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Chien CH, Chou TS, Chen LW, Lin CL, Chang JJ, Liu CJ, Chen SW, Hu CC, Chien RN. The Challenge of a Recall Program from a Community-Based Hepatitis C Screening Campaign: The Effectiveness in HCV Microelimination. Microorganisms 2024; 12:1402. [PMID: 39065170 PMCID: PMC11279112 DOI: 10.3390/microorganisms12071402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 07/03/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
The optimal strategy for the microelimination of HCV within community settings remains ambiguous. We evaluated the percentage of participants who achieved linkage to care (LTC) following the conclusion of a screening campaign and examined the diverse factors influencing LTC among these individuals. The effectiveness of recall intervention for the non-LTC population and its barriers were analyzed. We initiated an HCV patient recall program to identify HCV participants who might not be treated after the HCV screening campaign. The program staff recalled HCV participants who were lost to follow-up via telephone from March 2019 to June 2019. They were informed of HCV treatment's importance, efficacy, availability, and safety. Among 185 participants infected with HCV, 109 (58.9%) obtained LTC. Compared with those who had LTC, those without LTC were older, had lower education levels, were less aware of their HCV infection, less frequently lived in urban areas, and had less health insurance. At the end of the recall program, 125 (67.6%) persons had linkage to care. The proportion of LTC increased by 8.7%. In total, 119 persons had an HCV RNA test, and 82 (68.9%) had viremia. Of the 82 patients with viremia, 78 (95.1%) received antiviral therapy, and 76 (97.4%) achieved a sustained virological response. After a community screening campaign, 59% of participants with anti-HCV-positive tests had LTC. The recall program increased this by 9%. However, 32% of HCV participants still could not be linked to care. Outreach care for non-LTC patients is a method worth trying in order to achieve the microelimination of HCV in rural communities.
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Affiliation(s)
- Cheng-Hung Chien
- Liver Research Unit, Chang Gung Memorial Hospital, Keelung 204, Taiwan; (C.-H.C.); (T.-S.C.); (L.-W.C.); (C.-L.L.); (C.-C.H.)
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung 204, Taiwan
| | - Tien-Shin Chou
- Liver Research Unit, Chang Gung Memorial Hospital, Keelung 204, Taiwan; (C.-H.C.); (T.-S.C.); (L.-W.C.); (C.-L.L.); (C.-C.H.)
- Division of Gastroenterology, Chang Gung Memorial Hospital, Keelung 204, Taiwan; (J.-J.C.); (C.-J.L.); (S.-W.C.)
| | - Li-Wei Chen
- Liver Research Unit, Chang Gung Memorial Hospital, Keelung 204, Taiwan; (C.-H.C.); (T.-S.C.); (L.-W.C.); (C.-L.L.); (C.-C.H.)
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung 204, Taiwan
| | - Chih-Lang Lin
- Liver Research Unit, Chang Gung Memorial Hospital, Keelung 204, Taiwan; (C.-H.C.); (T.-S.C.); (L.-W.C.); (C.-L.L.); (C.-C.H.)
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung 204, Taiwan
| | - Jia-Jang Chang
- Division of Gastroenterology, Chang Gung Memorial Hospital, Keelung 204, Taiwan; (J.-J.C.); (C.-J.L.); (S.-W.C.)
| | - Ching-Jung Liu
- Division of Gastroenterology, Chang Gung Memorial Hospital, Keelung 204, Taiwan; (J.-J.C.); (C.-J.L.); (S.-W.C.)
| | - Shuo-Wei Chen
- Division of Gastroenterology, Chang Gung Memorial Hospital, Keelung 204, Taiwan; (J.-J.C.); (C.-J.L.); (S.-W.C.)
| | - Ching-Chih Hu
- Liver Research Unit, Chang Gung Memorial Hospital, Keelung 204, Taiwan; (C.-H.C.); (T.-S.C.); (L.-W.C.); (C.-L.L.); (C.-C.H.)
