathumwan, Bangkok, 10330, Thailand
| | - Win Min Han
- HIV-NAT, Thai Red Cross – AIDS Research Centre, 104 Ratchadamri Road, Pathumwan, Bangkok, 10330, Thailand
| | - Giten Khwairakpam
- TREAT Asia, Exchange Tower, 388 Sukhumvit Road, Suite 2104, Klongtoey, Bangkok, 10110, Thailand
| | - Pisit Tangkijvanich
- Center of Excellence in Hepatitis & Liver Cancer, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Gail V Matthews
- The Kirby Institute, University of New South Wales, NSW, Sydney, 2052, Australia
| | - Anchalee Avihingsanon
- HIV-NAT, Thai Red Cross – AIDS Research Centre, 104 Ratchadamri Road, Pathumwan, Bangkok, 10330, Thailand
- Tuberculosis Research Unit (TB RU), Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
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31
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Uusküla A, Talu A, Rannap J, Barnes DM, Jarlais DD. Rapid point-of-care (POC) testing for Hepatitis C antibodies in a very high prevalence setting: persons injecting drugs in Tallinn, Estonia. Harm Reduct J 2021; 18:39. [PMID: 33794927 PMCID: PMC8015736 DOI: 10.1186/s12954-021-00485-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 03/22/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Between December 2018 and January of 2019, we evaluated the accuracy of the point-of-care Hepatitis C (HCV) antibody test (POC; OraQuick HCV) used at a community-based needle and syringe exchange program serving persons who inject drugs in Tallinn, Estonia. METHODS We compared the results of screening for HCV antibodies by OraQuick (oral swab) and enzyme immunoassay (EIA; blood draw) and assessed test results implications in a high prevalence setting. Findings Of the 100 participants, 88 (88%) had reactive POC test results, and 93 were HCV antibody positive on EIA testing. Sensitivity, specificity and negative predictive value (NPV) for the POC assay with EIA as the relevant reference test were as follows: 94.6% (95% CI 90.0-99.2%), 100% and 58.3% (95% CI 30.4-86.2%). Of the 12 testing, HCV-negative with the POC only 7 (58.3%) were true negatives. CONCLUSIONS Oral swab rapid testing HCV screening in this nonclinical setting was sensitive and specific but had unacceptably low NPV. In high prevalence settings, POC tests with high sensitivity and that directly measure HCV RNA may be warranted.
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Affiliation(s)
- Anneli Uusküla
- Department of Family Medicine and Public Health, University of Tartu, Ravila 19, 50411, Tartu, Estonia.
| | - Ave Talu
- Department of Family Medicine and Public Health, University of Tartu, Ravila 19, 50411, Tartu, Estonia
| | - Jürgen Rannap
- Department of Family Medicine and Public Health, University of Tartu, Ravila 19, 50411, Tartu, Estonia
| | - David M Barnes
- School of Global Public Health, New York University, 665 Broadway, New York, NY, 10012, USA
| | - Don Des Jarlais
- School of Global Public Health, New York University, 665 Broadway, New York, NY, 10012, USA
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32
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Patel AA, Bui A, Prohl E, Bhattacharya D, Wang S, Branch AD, Perumalswami PV. Innovations in Hepatitis C Screening and Treatment. Hepatol Commun 2021; 5:371-386. [PMID: 33681673 PMCID: PMC7917266 DOI: 10.1002/hep4.1646] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/20/2020] [Accepted: 11/01/2020] [Indexed: 12/11/2022] Open
Abstract
New therapies offer hope for a cure to millions of persons living with hepatitis C virus (HCV) infection. HCV elimination is a global goal that will be difficult to achieve using the traditional paradigms of diagnosis and care. The current standard has evolved toward universal HCV screening and treatment, to achieve elimination goals. There are several steps between HCV diagnosis and cure with major barriers along the way. Innovative models of care can address barriers to better serve hardly reached populations and scale national efforts in the United States and abroad. Herein, we highlight innovative models of HCV care that aid in our progress toward HCV elimination.
