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Yela E, Solé N, Puig L, López Gallegos D, Clua-García R. Barriers to access to hepatitis C treatment with direct-acting antivirals in people who inject drugs in the community setting. Harm Reduct J 2024; 21:88. [PMID: 38678266 PMCID: PMC11055286 DOI: 10.1186/s12954-024-01009-7] [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: 02/07/2023] [Accepted: 04/22/2024] [Indexed: 04/29/2024] Open
Abstract
Barriers to access to hepatitis C treatment with direct-acting antivirals in people who inject drugs in the community setting. Qualitative study with prison population. Hepatitis C (HCV) treatments with direct-acting antiviral therapy (DAA) are an easy and effective option among people who inject drugs (PWID). However, difficulties in accessing and monitoring treatment in community services and dropouts on release from prison are detected among PWID. For this reason, the aim of the study is to know the access barriers in the diagnosis and treatment of HCV in community health services. An exploratory qualitative study was carried out through semi-structured interviews with 33 PWID recruited in a pre-trial detention prison in Barcelona. The information obtained was analysed using grounded theory. Among PWID sub-population entering prison, personal barriers are related to intense drug use, lack of interest and ignorance of HCV infection and treatment, as well as being in a situation of social exclusion. In relation to health providers, they reported receiving little information, the existence of language barriers in migrants, not receiving screening and treatment proposals, and having poor interactions with some professionals. Systemic barriers were expressed related to the health system circuit being complicated, perceiving little comprehensive care and lack of community support. It is recommended to intensify prevention and treatment campaigns, promoting drug substitution programmes than current ones, improve health education, make the diagnosis and treatment process more flexible, and promote social policies and holistic care for greater coverage of the needs of PWID.
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Affiliation(s)
- Elena Yela
- Sant Esteve Sesrovires Prison Health Care Team (Brians 1 Prison Centre), South Metropolitan Health Care Department, Catalan Health Institute, Sant Esteve Sesrovires, Barcelona, Spain.
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.
| | - Neus Solé
- Sant Esteve Sesrovires Prison Health Care Team (Brians 1 Prison Centre), South Metropolitan Health Care Department, Catalan Health Institute, Sant Esteve Sesrovires, Barcelona, Spain
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Lidia Puig
- Sant Esteve Sesrovires Prison Health Care Team (Brians 1 Prison Centre), South Metropolitan Health Care Department, Catalan Health Institute, Sant Esteve Sesrovires, Barcelona, Spain
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Darío López Gallegos
- South Metropolitan Health Care Department, Catalan Health Institute, Barcelona, Spain
| | - Rafael Clua-García
- Manresa Faculty of Health Sciences, University of Vic - Central University of Catalonia, Manresa, Spain
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Calleja JL, Espin J, Kaushik A, Hernandez-Guerra M, Blissett R, Yehoshua A, Igloi-Nagy A. The Efficiency of Increased HCV Testing and Treatment Strategies in Spain to Achieve Elimination Goals. PHARMACOECONOMICS - OPEN 2024; 8:221-233. [PMID: 38100074 PMCID: PMC10884368 DOI: 10.1007/s41669-023-00458-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/22/2023] [Indexed: 02/23/2024]
Abstract
BACKGROUND In 2015, Spain launched a national eradication strategy for hepatitis C virus (HCV), resulting in the highest treatment rate in Europe and substantial reductions in HCV prevalence. However, to achieve the goal of HCV elimination, it is necessary to scale-up the diagnosis, treatment, and management of HCV infection. OBJECTIVE Our aim was to assess the prevalence, incidence, and cost effectiveness of scaling-up compared with status quo scenarios. METHODS A compartmental dynamic transmission model was developed comprising of a cascade of care and a liver progression module. Cost and quality-of-life inputs were sourced from the literature. Key outcomes were the prevalence and incidence of HCV and the incremental cost per quality-adjusted life-year (QALY) and per life-year (LY). Outcomes for a hypothetical elimination strategy were compared with the status quo. RESULTS The base-case analysis found that scaling-up testing and treatment reduced both the prevalence and incidence of HCV over time, resulting in incremental costs per QALY and LY of €13,291 and €12,285 respectively, compared with the status quo. The main drivers of the cost-effectiveness results included cost of diagnosis, cost of treatment, proportion of people who are unaware, percentage of population who inject drugs, and calibration parameters related to HCV infection prevalence. CONCLUSIONS This analysis demonstrated that scaling-up testing and treatment with direct-acting antivirals may be an efficient strategy for reducing the incidence and prevalence of HCV and may help achieve HCV elimination goals in Spain.