- Division of Gastroenterology, Chang Gung Memorial Hospital, Keelung 204, Taiwan; (J.-J.C.); (C.-J.L.); (S.-W.C.)
| | - Rong-Nan Chien
- Liver Research Unit, Linkou Chang Gung Memorial Hospital and University College of Medicine, Taoyuan 333, Taiwan
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Farrugia A, Lenton E, Seear K, Kagan D, Valentine K, Fraser S, Mulcahy S, Edwards M, Jeffcote D. 'We've got a present for you': Hepatitis C elimination, compromised healthcare subjects and treatment as a gift. Soc Sci Med 2024; 340:116416. [PMID: 38039771 DOI: 10.1016/j.socscimed.2023.116416] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 11/07/2023] [Accepted: 11/09/2023] [Indexed: 12/03/2023]
Abstract
With the advent of highly effective and tolerable direct-acting antiviral treatments for hepatitis C, widespread optimism for and investment in the project of disease elimination now informs the public health response. In Australia, the Commonwealth government has invested heavily in elimination by universally subsidising treatment, promising access for all. Reflecting concerns that commonly accompany ambitious public health projects, cost for governments supporting access to the treatment and cost for individuals consuming it have emerged as central issues. Drawing on 30 interviews with people who have been cured of hepatitis C with direct-acting antivirals, this article examines how cost shapes experiences of hepatitis C treatment and cure in Australia. Drawing on Lauren Berlant's (2011) influential work on 'cruel optimism', we analyse three interconnected ways that notions of cost shape participants' views of treatment as a beneficent gift from the state: (1) understandings of treatment access as a form of 'luck'; (2) conceptions of the cost of treatment; and (3) criticisms of others who are seen to waste state resources by not taking up treatment or by re-acquiring hepatitis C. We argue that, together, these dynamics constitute people affected by hepatitis C not as citizens worthy of public investment and fundamentally entitled to care, but as second-class citizens less deserving of treatment and of the health care to which they might otherwise be considered entitled. It is within this dynamic that the compromised quality of elimination optimism takes shape, binding people affected by hepatitis C to an inequitable relationship to health care, reproduced through the very things that promise to free them of such inequality - investments in access to treatment and cure.
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Affiliation(s)
- Adrian Farrugia
- Australian Research Centre in Sex, Health and Society, La Trobe University, Australia; National Drug Research Institute, Curtin University, Australia.
| | - Emily Lenton
- Australian Research Centre in Sex, Health and Society, La Trobe University, Australia.
| | - Kate Seear
- Australian Research Centre in Sex, Health and Society, La Trobe University, Australia.
| | - Dion Kagan
- Australian Research Centre in Sex, Health and Society, La Trobe University, Australia.
| | - Kylie Valentine
- Social Policy Research Centre, University of New South Wales, Australia.
| | - Suzanne Fraser
- Australian Research Centre in Sex, Health and Society, La Trobe University, Australia; Centre for Social Research in Health, University of New South Wales, Australia.
| | - Sean Mulcahy
- Australian Research Centre in Sex, Health and Society, La Trobe University, Australia.
| | - Michael Edwards
- Faculty of Addiction Psychiatry, Royal Australian and New Zealand College of Psychiatrists, Australia.
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Kagan D, Seear K, Lenton E, Farrugia A, Valentine K, Mulcahy S, Fraser S. The trouble with normalisation: Transformations to hepatitis C health care and stigma in an era of viral elimination. SOCIOLOGY OF HEALTH & ILLNESS 2023; 45:1421-1440. [PMID: 37002705 DOI: 10.1111/1467-9566.13638] [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: 11/11/2022] [Accepted: 03/13/2023] [Indexed: 06/19/2023]
Abstract
Modern health-care systems have customarily approached hepatitis C in ways that resemble the public health approach to HIV/AIDS known as 'HIV exceptionalism'. HIV exceptionalism describes the unusual emphasis on privacy, confidentiality and consent in approaches to HIV and was partly developed to address HIV/AIDS-related stigma. In the case of hepatitis C, exceptionalist approaches have included diagnosis and treatment by specialist physicians and other 'boutique' public health strategies. The recent availability of highly effective, direct-acting antivirals alongside goals to eliminate hepatitis C have heralded dramatic changes to hepatitis C health care, including calls for its 'normalisation'. The corollary to exceptionalism, normalisation aims to bring hepatitis C into routine, mainstream health care. This article draws on interviews with stakeholders (n = 30) who work with hepatitis C-affected communities in policy, community, legal and advocacy settings in Australia, alongside Fraser et al.'s (2017, International Journal of Drug Policy, 44, 192-201) theorisation of stigma, and Rosenbrock et al.'s (1999, The AIDS policy cycle in Western Europe: from exceptionalism to normalisation. WZB Discussion Paper, No. P 99-202) critique of normalisation to consider the perceived effects of hepatitis C normalisation. Stakeholders described normalisation as a stigma-reducing process. However, they also expressed concerns about the ongoing stigma and discrimination that is not ameliorated by normalisation. We suggest that in centring normalisation, changes in health care may exaggerate the power of technological solutions to transform the meanings of hepatitis C.