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Affiliation(s)
- Arpan A. Patel
- Division of Digestive DiseasesDavid Geffen School of Medicine at UCLALos AngelesCAUSA
- Greater Los Angeles Veterans Affairs Medical CenterLos AngelesCAUSA
| | - Aileen Bui
- Division of General Internal MedicineDavid Geffen School of Medicine at UCLALos AngelesCAUSA
| | - Eian Prohl
- Division of General Internal MedicineDavid Geffen School of Medicine at UCLALos AngelesCAUSA
| | - Debika Bhattacharya
- Greater Los Angeles Veterans Affairs Medical CenterLos AngelesCAUSA
- Division of Infectious DiseasesDavid Geffen School of Medicine at UCLALos AngelesCAUSA
| | - Su Wang
- Saint Barnabas Medical CenterLivingstonNJUSA
- World Hepatitis AllianceLondonUnited Kingdom
| | - Andrea D. Branch
- Division of Liver DiseasesIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - Ponni V. Perumalswami
- Division of Liver DiseasesIcahn School of Medicine at Mount SinaiNew YorkNYUSA
- Division of Gastroenterology and HepatologyUniversity of MichiganAnn ArborMichiganUSA
- Veterans Affairs Ann Arbor Healthcare SystemAnn ArborMichiganUSA
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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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Xiao Y, Thompson AJ, Howell J. Point-of-Care Tests for Hepatitis B: An Overview. Cells 2020; 9:cells9102233. [PMID: 33023265 PMCID: PMC7650625 DOI: 10.3390/cells9102233] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 09/30/2020] [Accepted: 09/30/2020] [Indexed: 12/15/2022] Open
Abstract
Despite the heavy disease burden posed by hepatitis B, around 90% of people living with hepatitis B are not diagnosed globally. Many of the affected populations still have limited or no access to essential blood tests for hepatitis B. Compared to conventional blood tests which heavily rely on centralised laboratory facilities, point-of-care testing for hepatitis B has the potential to broaden testing access in low-resource settings and to engage hard-to-reach populations. Few hepatitis B point-of-care tests have been ratified for clinical use by international and regional regulatory bodies, and countries have been slow to adopt point-of-care testing into hepatitis B programs. This review presents currently available point-of-care tests for hepatitis B and their roles in the care cascade, reviewing evidence for testing performance, utility, acceptability, costs and cost-effectiveness when integrated into hepatitis B diagnosis and monitoring programs. We further discuss challenges and future directions in aspects of technology, implementation, and regulation when adopting point-of-care testing in hepatitis B programs.
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Affiliation(s)
- Yinzong Xiao
- Burnet Institute, 3004 Melbourne, VIC, Australia;
- Department of Gastroenterology, St Vincent’s Hospital, 3065 Fitzroy, VIC, Australia;
- Faculty of Medicine, University of Melbourne, 3010 Parkville, VIC, Australia
| | - Alexander J. Thompson
- Department of Gastroenterology, St Vincent’s Hospital, 3065 Fitzroy, VIC, Australia;
- Faculty of Medicine, University of Melbourne, 3010 Parkville, VIC, Australia
| | - Jessica Howell
- Burnet Institute, 3004 Melbourne, VIC, Australia;
- Department of Gastroenterology, St Vincent’s Hospital, 3065 Fitzroy, VIC, Australia;
- Faculty of Medicine, University of Melbourne, 3010 Parkville, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, 3004 Melbourne, VIC, Australia
- Correspondence:
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Kronfli N, Dussault C, Chalifoux S, Kavoukian H, Klein MB, Cox J. A randomized pilot study assessing the acceptability of rapid point-of-care hepatitis C virus (HCV) testing among male inmates in Montreal, Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 85:102921. [PMID: 32911319 DOI: 10.1016/j.drugpo.2020.102921] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/14/2020] [Accepted: 08/19/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The OraquickⓇ fingerprick point-of-care hepatitis C virus antibody (HCV-Ab) test is favoured to venipuncture among people who inject drugs; however, its acceptability in prison populations is unknown. We aimed to compare the acceptability of the OraquickⓇ versus standard venipuncture among people in prison. METHODS From October to December 2019, 280 sentenced male inmates at L'Établissement de Détention de Montréal (Quebec, Canada) were screened for participation, 150 excluded due to prior HCV screening, and 52 refused participation. The remaining 78 were randomized 1:1 to opt-out HCV-Ab screening with OraQuickⓇ or venipuncture (n = 39 each). Acceptability was determined by the proportion accepting to undergo screening. RESULTS The majority of participants (median age 33 years) reported a history of drug use (76%; 8% injection drug use); 47% perceived their HCV risk to be moderate/high. All inmates randomized to OraquickⓇ accepted testing while 87% accepted venipuncture. Among those who accepted OraquickⓇ vs. venipuncture, 100% vs. 97% were satisfied with the test, 97% vs. 94% would recommend the same test, and 100% vs. 76% would choose the same test again. CONCLUSION Adult incarcerated men in Canada were both more likely to accept OraquickⓇ compared to venipuncture, and to choose OraquickⓇ for future HCV screening.