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Affiliation(s)
- Jose Luis Calleja
- Hospital Universitario Puerta de Hierro, Universidad Autónoma de Madrid, Madrid, Spain
| | - Jaime Espin
- Escuela Andaluza de Salud Pública, Granada, Spain
| | | | | | | | - Alon Yehoshua
- Formerly of Gilead Sciences, Inc., Foster City, CA, USA
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Passos-Castilho AM, Murphy DG, Blouin K, Benedetti A, Panagiotoglou D, Bruneau J, Klein MB, Kwong JC, Sander B, Janjua NZ, Greenaway C. Ongoing Gaps in the Hepatitis C Care Cascade during the Direct-Acting Antiviral Era in a Large Retrospective Cohort in Canada: A Population-Based Study. Viruses 2024; 16:389. [PMID: 38543755 PMCID: PMC10975766 DOI: 10.3390/v16030389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 05/23/2024] Open
Abstract
To achieve hepatitis C virus (HCV) elimination, high uptake along the care cascade steps for all will be necessary. We mapped engagement with the care cascade overall and among priority groups in the post-direct-acting antivirals (DAAs) period and assessed if this changed relative to pre-DAAs. We created a population-based cohort of all reported HCV diagnoses in Quebec (1990-2018) and constructed the care cascade [antibody diagnosed, RNA tested, RNA positive, genotyped, treated, sustained virologic response (SVR)] in 2013 and 2018. Characteristics associated with RNA testing and treatment initiation were investigated using marginal logistic models via generalized estimating equations. Of the 31,439 individuals HCV-diagnosed in Quebec since 1990 and alive as of 2018, there was significant progress in engagement with the care cascade post- vs. pre-DAAs; 86% vs. 77% were RNA-tested, and 64% vs. 40% initiated treatment. As of 2018, a higher risk of not being RNA-tested or treated was observed among individuals born <1945 vs. >1965 [hazard ratio (HR); 95% CI; 1.35 (1.16-1.57)], those with material and social deprivation [1.21 (1.06-1.38)], and those with alcohol use disorder [1.21 (1.08-1.360]. Overall, non-immigrants had lower rates of RNA testing [0.76 (0.67-0.85)] and treatment initiation [0.63 (0.57-0.70)] than immigrants. As of 2018, PWID had a lower risk of not being RNA tested [0.67 (0.61-0.85)] but a similar risk of not being treated, compared to non-PWID. Engagement in the HCV care cascade have improved in the post-DAA era, but inequities remain. Vulnerable subgroups, including certain older immigrants, were less likely to have received RNA testing or treatment as of 2018 and would benefit from focused interventions to strengthen these steps.