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Affiliation(s)
- Dion Kagan
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, Victoria, Australia
| | - Kate Seear
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, Victoria, Australia
| | - Emily Lenton
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, Victoria, Australia
| | - Adrian Farrugia
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, Victoria, Australia
| | - Kylie Valentine
- Social Policy Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Sean Mulcahy
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, Victoria, Australia
| | - Suzanne Fraser
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, Victoria, Australia
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Seear K, Lenton E. Becoming posthuman: hepatitis C, the race to elimination and the politics of remaking the subject. HEALTH SOCIOLOGY REVIEW : THE JOURNAL OF THE HEALTH SECTION OF THE AUSTRALIAN SOCIOLOGICAL ASSOCIATION 2021; 30:229-243. [PMID: 34448668 DOI: 10.1080/14461242.2021.1971102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 08/16/2021] [Indexed: 05/22/2023]
Abstract
Hepatitis C has long been a public health problem in Australia. 'Revolutionary' new drugs with the potential to cure hepatitis C have now emerged. The Australian government has invested heavily in them, and has an ambitious goal to eliminate hepatitis C by 2030. Numerous shifts in policy and practice are required if the elimination agenda is to be realised. This paper explores the significance of these shifts. We ask: what is the race to elimination doing with the subject? We argue that the race to elimination can be understood, simultaneously, as a product of posthuman forces, capable of being analysed using the theoretical tools made available via the posthuman turn; producing an intervention in what it means to be human; and generating a dilemma for people who use (or used) drugs, people with hepatitis C, and posthuman scholarship. In drawing out these issues, we aim to: trace the significant developments underway in hepatitis C medicine and raise awareness of them; encourage reflection on the consequences of these developments; and invite reflections on what might be lost when the human is remade by hepatitis C medicine.
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Affiliation(s)
- Kate Seear
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, Australia
| | - Emily Lenton
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, Australia
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Andaluz García I, Arcos Rueda MDM, Montero Vega MD, Castillo Grau P, Martín Carbonero L, García-Samaniego Rey J, Romero Portales M, García Sánchez A, Busca Arenzana C, González García J, Montes Ramírez ML, Olveira Martín A. Patients with hepatitis C lost to follow-up: ethical-legal aspects and search results. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2021; 112:532-537. [PMID: 32579001 DOI: 10.17235/reed.2020.7077/2020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION data on the prevalence and characteristics of hepatitis C patients lost to follow-up are lacking. In addition, the identification of this population clashes with data protection regulations. METHODS the identification and contact protocol was submitted to the Health Care Ethics Committee. The protocol was based on anti-HCV serology test results for 2010-2018, which were obtained from the Microbiology Department. In addition, the situation of the patients in the hospital and regional database was analyzed, based on the following classification: a) chronic hepatitis C, if the last HCV RNA determination was positive; b) cured hepatitis C, if the last HCV RNA determination was negative after 12 weeks of treatment; and c) possible hepatitis C, if anti-HCV antibodies were positive with no result for HCV RNA. Lost patients were defined as those with chronic or possible hepatitis C and no follow-up in the Digestive Diseases or Internal Medicine Departments. The patients were contacted by postal mail and then by telephone, so that they could be offered treatment. RESULTS the Ethics Committee considered that the protocol fulfilled the bioethical principles of autonomy, beneficence, non-maleficence and justice and that contact was ethically desirable. From 4,816 positive anti-HCV serology results, 677 patients were identified who were lost to follow-up (14.06 %; 95 % CI, 13.2-15.2). The mean age was 54 years, 61 % were male, 12 % were foreign born and 95 % were mono-infected. The study of each serology result took 1.3 minutes. One-quarter (25 %) of the losses corresponded to the Digestive Diseases and Internal Medicine Departments. Of the 677 losses, serology testing had only been ordered for 449 patients (66.3 %) and the remaining 228 (33.7 %) also had a positive HCV RNA result. CONCLUSION a large number of patients with hepatitis C are lost to follow-up. Searching for and contacting these patients is legally and ethically viable.
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