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Affiliation(s)
- Nadine Kronfli
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University, Montreal, Quebec, Canada; Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.
| | - Camille Dussault
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Sylvie Chalifoux
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Hasmig Kavoukian
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Marina B Klein
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University, Montreal, Quebec, Canada; Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; CIHR Canadian HIV Trials Network, Vancouver, Canada
| | - Joseph Cox
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University, Montreal, Quebec, Canada; Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
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Chevaliez S, Wlassow M, Volant J, Roudot-Thoraval F, Bachelard A, Poiteau L, Trabut JB, Hézode C, Bourdel A, Dominguez S. Assessing Molecular Point-of-Care Testing and Dried Blood Spot for Hepatitis C Virus Screening in People Who Inject Drugs. Open Forum Infect Dis 2020; 7:ofaa196. [PMID: 32617372 PMCID: PMC7314587 DOI: 10.1093/ofid/ofaa196] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 05/23/2020] [Indexed: 12/15/2022] Open
Abstract
Background Injecting drug use is a major driver of hepatitis C virus (HCV) spread worldwide, and the World Health Organization (WHO) has identified people who inject drugs (PWID) as a key population to target for HCV screening and care. Point-of-care (POC) hepatitis C tests and dried blood spot (DBS) sampling offer benefits for the management of patients with HCV infection by increasing HCV testing and linkage to care in different nonclinical settings. The aims of this prospective study were to evaluate the feasibility and the acceptability of use HCV ribonucleic acid (RNA) POC and fingerstick DBS testing in social-medical risk-reduction centers and to describe the cascade of care among PWID in France. Methods Between June 2018 and February 2019, 89 consecutive HCV-seropositive PWID attending 2 drug treatment services and 1 supervised consumption room in inner Paris were invited to participate in further evaluation, undergoing a clinical review with a liver assessment and blood tests including fingerstick capillary whole blood POC HCV RNA testing and fingerstick DBS sampling. Results Of the 89 participants enrolled, HCV RNA was detected in 34 (38.6%) participants. Fingerstick whole blood POC RNA testing and HCV RNA detection from DBS sample were feasible and acceptable among PWID with no major difference in terms of HCV RNA detection rate. Overall, 16 participants received pan-genotypic antiviral treatment. The proportion of PWID with sustained virologic response at 12 weeks was 81.2%, with data for 3 patients still pending. Conclusions One-step screening strategy based on the detection of HCV RNA would engage people in care for treatment scale-up and HCV elimination.
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Affiliation(s)
- Stéphane Chevaliez
- National Reference Center for Viral Hepatitis B, C, and D, Department of Virology, Hôpital Henri Mondor, Université Paris-Est, Créteil, France.,INSERM U955, Créteil, France
| | - Mélanie Wlassow
- National Reference Center for Viral Hepatitis B, C, and D, Department of Virology, Hôpital Henri Mondor, Université Paris-Est, Créteil, France.,INSERM U955, Créteil, France
| | | | - Françoise Roudot-Thoraval
- INSERM U955, Créteil, France.,Department of Hepatology, Hôpital Henri Mondor, Université Paris-Est, Créteil, France
| | - Antoine Bachelard
- Department of Infectious Diseases, Hôpital Henri Mondor, Université Paris-Est, Créteil, France
| | - Lila Poiteau
- National Reference Center for Viral Hepatitis B, C, and D, Department of Virology, Hôpital Henri Mondor, Université Paris-Est, Créteil, France.,INSERM U955, Créteil, France
| | - Jean-Baptiste Trabut
- INSERM U955, Créteil, France.,Service d'Addictologie, Hôpital Henri Mondor, Université Paris-Est, Créteil, France
| | - Christophe Hézode
- INSERM U955, Créteil, France.,Department of Hepatology, Hôpital Henri Mondor, Université Paris-Est, Créteil, France
| | | | - Stéphanie Dominguez
- Department of Infectious Diseases, Hôpital Henri Mondor, Université Paris-Est, Créteil, France
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Scott N, Sacks-Davis R, Wade AJ, Stoove M, Pedrana A, Doyle JS, Thompson AJ, Wilson DP, Hellard ME. Australia needs to increase testing to achieve hepatitis C elimination. Med J Aust 2020; 212:365-370. [PMID: 32167586 PMCID: PMC7317196 DOI: 10.5694/mja2.50544] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 10/25/2019] [Indexed: 12/19/2022]
Abstract
Objectives To assess progress in Australia toward the 2030 WHO hepatitis C elimination targets two years after the introduction of highly effective direct‐acting antiviral (DAA) treatments. Design Analysis of quarterly data on government‐subsidised hepatitis C RNA testing and hepatitis C treatment in Australia, January 2013 – June 2018. Changes in testing and treatment levels associated with DAA availability were assessed in an autoregressive integrated moving average (ARIMA) statistical model, and the impact by 2030 of different levels of testing and treatment were estimated using a mathematical model. Major outcome measures Hepatitis C prevalence among people who inject drugs; annual hepatitis C incidence relative to 2015 levels; projections for the hepatitis C care cascade in 2030. Results The mean annual number of treatments initiated for people with hepatitis C increased from 6747 during 2013–2015 (before the introduction of DAAs) to 28 022 during 2016–18; the mean annual number of diagnostic RNA tests increased from 17 385 to 23 819. If current trends in testing and treatment continue (ie, 2018 testing numbers are maintained but treatment numbers decline by 50%), it is projected that by 2030 only 72% of infected people would be treated (by 2025 all people diagnosed with hepatitis C would be treated). The incidence of hepatitis C in 2030 would be 59% lower than in 2015, well short of the WHO target of an 80% reduction. The identification and testing of people exposed to hepatitis C must be increased by at least 50% for Australia to reach the WHO elimination targets. Conclusion Hepatitis C elimination programs in Australia should focus on increasing testing rates and linkage with care to maintain adequate levels of treatment.
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Elimination of hepatitis C virus infection among people who use drugs: Ensuring equitable access to prevention, treatment, and care for all. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 72:1-10. [PMID: 31345644 DOI: 10.1016/j.drugpo.2019.07.016] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 07/05/2019] [Accepted: 07/06/2019] [Indexed: 12/12/2022]
Abstract
There have been major strides towards the World Health Organization goal to eliminate hepatitis C virus (HCV) infection as a global public health threat. The availability of simple, well-tolerated direct-acting antiviral therapies for HCV infection that can achieve a cure in >95% of people has provided an important tool to help achieve the global elimination targets. Encouragingly, therapy is highly effective among people receiving opioid agonist therapy and people who have recently injected drugs. Moving forward, major challenges include ensuring that new infections are prevented from occurring and that people who are living with HCV are tested, linked to care, treated, receive appropriate follow-up, and have equitable access to care. This editorial highlights key themes and articles in a special issue focusing on the elimination of HCV among people who inject drugs. An overarching consideration flowing from this work is how to ensure equitable access to HCV treatment and care for all. This special issue maps the field in relation to: HCV prevention; the cascade of HCV care; strategies to enhance testing, linkage to care, and treatment uptake; and HCV treatment and reinfection. In addition, papers draw attention to the 'risk environments' and socio-ecological determinants of HCV acquisition, barriers to HCV care, the importance of messaging around the side-effects of new direct-acting antiviral therapies, the positive transformative potential of treatment and cure, and the key role of community-based drug user organizations in the HCV response. While this special issue highlights some successful efforts towards HCV elimination among people who inject drugs, it also highlights the relative lack of attention to settings in which resources enabling elimination are scarce, and where elimination hopes and potentials are less clear, such as in many low and middle income countries. Strengthening capacity in areas of the world where resources are more limited will be a critical step towards ensuring equity for all so that global HCV elimination among PWID can be achieved.
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