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Affiliation(s)
- Ana Maria Passos-Castilho
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
- Department of Medicine, McGill University, Montreal, QC H3G 2M1, Canada
| | - Donald G. Murphy
- Laboratoire de Santé Publique du Québec, Institut National de Santé Publique du Québec, Sainte-Anne-de-Bellevue, QC H9X 3R5, Canada;
| | - Karine Blouin
- Unité sur les Infections Transmissibles Sexuellement et par le Sang, Institut National de Santé Publique du Québec, Québec, QC H9X 3R5, Canada;
| | - Andrea Benedetti
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montreal, QC H3A 1G1, Canada; (A.B.); (D.P.)
| | - Dimitra Panagiotoglou
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montreal, QC H3A 1G1, Canada; (A.B.); (D.P.)
| | - Julie Bruneau
- CHUM Research Centre, Centre Hospitalier de l’Université de Montréal, Montreal, QC H2X 0A9, Canada;
| | - Marina B. Klein
- Research Institute of the McGill University Health Centre, Montreal, QC H3H 2R9, Canada;
| | - Jeffrey C. Kwong
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada;
- ICES, Toronto, ON M4N 3M5, Canada;
- Public Health Ontario, Toronto, ON M5G 1M1, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
| | - Beate Sander
- ICES, Toronto, ON M4N 3M5, Canada;
- Public Health Ontario, Toronto, ON M5G 1M1, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON M5G 2C4, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON M5T 3M6, Canada
| | - Naveed Z. Janjua
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada;
| | - Christina Greenaway
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
- Department of Medicine, McGill University, Montreal, QC H3G 2M1, Canada
- Division of Infectious Diseases, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
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Saludes V, Bordoy AE, Yela E, Turú E, Not A, López-Corbeto E, Egea-Cortés L, González-Candelas F, Casabona J, Marco A, Martró E. Incidence and molecular epidemiology of hepatitis C virus reinfection in prisons in Catalonia, Spain (Re-HCV study). Sci Rep 2023; 13:16012. [PMID: 37749145 PMCID: PMC10520040 DOI: 10.1038/s41598-023-42701-1] [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: 07/25/2023] [Accepted: 09/13/2023] [Indexed: 09/27/2023] Open
Abstract
Hepatitis C virus (HCV) reinfection may hamper HCV elimination in prisons. We aimed to (i) determine the reinfection rate in people treated for HCV in Catalan prisons, (ii) measure reinfection in people entering prisons, and (iii) characterize the molecular epidemiology of HCV in prisons and people who inject drugs (PWID) in the community. Re-HCV was a prospective study in eight prisons (2019-2020) including two groups: (1) people cured with treatment in prison and followed-up every 6 months, and (2) people testing HCV-RNA positive at incarceration. Bio-behavioral data were collected. HCV isolates were sequenced and phylogenetically analyzed with those of PWID in the community. Reinfection follow-up after treatment was achieved in 97 individuals (103.05 person-years). Two reinfections were detected, resulting in an incidence ≤ 10/100 person-years. Among people entering prison, 2% (359/17,732) were viremic, of which 334 (93.0%) were included, and 44 (13.5%) presented with reinfection (84.7% being PWID). Frequently, HCV isolates in prisons and PWID in the community were phylogenetically related. Although HCV reinfection is low after treatment, it is common in people entering Catalan prisons. To maintain a low HCV prevalence in prisons, harm-reduction services and test-and-treat programs for PWID should be strengthened both inside and outside prisons.
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Affiliation(s)
- Verónica Saludes
- Microbiology Department, Northern Metropolitan Clinical Laboratory, Germans Trias i Pujol Research Institute and Hospital (IGTP), Crta. del Canyet S/N, 08916, Badalona, Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Antoni E Bordoy
- Microbiology Department, Northern Metropolitan Clinical Laboratory, Germans Trias i Pujol Research Institute and Hospital (IGTP), Crta. del Canyet S/N, 08916, Badalona, Barcelona, Spain
| | - Elena Yela
- Brians-1 Prison Health Services, Sant Esteve Ses Rovires, Barcelona, Spain
| | - Elisabet Turú
- Prison Health Programme, Catalan Institute of Health (ICS), Barcelona, Spain
| | - Anna Not
- Microbiology Department, Northern Metropolitan Clinical Laboratory, Germans Trias i Pujol Research Institute and Hospital (IGTP), Crta. del Canyet S/N, 08916, Badalona, Barcelona, Spain
| | - Evelin López-Corbeto
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Centre for Epidemiological Studies On Sexually Transmitted Infections and HIV/AIDS of Catalonia (CEEISCAT), Public Health Agency of Catalonia (ASPCAT), Badalona, Spain
| | - Laia Egea-Cortés
- Centre for Epidemiological Studies On Sexually Transmitted Infections and HIV/AIDS of Catalonia (CEEISCAT), Public Health Agency of Catalonia (ASPCAT), Badalona, Spain
| | - Fernando González-Candelas
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Joint Research Unit Infection and Public Health FISABIO-University of Valencia I2SysBio, Valencia, Spain
| | - Jordi Casabona
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Centre for Epidemiological Studies On Sexually Transmitted Infections and HIV/AIDS of Catalonia (CEEISCAT), Public Health Agency of Catalonia (ASPCAT), Badalona, Spain
| | - Andrés Marco
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Prison Health Programme, Catalan Institute of Health (ICS), Barcelona, Spain
| | - Elisa Martró
- Microbiology Department, Northern Metropolitan Clinical Laboratory, Germans Trias i Pujol Research Institute and Hospital (IGTP), Crta. del Canyet S/N, 08916, Badalona, Barcelona, Spain.
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.
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Aponte-Meléndez Y, Mateu-Gelabert P, Eckhardt B, Fong C, Padilla A, Trinidad-Martínez W, Maldonado-Rodríguez E, Agront N. Hepatitis C virus care cascade among people who inject drugs in puerto rico: Minimal HCV treatment and substantial barriers to HCV care. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 8:100178. [PMID: 37555192 PMCID: PMC10404601 DOI: 10.1016/j.dadr.2023.100178] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 08/10/2023]
Abstract
Background People who inject drugs (PWID) in Puerto Rico are disproportionately affected by the hepatitis C virus (HCV) epidemic. However, there is a scarcity of data on the HCV care cascade among PWID in Puerto Rico. This study aims to describe the HCV cascade of care among PWID in Puerto Rico, identify gaps, and explore barriers to HCV care. Methods Participants were recruited using respondent-driven sampling and tested for both HCV antibodies (Ab) and RNA (ribonucleic acid) using rapid testing and dried blood spot samples (DBS). The cascade of care was estimated based on the DBS HCV Ab and RNA results, as well as self-reported data on HCV screening, linkage to care, treatment uptake and sustained virologic response collected through a questionnaire. The cascade was constructed sequentially, with each step using the number of people from the preceding step as the base denominator. The survey also assessed participants' perceived barriers to HCV care. Results Out of 150 participants, 126 (84%) had previously been HCV screened, 87% (109/126) were HCV Ab positive, 72% (79/109) were RNA positive,48% (38/79) were linked to care, 32% (12/38) initiated treatment, 58% (7/12) finished treatment, and 71% (5/7) achieved SVR. Barriers to HCV care included concerns about drug abstinence requirements, access to transportation, stigma in healthcare settings, and lack of knowledge about HCV treatment sites. Conclusion This study provides insights into the HCV cascade of care among PWID in Puerto Rico for the first time and highlights limited diagnosis, treatment uptake, and barriers to care.
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Affiliation(s)
- Yesenia Aponte-Meléndez
- CUNY Graduate School of Public Health and Health Policy, Institute for Implementation Science in Population Health(ISPH) 55 West 125th street, New York, NY 10027,USA
- NYU Rory Meyers College of Nursing 433 1st Ave., New York, NY 10010
| | - Pedro Mateu-Gelabert
- CUNY Graduate School of Public Health and Health Policy, Institute for Implementation Science in Population Health(ISPH) 55 West 125th street, New York, NY 10027,USA
| | - Benjamin Eckhardt
- New York University School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Chunki Fong
- CUNY Graduate School of Public Health and Health Policy, Institute for Implementation Science in Population Health(ISPH) 55 West 125th street, New York, NY 10027,USA
| | - Adriana Padilla
- CUNY Graduate School of Public Health and Health Policy, Institute for Implementation Science in Population Health(ISPH) 55 West 125th street, New York, NY 10027,USA
| | - Wanda Trinidad-Martínez
- CUNY Graduate School of Public Health and Health Policy, Institute for Implementation Science in Population Health(ISPH) 55 West 125th street, New York, NY 10027,USA
| | - Eric Maldonado-Rodríguez
- CUNY Graduate School of Public Health and Health Policy, Institute for Implementation Science in Population Health(ISPH) 55 West 125th street, New York, NY 10027,USA
| | - Nancy Agront
- AbbVie Corp., Paseo Caribe Building Suite 22415 Ave Munoz Rivera San Juan, 00901, Puerto Rico
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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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Seu R, Riback LR, Nyakowa M, Lizcano J, Musyoki H, Ross J, Cherutich P, Kurth AE, Akiyama MJ. Challenges and best practices for hepatitis C care among people who inject drugs in resource limited settings: focus group discussions with healthcare providers in Kenya. Glob Public Health 2022; 17:3627-3637. [PMID: 35941717 PMCID: PMC9898079 DOI: 10.1080/17441692.2022.2110919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 08/02/2022] [Indexed: 02/06/2023]
Abstract
People who inject drugs (PWID) living with Hepatitis C (HCV) in low- and middle-income countries face substantial barriers to HCV care. We sought to gain healthcare providers' perspectives on challenges and best practices for HCV care provision among PWID in Kenya. We conducted three focus group discussions (FGD) with 23 healthcare providers working with PWID living with HCV in Nairobi and Mombasa. Transcribed interviews were analysed thematically. Overarching themes regarding HCV prevention and treatment were: (1) lack of HCV-related knowledge at the provider and patient levels; (2) stigmatisation of people living with HCV and PWID; and (3) difficulties among PWID with navigating the healthcare system. Some providers suggested systematically integrating HCV care into existing PWID-specific harm reduction programs to improve HCV care provision as well as creating national HCV guidelines to guide clinicians. This study highlights the need for national HCV treatment guidelines and increased public HCV education, as well as culturally sensitive models integrating HCV care into programs PWID are already accessing. These strategies will be useful in improving access to HCV care among PWID and has the potential to decrease HCV transmission and prevalence among this vulnerable population.
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Affiliation(s)
- Rie Seu
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Lindsey R Riback
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Mercy Nyakowa
- Kenya Ministry of Health, National AIDS & STI Control Program (NASCOP), Nairobi, Kenya
| | - John Lizcano
- Yale University School of Nursing, Orange, CT, USA
| | - Helgar Musyoki
- Kenya Ministry of Health, National AIDS & STI Control Program (NASCOP), Nairobi, Kenya
| | - Jonathan Ross
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Peter Cherutich
- Kenya Ministry of Health, National AIDS & STI Control Program (NASCOP), Nairobi, Kenya
| | - Ann E Kurth
- Yale University School of Nursing, Orange, CT, USA
| | - Matthew J Akiyama
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
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8
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Lens S, Miralpeix A, Gálvez M, Martró E, González N, Rodríguez-Tajes S, Mariño Z, Saludes V, Reyes-Urueña J, Majó X, Colom J, Forns X. HCV microelimination in harm reduction centres has benefits beyond HCV cure but is hampered by high reinfection rates. JHEP Rep 2022; 4:100580. [PMID: 36316992 PMCID: PMC9617206 DOI: 10.1016/j.jhepr.2022.100580] [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: 05/23/2022] [Revised: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 12/02/2022] Open
Abstract
Background & Aims Significant scale-up of treatment among people who inject drugs (PWID) is crucial to achieve WHO HCV elimination targets. We explored the impact of on-site HCV diagnosis and treatment on PWID in an externalised hepatology clinic at the biggest harm reduction centre (HRC) in Barcelona attending to a marginalised PWID population with ongoing high-risk practices. Methods On-site HCV point-of-care testing was performed for diagnosis and treatment delivery. HCV-RNA was assessed at SVR12 (sustained virologic response at 12 weeks) and every 6 months. The programme included behavioural questionnaires at baseline and after treatment. Results Between 2018 and 2020, 919 individuals were prospectively enrolled. Of these, only 46% accepted HCV screening. HCV-RNA+ prevalence was 55.7% (n = 234). Of the 168 (72%) individuals starting treatment, 48% were foreigners, 32% homeless, 73% unemployed, and 62% had a history of incarceration. At enrolment, 70% injected drugs daily and 30% reported sharing needles or paraphernalia. Intention-to-treat SVR12 was 60%; only 4% were virological failures, the remaining were either early reinfections (20%) or losses to follow-up (16%). The overall reinfection rate during follow-up was 31/100 persons/year. HIV coinfection and daily injection were associated with a higher risk of reinfection. Nonetheless, beyond viral clearance, antiviral therapy was associated with a significant reduction in injection frequency, risk practices, and homelessness. Conclusions HCV treatment can be successfully delivered to active PWID with high-risk practices and has a significant benefit beyond HCV elimination. However, approaching this difficult spectrum of the PWID population implies significant barriers such as low rate of screening acceptance and high dropout and reinfection rates. Lay summary People who inject drugs attending harm reduction centres represent the most difficult population to treat for hepatitis C. We show that hepatitis C treatment has a significant benefit beyond viral cure, including improving quality of life, and decreasing injection frequency and risk practices. However, intrinsic barriers and the high reinfection rates hamper the achievement of viral microelimination in this setting. HCV treatment can be successfully delivered to active PWID with high-risk practices. HCV treatment has benefits beyond sustained virological response. PWID reported lower injection frequency and risk practices after engaging in the HCV programme. However, linkage-to-care for PWID attending harm reduction centres is challenging. The high dropout and reinfection rates hamper HCV microelimination in this population.
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Affiliation(s)
- Sabela Lens
- Liver Unit, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
- Biomedical Research Networking Centre in Liver and Digestive Diseases (CIBEREHD), Madrid, Spain
- Corresponding author. Address: Liver Unit, Hospital Clínic, IDIBAPS, C/Villarroel 170, 08036 Barcelona, Spain. Tel.: +34 227 5400, (ext.) 2093.
| | - Anna Miralpeix
- Liver Unit, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
- Biomedical Research Networking Centre in Liver and Digestive Diseases (CIBEREHD), Madrid, Spain
| | - Mont Gálvez
- Liver Unit, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
- Biomedical Research Networking Centre in Liver and Digestive Diseases (CIBEREHD), Madrid, Spain
| | - Elisa Martró
- Microbiology Department, Laboratori Clínic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Institut d’Investigació Germans Trias i Pujol (IGTP), Badalona, Spain
- Biomedical Research Networking Centre in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Noemi González
- REDAN La Mina, Parc de Salut Mar Barcelona, Institute of Neuropsychiatry and Addictions, Barcelona, Spain
| | - Sergio Rodríguez-Tajes
- Liver Unit, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
- Biomedical Research Networking Centre in Liver and Digestive Diseases (CIBEREHD), Madrid, Spain
| | - Zoe Mariño
- Liver Unit, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
- Biomedical Research Networking Centre in Liver and Digestive Diseases (CIBEREHD), Madrid, Spain
| | - Verónica Saludes
- Microbiology Department, Laboratori Clínic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Institut d’Investigació Germans Trias i Pujol (IGTP), Badalona, Spain
- Biomedical Research Networking Centre in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Juliana Reyes-Urueña
- Biomedical Research Networking Centre in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Centre for Epidemiological Studies of Sexually Transmitted Disease and AIDS in Catalonia (CEEISCAT), Generalitat de Catalunya, Badalona, Spain
| | - Xavier Majó
- Public Health Agency of Catalonia (ASPCAT), Government of Catalonia, Programme for Prevention, Control and Treatment of HIV, STIs and Viral Hepatitis, Barcelona, Spain
| | - Joan Colom
- Public Health Agency of Catalonia (ASPCAT), Government of Catalonia, Programme for Prevention, Control and Treatment of HIV, STIs and Viral Hepatitis, Barcelona, Spain
| | - Xavier Forns
- Liver Unit, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
- Biomedical Research Networking Centre in Liver and Digestive Diseases (CIBEREHD), Madrid, Spain
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Lazarus JV, Villota-Rivas M, Fernández I, Gea F, Ryan P, López SA, Guy D, Calleja JL, García-Samaniego J. A cascade of care analysis on the elimination of hepatitis C from public hospitals in Madrid. COMMUNICATIONS MEDICINE 2022; 2:20. [PMID: 35603271 PMCID: PMC9053180 DOI: 10.1038/s43856-022-00077-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 01/13/2022] [Indexed: 11/26/2022] Open
Abstract
Background Direct-acting antivirals can cure ≥95% of hepatitis C virus (HCV) cases, but do not reach everyone in need. This cross-sectional study analyses the HCV cascade of care (CoC) in Madrid, Spain, in high-risk patients, to inform micro-elimination measures. Methods From September 2019 to May 2021, data from medical records were collected and analysed from six public hospitals in Madrid, including seven adult, high-risk patient groups: patients in haemodialysis or pre-dialysis programmes, co-infected with HIV, with advanced liver disease (ALD), with hereditary haematological diseases, with transplants and people who inject drugs (PWID). Results Here we present an analysis of 3994 patients (68.8% male), 91.2% were tested for anti-HCV and 28.9% were positive. Of the total, 34.5% were tested for HCV–RNA and 62.4% of these were positive. Of those HCV–RNA positive, 98.0% were treatment-eligible: in 7.4%, treatment is ongoing and in 89.3% completed. Of the latter, 92.2% obtained a sustained virological response 12 weeks post treatment (SVR12). Of those with ongoing or completed treatment, 9.8% experienced loss to follow-up (LTFU) or had unknown SVR12, 50.3% developed hepatic and 20.3% extrahepatic complications. ALD patients had the highest proportion of HCV–RNA positives (32.5%). The lowest proportion of patients treated were PWID (85.2%). Conclusions Almost one in ten high-risk patients in six of Madrid’s public hospitals remains untested for HCV antibodies. An almost equal percentage of those untested have experienced LTFU, with the highest proportion in PWID. This approach to monitoring the HCV CoC is vital to inform measures to eliminate HCV in hospitals. Despite the existence of effective treatments with few side effects for hepatitis C virus (HCV), such treatments do not reach everyone in need and this means we cannot eliminate HCV. Here, we analysed HCV diagnoses, patients’ access to care and treatment rates in high-risk populations in major public hospitals in Madrid. Data were collected from adult patients in haemodialysis or pre-dialysis programmes, co-infected with HIV, with advanced liver disease, with hereditary haematological diseases, with transplants and people who inject drugs (PWID). Nearly 10% of high-risk patients in six of Madrid’s public hospitals did not have an initial test for HCV. An almost equal percentage of those who were not tested for HCV have not continued to be followed for care, primarily PWID. This approach to monitoring the HCV cascade of care is vital to inform measures to eliminate HCV in hospitals. Lazarus et al. evaluate the cascade of care for people with hepatitis C virus (HCV) treated within six public hospitals in Madrid, Spain. The authors report on potential gaps in care in specific populations, including inadequate testing and loss to follow-up, and their implications on HCV micro-elimination in Madrid.
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