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Wolfson-Stofko B, Hirode G, Vanderhoff A, Karkada J, Capraru C, Biondi MJ, Hansen B, Shah H, Janssen HLA, Feld JJ. Real-world hepatitis C prevalence and treatment uptake at opioid agonist therapy clinics in Ontario, Canada. J Viral Hepat 2024; 31:240-247. [PMID: 38385850 DOI: 10.1111/jvh.13931] [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: 10/28/2023] [Revised: 02/02/2024] [Accepted: 02/15/2024] [Indexed: 02/23/2024]
Abstract
Widespread screening for hepatitis C virus (HCV) is necessary for Canada to meet its HCV elimination goals by 2030. People who currently or previously injected drugs are at high risk for HCV. Opioid agonist therapy (OAT, such as methadone and buprenorphine) has been shown to help stabilize the lives of people who are opioid-dependent. The distribution of OAT in North America typically requires daily, weekly, or monthly clinic visits and presents an opportunity for engagement, screening and treatment for those at high-risk of HCV. In this study, HCV screening was conducted by staff at OAT clinics in Ontario from 2016 to 2020 and those with chronic infections were treated on-site with direct-acting antivirals. Point-of-care or dried blood spot (DBS) testing was used for antibodies, DBS or serum for HCV RNA and serum for HCV RNA at SVR12 (sustained virological response). Clinics screened 1954 people (mean age 40 years ±12, 63% male). Forty-five percent were antibody positive, of whom 64% were HCV RNA+. Eighty percent of those RNA+ set an appointment in which 99% attended. Ninety-six percent started treatment with 87% completing treatment. Sixty-eight percent of people who completed treatment submitted a sample for SVR12 testing of which 97% achieved a virological cure. Results suggest that HCV screening and treatment at OAT clinics is feasible, effective and warrants expansion. Data suggest strong treatment adherence due to high rates of SVR12 comparable with other OAT-based HCV treatment programs. The lack of SVR12 sampling could be addressed by either on-site phlebotomy or incentivizing SVR12 sampling.
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Affiliation(s)
- B Wolfson-Stofko
- Viral Hepatitis Care Network (VIRCAN), Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada
- Center for Drug Use and HIV/HCV Research (CDUHR), College of Global Public Health, New York University, New York, New York, USA
| | - G Hirode
- Viral Hepatitis Care Network (VIRCAN), Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada
| | - A Vanderhoff
- Viral Hepatitis Care Network (VIRCAN), Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada
| | - J Karkada
- Viral Hepatitis Care Network (VIRCAN), Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada
| | - C Capraru
- Viral Hepatitis Care Network (VIRCAN), Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada
| | - M J Biondi
- Viral Hepatitis Care Network (VIRCAN), Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada
- School of Nursing, York University, Toronto, Ontario, Canada
| | - B Hansen
- Viral Hepatitis Care Network (VIRCAN), Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada
- Division of Gastroenterology & Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Biostatistics, Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - H Shah
- Viral Hepatitis Care Network (VIRCAN), Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada
| | - H L A Janssen
- Viral Hepatitis Care Network (VIRCAN), Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada
- Division of Gastroenterology & Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - J J Feld
- Viral Hepatitis Care Network (VIRCAN), Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada
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2
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Marshall AD, Willing AR, Kairouz A, Cunningham EB, Wheeler A, O'Brien N, Perera V, Ward JW, Hiebert L, Degenhardt L, Hajarizadeh B, Colledge S, Hickman M, Jawad D, Lazarus JV, Matthews GV, Scheibe A, Vickerman P, Dore GJ, Grebely J. Direct-acting antiviral therapies for hepatitis C infection: global registration, reimbursement, and restrictions. Lancet Gastroenterol Hepatol 2024; 9:366-382. [PMID: 38367631 DOI: 10.1016/s2468-1253(23)00335-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/25/2023] [Accepted: 10/02/2023] [Indexed: 02/19/2024]
Abstract
Direct-acting antivirals (DAAs) for hepatitis C virus (HCV) infection have delivered high response rates (>95%) and simplified the management of HCV treatment, permitting non-specialists to manage patients without advanced liver disease. We collected and reviewed global data on the registration and reimbursement (government subsidised) of HCV therapies, including restrictions on reimbursement. Primary data collection occurred between Nov 15, 2021, and July 24, 2023, through the assistance of a global network of 166 HCV experts. We retrieved data for 160 (77%) of 209 countries and juristrictions. By mid-2023, 145 (91%) countries had registered at least one of the following DAA therapies: sofosbuvir-velpatasvir, sofosbuvir-velpatasvir-voxilaprevir, glecaprevir-pibrentasvir, sofosbuvir-daclatasvir, or sofosbuvir. 109 (68%) countries reimbursed at least one DAA therapy. Among 102 low-income and middle-income countries (LMICs), 89 (87%) had registered at least one HCV DAA therapy and 53 (52%) reimbursed at least one DAA therapy. Among all countries with DAA therapy reimbursement (n=109), 66 (61%) required specialist prescribing, eight (7%) had retreatment restrictions, seven (6%) had an illicit drug use restriction, five (5%) had an alcohol use restriction, and three (3%) had liver disease restrictions. Global access to DAA reimbursement remains uneven, with LMICs having comparatively low reimbursement compared with high-income countries. To meet WHO goals for HCV elimination, efforts should be made to assist countries, particularly LMICs, to increase access to DAA reimbursement and remove reimbursement restrictions-especially prescriber-type restrictions-to ensure universal access.
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Affiliation(s)
- Alison D Marshall
- Viral Hepatitis Clinical Research Program, The Kirby Institute, University of New South Wales, Sydney, NSW, Australia; Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia.
| | - Alex R Willing
- Viral Hepatitis Clinical Research Program, The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Abe Kairouz
- Viral Hepatitis Clinical Research Program, The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Evan B Cunningham
- Viral Hepatitis Clinical Research Program, The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Alice Wheeler
- Viral Hepatitis Clinical Research Program, The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | | | | | - John W Ward
- Coalition for Global Hepatitis Elimination, Task Force for Global Health, Decatur, GA, USA
| | - Lindsey Hiebert
- Coalition for Global Hepatitis Elimination, Task Force for Global Health, Decatur, GA, USA
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Behzad Hajarizadeh
- Viral Hepatitis Clinical Research Program, The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Samantha Colledge
- National Drug Research Institute, Curtin University, Perth, WA, Australia
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Danielle Jawad
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (IS Global), Hospital Clinic, University of Barcelona, Barcelona, Spain; CUNY Graduate School of Public Health and Health Policy, New York, NY, USA
| | - Gail V Matthews
- Therapeutic and Vaccine Research Program, The Kirby Institute, University of New South Wales, Sydney, NSW, Australia; St Vincent's Hospital, Darlinghurst, Sydney, NSW, Australia
| | - Andrew Scheibe
- TB HIV Care, Cape Town, South Africa; Community Orientated, Primary Care Research Unit, Department of Family Medicine, University of Pretoria, Pretoria, South Africa
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Gregory J Dore
- Viral Hepatitis Clinical Research Program, The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Jason Grebely
- Viral Hepatitis Clinical Research Program, The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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3
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Kim RG, Price JC. A framework for approaching hepatitis C reinfection in people who use drugs. Clin Liver Dis (Hoboken) 2024; 23:e0200. [PMID: 38872769 PMCID: PMC11168836 DOI: 10.1097/cld.0000000000000200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 03/29/2024] [Indexed: 06/15/2024] Open
Affiliation(s)
- Rebecca G. Kim
- Department of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Jennifer C. Price
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
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Zhang Y, Li J, Xie Y, Wu D, Ong J, Marley G, Kamarulzaman A, Lu H, Zou F, Smith JS, Tucker JD, Fu G, Tang W. Pay-it-forward incentives for hepatitis virus testing in men who have sex with men: a cluster randomized trial. Nat Med 2023; 29:2241-2247. [PMID: 37640859 DOI: 10.1038/s41591-023-02519-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 07/28/2023] [Indexed: 08/31/2023]
Abstract
Pay-it-forward incentives involve having a person receive a free test with community-generated messages and then asking if those who received a free test would like to donate money to support others to receive free testing. Here we undertook a two-arm cluster-randomized trial to evaluate pay-it-forward incentives with active community participation to promote hepatitis B virus (HBV) and hepatitis C virus (HCV) testing among men who have sex with men in China. Men randomized to the pay-it-forward arm received free HBV and HCV testing and were offered a chance to pay-it-forward by donating money to support the testing of another anonymous person. Each participant paid for their HCV and HBV test at 7.7 USD per test in the standard-of-care arm. The primary outcome was the proportion of men who tested for HBV and HCV. Between 28 March and 6 November 2021, 32 groups (10 men per group) of men were randomized to the pay-it-forward (n = 160, 16 clusters) and standard-of-care (n = 162, 16 clusters) arms, respectively. HBV and HCV rapid testing were higher in the pay-it-forward arm (59.4%) than in the standard-of-care arm (25.3%) (proportion difference 35.2%, 95% confidence interval 24.1-46.3%). No adverse events were reported. The community-led pay-it-forward incentives improved HBV and HCV testing among men who have sex with men. Clinical Trial registration: ChiCTR 2100046140.
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Affiliation(s)
- Ye Zhang
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Jianjun Li
- Department of HIV/STI Prevention and Control, Jiangsu Provincial Center for Diseases Prevention and Control, Nanjing, China
| | - Yewei Xie
- University of North Carolina Project-China, Guangzhou, China
| | - Dan Wu
- School of Public Health, Nanjing Medical University, Nanjing, China
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Jason Ong
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Gifty Marley
- University of North Carolina Project-China, Guangzhou, China
| | - Adeeba Kamarulzaman
- University of Malaysia, Kuala Lumpur, Malaysia
- International AIDS Society, Geneva, Switzerland
| | - Haidong Lu
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Fei Zou
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Jennifer S Smith
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Joseph D Tucker
- University of North Carolina Project-China, Guangzhou, China
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Gengfeng Fu
- Department of HIV/STI Prevention and Control, Jiangsu Provincial Center for Diseases Prevention and Control, Nanjing, China.
| | - Weiming Tang
- University of North Carolina Project-China, Guangzhou, China.
- Guangdong Second Provincial General Hospital, Guangzhou, China.
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Winter RJ, Sheehan Y, Papaluca T, Macdonald GA, Rowland J, Colman A, Stoove M, Lloyd AR, Thompson AJ. Consensus recommendations on the management of hepatitis C in Australia's prisons. Med J Aust 2023; 218:231-237. [PMID: 36871200 DOI: 10.5694/mja2.51854] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 01/04/2023] [Indexed: 03/06/2023]
Abstract
INTRODUCTION Prison settings represent the highest concentration of prevalent hepatitis C cases in Australia due to the high rates of incarceration among people who inject drugs. Highly effective direct-acting antiviral (DAA) therapies for hepatitis C virus (HCV) infection are available to people incarcerated in Australian prisons. However, multiple challenges to health care implementation in the prison sector present barriers to people in prison reliably accessing hepatitis C testing, treatment, and prevention measures. MAIN RECOMMENDATIONS This Consensus statement highlights important considerations for the management of hepatitis C in Australian prisons. High coverage testing, scale-up of streamlined DAA treatment pathways, improved coverage of opioid agonist therapy, and implementation and evaluation of regulated provision of prison needle and syringe programs to reduce HCV infection and reinfection are needed. CHANGES IN MANAGEMENT AS A RESULT OF THIS STATEMENT The recommendations set current best practice standards in hepatitis C diagnosis, treatment and prevention in the Australian prison sector based on available evidence. Prison-based health services should strive to simplify and improve efficiency in the provision of the hepatitis C care cascade, including strategies such as universal opt-out testing, point-of-care testing, simplified assessment protocols, and earlier confirmation of cure. Optimising hepatitis C management in prisons is essential to prevent long term adverse outcomes for a marginalised population living with HCV. Scale-up of testing and treatment in prisons will make a major contribution towards Australia's efforts to eliminate hepatitis C as a public health threat by 2030.
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Affiliation(s)
- Rebecca J Winter
- Monash University, Melbourne, VIC
- Burnet Institute, Melbourne, VIC
- St Vincent's Hospital, Melbourne, VIC
| | - Yumi Sheehan
- Kirby Institute, University of New South Wales, Sydney, NSW
| | - Timothy Papaluca
- St Vincent's Hospital, Melbourne, VIC
- University of Melbourne, Melbourne, VIC
| | - Graeme A Macdonald
- University of Queensland, Brisbane, QLD
- Princess Alexandra Hospital, Brisbane, QLD
| | - Joy Rowland
- Department of Justice, Government of Western Australia, Perth, WA
| | | | - Mark Stoove
- Monash University, Melbourne, VIC
- Burnet Institute, Melbourne, VIC
| | - Andrew R Lloyd
- Kirby Institute, University of New South Wales, Sydney, NSW
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Di Ciaccio M, Villes V, Perfect C, El Kaim JL, Donatelli M, James C, Easterbrook P, Delabre RM. Need for integration of hepatitis C (HCV) services in community-based settings for people who inject drugs: results from a global values and preferences survey. Harm Reduct J 2023; 20:15. [PMID: 36759855 PMCID: PMC9909907 DOI: 10.1186/s12954-023-00743-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/25/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND To inform the development of updated World Health Organization (WHO) guidelines on simplified service delivery for HCV infection, a global survey was undertaken among people affected or infected by HCV. The objective of this analysis is to identify specific needs and preferences among people who inject drugs. METHODS A multi-country, anonymous, self-administered online survey conducted in 2021 was developed by Coalition PLUS and the World Hepatitis Alliance in partnership with the WHO. Preferences for test and treat locations and simplifying HCV care were collected among people affected or infected by HCV. Chi-square tests were used to compare respondents who identified with current or former injection drug users through identification with key population to other respondents who did not identify with this key population. RESULTS Among 202 respondents, 62 (30.7%) identified with current/former injection drug users. Compared to other respondents, they were: older [median (IQR): 48 (36-57) vs. 39 (31-51) years, p = 0.003]; more likely to have been tested for HCV (90.2% vs. 64.3%, p = 0.001); more likely to prefer testing in a community-based centre (CBC) (55.4% vs. 33.3%, p = 0.005); or in a support centres for people who use drugs (SCPUD)(50.0% vs. 9.8%, p < 0.001). The most important considerations regarding testing locations among people identified with current/former injection drug users (compared to the other respondents) were: non-judgemental atmosphere (p < 0.001), anonymity (p = 0.018) and community worker (CW) presence (p < 0.001). People identified with current/former injection drug users were more likely to prefer to receive HCV treatment in a CBC (63.0% vs. 44.8%, p = 0.028) or in a SCPUD (46.3% vs. 9.5%, p < 0.001), compared to the other respondents. The most important considerations regarding treatment locations among people identified with current/former injection drug users were the non-stigmatising/non-judgemental approach at the site (p < 0.001) and the presence of community-friendly medical personnel or CW (p = 0.016 and 0.002), compared to the other respondents. CONCLUSION The preferences of people identified with current/former injection drug users indicated specific needs concerning HCV services. Integration of HCV services in community-based risk reduction centres may be an important element in the development of adapted services to increase uptake and retention in HCV care among this population.
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Affiliation(s)
- M. Di Ciaccio
- Community-Based Research Laboratory, Coalition PLUS, Pantin, France
| | - V. Villes
- Community-Based Research Laboratory, Coalition PLUS, Pantin, France
| | - C. Perfect
- Advocacy Department, Coalition PLUS, Pantin, France
| | | | - M. Donatelli
- Advocacy Department, Coalition PLUS, Pantin, France
| | - C. James
- World Hepatitis Alliance, London, UK
| | - P. Easterbrook
- grid.3575.40000000121633745Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - R. M. Delabre
- Community-Based Research Laboratory, Coalition PLUS, Pantin, France
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Chen GJ, Ho SY, Su LH, Chang SY, Hsieh SM, Sheng WH, Liu WD, Huang YS, Lin KY, Chen YT, Su YC, Liu WC, Sun HY, Hung CC. Hepatitis C microelimination among people living with HIV in Taiwan. Emerg Microbes Infect 2022; 11:1664-1671. [PMID: 35608049 PMCID: PMC9225706 DOI: 10.1080/22221751.2022.2081620] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
To reach the WHO target of hepatitis C virus (HCV) elimination by 2025, Taiwan started to implement free-of-charge direct-acting antiviral (DAA) treatment programme in 2017. Evaluating the progress of HCV microelimination among people living with HIV (PLWH) is a critical step to identify the barriers to HCV elimination. PLWH seeking care at a major hospital designated for HIV care in Taiwan between January 2011 and December 2021 were retrospectively included. For PLWH with HCV-seropositive or HCV seroconversion during the study period, serial HCV RNA testing was performed using archived samples to confirm the presence of HCV viremia and estimate the prevalence and incidence of HCV viremia. Overall, 4199 PLWH contributed to a total of 27,258.75 person-years of follow-up (PYFU). With the reimbursement of DAAs and improvement of access to treatments, the prevalence of HCV viremia has declined from its peak of 6.21% (95% CI, 5.39–7.12%) in 2018 to 2.09% (95% CI, 1.60–2.77%) in 2021 (decline by 66.4% [95% CI, 55.4–74.7%]); the incidence has declined from 25.94 per 1000 PYFU (95% CI, 20.44–32.47) in 2019 to 12.15% per 1000 PYFU (95% CI, 8.14–17.44) (decline by 53.2% [95% CI, 27.3–70.6%]). However, the proportion of HCV reinfections continued to increase and accounted for 82.8% of incident HCV infections in 2021. We observed significant declines of HCV viremia among PLWH with the expansion of the DAA treatment programme in Taiwan. Further improvement of the access to DAA retreatments is warranted to achieve the goal of HCV microelimination.
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Affiliation(s)
- Guan-Jhou Chen
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.,Min-Sheng General Hospital, Taoyuan, Taiwan
| | - Shu-Yuan Ho
- Department of Laboratory Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Li-Hsin Su
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Sui-Yuan Chang
- Department of Laboratory Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Clinical Laboratory Sciences and Medical Biotechnology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Szu-Min Hsieh
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wang-Huei Sheng
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wang-Da Liu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Yu-Shan Huang
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Kuan-Yin Lin
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yi-Ting Chen
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yi-Ching Su
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wen-Chun Liu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsin-Yun Sun
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chien-Ching Hung
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Tropical Medicine and Parasitology, National Taiwan University College of Medicine, Taipei, Taiwan
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8
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Drysdale K, Rance J, Cama E, Treloar C, Mao L. What is known about the care and support provided for an ageing population with lived experience of chronic viral hepatitis as they near end-of-life: A scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e3775-e3788. [PMID: 36259240 PMCID: PMC10092025 DOI: 10.1111/hsc.14066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 06/09/2022] [Accepted: 10/01/2022] [Indexed: 06/16/2023]
Abstract
Ageing with a chronic hepatitis B (HBV) or hepatitis C (HCV) infection is an emerging public health priority. For people living with chronic viral hepatitis, their disease progression into old age is both underpinned by their existing blood borne virus and the potential emergence of other infectious and non-infectious conditions. These twinned pathways bring additional challenges to the care and support for people as they near end of life. This scoping review sought to examine what is known about the experiences of the end-of-life phase of an increasing population ageing with HBV and HCV in studies conducted in high-income settings and published in peer reviewed literature (2010-2021). In interpreting this literature, we found that challenges in determining the end-of life phase for people with lived experience of HBV or HCV are exacerbated by the conflation of aetiologies into a singular diagnosis of end-stage liver disease. Studies overwhelmingly reported the clinical aspects of end-of-life care (i.e. prognosis assessment and symptom management) with less attention paid to educative aspects (i.e. advance care directives and surrogate decision makers, discussion of treatment options and determining goals of care). Psychosocial interventions (i.e. quality of life beyond symptom management, including emotional/spiritual support and family and bereavement support) received limited attention in the literature, though there was some recognition that psychosocial interventions should be part of end-of-life care provision. Given the focus on the prominent disease presentation of liver cirrhosis and/or end-stage liver disease, the social and cultural dimensions of these infections have received less attention in the literature on end-of-life in the context of chronic viral hepatitis.
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Affiliation(s)
- Kerryn Drysdale
- Centre for Social Research in HealthUNSW SydneySydneyAustralia
| | - Jake Rance
- Centre for Social Research in HealthUNSW SydneySydneyAustralia
| | - Elena Cama
- Centre for Social Research in HealthUNSW SydneySydneyAustralia
| | - Carla Treloar
- Centre for Social Research in HealthUNSW SydneySydneyAustralia
| | - Limin Mao
- Centre for Social Research in HealthUNSW SydneySydneyAustralia
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9
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Tasavon Gholamhoseini M, Sharafi H, Hl Borba H, Alavian SM, Sabermahani A, Hajarizadeh B. Economic evaluation of pan-genotypic generic direct-acting antiviral regimens for treatment of chronic hepatitis C in Iran: a cost-effectiveness study. BMJ Open 2022; 12:e058757. [PMID: 35676019 PMCID: PMC9185662 DOI: 10.1136/bmjopen-2021-058757] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Low-cost generic direct-acting antiviral (DAA) regimens for treatment of hepatitis C virus (HCV) are available in several low-income/middle-income countries, important for treatment scale-up. This study evaluated the cost-effectiveness of genotype-dependent and pan-genotypic DAA regimens in Iran as an example of a resource-limited setting. METHODS A Markov model was developed to simulate HCV natural history. A decision tree was developed for HCV treatment, assuming four scenarios, including scenario 1: genotyping, sofosbuvir/ledipasvir (SOF/LDV) for genotype 1, and sofosbuvir/daclatasvir (SOF/DCV) for genotype 3; scenario 2: genotyping, SOF/LDV for genotype 1, and sofosbuvir/velpatasvir (SOF/VEL) for genotype 3; scenario 3: no genotyping and SOF/DCV for all; and scenario 4: no genotyping and SOF/VEL for all. A 1-year cycle length was used to calculate the cumulative cost and effectiveness over a lifetime time horizon. We calculated quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER) using a health system perspective. Costs were converted to US dollars using purchasing power parity exchange rate ($PPP). All costs and outcomes were discounted at an annual rate of 3%. RESULTS Among people with no cirrhosis, scenario 3 had the minimum cost, compared with which scenario 4 was cost-effective with an ICER of 4583 $PPP per QALY (willingness-to-pay threshold: 9,311 $PPP per QALY). Among both people with compensated or decompensated cirrhosis, scenario 4 was cost saving. In sensitivity analysis, scenario 4 would be also cost-saving among people with no cirrhosis provided a 39% reduction in the cost of 12 weeks SOF/VEL. CONCLUSION Initiating all patients on pan-genotypic generic DAA regimens with no pretreatment genotyping was cost-effective compared with scenarios requiring pretreatment HCV genotype tests. Among generic pan-genotypic DAA regimens, SOF/VEL was cost-effective, for people with no cirrhosis and cost-saving for those with cirrhosis.
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Affiliation(s)
- Mohammad Tasavon Gholamhoseini
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Helena Hl Borba
- Department of Pharmacy, Federal University of Parana, Curitiba, Parana, Brazil
| | | | - Asma Sabermahani
- Department of Management, Health Policy and Health Economics, Kerman University of Medical Sciences, Kerman, Iran
| | - Behzad Hajarizadeh
- The Kirby Institute, University of New South Wales (UNSW Sydney), Sydney, New South Wales, Australia
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10
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Setting foot in private spaces: extending the hepatitis C cascade of care to automatic needle/syringe dispensing machines, a mixed methods study. Harm Reduct J 2022; 19:56. [PMID: 35643528 PMCID: PMC9148492 DOI: 10.1186/s12954-022-00640-6] [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: 03/16/2022] [Accepted: 05/21/2022] [Indexed: 12/03/2022] Open
Abstract
Background Global commitment to achieving hepatitis C virus (HCV) elimination has enhanced efforts in improving access to direct-acting antiviral (DAA) treatments for people who inject drugs (PWID). Scale-up of efforts to engage hard-to-reach groups of PWID in HCV testing and treatment is crucial to success. Automatic needle/syringe dispensing machines (ADMs) have been used internationally to distribute sterile injecting equipment. ADMs are a unique harm reduction service, affording maximum anonymity to service users. This paper explores the feasibility and acceptability of extending the HCV cascade of care to sites where ADMs are located.
Methods The ADM users into Treatment (ADMiT) study was undertaken in a metropolitan region in Sydney, Australia. This mixed methods study involved analysis of closed-circuit television footage, ethnographic methods (fieldwork observation and in-depth interviews) and structured surveys. Researchers and peers conducted fieldwork and data collection over 10 weeks at one ADM site, including offering access to HCV testing and treatment. Results Findings from 10 weeks of fieldwork observations, 70 survey participants and 15 interviews highlighted that there is scope for engaging with this population at the time they use the ADM, and enhanced linkage to HCV testing and treatment may be warranted. Most survey participants reported prior HCV testing, 61% in the last 12 months and 38% had received HCV treatment. However, fieldwork revealed that most people observed using the ADM were not willing to engage with the researchers. Field work data and interviews suggested that extending the HCV cascade of care to ADMs may encroach on what is a private space for many PWID, utilized specifically to avoid engagement. Discussion Enhanced linkage to HCV testing and treatment for people who use ADMs may be warranted. However, data suggested that extending the HCV cascade of care to ADMs may encroach on what is a private space for many PWID, utilized specifically to avoid engagement. The current study raises important public health questions about the need to ensure interventions reflect the needs of affected communities, including their right to remain anonymous.
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11
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Martel-Laferrière V, Feaster DJ, Metsch LR, Shackman BR, Loignon C, Nosyk B, Tookes H, Behrends CN, Arruda N, Adigun O, Goyer ME, Kolber MA, Mary JF, Rodriguez AE, Yanez IG, Pan Y, Khemiri R, Gooden L, Sako A, Bruneau J. M 2HepPrEP: study protocol for a multi-site multi-setting randomized controlled trial of integrated HIV prevention and HCV care for PWID. Trials 2022; 23:341. [PMID: 35461260 PMCID: PMC9034074 DOI: 10.1186/s13063-022-06085-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 02/05/2022] [Indexed: 12/15/2022] Open
Abstract
Background Opioid use is escalating in North America and comes with a multitude of health consequences, including HIV and hepatitis C virus (HCV) outbreaks among persons who inject drugs (PWID). HIV pre-exposure prophylaxis (PrEP) and HCV treatment regimens have transformative potential to address these co-occurring epidemics. Evaluation of innovative multi-modal approaches, integrating harm reduction, opioid agonist therapy (OAT), PrEP, and HCV treatment is required. The aim of this study is to assess the effectiveness of an on-site integrated care model where delivery of PrEP and HCV treatment for PWID takes places at syringe service programs (SSP) and OAT programs compared with referring PWID to clinical services in the community through a patient navigation model and to examine how structural factors interact with HIV prevention adherence and HCV treatment outcomes. Methods The Miami-Montreal Hepatitis C and Pre-Exposure Prophylaxis trial (M2HepPrEP) is an open-label, multi-site, multi-center, randomized, controlled, superiority trial with two parallel treatment arms. A total of 500 persons who injected drugs in the prior 6 months and are eligible for PrEP will be recruited in OAT clinics and SSP in Miami, FL, and Montréal, Québec. Participants will be randomized to either on-site care, with adherence counseling, or referral to off-site clinics assisted by a patient navigator. PrEP will be offered to all participants and HCV treatment to those HCV-infected. Co-primary endpoints will be (1) adherence to pre-exposure prophylaxis medication at 6 months post-randomization and (2) HCV sustained virological response (SVR) 12 weeks post-treatment completion among participants who were randomized within the HCV stratum. Up to 100 participants will be invited to participate in a semi-structured interview regarding perceptions of adherence barriers and facilitators, after their 6-month assessment. A simulation model-based cost-effectiveness analysis will be performed to determine the comparative value of the strategies being evaluated. Discussion The results of this study have the potential to demonstrate the effectiveness and cost-effectiveness of offering PrEP and HCV treatment in healthcare venues frequently attended by PWID. Testing the intervention in two urban centers with high disease burden among PWID, but with different healthcare system dynamics, will increase generalizability of findings. Trial registration Clinicaltrials.gov NCT03981445. Trial registry name: Integrated HIV Prevention and HCV Care for PWID (M2HepPrEP). Registration date: June 10, 201. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06085-3.
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Affiliation(s)
- Valérie Martel-Laferrière
- Centre hospitalier de l'Université de Montréal, Montreal, Canada. .,Faculté de médecine: Université de Montréal, Montreal, Canada. .,Centre de Recherche du CHUM: Centre hospitalier de l'Université de Montréal Centre de Recherche, Montreal, Canada.
| | | | - Lisa R Metsch
- Columbia University Mailman School of Public Health, New York City, USA
| | - Bruce R Shackman
- Weill Cornell Medical College: Weill Cornell Medicine, New York City, USA
| | | | | | - Hansel Tookes
- University of Miami Miller School of Medicine, Miami, USA
| | - Czarina N Behrends
- Weill Cornell Medical College: Weill Cornell Medicine, New York City, USA
| | - Nelson Arruda
- Direction régionale de la santé publique de Montréal, Montreal, Canada
| | | | - Marie-Eve Goyer
- Faculté de médecine: Université de Montréal, Montreal, Canada
| | | | | | | | - Iveth G Yanez
- Columbia University Mailman School of Public Health, New York City, USA
| | - Yue Pan
- University of Miami Department of Public Health Sciences, Miami, USA
| | - Rania Khemiri
- Centre de Recherche du CHUM: Centre hospitalier de l'Université de Montréal Centre de Recherche, Montreal, Canada
| | - Lauren Gooden
- Columbia University Mailman School of Public Health, New York City, USA
| | - Aïssata Sako
- Centre de Recherche du CHUM: Centre hospitalier de l'Université de Montréal Centre de Recherche, Montreal, Canada
| | - Julie Bruneau
- Centre hospitalier de l'Université de Montréal, Montreal, Canada.,Faculté de médecine: Université de Montréal, Montreal, Canada.,Centre de Recherche du CHUM: Centre hospitalier de l'Université de Montréal Centre de Recherche, Montreal, Canada
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12
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Carson JM, Dore GJ, Lloyd AR, Grebely J, Byrne M, Cunningham E, Amin J, Vickerman P, Martin NK, Treloar C, Martinello M, Matthews GV, Hajarizadeh B. Hepatitis C virus reinfection following direct acting antiviral treatment in the prison setting: the SToP-C study. Clin Infect Dis 2022; 75:1809-1819. [PMID: 35362522 DOI: 10.1093/cid/ciac246] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Injection drug use (IDU) following treatment for hepatitis C virus (HCV) may lead to reinfection, particularly if access to harm reduction services is suboptimal. This study assessed HCV reinfection risk following direct-acting antiviral therapy within Australian prisons that had opioid agonist therapy (OAT) programs but did not have needle and syringe programs (NSP). METHODS The Surveillance and Treatment of Prisoners with hepatitis C (SToP-C) study enrolled people incarcerated in four prisons between 2014-2019. Participants treated for HCV were followed every 3-6 months to identify reinfection (confirmed by sequencing). Reinfection incidence and associated factors were evaluated. FINDINGS Among 388 participants receiving treatment, 161 had available post-treatment follow-up and were included in analysis (92% male; median age 33 years; 67% IDU in prison; median follow-up 9 months). Among those with recent (in the past month) IDU (n=71), 90% had receptive needle/syringe sharing. During 145 person-years (PY) of follow-up, 18 cases of reinfection were identified. Reinfection incidence was 12.5/100 PY (95%CI: 7.9-19.8) overall, increasing to 28.7/100 PY; (95%CI 16.3-50.6) among those with recent IDU and needle/syringe sharing. In adjusted analysis, recent IDU with needle/syringe sharing was associated with increased reinfection risk (adjusted hazard ratio [AHR] 14.62; 95%CI 1.84-116.28; p=0.011) and longer HCV testing interval with decreased risk (i.e., chance of detection; AHR 0.41 per each month increase; 95%CI 0.26-0.64; p<0.001). CONCLUSION A high rate of HCV reinfection was observed within prison. Post-treatment surveillance and retreatment are essential to limit the impact of reinfection. High-coverage OAT and NSP should be considered within prisons.
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Affiliation(s)
| | | | | | | | | | | | - Janaki Amin
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Peter Vickerman
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Natasha K Martin
- Division of Infectious Diseases & Global Public Health, University of California San Diego, San Diego, USA
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
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13
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Mirzazadeh A, Hosseini-Hooshyar S, Shahesmaeili A, Sharafi H, Shafiei M, Zarei J, Mousavian G, Tavakoli F, Ghalekhani N, Shokoohi M, Khezri M, Mehmandoost S, Shojaei MR, Karamouzian M, Briceno A, Morris MD, Alavian SM, Haghdoost AA, Sharifi H, Page KA. An on-site community-based model for hepatitis C screening, diagnosis, and treatment among people who inject drugs in Kerman, Iran: The Rostam study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 102:103580. [PMID: 35074607 PMCID: PMC10478571 DOI: 10.1016/j.drugpo.2022.103580] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/21/2021] [Accepted: 12/28/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND People who inject drugs (PWID) are at high risk for hepatitis C virus (HCV) infection and its complications in many countries, including Iran. This pilot study aimed to evaluate the effect of a community-based HCV model of care on HCV testing and treatment initiation among PWID in Kerman, Iran. METHODS This study is part of the Rostam study and is a non-randomized trial evaluating the effect of on-site HCV- antibody rapid testing, venipuncture for HCV RNA testing, and treatment eligibility assessment on HCV testing and treatment initiation among PWID. Recruitment, interviews, and HCV screening, diagnosis, and treatment were all conducted at a community-based drop-in center (DIC) serving PWID clients. RESULTS A total of 171 PWID (median age of 39 years and 89.5% male) were recruited between July 2018 and May 2019. Of 62 individuals who were HCV antibody positive, 47 (75.8%) were HCV RNA positive. Of RNA-positive individuals, 36 (76.6%) returned for treatment eligibility assessment. Of all the 36 participants eligible for treatment, 34 (94.4%) initiated HCV antiviral therapy. A sustained virologic response at 12 weeks post-treatment was 76.5% (26/34) in the intention-to-treat (ITT group) analysis and 100% (23/23) in the per-protocol (PP group) analysis. CONCLUSION Our integrated on-site community-based HCV care model within a DIC setting suggested that HCV care including HCV testing and treatment uptake can be successfully delivered outside of hospitals or specialized clinics; a model which is more likely to reach PWID and can provide significant progress towards HCV elimination among this population.
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Affiliation(s)
- Ali Mirzazadeh
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran; Department of Epidemiology and Biostatistics, Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA.
| | - Samira Hosseini-Hooshyar
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran; The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Armita Shahesmaeili
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Mohammad Shafiei
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Jasem Zarei
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ghazal Mousavian
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Fatemeh Tavakoli
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Nima Ghalekhani
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mostafa Shokoohi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Mehrdad Khezri
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Soheil Mehmandoost
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Reza Shojaei
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Karamouzian
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran; Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Alya Briceno
- Department of Epidemiology and Biostatistics, Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA; Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Meghan D Morris
- Department of Epidemiology and Biostatistics, Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
| | | | - Ali-Akbar Haghdoost
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Kimberly A Page
- Epidemiology, Biostatistics and Preventive Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
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14
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Four Weeks Treatment with Glecaprevir/Pibrentasvir + Ribavirin-A Randomized Controlled Clinical Trial. Viruses 2022; 14:v14030614. [PMID: 35337021 PMCID: PMC8948928 DOI: 10.3390/v14030614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 03/14/2022] [Indexed: 01/25/2023] Open
Abstract
Enhancing treatment uptake for hepatitis C to achieve the elimination goals set by the World Health Organization could be achieved by reducing the treatment duration. The aim of this study was to compare the sustained virological response at week 12 (SVR12) after four weeks of glecaprevir/pibrentasvir (GLE/PIB) + ribavirin compared to eight weeks of GLE/PIB and to estimate predictors for SVR12 with four weeks of treatment through a multicenter open label randomized controlled trial. Patients were randomized 2:1 (4 weeks:8 weeks) and stratified by genotype 3 and were treatment naïve of all genotypes and without significant liver fibrosis. A total of 27 patients were analyzed for predictors for SVR12, including 15 from the first pilot phase of the study. In the ‘modified intention to treat’ group, 100% (7/7) achieved cure after eight weeks and for patients treated for four weeks the SVR12 was 58.3% (7/12). However, patients with a baseline viral load <2 mill IU/mL had 93% SVR12. The study closed prematurely due to the low number of included patients due to the COVID-19 pandemic. Our results suggest that viral load should be taken into account when considering trials of short course treatment.
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15
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Picchio CA, Lens S, Hernandez-Guerra M, Arenas J, Andrade RJ, Crespo J, García-Samaniego J, Romero-Gómez M, Turnes J, Calleja JL, Simón MÁ, White TM, Riveiro-Barciela M, Pocurull A, Morales-Arraez D, Gómez A, Buti M, Lazarus JV. Late presentation of chronic HBV and HCV patients seeking first time specialist care in Spain: a 2-year registry review. Sci Rep 2021; 11:24133. [PMID: 34921156 PMCID: PMC8683418 DOI: 10.1038/s41598-021-01885-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 10/18/2021] [Indexed: 12/23/2022] Open
Abstract
Chronic viral hepatitis infection affects an estimated 325 million people globally. People who initiate treatment after significant disease progression face increased risk of severe liver complications and death. Data are scarce on the characteristics and risk factors of people who present late to care in Spain and globally. Data were collected from January 2018 to December 2019 to report late presentation (LP) to specialist care at 11 large university hospitals in Spain to assess related risk factors using a multivariable logistic regression model. 2290 (CHB = 505, CHC = 1785) patients were analysed, with 581 (25.2%) presenting late. Hepatitis C patients more frequently reported LP compared to hepatitis B patients (28.1% vs 15.0%; p < 0.001). Older age (p < 0.001), being male (p < 0.001), being Spanish-born (p < 0.001), and having an unknown origin of referral (p = 0.08) were associated with a higher likelihood of LP. Advanced liver disease was identified in 533 (23%) patients and late-stage liver disease in 124 (5.4%). LP, including with irreversible liver damage, to viral hepatitis specialist care is frequent in Spain, despite being a country with unrestricted treatment access. Initiatives to reduce LP should specifically target men, older individuals, foreign-born populations for CHB, and Spanish nationals for CHC.
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Affiliation(s)
- Camila A Picchio
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Sabela Lens
- Liver Unit, Hospital Clinic, Universidad de Barcelona, Barcelona, Spain
- IDIBAPS, University of Barcelona, Barcelona, Spain
- CIBER Hepatic and Digestive Diseases (CIBERehd), Instituto Carlos III, Madrid, Spain
| | - Manuel Hernandez-Guerra
- Department of Gastroenterology, University Hospital of the Canary Islands, San Cristóbal de La Laguna, Spain
| | - Juan Arenas
- Biodonostia, Liver Diseases Research Group, Osakidetza Basque Health Service, Donostia University Hospital, San Sebastián, Spain
| | - Raúl J Andrade
- CIBER Hepatic and Digestive Diseases (CIBERehd), Instituto Carlos III, Madrid, Spain
- Unidad de Gestión Clínica de Enfermedades Digestivas, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain
| | - Javier Crespo
- Gastroenterology and Hepatology Unit, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain
| | - Javier García-Samaniego
- CIBER Hepatic and Digestive Diseases (CIBERehd), Instituto Carlos III, Madrid, Spain
- Liver Unit, Department of Gastroenterology, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Manuel Romero-Gómez
- UCM Digestive Diseases, Hospital Universitario Virgen del Rocío, Institute of Biomedicine of Seville, Universidad de Sevilla, Seville, Spain
| | - Juan Turnes
- Complejo Hospitalario Universitario de Pontevedra, Instituto de Investigación Sanitaria Galicia Sur (IISGS), Pontevedra, Spain
| | - José Luis Calleja
- CIBER Hepatic and Digestive Diseases (CIBERehd), Instituto Carlos III, Madrid, Spain
- Gastroenterology and Hepatology Department, Hospital Universitario Puerta del Hierro de, Universidad Autónoma de Madrid, Madrid, Spain
| | - Miguel Ángel Simón
- Department of Digestive Diseases, Hospital Clínico de Zaragoza, Zaragoza, Spain
- Instituto de Investigación Sanitario Aragón (IIS Aragón), Zaragoza, Spain
| | - Trenton M White
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | | | - Anna Pocurull
- Liver Unit, Hospital Clinic, Universidad de Barcelona, Barcelona, Spain
- IDIBAPS, University of Barcelona, Barcelona, Spain
- CIBER Hepatic and Digestive Diseases (CIBERehd), Instituto Carlos III, Madrid, Spain
| | - Dalia Morales-Arraez
- Department of Gastroenterology, University Hospital of the Canary Islands, San Cristóbal de La Laguna, Spain
| | - Alexandra Gómez
- Biodonostia, Liver Diseases Research Group, Osakidetza Basque Health Service, Donostia University Hospital, San Sebastián, Spain
| | - Maria Buti
- CIBER Hepatic and Digestive Diseases (CIBERehd), Instituto Carlos III, Madrid, Spain
- Liver Unit, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain.
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Seear K, Lenton E. Becoming posthuman: hepatitis C, the race to elimination and the politics of remaking the subject. HEALTH SOCIOLOGY REVIEW : THE JOURNAL OF THE HEALTH SECTION OF THE AUSTRALIAN SOCIOLOGICAL ASSOCIATION 2021; 30:229-243. [PMID: 34448668 DOI: 10.1080/14461242.2021.1971102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 08/16/2021] [Indexed: 05/22/2023]
Abstract
Hepatitis C has long been a public health problem in Australia. 'Revolutionary' new drugs with the potential to cure hepatitis C have now emerged. The Australian government has invested heavily in them, and has an ambitious goal to eliminate hepatitis C by 2030. Numerous shifts in policy and practice are required if the elimination agenda is to be realised. This paper explores the significance of these shifts. We ask: what is the race to elimination doing with the subject? We argue that the race to elimination can be understood, simultaneously, as a product of posthuman forces, capable of being analysed using the theoretical tools made available via the posthuman turn; producing an intervention in what it means to be human; and generating a dilemma for people who use (or used) drugs, people with hepatitis C, and posthuman scholarship. In drawing out these issues, we aim to: trace the significant developments underway in hepatitis C medicine and raise awareness of them; encourage reflection on the consequences of these developments; and invite reflections on what might be lost when the human is remade by hepatitis C medicine.
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Affiliation(s)
- Kate Seear
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, Australia
| | - Emily Lenton
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, Australia
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Clark PJ. Eliminating hepatitis C in Australia needs informed patients and enabled GPs. Med J Aust 2021; 215:318-319. [PMID: 34519036 DOI: 10.5694/mja2.51264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 08/25/2021] [Accepted: 08/25/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Paul J Clark
- The University of Queensland, Brisbane, QLD.,Princess Alexandra Hospital, Brisbane, QLD.,Mater Hospital, Brisbane, QLD
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Rance J, Lafferty L, Treloar C. Expert stakeholder perspectives on the acceptability of treatment-as-prevention in prison: a qualitative substudy of the 'Surveillance and Treatment of Prisoners with Hepatitis C' project (SToP-C). Addiction 2021; 116:2761-2769. [PMID: 33751739 DOI: 10.1111/add.15477] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/21/2020] [Accepted: 02/24/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS Mathematical modelling has demonstrated the theoretical feasibility of HCV treatment-as-prevention strategies in custodial settings, yet limited empirical data exists. The Australian 'Surveillance and Treatment of Prisoners with Hepatitis C' study is the world's first trial of hepatitis C virus (HCV) treatment-as-prevention in prison. This study aimed to analyse how expert stakeholders involved in the Australian HCV response assessed the acceptability of HCV treatment-as-prevention in prison using interview data from the SToP-C qualitative substudy. DESIGN AND SETTING Qualitative analysis using semi-structured interviews in Australia. PARTICIPANTS Nineteen key HCV experts. MEASUREMENTS Drawing upon Sekhon's theoretical framework of acceptability, data were organized thematically under four component constructs of acceptability: affective attitude; ethicality; opportunity costs; and perceived effectiveness. FINDINGS Most differences in participant assessments of acceptability were a matter of relative emphasis and prioritization rather than absolute polarity. Nonetheless, a small minority of participants was overtly critical of the approach. Arguing against the focus on treatment, they instead advocated for prevention-as-prevention, including the improvement and expansion of existing harm reduction measures. CONCLUSIONS Qualitative analysis of expert stakeholder assessments of the acceptability of hepatitis C virus treatment-as-prevention in Australian prisons found no opposition to the universal rollout of direct-acting anti-virals, but most voiced concern regarding the lack of effective primary prevention in Australian prisons.
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Affiliation(s)
- Jake Rance
- Centre for Social Research in Health, UNSW Sydney, Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Lise Lafferty
- Centre for Social Research in Health, UNSW Sydney, Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
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- Centre for Social Research in Health, UNSW Sydney, Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
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Clipman SJ, Mehta SH, Rodgers MA, Duggal P, Srikrishnan AK, Saravanan S, Balakrishnan P, Vasudevan CK, Ray SC, Kumar MS, Quinn TC, Cloherty GA, Lucas GM, Solomon SS. Spatiotemporal Phylodynamics of Hepatitis C Among People Who Inject Drugs in India. Hepatology 2021; 74:1782-1794. [PMID: 34008172 PMCID: PMC8756458 DOI: 10.1002/hep.31912] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 04/23/2021] [Accepted: 05/07/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND AIMS Implementing effective interventions for HCV requires a detailed understanding of local transmission dynamics and geospatial spread. Little is known about HCV phylodynamics, particularly among high-burden populations, such as people who inject drugs (PWID). APPROACH AND RESULTS We used 483 HCV sequences and detailed individual-level data from PWID across four Indian cities. Bayesian phylogeographic analyses were used to evaluate transmission hotspots and geospatial diffusion of the virus. Phylogenetic cluster analysis was performed to infer epidemiologic links and factors associated with clustering. A total of 492 HIV sequences were used to draw comparisons within the same population and, in the case of coinfections, evaluate molecular evidence for shared transmission pathways. Overall, 139/483 (28.8%) of HCV sequences clustered with a median cluster size of 3 individuals. Genetically linked participants with HCV were significantly younger and more likely to be infected with HCV subtype 3b as well as to live and inject close to one another. Phylogenetic evidence suggests likely ongoing HCV infection/reinfection with limited support for shared HIV/HCV transmission pathways. Phylogeographic analyses trace historic HCV spread back to Northeastern India and show diffusion patterns consistent with drug trafficking routes. CONCLUSIONS This study characterizes HCV phylodynamics among PWID in a low and middle-income country setting. Heterogeneity and recent genetic linkage of HCV across geographically disparate Indian states suggest that targeted interventions could help prevent reimportation of virus through drug trafficking routes.
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Affiliation(s)
- Steven J. Clipman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Shruti H. Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Mary A. Rodgers
- Abbott Diagnostics, Infectious Disease Research, Abbott Park, Illinois, United States of America
| | - Priya Duggal
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | - Shanmugam Saravanan
- YR Gaitonde Centre for AIDS Research and Education (YRGCARE), Chennai, India
| | | | | | - Stuart C. Ray
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | | | - Thomas C. Quinn
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America,Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Gavin A. Cloherty
- Abbott Diagnostics, Infectious Disease Research, Abbott Park, Illinois, United States of America
| | - Gregory M. Lucas
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Sunil S. Solomon
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America,YR Gaitonde Centre for AIDS Research and Education (YRGCARE), Chennai, India,Corresponding author: Sunil S. Solomon, MBBS, PhD, MPH, Johns Hopkins University School of Medicine, 1830 E Monument Street, Rm 444, Baltimore, MD 21287, , Phone: (443) 287-9596
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20
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Levander XA, Vega TA, Seaman A, Korthuis PT, Englander H. Utilising an access to care integrated framework to explore the perceptions of hepatitis C treatment of hospital-based interventions among people who use drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 96:103356. [PMID: 34226111 PMCID: PMC8568624 DOI: 10.1016/j.drugpo.2021.103356] [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: 02/13/2021] [Revised: 06/15/2021] [Accepted: 06/16/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Gaps remain in the hepatitis C virus (HCV) care cascade for people who use drugs (PWUD). Acute medical or surgical illnesses requiring hospitalisation are an opportunity to address addiction, but how inpatient strategies could affect HCV care accessibility for PWUD remains unknown. We explored patient perspectives of hospital-based interventions using an integrated framework of access to HCV care. METHODS We conducted a qualitative study of hospitalised adults (n=27) with HCV and addiction admitted to an urban academic medical centre in the United States between June and November 2019. Individual interviews were audio-recorded, transcribed, and dual-coded. We analysed data with coding specific for hospital-based interventions including screening, conducting HCV-related laboratory work-up, starting treatment, connecting with peers, and coordinating outpatient care. We analysed coded data at the semantic level for emergent themes using a framework approach based off an integrated framework of access to HCV care. RESULTS The majority of participants primarily used opioids (78%), were white (85%) and men (67%). Participants frequently reported HCV screening during previous hospitalisation with rare inpatient connection to HCV-related services. Participants expressed willingness to discuss HCV treatment candidacy during hospitalisation; however, lack of inpatient conversations led to perception that "nothing could be done" during admission. Participants expressed interest in completing inpatient HCV work-up to "get the ball rollin'" - consolidating care would enhance outpatient service permeability by reducing barriers. Others resisted HCV care coordination, preferring to focus on "immediate" issues including health conditions and addiction treatment. Participants also expressed openness to engaging with peers about HCV, noting shared drug use experience as critical to a peer relationship when discussing HCV. CONCLUSION Hospitalised PWUD have varied priorities, necessitating adaptable interventions for addressing HCV. Hospitalisation can be an opportunity to address HCV access to care including identification of treatment eligibility, consolidation of care, and facilitation of HCV-related referrals.
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Affiliation(s)
- Ximena A Levander
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Section of Addiction Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR, 97239 United States.
| | - Taylor A Vega
- School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, United States
| | - Andrew Seaman
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Section of Addiction Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR, 97239 United States; Central City Concern, 232 NW 6th Ave., Portland, OR, 97209, United States
| | - P Todd Korthuis
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Section of Addiction Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR, 97239 United States
| | - Honora Englander
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Section of Addiction Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR, 97239 United States; Department of Medicine, Division of Hospital Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR, 97239 United States
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21
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Selfridge M, Cunningham EB, Barnett T, Drost A, Gray-Schleihauf C, Guarasci K, Lundgren K, Milne R, Grebely J, Fraser C. Reinfection following successful direct-acting antiviral therapy for HCV infection among people attending an inner-city community health centre in Victoria, Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 96:103418. [PMID: 34538704 DOI: 10.1016/j.drugpo.2021.103418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 07/08/2021] [Accepted: 08/06/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Studies of HCV reinfection following direct-acting antiviral (DAA) therapy among PWID have been limited by short follow-up and small case numbers. This study evaluated the incidence of HCV reinfection following successful DAA therapy among people attending an inner-city community health centre in Victoria, Canada. METHODS In this observational study, participants treated with DAA therapy between November 2014 and December 31, 2019 were included. Retrospective chart review was performed to assess demographics, recent injecting drug use at treatment initiation (previous six months), opioid agonist treatment (OAT), and HIV. Endpoints included sustained virologic response (SVR), HCV reinfection, and mortality. RESULTS Of 482 participants initiating DAA treatment, 30% were female, 46% were receiving OAT, 49% had recent injection drug use, 15% had HIV/HCV coinfection, and 22% had cirrhosis. Treatment completion was 97% (468/482; 12 discontinued therapy, and 2 died during treatment). SVR was 87% (418/482). Outcomes among those who completed treatment but did not achieve SVR (n=53), included loss to follow-up (n=11), HCV RNA for SVR testing not completed (n=18), viral relapse (n=6), reinfection (n=5) and viral recurrence (n=5, unable to distinguish viral relapse from reinfection), and death (n=7). The rate of HCV reinfection was 3.6/100 person-years (95% confidence interval [CI] 2.4-5.5; 22 cases; 602 person-years follow-up). Factors associated with an increased risk of HCV reinfection included recent injection drug use (adjusted relative risk [aRR] 8.55, 95% CI 1.98-36.96) and HIV co-infection (aRR 2.35, 95% CI 1.01-5.44). Fifty-five people died (overdose, n=19) during (n=2) or following (n=53) therapy (7.4/100 person-years; 95% CI 5.6-9.6). CONCLUSION This study demonstrates ongoing reinfection among a marginalized population at an inner-city community health centre, with higher rates among those with HIV and recent injecting drug use. The rates of reinfection and mortality highlight the importance of integrating HCV care with strategies to address drug-related harms.
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Affiliation(s)
| | | | | | - Anne Drost
- Cool Aid Community Health Centre, Victoria, Canada
| | | | | | | | - Roz Milne
- Cool Aid Community Health Centre, Victoria, Canada
| | | | - Chris Fraser
- Cool Aid Community Health Centre, Victoria, Canada
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22
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Kwon JA, Dore GJ, Hajarizadeh B, Alavi M, Valerio H, Grebely J, Guy R, Gray RT. Australia could miss the WHO hepatitis C virus elimination targets due to declining treatment uptake and ongoing burden of advanced liver disease complications. PLoS One 2021; 16:e0257369. [PMID: 34529711 PMCID: PMC8445464 DOI: 10.1371/journal.pone.0257369] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 08/28/2021] [Indexed: 11/25/2022] Open
Abstract
Australia was one of the first countries to introduce government-funded unrestricted access to direct-acting antiviral (DAA) therapy, with 88,790 treated since March 2016. However, treatment uptake is declining which could potentially undermine Australia's progress towards the WHO HCV elimination targets. Using mathematical modelling, we updated estimates for those living with chronic HCV in Australia, new cases of decompensated cirrhosis (DC), hepatocellular carcinoma (HCC), and liver-related mortality among the HCV-cured and viraemic populations from 2015 to 2030. We considered various DAA treatment scenarios incorporating annual treatment numbers to 2020, and subsequent uptake per year of 6,790 (pessimistic), 8,100 (intermediate), and 11,310 (optimistic). We incorporated the effects of excess alcohol consumption and reduction in progression to DC and HCC among cirrhosis-cured versus viraemic individuals. At the end of 2020, we estimated 117,810 Australians were living with chronic HCV. New cases per year of DC, HCC, and liver-related mortality among the HCV viraemic population decreased rapidly from 2015 (almost eliminated by 2030). In contrast, the growing population size of those cured with advanced liver disease meant DC, HCC, and liver-related mortality declined slowly. The estimated reduction in liver-related mortality from 2015 to 2030 in the combined HCV viraemic and cured population is 25% in the intermediate scenario. With declining HCV treatment uptake and ongoing individual-level risk of advanced liver disease complications, including among cirrhosis-cured individuals, Australia is unlikely to achieve all WHO HCV elimination targets by 2030.
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Affiliation(s)
- Jisoo A. Kwon
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Gregory J. Dore
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | | | - Maryam Alavi
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Heather Valerio
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Jason Grebely
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Rebecca Guy
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Richard T. Gray
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
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23
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Castry M, Cousien A, Supervie V, Velter A, Ghosn J, Paltiel AD, Yazdanpanah Y, Deuffic-Burban S. Impact of test-and-treat and risk reduction strategies on HCV transmission among MSM living with HIV in France: a modelling approach. Gut 2021; 70:1561-1569. [PMID: 33109688 DOI: 10.1136/gutjnl-2020-321744] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 09/24/2020] [Accepted: 10/02/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Since the early 2000s, there has been an epidemic of HCV occurring among men who have sex with men (MSM) living with HIV, mainly associated with high-risk sexual and drug-related behaviours. Early HCV diagnosis and treatment, and behavioural risk-reduction, may be effective to eliminate HCV among MSM living with HIV. DESIGN We developed a deterministic dynamic compartmental model to simulate the impact of test-and-treat and risk-reduction strategies on HCV epidemic (particularly on incidence and prevalence) among MSM living with HIV in France. We accounted for HIV and HCV cascades of care, HCV natural history and heterogeneity in HCV risk behaviours. The model was calibrated to primary HCV incidence observed between 2014 and 2017 among MSM living with HIV in care (ANRS CO4-French hospital database on HIV (FHDH)). RESULTS With current French practices (annual HCV screening and immediate treatment), total HCV incidence would fall by 70%, from 0.82/100 person-years in 2015 to 0.24/100 person-years in 2030. It would decrease to 0.19/100 person-years in 2030 with more frequent screening and to 0.19 (0.12)/100 person-years in 2030 with a 20% (50%) risk-reduction. When combining screening every 3 months with a 50% risk-reduction, HCV incidence would be 0.11/100 person-years in 2030, allowing to get close to the WHO target (90% reduction from 2015 to 2030). Similarly, HCV prevalence would decrease from 2.79% in 2015 to 0.48% in 2030 (vs 0.71% with current practices). CONCLUSION Combining test-and-treat and risk-reduction strategies could have a marked impact on the HCV epidemic, paving the way to HCV elimination among MSM living with HIV.
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Affiliation(s)
- Mathieu Castry
- Université de Paris, Inserm, IAME, F-75006 Paris, France
| | | | - Virginie Supervie
- Sorbonne Université, Inserm, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France
| | - Annie Velter
- Department of Infectious Diseases, Santé Publique France, French national public health agency, Saint-Maurice, France
| | - Jade Ghosn
- Université de Paris, Inserm, IAME, F-75006 Paris, France.,Service de Maladies Infectieuses et Tropicales, Hôpital Bichat Claude-Bernard, F-75018 Paris, France
| | - A David Paltiel
- Department of Health Policy and Management, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Yazdan Yazdanpanah
- Université de Paris, Inserm, IAME, F-75006 Paris, France.,Service de Maladies Infectieuses et Tropicales, Hôpital Bichat Claude-Bernard, F-75018 Paris, France
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24
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Havens JR, Schaninger T, Fraser H, Lofwall M, Staton M, Young AM, Hoven A, Walsh SL, Vickerman P. Eliminating hepatitis C in a rural Appalachian county: protocol for the Kentucky Viral Hepatitis Treatment Study (KeY Treat), a phase IV, single-arm, open-label trial of sofosbuvir/velpatasvir for the treatment of hepatitis C. BMJ Open 2021; 11:e041490. [PMID: 34226208 PMCID: PMC8258565 DOI: 10.1136/bmjopen-2020-041490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The overall goal of the Kentucky Viral Hepatitis Treatment Study (KeY Treat) is to eliminate hepatitis C transmission from a county in Appalachian Kentucky by removing the barriers to accessing hepatitis C virus (HCV) treatment. METHODS/ANALYSIS KeY Treat is a phase IV, open-label, single-arm clinical trial of sofosbuvir/velpatasvir (SOF/VEL) for the treatment of viraemic HCV infections. Those eligible for KeY Treat are at least 18 years of age, viraemic and are residents of the target county. Pregnant women are not eligible. Rapid HCV RNA screening is used to determine eligibility, and those with a quantifiable viral load (VL) consenting to participate initiate SOF/VEL on the same day. All pharmacologic treatment and related medical care is provided free of charge using a non-specialist provider model. Follow-up visits occur at 2, 6 and 12 weeks during treatment to assess medication adherence (measured via VL and self-report), side effects and engagement in risk behaviours. Post-treatment visits occur at 12 weeks (sustained virologic response (SVR12) visit), 6 months and 12 months post-treatment completion to assess re-infection. A control county has also been identified, and prevalence and incidence of chronic HCV infections will be compared with the target community longitudinally. The primary outcome to assess elimination is SVR12. However, several outcomes will be measured to assess the effectiveness of removing the barriers to HCV treatment, including treatment entry, completion and re-infection. Analyses will be conducted via a generalised linear model framework that can incorporate flexible covariate adjustment and multiple outcome types with a compatible link function. Mathematical modelling will be completed assessing the impact and cost-effectiveness of the intervention. ETHICS AND DISSEMINATION KeY Treat has been approved by the Institutional Review Board at the University of Kentucky. Results from KeY Treat will be presented at conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT03949764.
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Affiliation(s)
- Jennifer R Havens
- Behavioral Science, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Takako Schaninger
- Infectious Diseases, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Hannah Fraser
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Michelle Lofwall
- Behavioral Science, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Michele Staton
- Behavioral Science, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - April M Young
- Epidemiology, University of Kentucky College of Public Health, Lexington, Kentucky, USA
| | - Ardis Hoven
- Infectious Diseases, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Sharon L Walsh
- Behavioral Science, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Peter Vickerman
- Population Health Sciences, University of Bristol, Bristol, UK
- London School of Hygiene & Tropical Medicine, London, UK
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25
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Levander XA, Vega TA, Seaman A, Korthuis PT, Englander H. Exploring how hospitalization can alter hepatitis c virus treatment prioritization and trajectories in people who use drugs: A qualitative analysis. Subst Abus 2021; 43:245-252. [PMID: 34161198 PMCID: PMC8695635 DOI: 10.1080/08897077.2021.1932699] [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: 01/03/2023]
Abstract
Background: People who use drugs (PWUD) have high rates of hepatitis C virus (HCV) infection. Hospitalization can be a time for PWUD to engage in addiction treatment, but little is known about how hospitalization shapes HCV treatment readiness. We aimed to describe how hospitalization and addiction medicine consult service (AMCS) can alter HCV prioritization of inpatient PWUD with HCV. Methods: We conducted a qualitative study consisting of semi-structured interviews (n = 27) of hospitalized adults with addiction and HCV infection seen by an AMCS at a single, urban, academic center. Interviews were audio-recorded, transcribed, and coded iteratively at the semantic level, and analyzed for themes. Results: Of the 27 participants, most identified as Caucasian (85%), male gender (67%), and they primarily used opioids (78%); approximately half (48%) reported HCV diagnosis over 5 years ago. We identified three main themes around hospitalization altering the prioritizations and HCV treatment preferences for PWUD: (1) HCV treatment non-engaged (2) HCV treatment urgency, and (3) HCV treatment in the future. Those wanting to treat HCV-whether urgently or in the future-shared the overlapping theme of hospitalization as a reachable moment for their addiction and HCV. These participants recognized the long-term benefits of addressing HCV and connected their hospitalization to substance use. Conclusion: In our study, PWUD with HCV expressed varying and competing priorities and life circumstances contributing to three main HCV treatment trajectories. Our results suggest ways hospitalization can serve as an HCV touchpoint for PWUD, especially in the context of addressing substance use, and could be used when designing and implementing targeted interventions to improve the HCV care continuum for PWUD.
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Affiliation(s)
- Ximena A. Levander
- Section of Addiction Medicine, Division of General Internal Medicine and Geriatrics, Department of Medicine Oregon Health and Science University, Portland, OR, USA
| | - Taylor A. Vega
- School of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Andrew Seaman
- Section of Addiction Medicine, Division of General Internal Medicine and Geriatrics, Department of Medicine Oregon Health and Science University, Portland, OR, USA
- Central City Concern, Portland, OR, USA
| | - P. Todd Korthuis
- Section of Addiction Medicine, Division of General Internal Medicine and Geriatrics, Department of Medicine Oregon Health and Science University, Portland, OR, USA
| | - Honora Englander
- Section of Addiction Medicine, Division of General Internal Medicine and Geriatrics, Department of Medicine Oregon Health and Science University, Portland, OR, USA
- Division of Hospital Medicine, Department of Medicine, Oregon Health and Science University, Portland, OR, USA
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26
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Pourmarzi D, Smirnov A, Hall L, FitzGerald G, Rahman T. 'I'm over the moon!': patient-perceived outcomes of hepatitis C treatment. Aust J Prim Health 2021; 26:319-324. [PMID: 32580867 DOI: 10.1071/py20013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/29/2020] [Indexed: 12/15/2022]
Abstract
Understanding patient-perceived outcomes is crucial for assessing the effectiveness and acceptability of hepatitis C virus (HCV) treatment. This study aimed to explore patient-perceived outcomes of receiving direct-acting antivirals (DAAs). This study was a part of a mixed-methods case study of the Prince Charles Hospital program for improving access to HCV treatment in community settings. Data were collected using semi-structured interviews with nine patients who were in different stages of their treatment for HCV. The participants were recruited using purposive sampling. All interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. Patients emphasised 'having more energy' when reporting improvements in their physical health following treatment. They also reported a newly developed sense of freedom and hope. Improved physical and mental health empowered them to start a healthy lifestyle and to practise self-protection from the risk of re-infection. Patients highlighted their desire to help other patients to receive treatment, which was connected to their experience of the services that they received and their perceived health outcomes. Patients expect and experience various outcomes that are related to the physical, psychological and social aspects of living with, and being cured of HCV. Emphasis on the short-term outcomes of receiving HCV treatment may improve HCV treatment uptake and adherence rates.
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Affiliation(s)
- Davoud Pourmarzi
- School of Public Health and Social Work, Faculty of Health, Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology, Brisbane, Qld 4059, Australia; and National Centre for Epidemiology and Population Health, Research School of Population Health, College of Health and Medicine, The Australian National University, Canberra, ACT 2601, Australia; and Corresponding author.
| | - Andrew Smirnov
- National Centre for Epidemiology and Population Health, Research School of Population Health, College of Health and Medicine, The Australian National University, Canberra, ACT 2601, Australia
| | - Lisa Hall
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Qld 4006, Australia
| | - Gerard FitzGerald
- School of Public Health and Social Work, Faculty of Health, Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology, Brisbane, Qld 4059, Australia
| | - Tony Rahman
- Department of Gastroenterology and Hepatology, The Prince Charles Hospital, Brisbane, Qld 4032, Australia
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27
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Jacob J, Goodyear T, Coulaud PJ, Hoong P, Ti L, Knight R. "I want to feel young again": experiences and perspectives of young people who inject drugs living with hepatitis C in Vancouver, Canada. Canadian Journal of Public Health 2021; 112:947-956. [PMID: 34115340 DOI: 10.17269/s41997-021-00535-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 04/27/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES People who inject drugs (PWID) are disproportionately impacted by hepatitis C virus (HCV). Despite the availability and efficacy of direct-acting antiviral (DAA) HCV therapies, treatment rates remain low among PWID. Among PWID, those who are young (under age 30) experience high rates of HCV and also face distinct barriers to care. The objective of this study is to identify facilitators and barriers to navigating various facets of the HCV cascade of care, including DAA treatment access, among young PWID. METHODS We draw on data from in-depth, semi-structured interviews conducted between May and November 2019 with a sample of 11 young, street-involved PWID who have lived experience of HCV and who live in Metro Vancouver, Canada. Informed by a social constructivist epistemology, data were thematically analyzed using an equity-oriented theoretical framework. RESULTS Our analysis yielded two key themes. First, participants described facilitators to HCV care access, including individual factors (e.g., desire to be cured, knowledge of side effects) and healthcare and socio-contextual factors (e.g., peer supports, supportive youth-specific services). Second, participants described a contrasting set of barriers to HCV care access, including concerns over treatment side effects and (in)eligibility, complex healthcare system navigation, substance use- and housing-related stigma, and clinician gatekeeping of DAAs. CONCLUSION Findings from this study underscore the need for HCV-related knowledge-building efforts among young PWID and clinicians. Also needed are structural policy interventions to facilitate access to DAAs, including anti-stigma efforts, access to safe housing, and the scale-up of low-barrier youth-specific services and decentralized HCV care.
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Affiliation(s)
- Jessica Jacob
- British Columbia Centre on Substance Use, 400-1045 Howe St, Vancouver, V6Z 2A9, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Trevor Goodyear
- British Columbia Centre on Substance Use, 400-1045 Howe St, Vancouver, V6Z 2A9, BC, Canada.,School of Nursing, University of British Columbia, Vancouver, Canada
| | - Pierre-Julien Coulaud
- British Columbia Centre on Substance Use, 400-1045 Howe St, Vancouver, V6Z 2A9, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Peter Hoong
- British Columbia Centre on Substance Use, 400-1045 Howe St, Vancouver, V6Z 2A9, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Lianping Ti
- British Columbia Centre on Substance Use, 400-1045 Howe St, Vancouver, V6Z 2A9, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Rod Knight
- British Columbia Centre on Substance Use, 400-1045 Howe St, Vancouver, V6Z 2A9, BC, Canada. .,Department of Medicine, University of British Columbia, Vancouver, Canada.
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28
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Duarte G, Pezzuto P, Barros TD, Mosimann G, Martinez-Espinosa FE. Brazilian Protocol for Sexually Transmitted Infections 2020: viral hepatitis. Rev Soc Bras Med Trop 2021; 54:e2020834. [PMID: 34008732 PMCID: PMC8210490 DOI: 10.1590/0037-8682-834-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/10/2021] [Indexed: 12/09/2022] Open
Abstract
This article discusses viral hepatitis, a theme addressed by the Clinical Protocol and Therapeutic Guidelines to Comprehensive Care for People with Sexually Transmitted Infections and, more precisely, by the Clinical Protocols and Therapeutic Guidelines for Hepatitis B and Hepatitis C and Coinfections, published by the Brazilian Ministry of Health. Besides the broad spectrum of health impairment, hepatitis A, B, and C viruses also present different transmission forms, whether parenteral, sexual, vertical, or fecal-oral. Among the strategies suggested for the control of viral hepatitis, in addition to behavioral measures, are expanded diagnosis, early vaccination against hepatitis A and hepatitis B viruses, and access to available therapeutic resources. Considering vertical transmission of the hepatitis B and hepatitis C viruses, screening for pregnant women with chronic hepatitis B and C is an essential perinatal health strategy, indicating with precision those who can benefit from the prophylactic interventions. Viral hepatitis A, B, and C are responsible for more than 1.34 million deaths worldwide every year, from which 66% are the result of hepatitis B, 30% of hepatitis C, and 4% of hepatitis A.
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Affiliation(s)
- Geraldo Duarte
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, SP, Brasil
| | - Paula Pezzuto
- Ministério da Saúde, Secretaria de Vigilância em Saúde, Brasília, DF, Brasil
| | - Tiago Dahrug Barros
- Ministério da Saúde, Secretaria de Vigilância em Saúde, Brasília, DF, Brasil
| | - Gláucio Mosimann
- Ministério da Saúde, Secretaria de Vigilância em Saúde, Brasília, DF, Brasil
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Hajarizadeh B, Grebely J, Byrne M, Marks P, Amin J, McManus H, Butler T, Cunningham EB, Vickerman P, Martin NK, McHutchison JG, Brainard DM, Treloar C, Chambers GM, Grant L, Mcgrath C, Lloyd AR, Dore GJ. Evaluation of hepatitis C treatment-as-prevention within Australian prisons (SToP-C): a prospective cohort study. Lancet Gastroenterol Hepatol 2021; 6:533-546. [PMID: 33965006 DOI: 10.1016/s2468-1253(21)00077-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/25/2021] [Accepted: 02/25/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Limited empirical evidence exists for the effectiveness of hepatitis C virus (HCV) treatment-as-prevention. The Surveillance and Treatment of Prisoners with hepatitis C (SToP-C) study aimed to assess the effect of HCV treatment-as-prevention in the prison setting. METHODS SToP-C was a prospective study, including a before-and-after analysis, within a cohort of people incarcerated in two maximum-security prisons (male) and two medium-security prisons (one male, one female) in New South Wales, Australia. All prison inmates aged at least 18 years were eligible for enrolment. After HCV testing, participants were monitored for risk behaviours and HCV infection, among three sub-populations: uninfected (HCV antibody-negative); previously infected (HCV antibody-positive, HCV RNA-negative); and infected (HCV antibody and HCV RNA-positive). Uninfected participants were followed up every 3-6 months to detect HCV primary infection and previously infected participants were followed up every 3-6 months to detect re-infection. Participants with HCV infection were assessed for treatment, initially standard-of-care treatment (administered by prison health services) from 2014 to mid-2017, then direct-acting antiviral (DAA) treatment scale-up from mid-2017 onwards (12 weeks of sofosbuvir plus velpatasvir, administered through SToP-C). Participants were followed up until study closure in November, 2019. The primary study outcome was HCV incidence before and after DAA treatment scale-up among participants at risk of HCV primary infection or re-infection. This study is registered with ClinicalTrials.gov, NCT02064049. FINDINGS Between Oct 30, 2014, and Sept 30, 2019, 3691 participants were enrolled in the SToP-C study. 719 (19%) participants had detectable HCV RNA, 2240 (61%) were at risk of primary HCV infection, and 725 (20%) were at risk of re-infection at baseline. DAA treatment was initiated in 349 (70%) of 499 eligible participants during the treatment scale-up period. The HCV incidence analysis comprised 1643 participants at risk of HCV infection or re-infection during longitudinal follow-up (median age 33 years [IQR 27-42]; 1350 [82%] male). 487 (30%) of 1643 participants reported injecting drugs in prison. HCV incidence decreased from 8·31 per 100 person-years in the pre-treatment scale-up period to 4·35 per 100 person-years in the post-treatment scale-up period (incidence rate ratio [IRR] 0·52 [95% CI 0·36-0·78]; p=0·0007). The incidence of primary infection decreased from 6·64 per 100 person-years in the pre-treatment scale-up period to 2·85 per 100 person-years in the post-treatment scale-up period (IRR 0·43 [95% CI 0·25-0·74]; p=0·0019), whereas the incidence of re-infection decreased from 12·36 per 100 person-years to 7·27 per 100 person-years (0·59 [0·35-1·00]; p=0·050). Among participants reporting injecting drugs during their current imprisonment, the incidence of primary infection decreased from 39·08 per 100 person-years in the pre-treatment scale-up period to 14·03 per 100 person-years in the post-treatment scale-up period (IRR 0·36 [95% CI 0·16-0·80]; p=0·0091), and the incidence of re-infection decreased from 15·26 per 100 person-years to 9·34 per 100 person-years (0·61 [0·34-1·09]; p=0·093). The adjusted analysis (adjusted for age, Indigenous Australian ethnicity, duration of stay in prison, previous imprisonment, injecting drug use status, and prison site) indicated a significant reduction in the risk of HCV infection between the pre-DAA treatment scale-up and post-DAA treatment scale-up periods (adjusted hazard ratio 0·50 [95% CI 0·33-0·76]; p=0·0014). INTERPRETATION DAA treatment scale-up was associated with reduced HCV incidence in prison, indicative of a beneficial effect of HCV treatment-as-prevention in this setting. These findings support broad DAA treatment scale-up within incarcerated populations. FUNDING Australian National Health and Medical Research Council Partnership Project Grant and Gilead Sciences.
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Affiliation(s)
| | - Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Marianne Byrne
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Pip Marks
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Janaki Amin
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Hamish McManus
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Tony Butler
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | | | - Peter Vickerman
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Natasha K Martin
- Population Health Sciences, University of Bristol, Bristol, UK; Division of Infectious Diseases & Global Public Health, University of California San Diego, San Diego, CA, USA
| | | | | | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | | | - Luke Grant
- Corrective Services NSW, Sydney, NSW Australia
| | - Colette Mcgrath
- Justice Health and Forensic Mental Health Network, NSW Health, Sydney, NSW, Australia
| | - Andrew R Lloyd
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Gregory J Dore
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.
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30
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Rance J, Lafferty L, Treloar C. Considering treatment-as-prevention scale-up for Australian prisons: a qualitative sub-study of expert stakeholders from the Australian 'surveillance and treatment of prisoners with hepatitis C' project (SToP-C). Harm Reduct J 2021; 18:46. [PMID: 33902595 PMCID: PMC8073887 DOI: 10.1186/s12954-021-00494-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/11/2021] [Indexed: 12/03/2022] Open
Abstract
Background With direct-acting antivirals dramatically reshaping the public health response to the hepatitis C virus (HCV), prisons are set to play a critical role in elimination efforts. Despite the theoretical demonstration of HCV treatment-as-prevention in prison in mathematical modeling, limited empirical data exist. The Australian ‘Surveillance and Treatment of Prisoners with Hepatitis C’ project (SToP-C) is the world’s first trial of HCV treatment-as-prevention in prison. Drawing on interviews with HCV expert stakeholders, this paper explores the factors respondents identified as crucial to the success of future scale-up. Accounting for such perspectives matters because of the influence expert discourse has in shaping implementation.
Methods Semi-structured interviews were conducted with nineteen HCV experts working across key policy, advocacy, research and clinical dimensions of the Australian HCV response. Data were coded using qualitative data management software (NVivo 11). Analysis proceeded via a hybrid deductive and inductive approach. Results Notwithstanding concerns regarding the lack of primary prevention in Australian prisons, stakeholders reported broad levels of support for the intervention and for the future scale-up of HCV treatment. A number of considerations, both external and internal to the prison system, were identified as key. The principal external factor was an enabling political-cum-policy environment; internal factors included: obtaining support from prisons’ executive and custodial staff; promoting health within a security-first institutional culture; allocating time for treatment within prisoners’ tightly regulated schedules; ensuring institutional stability during treatment given the routine movement of prisoners between prisons; prioritizing the availability of retreatment given the paucity of primary prevention; and securing sufficient clinical space for treatment. Conclusion The challenges to implementation are considerable, ranging from macrolevel concerns to in-prison logistical matters. Nonetheless, we argue that prisons remain an obvious setting for treatment scale-up, not only for prevention and potential elimination benefit, but for the treatment opportunities they afford a socially disadvantaged and underserved population. While noting widespread concerns among respondents regarding the paucity of primary prevention in Australian prisons, results indicate broad levels of support among expert stakeholders for HCV treatment scale-up in prison.
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Affiliation(s)
- Jake Rance
- Centre for Social Research in Health, University of New South Wales, Level 3, John Goodsell Building, Sydney, NSW, 2052, Australia.
| | - Lise Lafferty
- Centre for Social Research in Health, University of New South Wales, Level 3, John Goodsell Building, Sydney, NSW, 2052, Australia
| | - Carla Treloar
- Centre for Social Research in Health, University of New South Wales, Level 3, John Goodsell Building, Sydney, NSW, 2052, Australia
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31
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Duarte G, Pezzuto P, Barros TD, Mosimann Junior G, Martínez-Espinosa FE. [Brazilian Protocol for Sexually Transmitted Infections 2020: viral hepatitis]. ACTA ACUST UNITED AC 2021; 30:e2020834. [PMID: 33729415 DOI: 10.1590/s1679-4974202100016.esp1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 10/03/2020] [Indexed: 01/01/2023]
Abstract
This article discusses viral hepatitis, a theme addressed by the Clinical Protocol and Therapeutic Guidelines to Comprehensive Care for People with Sexually Transmitted Infections and, more precisely, by the Clinical Protocols and Therapeutic Guidelines for Hepatitis B and Hepatitis C and Coinfections, published by the Brazilian Ministry of Health. Besides the broad spectrum of health impairment, hepatitis A, B and C viruses also present different forms of transmission, whether parenteral, sexual, vertical or oral. Among the strategies suggested for the control of viral hepatitis, in addition to behavioral measures, are expanded diagnosis, early vaccination against hepatitis A and hepatitis B viruses, and access to available therapeutic resources. Considering vertical transmission of the hepatitis B and hepatitis C viruses, screening for pregnant women with chronic hepatitis B and C is an important perinatal health strategy, indicating with precision those who can benefit from the prophylactic interventions.
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Affiliation(s)
- Geraldo Duarte
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, SP, Brasil
| | - Paula Pezzuto
- Ministério da Saúde, Secretaria de Vigilância em Saúde, Brasília, DF, Brasil
| | - Tiago Dahrug Barros
- Ministério da Saúde, Secretaria de Vigilância em Saúde, Brasília, DF, Brasil
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32
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Kwon JA, Chambers GM, Luciani F, Zhang L, Kinathil S, Kim D, Thein HH, Botha W, Thompson S, Lloyd A, Yap L, Gray RT, Butler T. Hepatitis C treatment strategies in prisons: A cost-effectiveness analysis. PLoS One 2021; 16:e0245896. [PMID: 33571196 PMCID: PMC7877645 DOI: 10.1371/journal.pone.0245896] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 01/08/2021] [Indexed: 02/07/2023] Open
Abstract
In Australian prisons approximately 20% of inmates are chronically infected with hepatitis C virus (HCV), providing an important population for targeted treatment and prevention. A dynamic mathematical model of HCV transmission was used to assess the impact of increasing direct-acting antiviral (DAA) treatment uptake on HCV incidence and prevalence in the prisons in New South Wales, Australia, and to assess the cost-effectiveness of alternate treatment strategies. We developed four separate models reflecting different average prison lengths of stay (LOS) of 2, 6, 24, and 36 months. Each model considered four DAA treatment coverage scenarios of 10% (status-quo), 25%, 50%, and 90% over 2016–2045. For each model and scenario, we estimated the lifetime burden of disease, costs and changes in quality-adjusted life years (QALYs) in prison and in the community during 2016–2075. Costs and QALYs were discounted 3.5% annually and adjusted to 2015 Australian dollars. Compared to treating 10% of infected prisoners, increasing DAA coverage to 25%, 50%, and 90% reduced HCV incidence in prisons by 9–33% (2-months LOS), 26–65% (6-months LOS), 37–70% (24-months LOS), and 35–65% (36-months LOS). DAA treatment was highly cost-effective among all LOS models at conservative willingness-to-pay thresholds. DAA therapy became increasingly cost-effective with increasing coverage. