1
|
Cox-North P, Wiggins L, Stockton J, Huriaux E, Fliss M, Evaskus L, Pike K, Basu A, Kohler P. Provider reported implementation barriers to hepatitis C elimination in Washington State. BMC PRIMARY CARE 2024; 25:252. [PMID: 38992590 PMCID: PMC11241921 DOI: 10.1186/s12875-024-02507-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 07/01/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND Despite curative treatment options since 2014, only 12% of individuals in Washington State diagnosed with Hepatitis C (HCV) received treatment in 2018. Washington State agencies launched an elimination plan in 2019 to promote access to and delivery of HCV screening and treatment. The purpose of this study is to evaluate provider and health system barriers to successful implementation of HCV screening and treatment across Washington State. METHODS This is a cross-sectional online survey of 547 physicians, nurse practitioners, physician assistants, and clinical pharmacists who provide care to adult patients in Washington State conducted in 2022. Providers were eligible if they worked in a primary care, infectious disease, gastroenterology, or community health settings. Questions assessed HCV screening and treating practices, implementation barriers, provider knowledge, observed stigma, and willingness to co-manage HCV and substance use disorder. Chi-squared or fishers exact tests compared characteristics of those who did and did not screen or treat. RESULTS Provider adoption of screening for HCV was high across the state (96%), with minimal barriers identified. Fewer providers reported treating HCV themselves (28%); most (71%) referred their patients to another provider. Barriers identified by those not treating HCV included knowledge deficit (64%) and lack of organizational support (24%). The barrier most identified in those treating HCV was a lack of treating clinicians (18%). There were few (< 10%) reports of observed stigma in settings of HCV treatment. Most clinicians (95%) were willing to prescribe medication for substance use disorders to those that were using drugs including alcohol. CONCLUSION Despite widespread screening efforts, there remain barriers to implementing HCV treatment in Washington State. Lack of treating clinicians and clinician knowledge deficit were the most frequently identified barriers to treating HCV. To achieve elimination of HCV by 2030, there is a need to grow and educate the clinician workforce treating HCV.
Collapse
Affiliation(s)
- Paula Cox-North
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Box 357260, Seattle, Washington, 98195, USA.
| | - Lisa Wiggins
- Department of Child, Family, and Population Health Nursing, University of Washington, Box 357260, Seattle, Washington, 98195, USA
| | - Jon Stockton
- Department of Health, Washington State, Tumwater, Washington, USA
| | - Emalie Huriaux
- Department of Health, Washington State, Tumwater, Washington, USA
| | - Mary Fliss
- Washington State Office of Financial Management, Olympia, WA, USA
| | - Leta Evaskus
- Washington State Health Care Authority, Olympia, WA, USA
| | - Kenneth Pike
- Office of Nursing Research, University of Washington, Box 357260, Seattle, Washington, 98195, USA
| | - Anirban Basu
- Department of Pharmacy, University of Washington, Box 357630, Seattle, Washington, 98195, USA
| | - Pamela Kohler
- Department of Child, Family, and Population Health Nursing, University of Washington, Box 357260, Seattle, Washington, 98195, USA
- Department of Global Health, University of Washington, Box 351620, Seattle, Washington, 98195, USA
| |
Collapse
|
2
|
McMahan VM, Atkins DL, Buckler S, Violette LR, Niemann L, Frank N, Kimiam Waters, Herrera Perales LE, Viquez L, Tung E, Stekler JD. Challenges recruiting and retaining people at risk for HIV who use methamphetamine in a randomized PrEP adherence trial in Seattle, WA. Int J STD AIDS 2024; 35:635-643. [PMID: 38630433 DOI: 10.1177/09564624241244835] [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] [Indexed: 07/28/2024]
Abstract
BACKGROUND Methamphetamine is associated with increased HIV risk and suboptimal adherence to pre-exposure prophylaxis (PrEP). Interventions to support PrEP adherence for people who use methamphetamine are needed. METHODS We evaluated peer navigation to support adherence among people initiating PrEP who use methamphetamine. The HIV Prevention in Methamphetamine Users (HMU!) study enrolled participants from May 2018-January 2022 in Seattle, WA, and followed them for 6 months. Surveys collected sociodemographic, drug use, and sexual behavior data at enrollment, month 3, and month 6. Dried blood spots (DBS) were collected at months 1, 3, and 6 to measure PrEP adherence. RESULTS We enrolled 21 participants of a target sample of 40, of whom 20 were prescribed PrEP. Nine participants (43%) received peer navigation and 12 (57%) received standard of care or text messaging. At baseline, most participants reported at least weekly methamphetamine use (17, 81%) and condomless receptive anal intercourse (CRAI) (16, 76%). One-third reported CRAI with a partner with HIV. Among those who provided a DBS, 78% and 50% had results commensurate with ≥4 pills/week at the month 3 and 6 visit, respectively. More than half of those prescribed PrEP completed a month 6 visit (11, 55%). Retention was not associated with peer support compared to standard of care or text messaging (p = .20). CONCLUSIONS We enrolled half our target sample size despite extensive recruitment efforts. As expected, participants had challenges with PrEP adherence and persistence. While peer navigation interventions should be studied further, additional interventions are likely needed to support PrEP uptake, adherence, and persistence among people who use methamphetamine.
Collapse
Affiliation(s)
- Vanessa M McMahan
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Dana L Atkins
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Smitty Buckler
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Lauren R Violette
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Lisa Niemann
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Noah Frank
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Kimiam Waters
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
| | | | - Luis Viquez
- Seattle's LGBTQ+ Center (formerly Gay City), Seattle, WA, USA
| | - Elyse Tung
- Kelley-Ross Pharmacy Group, Seattle, WA, USA
| | - Joanne D Stekler
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
| |
Collapse
|
3
|
Ryan P, Valencia J, Cuevas G, Amigot-Sanchez R, Martínez I, Lazarus JV, Pérez-García F, Resino S. Decrease in active hepatitis C infection among people who use drugs in Madrid, Spain, 2017 to 2023: a retrospective study. Euro Surveill 2024; 29:2300712. [PMID: 39027941 PMCID: PMC11258947 DOI: 10.2807/1560-7917.es.2024.29.29.2300712] [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: 12/11/2023] [Accepted: 04/24/2024] [Indexed: 07/20/2024] Open
Abstract
BackgroundPeople who use drugs (PWUD) are a key target population to reduce the burden of hepatitis C virus (HCV) infection.AimTo assess risk factors and temporal trends of active HCV infection in PWUD in Madrid, Spain.MethodsWe conducted a retrospective study between 2017 and 2023, including 2,264 PWUD visiting a mobile screening unit. Data about epidemiology, substance use and sexual risk behaviour were obtained through a 92-item questionnaire. HCV was detected by antibody test, followed by RNA test. The primary outcome variable was active HCV infection prevalence, calculated considering all individuals who underwent RNA testing and analysed by logistic regression adjusted by the main risk factors.ResultsOf all participants, 685 tested positive for anti-HCV antibodies, and 605 underwent RNA testing; 314 had active HCV infection, and 218 initiated treatment. People who inject drugs (PWID) were identified as the main risk group. The active HCV infection rate showed a significant downward trend between 2017 and 2023 in the entire study population (23.4% to 6.0%), among PWID (41.0% to 15.0%) and PWUD without injecting drug use (7.0% to 1.3%) (p < 0.001 for all). These downward trends were confirmed by adjusted logistic regression for the entire study population (adjusted odds ratio (aOR): 0.78), PWID (aOR: 0.78), and PWUD non-IDU (aOR: 0.78).ConclusionsOur study demonstrates a significant reduction in active HCV infection prevalence among PWUD, particularly in PWID, which suggests that efforts in the prevention and treatment of HCV in Madrid, Spain, have had an impact on the control of HCV infection.
Collapse
Affiliation(s)
- Pablo Ryan
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Hospital Universitario Infanta Leonor, Madrid, Spain
- Universidad Complutense de Madrid (UCM), Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Jorge Valencia
- Unidad de Reducción de Daños 'SMASD', Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | - Rafael Amigot-Sanchez
- Unidad de Infección e Viral e Inmunidad, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Isidoro Martínez
- Unidad de Infección e Viral e Inmunidad, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Jeffrey V Lazarus
- CUNY Graduate School of Public Health and Health Policy (CUNY SPH), New York, United States
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Felipe Pérez-García
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Servicio de Microbiología Clínica, Hospital Universitario Príncipe de Asturias, Madrid, Spain
- Universidad de Alcalá, Facultad de Medicina, Departamento de Biomedicina y Biotecnología, Madrid, Spain
| | - Salvador Resino
- Unidad de Infección e Viral e Inmunidad, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
4
|
Rajkumar N, Khumukcham LS, Thangjam D, Singh S, Khwairakpam G, Shilton S, Goel A. Decentralised same day test and treatment of hepatitis C levering existing peer support networks among men who inject drugs: feasibility and effectiveness. Harm Reduct J 2024; 21:98. [PMID: 38769517 PMCID: PMC11103967 DOI: 10.1186/s12954-024-01001-1] [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: 03/04/2024] [Accepted: 04/06/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Prevalence of hepatitis C virus (HCV) infection among people who inject drugs in the state of Manipur, India, is 43%; however, access to care is poor. We piloted a Community-led and comprehensive hepatitis care model that included same-day HCV treatment at drug treatment centres. METHODS Screening was conducted through venipuncture samples collected by community peer PWID, using HCV antibody (HCV Ab) rapid screening and hepatitis B virus (HBV) surface antigen (HBsAg) rapid diagnostic tests. Reactive HCV Ab samples were tested for HCV RNA using near point-of-care Truenat® HCV on Truelab® Quattro. Eligible HCV RNA-positive participants were treated on the same day using direct-acting antivirals and followed for sustained virologic response (SVR). HBsAg-negative participants received rapid HBV vaccination regimen while those positive for HBsAg were tested for DNA and referred for treatment. RESULTS Between November 2021 and August 2022, 643 individuals were approached and 503 consented and were screened. All screened were males with history of injection drug use, and a median age of 27 years (IQR 23-32). Of the 241 (47.9%) HCV Ab reactive all underwent RNA testing and 156 (64.7%) were RNA detectable. Of those with viraemia, 155 (99.4%) were initiated on treatment with 153 (98.1%) on same day, with 2 (1.2%) HBsAg positive and waiting for HBV DNA results. Among those 153, median time from HCV Ab screening to treatment was 6 h 38 min (IQR 5 h 42 min-8 h 23 min). In total 155 (100%) completed HCV treatment, of those 148 (95.5%) completed SVR testing and 130 (87.8%) achieved SVR12. 27 (5%) participants were HBsAg-positive, 3 (11.1%) were also living with HCV viraemia; 443 (97.6%) were eligible for vaccination and 436 (98.4%) received all 3 vaccine doses. CONCLUSION Community-led hepatitis care incorporating same day "test and treat" for HCV was feasible and effective. HBV screening identified a large proportion who were unvaccinated. Peer support extended resulted in ensuring compliance to care and treatment cascade and completing all the three doses of HBV vaccination. As the screening, diagnostics infrastructure and vaccine are available in most countries with national viral hepatitis programs also in place, our model can be adapted or replicated to progress towards global elimination targets.
Collapse
Affiliation(s)
| | | | | | - Surender Singh
- Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | | | | | - Amit Goel
- Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| |
Collapse
|
5
|
Chirunomula S, Muscarella A, Whelchel K, Gispen F, Marcovitz D, White K, Chastain C. Hepatitis C Cascade of Care in a Multidisciplinary Substance Use Bridge Clinic Model in Tennessee. Open Forum Infect Dis 2024; 11:ofae205. [PMID: 38770209 PMCID: PMC11103616 DOI: 10.1093/ofid/ofae205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 04/15/2024] [Indexed: 05/22/2024] Open
Abstract
Many barriers prevent individuals with substance use disorders from receiving hepatitis C virus (HCV) treatment. This study describes 96 patients with active HCV treated in an opioid use disorder bridge clinic model. Of 33 patients who initiated treatment, 25 patients completed treatment, and 13 patients achieved sustained virologic response.
Collapse
Affiliation(s)
- Samantha Chirunomula
- Division of Infectious Diseases, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Anahit Muscarella
- Department of Pharmacy, Vanderbilt Specialty Pharmacy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kristen Whelchel
- Department of Pharmacy, Vanderbilt Specialty Pharmacy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Fiona Gispen
- Division of Infectious Diseases, Weill Cornell Medicine, New York, New York, USA
| | - David Marcovitz
- Division of Addiction Psychiatry, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Katie White
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Cody Chastain
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| |
Collapse
|
6
|
Barré T, Bourlière M, Parlati L, Ramier C, Marcellin F, Protopopescu C, Di Beo V, Cagnot C, Dorival C, Nicol J, Zoulim F, Carrat F, Carrieri P. Hepatitis C virus cure from direct-acting antivirals and mortality: Are people with and without a history of injection drug use in the same boat? (ANRS CO22 Hepather cohort). Drug Alcohol Rev 2024; 43:718-731. [PMID: 38133601 DOI: 10.1111/dar.13802] [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: 07/10/2023] [Revised: 11/29/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION The risk of mortality in people with a history of injection drug use (PHID) is high, as is the prevalence of hepatitis C virus (HCV) infection. Although direct-acting antivirals (DAA) are effective in this population in terms of sustained virological response, it is not known whether PHID benefit as much as people with no history of injection drug use from DAA-related HCV cure in terms of reduced all-cause mortality. METHODS Using Cox proportional hazards models based on the ANRS CO22 Hepather cohort data (n = 9735), we identified factors associated with all-cause mortality among HCV-infected people. We tested for interaction effects between drug injection status, HCV cure and other explanatory variables. RESULTS DAA-related HCV cure was associated with a 66% (adjusted hazard ratio [95% confidence interval]: 0.34 [0.29-0.39]) lower risk of all-cause mortality, irrespective of drug injection status. Detrimental effects of unhealthy alcohol use on mortality were identified in PHID only. DISCUSSION AND CONCLUSIONS DAA-related HCV cure led to comparable benefits in terms of reduced mortality in PHID and people with no history of injection drug use. Policies and strategies to enhance DAA uptake among PHID are needed to lower mortality in this population. Clinical trial registration details: ClinicalTrials.gov: NCT01953458.
Collapse
Affiliation(s)
- Tangui Barré
- Aix Marseille Université, Institut National de la Santé et de la Recherche Médicale, Institut de Recherche pour le Developpement , Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Institut des Sciences de la Santé Publique d'Aix-Marseille, Marseille, France
| | - Marc Bourlière
- Aix Marseille Université, Institut National de la Santé et de la Recherche Médicale, Institut de Recherche pour le Developpement , Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Institut des Sciences de la Santé Publique d'Aix-Marseille, Marseille, France
- Département d'hépatologie et gastroentérologie, Hôpital Saint Joseph, Marseille, France
| | - Lucia Parlati
- Université de Paris Cité; Institut National de la Santé et de la Recherche Médicale; Assistance Publique-Hôpitaux de Paris, Département d'Hépatologie/Addictologie, Hôpital Cochin, Paris, France
| | - Clémence Ramier
- Aix Marseille Université, Institut National de la Santé et de la Recherche Médicale, Institut de Recherche pour le Developpement , Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Institut des Sciences de la Santé Publique d'Aix-Marseille, Marseille, France
| | - Fabienne Marcellin
- Aix Marseille Université, Institut National de la Santé et de la Recherche Médicale, Institut de Recherche pour le Developpement , Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Institut des Sciences de la Santé Publique d'Aix-Marseille, Marseille, France
| | - Camelia Protopopescu
- Aix Marseille Université, Institut National de la Santé et de la Recherche Médicale, Institut de Recherche pour le Developpement , Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Institut des Sciences de la Santé Publique d'Aix-Marseille, Marseille, France
| | - Vincent Di Beo
- Aix Marseille Université, Institut National de la Santé et de la Recherche Médicale, Institut de Recherche pour le Developpement , Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Institut des Sciences de la Santé Publique d'Aix-Marseille, Marseille, France
| | - Carole Cagnot
- ANRS | Emerging Infectious Diseases, Department of Clinical Research, Paris, France
| | - Celine Dorival
- Institut National de la Santé et de la Recherche Médicale, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France
| | - Jérôme Nicol
- Institut National de la Santé et de la Recherche Médicale, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France
| | - Fabien Zoulim
- Institut National de la Santé et de la Recherche Médicale U1052, Centre National de la Recherche Scientifique, Unités Mixtes de Recherche-5286, Cancer Research Center of Lyon, Lyon, France
- University of Lyon, Université Claude-Bernard, Lyon, France
- Hospices Civils de Lyon, Lyon, France
| | - Fabrice Carrat
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Hôpital Saint-Antoine, Unité de Santé Publique, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Patrizia Carrieri
- Aix Marseille Université, Institut National de la Santé et de la Recherche Médicale, Institut de Recherche pour le Developpement , Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Institut des Sciences de la Santé Publique d'Aix-Marseille, Marseille, France
| |
Collapse
|
7
|
Appa A, Baral S, Stein B, Knight K, Gandhi M, Coffin P, Martin M. The IMPACT (Infection Management Plus Addiction Care Together) Pilot: A Case Series of Combined Contingency Management for Substance Use Disorders and Antibiotic Adherence in the Hospital Setting. J Addict Med 2024; 18:138-143. [PMID: 38109334 PMCID: PMC10939948 DOI: 10.1097/adm.0000000000001254] [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] [Indexed: 12/20/2023]
Abstract
OBJECTIVES Psychostimulant-related mortality is rising alongside increasing substance use-related hospitalizations, which are commonly complicated by patient-directed (or "against medical advice") discharges. Contingency management (CM) is an underused evidence-based treatment for substance use disorders with proven efficacy to support medication adherence. Our objective was to describe feasibility and preliminary effectiveness of a novel CM intervention incentivizing both drug use reduction and antibiotic adherence in the hospital setting. METHODS We conducted a pilot intervention of twice weekly CM for stimulant and/or opioid use disorder and antibiotic adherence conducted on inpatient wards and/or an embedded skilled nursing facility in an urban public hospital. Based on point-of-care urine drug test results and objective antibiotic adherence review, participants earned increasing opportunities to receive incentives. We measured feasibility via number of visits attempted and cost of gift cards dispensed. We evaluated effectiveness via antibiotic completion, discharge type, and participant perception of intervention effectiveness collected via structured survey. RESULTS Of 13 participants enrolled, most had opioid use disorder (fentanyl in 10/13) and stimulant use disorder (methamphetamine in 7/13). Almost all were receiving treatment for osteomyelitis and/or endocarditis (12/13). Feasibility challenges included competing demands of acute care with variable range of completed visits per participant (1-12 visits). Despite this, antibiotic completion was high (92%, 12/13 participants) with only two patient-directed discharges. Participants described CM as very effective in aiding infection treatment but had greater variability in beliefs regarding CM facilitation of reduced drug use. CONCLUSIONS Providing CM in the hospital setting may represent an effective approach to improving health outcomes by increasing antibiotic adherence and addressing substance use.
Collapse
Affiliation(s)
- Ayesha Appa
- Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins University, Baltimore, USA
| | - Brianna Stein
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, USA
| | - Kelly Knight
- Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Monica Gandhi
- Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Phillip Coffin
- San Francisco Department of Public Health, San Francisco, USA
| | - Marlene Martin
- Department of Medicine, University of California, San Francisco, San Francisco, USA
| |
Collapse
|
8
|
Piselli P, Boschini A, Gianfreda R, Nappo A, Cimaglia C, Scarfò G, Smacchia C, Paoletti R, Duehren S, Girardi E. Integration of Hepatitis C and Addiction Treatment in People Who Inject Drugs: The San Patrignano HCV-Free and Drug-Free Experience. Viruses 2024; 16:375. [PMID: 38543741 PMCID: PMC10974793 DOI: 10.3390/v16030375] [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: 01/18/2024] [Revised: 02/19/2024] [Accepted: 02/21/2024] [Indexed: 05/23/2024] Open
Abstract
Injection drug use represents an important contributor to hepatitis C virus (HCV) transmission, hence therapeutic communities (TCs) are promising points of care for the identification and treatment of HCV-infected persons who inject drugs (PWIDs). We evaluated the effectiveness and efficacy of an HCV micro-elimination program targeting PWIDs in the context of a drug-free TC; we applied the cascade of care (CoC) evaluation by calculating frequencies of infection diagnosis, confirmation, treatment and achievement of a sustained virological response (SVR). We also evaluated the risk of reinfection of PWIDs achieving HCV eradication by collecting follow-up virologic information of previously recovered individuals and eventual relapse in drug use, assuming the latter as a potential source of reinfection. We considered 811 PWIDs (aged 18+ years) residing in San Patrignano TC at the beginning of the observation period (January 2018-March 2022) or admitted thereafter, assessing for HCV and HIV serology and viral load by standard laboratory procedures. Ongoing infections were treated with direct-acting antivirals (DAA), according to the current national guidelines. Out of the 792 individuals tested on admission, 503 (63.5%) were found to be seropositive for antibodies against HCV. A total of 481 of these 503 individuals (95.6%) underwent HCV RNA testing. Out of the 331 participants positive for HCV RNA, 225 were ultimately prescribed a DAA treatment with a sustained viral response (SVR), which was achieved by 222 PWIDs (98.7%). Of the 222 PWIDs, 186 (83.8%) with SVR remained HCV-free on follow-up (with a median follow-up of 2.73 years after SVR ascertainment). The CoC model in our TC proved efficient in implementing HCV micro-elimination, as well as in preventing reinfection and promoting retention in the care of individuals, which aligns with the therapeutic goals of addiction treatment.
Collapse
Affiliation(s)
- Pierluca Piselli
- Clinical Epidemiology Unit, Department of Epidemiology and Preclinical Research, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, 00149 Rome, Italy; (A.N.); (C.C.); (G.S.); (E.G.)
| | - Antonio Boschini
- Medical Center, Comunità di S. Patrignano, 47853 Coriano, RN, Italy; (A.B.); (C.S.); (R.P.); (S.D.)
| | - Romina Gianfreda
- Infectious Disease Unit, Hospital of Rimini “Gli Infermi”, 47923 Rimini, Italy;
| | - Alessandra Nappo
- Clinical Epidemiology Unit, Department of Epidemiology and Preclinical Research, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, 00149 Rome, Italy; (A.N.); (C.C.); (G.S.); (E.G.)
| | - Claudia Cimaglia
- Clinical Epidemiology Unit, Department of Epidemiology and Preclinical Research, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, 00149 Rome, Italy; (A.N.); (C.C.); (G.S.); (E.G.)
| | - Gianpaolo Scarfò
- Clinical Epidemiology Unit, Department of Epidemiology and Preclinical Research, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, 00149 Rome, Italy; (A.N.); (C.C.); (G.S.); (E.G.)
| | - Camillo Smacchia
- Medical Center, Comunità di S. Patrignano, 47853 Coriano, RN, Italy; (A.B.); (C.S.); (R.P.); (S.D.)
| | - Raffaella Paoletti
- Medical Center, Comunità di S. Patrignano, 47853 Coriano, RN, Italy; (A.B.); (C.S.); (R.P.); (S.D.)
| | - Sarah Duehren
- Medical Center, Comunità di S. Patrignano, 47853 Coriano, RN, Italy; (A.B.); (C.S.); (R.P.); (S.D.)
| | - Enrico Girardi
- Clinical Epidemiology Unit, Department of Epidemiology and Preclinical Research, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, 00149 Rome, Italy; (A.N.); (C.C.); (G.S.); (E.G.)
| |
Collapse
|
9
|
Lopes SS, Pericot-Valverde I, Lum PJ, Taylor LE, Mehta SH, Tsui JI, Feinberg J, Kim AY, Norton BL, Page K, Murray-Krezan C, Anderson J, Karasz A, Arnsten J, Moschella P, Heo M, Litwin AH. Overreporting of adherence to hepatitis C direct-acting antiviral therapy and sustained virologic response among people who inject drugs in the HERO study. BMC Infect Dis 2024; 24:251. [PMID: 38395747 PMCID: PMC10893697 DOI: 10.1186/s12879-024-09124-3] [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: 11/29/2023] [Accepted: 02/12/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Self-reported adherence to direct-acting antivirals (DAAs) to treat hepatitis C virus (HCV) among persons who inject drugs (PWID) is often an overreport of objectively measured adherence. The association of such overreporting with sustained virologic response (SVR) is understudied. This study among PWID aimed to determine a threshold of overreporting adherence that optimally predicts lower SVR rates, and to explore correlates of the optimal overreporting threshold. METHODS This study analyzed per-protocol data of participants with adherence data (N = 493) from the HERO (Hepatitis C Real Options) study. Self-reported and objective adherence to a 12-week DAA regimen were measured using visual analogue scales and electronic blister packs, respectively. The difference (Δ) between self-reported and objectively measured adherence was calculated. We used the Youden index based on receiver operating characteristic (ROC) curve analysis to identify an optimal threshold of overreporting for predicting lower SVR rates. Factors associated with the optimal threshold of overreporting were identified by comparing baseline characteristics between participants at/above versus those below the threshold. RESULTS The self-reported, objective, and Δ adherence averages were 95.1% (SD = 8.9), 75.9% (SD = 16.3), and 19.2% (SD = 15.2), respectively. The ≥ 25% overreporting threshold was determined to be optimal. The SVR rate was lower for ≥ 25% vs. < 25% overreporting (86.7% vs. 95.8%, p <.001). The factors associated with ≥ 25% Δ adherence were unemployment; higher number of days and times/day of injecting drugs; higher proportion of positive urine drug screening for amphetamine, methamphetamine, and oxycodone, and negative urine screening for THC (tetrahydrocannabinol)/cannabis. CONCLUSIONS Self-reported DAA adherence was significantly greater than objectively measured adherence among PWID by 19.2%. Having ≥ 25% overreported adherence was associated with optimal prediction of lower SVR rates. PWID with risk factors for high overreporting may need to be more intensively managed to promote actual adherence.
Collapse
Affiliation(s)
- Snehal S Lopes
- Department of Public Health Sciences, Clemson University, 29634, Clemson, SC, USA
| | - Irene Pericot-Valverde
- Department of Psychology, College of Behavioral, Social, and Health Sciences, Clemson University, 29634, Clemson, SC, USA
| | - Paula J Lum
- Department of Medicine, University of California, San Francisco, 1001 Potrero Ave, 94110, San Francisco, CA, USA
| | - Lynn E Taylor
- Department of Pharmacy Practice and Clinical Research, University of Rhode Island, 7 Greenhouse Road, 02881, Kingston, RI, USA
| | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E6546, 21205, Baltimore, MD, USA
| | - Judith I Tsui
- Department of Medicine, University of Washington, 325 9th Ave, 98104, Seattle, WA, USA
| | - Judith Feinberg
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, 930 Chestnut Ridge Road, 26505, Morgantown, WV, USA
- Department of Medicine, Section of Infectious Diseases, West Virginia University School of Medicine, 1 Medical Center Drive, 26506, Morgantown, WV, USA
| | - Arthur Y Kim
- Division of Infectious Diseases, Massachusetts General Hospital, 55 Fruit St, 02114, Boston, MA, USA
- Harvard Medical School, 02115, Boston, MA, USA
| | - Brianna L Norton
- Albert Einstein College of Medicine, 10461, Bronx, NY, USA
- Department of Medicine, Montefiore Medical Center, 10467, Bronx, NY, USA
| | - Kimberly Page
- Department of Internal Medicine, Health Sciences Center, University of New Mexico, University of New Mexico, MSC 10, 5550, 87131, Albuquerque, NM, USA
| | - Cristina Murray-Krezan
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, 15213, Pittsburgh, PA, USA
| | - Jessica Anderson
- Department of Internal Medicine, Health Sciences Center, University of New Mexico, University of New Mexico, MSC 10, 5550, 87131, Albuquerque, NM, USA
| | - Alison Karasz
- UMass Chan Medical School, University of Massachusetts Medical School, 55 Lake Ave, North, 01605, Worcester, MA, USA
| | - Julia Arnsten
- Albert Einstein College of Medicine, 10461, Bronx, NY, USA
- Department of Medicine, Montefiore Medical Center, 10467, Bronx, NY, USA
| | - Phillip Moschella
- Department of Emergency Medicine, Prisma Health, Greenville, SC, USA
- School of Health Research, Clemson University, Clemson, SC, USA
- Department of Medicine, University of South Carolina School of Medicine, 876 W Faris Rd, 29605, Greenville, SC, USA
| | - Moonseong Heo
- Department of Public Health Sciences, Clemson University, 29634, Clemson, SC, USA
| | - Alain H Litwin
- School of Health Research, Clemson University, Clemson, SC, USA.
- Department of Medicine, University of South Carolina School of Medicine, 876 W Faris Rd, 29605, Greenville, SC, USA.
- Department of Medicine, Prisma Health, 29605, Greenville, SC, USA.
| |
Collapse
|
10
|
O'Sullivan M, Jones AM, Mourad A, Haddadin Y, Verma S. Excellent hepatitis C virus cure rates despite increasing complexity of people who use drugs: Integrated-Test-stage Treat study final outcomes. J Viral Hepat 2024; 31:66-77. [PMID: 38018328 DOI: 10.1111/jvh.13897] [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: 06/15/2023] [Revised: 08/27/2023] [Accepted: 10/31/2023] [Indexed: 11/30/2023]
Abstract
Achieving hepatitic C virus (HCV) elimination requires linking people who use drugs (PWUD) into care. We report final direct-acting antivirals (DAAs)-based outcomes from the Integrated-Test-stage -Treat (ITTREAT) study. Project ITTREAT (2013-2021), based at an addiction centre, was a 'one-stop' service with innovative linkage to care strategies. Primary outcome was sustained virological response (SVR12) (intention to treat ITT) including whether individuals were recruited in first (period 1) versus last four (period 2 included the COVID-19 pandemic) years of the study. Number recruited were n = 765, mean age 40.9 ± 10.1 years, 78% males, history of current/past injecting drug use (IDU) and alcohol use being 77% and 90%, respectively. Prevalence of a positive HCV PCR was 84% with 19% having cirrhosis. Comparing those recruited in period 2 versus period 1, there was increasing prevalence of IDU, 90% versus 72% (p < .001); homelessness, 67% versus 50% (p < .001); psychiatric diagnosis, 84% versus 50% (p < .001); overdose history 71% versus 31% (p < .001), receiving opioid agonist treatment (OAT) 75% versus 52% (p < .001) and comorbidity 44% versus 25% (p < .001). Of those treated with DAAs (n = 272), ITT SVR rates were 86% (95% CI: 81%-90%), being similar in period 2 versus period 1. Predictors of non-SVR were receiving OAT (OR 0.33, 95% CI: 0.12-0.87, p = .025) and ≥80% adherence (OR 0.01, 95% CI: 0.003-0.041, p < .001). Reinfection rates period 2 versus period 1 (per 100 person-years) were 1.84 versus 1.70, respectively. In the treated cohort, mortality was 15%, being mostly drug-related. Despite increasing complexity of PWUD, high SVR12 rates are achievable with use of OAT and good adherence.
Collapse
Affiliation(s)
- Margaret O'Sullivan
- University Hospitals Sussex NHS Foundation Trust Brighton and Sussex University, Brighton, UK
| | | | - Adele Mourad
- University Hospitals Sussex NHS Foundation Trust Brighton and Sussex University, Brighton, UK
- Brighton & Sussex Medical School, Brighton, UK
| | - Yazan Haddadin
- University Hospitals Sussex NHS Foundation Trust Brighton and Sussex University, Brighton, UK
- Brighton & Sussex Medical School, Brighton, UK
| | - Sumita Verma
- University Hospitals Sussex NHS Foundation Trust Brighton and Sussex University, Brighton, UK
- Brighton & Sussex Medical School, Brighton, UK
| |
Collapse
|
11
|
Lopes SS, Pericot-Valverde I, Arnsten J, Lum PJ, Taylor LE, Mehta SH, Tsui JI, Feinberg J, Kim AY, Norton BL, Page K, Murray-Krezan C, Anderson J, Moschella P, Heo M, Litwin AH. Self-reported and measured adherence to hepatitis C direct-acting antiviral therapy and sustained virologic response among people who inject drugs: The HERO study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 123:104288. [PMID: 38103458 DOI: 10.1016/j.drugpo.2023.104288] [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: 08/14/2023] [Revised: 11/30/2023] [Accepted: 12/02/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Objective adherence measures, such as electronic blister pack (BP), for direct-acting antivirals (DAAs) for hepatitis C virus (HCV) treatment have high accuracy, but their use is limited in real practice settings. We examined the association of self-reported adherence using a visual analogue scale (VAS) with objective BP adherence and sustained virologic response (SVR) among people who inject drugs. METHODS We conducted secondary analyses using a subset of participants (N = 493) from the per-protocol sample of the HERO study, a pragmatic randomized trial of HCV treatment interventions that used both VAS and BP to measure adherence to a 12-week sofosbuvir/velpatasvir DAA regimen. Multivariable mixed-effects regression models tested the association of self-report adherence level with longitudinal weekly objective adherence. Multivariable logistic regression tested the association of self-report adherence with SVR. RESULTS The average VAS and BP adherences were 95.1 % (SD = 8.9 %) and 76.0 % (16.0 %), respectively, and the proportion of the participants achieving SVR was 92.9 %. The estimated adjusted mean objective adherence was significantly different (-16 %; 95 % CI: -22 %, -11 %, p < .001) between participants with 100 % and <80 % VAS adherence. The likelihood of SVR was significantly lower for those with <80 % VAS adherence [adjusted OR = 0.07; 95 % CI: 0.02, 0.24; p < .001] compared to those with 100 %. CONCLUSION Self-reported adherence overestimated objective adherence. However, higher self-report adherence was significantly associated with higher objective adherence. Also, self-reported adherence ≥80 % was significantly associated with SVR. Thus, the self-report measure has utility as a monitoring tool for adherence during DAA treatment.
Collapse
Affiliation(s)
- Snehal S Lopes
- Department of Public Health Sciences, Clemson University, Clemson, SC 29634, USA
| | - Irene Pericot-Valverde
- Department of Psychology, College of Behavioral, Social, and Health Sciences, Clemson University, Clemson, SC 29634, USA
| | - Julia Arnsten
- Albert Einstein College of Medicine, Bronx, NY 10461, USA; Department of Medicine, Montefiore Medical Center, Bronx, NY 10467, USA
| | - Paula J Lum
- Department of Medicine, University of California, 1001 Potrero Ave, San Francisco, CA 94110, USA
| | - Lynn E Taylor
- College of Pharmacy, University of Rhode Island, 7 Greenhouse Road, Kingston, RI 02881, USA
| | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615N. Wolfe Street, Room E6546, Baltimore, MD 21205, USA
| | - Judith I Tsui
- Department of Medicine, University of Washington, 325 9th Ave., Seattle, WA 98104, USA
| | - Judith Feinberg
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, 930 Chestnut Ridge Road, Morgantown, WV 26505, USA; Department of Medicine, Section of Infectious Diseases, West Virginia University School of Medicine, 930 Chestnut Ridge Road, Morgantown, WV 26505, USA
| | - Arthur Y Kim
- Division of Infectious Diseases, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, USA; Harvard Medical School, Boston, MA 02115, USA
| | - Brianna L Norton
- Albert Einstein College of Medicine, Bronx, NY 10461, USA; Department of Medicine, Montefiore Medical Center, Bronx, NY 10467, USA
| | - Kimberly Page
- Department of Internal Medicine, University of New Mexico Health Sciences Center, University of New Mexico MSC 10 5550, Albuquerque, NM 87131, USA
| | - Cristina Murray-Krezan
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Jessica Anderson
- Department of Internal Medicine, University of New Mexico Health Sciences Center, University of New Mexico MSC 10 5550, Albuquerque, NM 87131, USA
| | - Phillip Moschella
- Department of Emergency Medicine, Prisma Health, Greenville, SC, USA; School of Health Research, Clemson University, Clemson, SC, USA; Department of Medicine, University of South Carolina School of Medicine, 876W Faris Rd, Greenville, SC 29605, USA
| | - Moonseong Heo
- Department of Public Health Sciences, Clemson University, Clemson, SC 29634, USA
| | - Alain H Litwin
- School of Health Research, Clemson University, Clemson, SC, USA; Department of Medicine, University of South Carolina School of Medicine, 876W Faris Rd, Greenville, SC 29605, USA; Department of Medicine, Prisma Health, Greenville, SC, USA.
| |
Collapse
|
12
|
Horváth I, Mårdh O, Schwarz T. Models of good practice to enhance infectious disease care cascades among people who inject drugs: a qualitative study of interventions implemented in European settings. BMC Health Serv Res 2023; 23:1352. [PMID: 38049823 PMCID: PMC10696743 DOI: 10.1186/s12913-023-10412-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 11/30/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND People who inject drugs (PWID) in Europe are at an increased risk of HIV/AIDS, chronic viral hepatitis B (HBV) and C (HCV), and tuberculosis (TB). We aimed to complement the evidence base on interventions optimising their care cascade with evidence from models of good practice (MoGPs) implemented in the EU/EEA and countries from the Eastern European region. METHODS A model of good practice (MoGP) was defined as (a package of) interventions with proven effectiveness in certain settings that are likely to be replicable and sustainable in other settings or countries. Fifteen MoGPs, identified by the European Centre for Disease Prevention and Control (ECDC) and the European Monitoring Centre on Drugs and Drug Addiction (EMCDDA) following a call launched in 2020, have been analysed. For the 15 MoGPs, a qualitative content analysis was conducted of (i) intervention characteristics and (ii) enabling factors. Information was extracted and summarised for community-based testing, linkage to care and adherence to treatment. RESULTS MoGPs emerged from projects implemented in Belarus, Norway, Portugal, the Republic of Moldova, Spain, and the UK alongside the multi-country HepCare project (Ireland, Romania, Spain, the UK) targeting either HCV (6/15) or HIV/AIDS (4/15), alone or combined with HBV, and/or TB (5/15). All MoGPs used packages of interventions, with decentralisation of services (15/15), cooperation among service providers (14/15), integrated services (10/15), peer interventions (12/15), and case management (4/15) reported across all stages of the care cascade. The synthesis of enablers shows that when replicating interventions in other settings, consideration should be given to national (legal) frameworks, characteristics of and proximity between healthcare and service providers, and establishing relations of trust with PWID. CONCLUSION To improve the cascade of care for PWID in European settings, care structures and pathways should be simplified, based on cooperation and multidisciplinary. MoGPs can provide implementation-based evidence on interventions alongside evidence from peer-reviewed literature to optimise the care cascade among PWID.
Collapse
Affiliation(s)
- Ilonka Horváth
- Austrian National Public Health Institute (Gesundheit Österreich GmbH, GOEG), Vienna, Austria.
| | - Otilia Mårdh
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Tanja Schwarz
- Austrian National Public Health Institute (Gesundheit Österreich GmbH, GOEG), Vienna, Austria
| |
Collapse
|
13
|
Dröse S, Øvrehus ALH, Holm DK, Røge BT, Christensen PB. Hepatitis C screening and linkage to care with a mobile clinic in Southern Denmark. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 121:104180. [PMID: 37714009 DOI: 10.1016/j.drugpo.2023.104180] [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: 04/14/2023] [Revised: 08/25/2023] [Accepted: 08/25/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND Knowing the prevalence of hepatitis C (HCV) in risk groups is essential for elimination. The aim of the study was to assess HCV prevalence among people with different risk profiles and the feasibility of linking people with HCV to care. METHODS In Southern Denmark we tested people who were using shelters, cafés, and facilities for marginalized populations and the general population. We established a mobile clinic for HCV testing offering point-of-care HCV-antibody (HCV-Ab), point-of-care HCV RNA testing, and dried blood spot (DBS) testing. People with HCV infection were linked to care. RESULTS Among 802 tested persons, we found an HCV-Ab /HCV RNA prevalence of 13% (n = 101) /3% (n = 24). We found a prevalence of 20% (n = 97)/5% (n = 24) among 475 persons tested at locations attended by people who inject drugs but 0%/0% when testing the general population. Of 24 people who were HCV RNA positive, 83% (n = 20) initiated treatment, 13% (n = 3) spontaneously cleared their infection, and one was lost to follow-up. CONCLUSION General population testing has limited utility while focus on settings attended by people with increased HCV risk is more feasible. Linkage of people with a current HCV infection to care is feasible.
Collapse
Affiliation(s)
- Sandra Dröse
- Department of Infectious Diseases, Odense University Hospital, J. B. Winsloews Vej 4, Indgang 18 Penthouse 2. sal, DK-5000 Odense C, Denmark; Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Winsløwparken 19, 3. sal, DK-5000 Odense, Denmark; OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense.
| | - Anne Lindebo Holm Øvrehus
- Department of Infectious Diseases, Odense University Hospital, J. B. Winsloews Vej 4, Indgang 18 Penthouse 2. sal, DK-5000 Odense C, Denmark; Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Winsløwparken 19, 3. sal, DK-5000 Odense, Denmark
| | - Dorte Kinggaard Holm
- Department of Clinical Immunology, Odense University Hospital, J. B. Winsloews Vej 4, DK-5000 Odense C Odense, Denmark
| | - Birgit Thorup Røge
- Department of Medicine, Lillebaelt Hospital, Sygehusvej 24, DK-6000 Kolding, Denmark
| | - Peer Brehm Christensen
- Department of Infectious Diseases, Odense University Hospital, J. B. Winsloews Vej 4, Indgang 18 Penthouse 2. sal, DK-5000 Odense C, Denmark; Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Winsløwparken 19, 3. sal, DK-5000 Odense, Denmark
| |
Collapse
|
14
|
Schwarz C, Schubert R, Schwarz M, Schütz A, Jenke A, Bauer D, Steinwender B, Gutic E, Reiberger T, Haltmayer H, Gschwantler M. CHIME - A tailored HCV microelimination project in Viennese people who inject drugs at drug centralized substitution centers. J Virus Erad 2023; 9:100338. [PMID: 37663576 PMCID: PMC10474458 DOI: 10.1016/j.jve.2023.100338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/28/2023] [Accepted: 07/17/2023] [Indexed: 09/05/2023] Open
Abstract
Background Hepatitis C remains highly prevalent among people who inject drugs (PWIDs). We propose an integrated approach for screening/diagnostic testing and treatment in 6,665 Viennese PWIDs registered to access opioid agonist therapy (OAT). Methods OAT prescriptions were required monthly at one of nine approved authorities, making them ideal platforms for hepatitis C virus (HCV) screening. All PWIDs attending these authorities between January 2019 and March 2020 were offered on-site HCV screening, and consecutive HCV RNA PCR in case of positive HCV serology. In HCV viremic PWIDs, offsite referral to HCV care and treatment according to directly observed therapy (DOT) alongside OAT were performed. Results 4,327/6,665 (64.9%) individuals were contacted before the COVID-19-related project discontinuation. There were 1,538/4,327 (35.5%) individuals who had participated in the study. HCV serology was available in 1,510/1,538 (98.2%): 795/1,519 (52.6%) had a positive serology, among whom 632 (79.5%) were followed-up with a PCR test. In 8/1,538 (0.5%) additional study participants HCV RNA PCR was assessed without prior serological screening. 239/640 (37.3%) individuals were HCV viremic with 51 (21.3%) having started on direct-acting antivirals (DAAs). 48/51 (94.1%) had completed treatment, among whom 42 (87.5% according to ITT) had achieved sustained virologic response at 12 weeks after completing treatment (SVR12) and 6 (12.5%) had been lost to follow-up after completion of therapy (SVR12 according to mITT: 42/42, 100%). No treatment failures had occurred. Conclusion Providing integrated point-of-care HCV screening/diagnostic testing at central OAT approved centers, followed by DOT with DAAs, represents an effective HCV microelimination strategy. While some PWIDs were lost in the cascade to cure and the absolute number of SVR was limited by the COVID-19 pandemic, our approach will allow linkage to care in a large proportion of Viennese PWIDs.
Collapse
Affiliation(s)
- Caroline Schwarz
- Klinik Ottakring, Department of Internal Medicine IV, Vienna, Austria
- Medical University of Vienna, Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Vienna, Austria
- Vienna HIV & Liver Study Group, Vienna, Austria
| | - Raphael Schubert
- Suchthilfe Wien gGmbH, Ambulatorium Suchthilfe Wien, Vienna, Austria
| | - Michael Schwarz
- Klinik Ottakring, Department of Internal Medicine IV, Vienna, Austria
- Medical University of Vienna, Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Vienna, Austria
- Vienna HIV & Liver Study Group, Vienna, Austria
| | - Angelika Schütz
- Suchthilfe Wien gGmbH, Ambulatorium Suchthilfe Wien, Vienna, Austria
| | - Anika Jenke
- Suchthilfe Wien gGmbH, Ambulatorium Suchthilfe Wien, Vienna, Austria
| | - David Bauer
- Klinik Ottakring, Department of Internal Medicine IV, Vienna, Austria
- Medical University of Vienna, Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Vienna, Austria
- Vienna HIV & Liver Study Group, Vienna, Austria
| | | | - Enisa Gutic
- Klinik Ottakring, Department of Internal Medicine IV, Vienna, Austria
| | - Thomas Reiberger
- Medical University of Vienna, Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Vienna, Austria
- Vienna HIV & Liver Study Group, Vienna, Austria
| | - Hans Haltmayer
- Suchthilfe Wien gGmbH, Ambulatorium Suchthilfe Wien, Vienna, Austria
| | - Michael Gschwantler
- Klinik Ottakring, Department of Internal Medicine IV, Vienna, Austria
- Sigmund Freud University, Vienna, Austria
| |
Collapse
|
15
|
Corona-Mata D, Rivero-Juárez A, Camacho Á, Ruiz-Torres L, Ruiz-Cáceres I, de la Fuente Darder B, Cáceres-Anillo D, de Guía Castro-Granados M, Lizaur-Barbudo M, Victoria Cabrera-Gisbert M, Redondo-Écija J, Aparicio-Aparicio A, Manchado-López L, Cobos L, Pérez-Valero I, Rivero A. Efficacy of a comprehensive strategy for the detection and treatment of hepatitis C infection in a population attending addiction centers. Front Public Health 2023; 11:1092960. [PMID: 36817894 PMCID: PMC9932806 DOI: 10.3389/fpubh.2023.1092960] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/16/2023] [Indexed: 02/05/2023] Open
Abstract
Background and aims The burden hepatitis C infection in people with history or current drug use suppose a high risk of hepatic complications and transmission infectious disease. This population is poor linked to heath system and is difficult to achieve them and support treatment because they have high rates of lost follow-up. Our aim was to evaluate an intervention for the diagnosis and treatment of chronic hepatitis C and HIV in this population. Methods Six-hundred and eighty-three people attended in Drugs and Addictions Centers (DAC) were asked to participate in health counseling and provide blood sample for test HCV, HIV, and syphilis from April 2019 to June 2020. Totally 556 subjects were surveyed and tested. All of them were assigned to a patient navigation program to improve health education and linking to the sanitary system. Hepatitis C infection patients were evaluated in an ampliated medical consult to evaluate hepatic stage with transient liver elastography and initiated Direct Acting Antivirals to achieve Sustained Viral Response. Results Of the 556 patients who agreed to participate in the study, 33 (5.9%) had active HCV infection. Of the 33 patients infected with HCV, three were lost to follow-up once the diagnosis of HCV infection was made. Twenty-eight patients (93.3%) completed treatment and 26 achieved Sustained Viral Response (78.8%). Of the 30 patients, seven (23.3%) had advanced fibrosis, and of these, four (16.6%) had liver cirrhosis. One of the cirrhotic patients had hepatic space-occupying lesions at the baseline evaluation and was diagnosed with hepatocarcinoma. Conclusions Our study suggests that the implementation of strategies based on personalized intervention models can contribute to the control of HCV infection in DAC users.
Collapse
Affiliation(s)
- Diana Corona-Mata
- Infectious Diseases Department, Maimonides Institute of Biomedical Research of Córdoba (IMIBIC), Reina Sofía University Hospital of Córdoba, University of Córdoba, Córdoba, Spain
| | - Antonio Rivero-Juárez
- Infectious Diseases Department, Maimonides Institute of Biomedical Research of Córdoba (IMIBIC), Reina Sofía University Hospital of Córdoba, University of Córdoba, Córdoba, Spain,CIBERINFEC, ISCIII – CIBER of Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain,*Correspondence: Antonio Rivero-Juárez ✉
| | - Ángela Camacho
- Infectious Diseases Department, Maimonides Institute of Biomedical Research of Córdoba (IMIBIC), Reina Sofía University Hospital of Córdoba, University of Córdoba, Córdoba, Spain,CIBERINFEC, ISCIII – CIBER of Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain
| | - Laura Ruiz-Torres
- Infectious Diseases Department, Maimonides Institute of Biomedical Research of Córdoba (IMIBIC), Reina Sofía University Hospital of Córdoba, University of Córdoba, Córdoba, Spain
| | - Inmaculada Ruiz-Cáceres
- Infectious Diseases Department, Maimonides Institute of Biomedical Research of Córdoba (IMIBIC), Reina Sofía University Hospital of Córdoba, University of Córdoba, Córdoba, Spain
| | - Bartolomé de la Fuente Darder
- Unidad de Drogas y Adicciones-CPD (UDA-CPD), Instituto Provincial Bienestar Social, Diputación Córdoba, Córdoba, Spain
| | | | - María de Guía Castro-Granados
- Unidad de Drogas y Adicciones-CPD (UDA-CPD), Instituto Provincial Bienestar Social, Diputación Córdoba, Córdoba, Spain
| | - María Lizaur-Barbudo
- Unidad de Drogas y Adicciones-CPD (UDA-CPD), Instituto Provincial Bienestar Social, Diputación Córdoba, Córdoba, Spain
| | | | - Justa Redondo-Écija
- Unidad de Drogas y Adicciones-CPD (UDA-CPD), Instituto Provincial Bienestar Social, Diputación Córdoba, Córdoba, Spain
| | - Ana Aparicio-Aparicio
- Unidad de Drogas y Adicciones-CPD (UDA-CPD), Instituto Provincial Bienestar Social, Diputación Córdoba, Córdoba, Spain
| | - Leticia Manchado-López
- Unidad de Drogas y Adicciones-CPD (UDA-CPD), Instituto Provincial Bienestar Social, Diputación Córdoba, Córdoba, Spain
| | - Luciano Cobos
- Unidad de Drogas y Adicciones-CPD (UDA-CPD), Instituto Provincial Bienestar Social, Diputación Córdoba, Córdoba, Spain
| | - Ignacio Pérez-Valero
- Infectious Diseases Department, Maimonides Institute of Biomedical Research of Córdoba (IMIBIC), Reina Sofía University Hospital of Córdoba, University of Córdoba, Córdoba, Spain,CIBERINFEC, ISCIII – CIBER of Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain
| | - Antonio Rivero
- Infectious Diseases Department, Maimonides Institute of Biomedical Research of Córdoba (IMIBIC), Reina Sofía University Hospital of Córdoba, University of Córdoba, Córdoba, Spain,CIBERINFEC, ISCIII – CIBER of Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
16
|
Cunningham EB, Wheeler A, Hajarizadeh B, French CE, Roche R, Marshall AD, Fontaine G, Conway A, Bajis S, Valencia BM, Presseau J, Ward JW, Degenhardt L, Dore GJ, Hickman M, Vickerman P, Grebely J. Interventions to enhance testing and linkage to treatment for hepatitis C infection for people who inject drugs: A systematic review and meta-analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 111:103917. [PMID: 36542883 DOI: 10.1016/j.drugpo.2022.103917] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 11/10/2022] [Accepted: 11/12/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND With the advent of direct acting antiviral (DAA) therapies for the treatment of hepatitis C virus (HCV), the World Health Organization recommended a goal to eliminate HCV as a public health threat globally by 2030. With the majority of new and existing infections in high income countries occurring among people who inject drugs, achieving this goal will require the design and implementation of interventions which address the unique barriers to HCV care faced by this population. METHODS In this systematic review and meta-analysis, we searched bibliographic databases and conference abstracts to July 21, 2020 for studies assessing interventions to improve the following study outcomes: HCV antibody testing, HCV RNA testing, linkage to care, and treatment initiation. We included both randomised and non-randomised studies which included a comparator arm. We excluded studies which enrolled only paediatric populations (<18 years old) and studies where the intervention was conducted in a different healthcare setting than the control or comparator. This analysis was restricted to studies conducted among people who inject drugs. Data were extracted from the identified records and meta-analysis was used to pool the effect of interventions on study outcomes. This study was registered in PROSPERO (CRD42020178035). FINDINGS Of 15,342 unique records, 45 studies described the implementation of an intervention to improve HCV testing, linkage to care and treatment initiation among people who inject drugs. These included 27 randomised trials and 18 non-randomised studies with the risk of bias rated as "critical" for most non-randomised studies. Patient education and patient navigation to address patient-level barriers to HCV care were shown to improve antibody testing uptake and linkage to HCV care respectively although patient education did not improve antibody testing when restricted to randomised studies. Provider care coordination to address provider level barriers to HCV care was effective at improving antibody testing uptake. Three different interventions to address systems-level barriers to HCV care were effective across different stages of HCV care: point-of-care antibody testing (linkage to care); dried blood-spot testing (antibody testing uptake); and integrated care (linkage to care and treatment initiation). INTERPRETATION Multiple interventions are available that can address the barriers to HCV care for people who inject drugs at the patient-, provider-, and systems-level. The design of models of care to improve HCV testing and treatment among people who inject drugs must consider the unique barriers to care that this population faces. Further research, including high-quality randomised controlled trials, are needed to robustly assess the impact these interventions can have in varied populations and settings.
Collapse
Affiliation(s)
| | - Alice Wheeler
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | | | - Clare E French
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1UD, UK; NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Rachel Roche
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Division, National Infection Service, Public Health England Colindale, London, UK; The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL, NIHR, London, UK
| | - Alison D Marshall
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - Guillaume Fontaine
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Anna Conway
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - Sahar Bajis
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | | | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - John W Ward
- Coalition for Global Hepatitis Elimination, The Task Force for Global Health, Decatur GA, USA
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Gregory J Dore
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1UD, UK; NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1UD, UK; NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| |
Collapse
|
17
|
Fomiatti R, Shaw F, Fraser S. 'It's a different way to do medicine': Exploring the affordances of telehealth for hepatitis C healthcare. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 110:103875. [PMID: 36257085 DOI: 10.1016/j.drugpo.2022.103875] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 09/27/2022] [Accepted: 09/29/2022] [Indexed: 11/07/2022]
Abstract
While the use of telehealth was common in hepatitis C healthcare in Australia in remote and regional areas prior to the COVID-19 pandemic, it has been used more broadly to improve access to hepatitis C heathcare during the pandemic. Despite its widespread uptake, little research has explored how telehealth shapes hepatitis C healthcare. In this article, we draw on the concept of affordances (Latour, 2002) and interviews with 25 healthcare practitioners to explore the emergent possibilities for hepatitis C care that take shape through telehealth. Despite suggestions that telehealth is comparable to in-person care, healthcare practitioners' accounts suggest that telehealth significantly changes the nature of their experience of providing healthcare for hepatitis C. According to these service practitioners, while it increased access to hepatitis C healthcare during the pandemic, it also afforded narrower, less personal healthcare encounters, with a focus on simple and singular issues, and reduced opportunities for communication and rapport. These affordances also discouraged the use of interpreters and by extension the inclusion of patients from non-English speaking backgrounds. However, the data collected also suggest that telehealth has the potential to afford more informal and relaxed healthcare environments and dispositions between healthcare practitioners and patients, potentially disrupting classic practitioner-patient power dynamics. In concluding, the article considers how telehealth models of care might better afford quality hepatitis C healthcare and care beyond COVID-19 pandemic conditions.
Collapse
Affiliation(s)
- Renae Fomiatti
- School of Humanities and Social Sciences, Deakin University; Australian Research Centre in Sex, Health and Society, La Trobe University.
| | - Frances Shaw
- ARC Centre of Excellence for Automated Decision-Making and Society, Swinburne University of Technology
| | - Suzanne Fraser
- Australian Research Centre in Sex, Health and Society, La Trobe University; Centre for Social Research in Health, University of New South Wales
| |
Collapse
|
18
|
Burgui C, San Miguel R, Goñi-Esarte S, Juanbeltz R, Úriz-Otano JI, Reparaz J, Sarobe M, Zozaya JM, Castilla J. Effectiveness of hepatitis C antiviral treatment and feasibility of hepatitis C elimination goal. Postgrad Med 2022; 135:352-360. [PMID: 36305320 DOI: 10.1080/00325481.2022.2141499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Second-generation direct-acting antivirals (DAAs) have shown high efficacy in the treatment of chronic hepatitis C virus (HCV) infections in clinical trials. This study aimed to estimate the effectiveness in real-life conditions and their capacity to eliminate HCV infection in the general population. METHODS In this observational cohort study, patients with active HCV infection who commenced DAA treatment between 2015 and 2020 in Navarre, Spain, were studied. Sustained virological response (SVR), defined as an undetectable viral load 12 weeks after the end of treatment, was evaluated until the end of 2021. RESULTS Of a total 1366 HCV-infected patients that commenced treatment, 19.3% (n = 263) were HIV-coinfected. After the first DAA treatment, SVR was achieved in 96.6% (n = 1320/1366) of patients and in 97.7% (95% confidence interval [CI] 96.6%-98.3%) of those who completed treatment (per-protocol analysis; n = 1320/1351). SVR was achieved in 97.9% (n = 1066/1089) and 96.9% (n = 254/262) of mono-infected and HIV-coinfected patients, respectively. Thirty-one patients had virological failure due to non-response (n = 19), poor compliance (n = 9), and with adverse events (n = 3). Of 27 patients that received a second treatment, 24 attained SVR (one after a third treatment), two died, and one that did not achieve SVR declined a third treatment. Three patients were re-infected, re-treated, and achieved SVR. At the end of the study, 1344 patients (98.4%, 95% CI 97.6%-98.9%) had achieved SVR, and only 1.8% needed more than one course of treatment. All patients who completed the treatment and were followed-up achieved SVR. CONCLUSION With DAAs, SVR was achieved in all patients with active HCV infection who completed follow-up, and a second course of treatment was only necessary in a small proportion of patients. Adherence to treatment is essential for HCV infection elimination.
Collapse
Affiliation(s)
- Cristina Burgui
- Instituto de Salud Pública de Navarra, Pamplona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Ramón San Miguel
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- Servicio de Farmacia Hospitalaria, Hospital Universitario de Navarra, Pamplona, Spain
| | - Silvia Goñi-Esarte
- Servicio de Digestivo, Hospital Universitario de Navarra, Pamplona, Spain
| | - Regina Juanbeltz
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- Servicio de Farmacia Hospitalaria, Hospital Universitario de Navarra, Pamplona, Spain
| | - Juan Isidro Úriz-Otano
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- Servicio de Digestivo, Hospital Universitario de Navarra, Pamplona, Spain
| | - Jesús Reparaz
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- Servicio de Medicina Interna, Hospital Universitario de Navarra, Pamplona, Spain
| | - Maite Sarobe
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- Servicio de Farmacia Hospitalaria, Hospital Universitario de Navarra, Pamplona, Spain
| | - José Manuel Zozaya
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- Servicio de Digestivo, Hospital Universitario de Navarra, Pamplona, Spain
| | - Jesús Castilla
- Instituto de Salud Pública de Navarra, Pamplona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| |
Collapse
|
19
|
Nevola R, Rosato V, Conturso V, Perillo P, Le Pera T, Del Vecchio F, Mastrocinque D, Pappalardo A, Imbriani S, Delle Femine A, Piacevole A, Claar E. Can Telemedicine Optimize the HCV Care Cascade in People Who Use Drugs? Features of an Innovative Decentralization Model and Comparison with Other Micro-Elimination Strategies. BIOLOGY 2022; 11:biology11060805. [PMID: 35741326 PMCID: PMC9219847 DOI: 10.3390/biology11060805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 05/21/2022] [Accepted: 05/21/2022] [Indexed: 11/25/2022]
Abstract
Simple Summary The global fight against the hepatitis C virus (HCV) involves the processes of micro-elimination of populations at risk. People who use drugs (PWUDs) represent a viral reservoir, due to the historical challenge in treating this population. In particular, the difficulties in the linkage to care of these patients, as well as low adherence to therapies and follow-up and the risk of re-infection make PWUDs a “difficult-to-treat” population. In view of this, the testing of effective management and treatment models for chronic HCV infection in PWUDs is crucial for promoting its elimination. Telemedicine could be a successful solution in the integration and decentralization of care services. Abstract People who use drugs (PWUDs) are a crucial population in the global fight against viral hepatitis. The difficulties in linkage to care, the low adherence to therapy, the frequent loss to follow-up and the high risk of re-infection make the eradication process of the hepatitis C virus (HCV) really hard in this viral reservoir. Several management and treatment models have been tested with the aim of optimizing the HCV care cascade in PWUDs. Models of decentralization of the care process and integration of services seem to provide the highest success rates. Giving this, telemedicine could favor the decentralization of diagnostic-therapeutic management, key for the implementation of linkage to care, reduction of waiting times, optimization of adherence and results and reduction of the costs. The purpose of this literature review is to examine the role and possible impact of telemedicine in optimizing the HCV care cascade, comparing the different care models that have shown to improve the linkage to care and therapeutic adherence in this special population.
Collapse
Affiliation(s)
- Riccardo Nevola
- Hepatology Unit, Ospedale Evangelico Betania, 80147 Naples, Italy; (V.R.); (P.P.); (D.M.); (A.P.); (E.C.)
- Internal Medicine Unit, Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (S.I.); (A.D.F.); (A.P.)
- Correspondence: ; Tel.: +39-081-566-4173
| | - Valerio Rosato
- Hepatology Unit, Ospedale Evangelico Betania, 80147 Naples, Italy; (V.R.); (P.P.); (D.M.); (A.P.); (E.C.)
| | - Vincenza Conturso
- Service for Addiction, DS32, ASL Napoli 1, 80147 Naples, Italy; (V.C.); (T.L.P.); (F.D.V.)
| | - Pasquale Perillo
- Hepatology Unit, Ospedale Evangelico Betania, 80147 Naples, Italy; (V.R.); (P.P.); (D.M.); (A.P.); (E.C.)
| | - Teresa Le Pera
- Service for Addiction, DS32, ASL Napoli 1, 80147 Naples, Italy; (V.C.); (T.L.P.); (F.D.V.)
| | - Ferdinando Del Vecchio
- Service for Addiction, DS32, ASL Napoli 1, 80147 Naples, Italy; (V.C.); (T.L.P.); (F.D.V.)
| | - Davide Mastrocinque
- Hepatology Unit, Ospedale Evangelico Betania, 80147 Naples, Italy; (V.R.); (P.P.); (D.M.); (A.P.); (E.C.)
| | - Annalisa Pappalardo
- Hepatology Unit, Ospedale Evangelico Betania, 80147 Naples, Italy; (V.R.); (P.P.); (D.M.); (A.P.); (E.C.)
| | - Simona Imbriani
- Internal Medicine Unit, Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (S.I.); (A.D.F.); (A.P.)
| | - Augusto Delle Femine
- Internal Medicine Unit, Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (S.I.); (A.D.F.); (A.P.)
| | - Alessia Piacevole
- Internal Medicine Unit, Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (S.I.); (A.D.F.); (A.P.)
| | - Ernesto Claar
- Hepatology Unit, Ospedale Evangelico Betania, 80147 Naples, Italy; (V.R.); (P.P.); (D.M.); (A.P.); (E.C.)
| |
Collapse
|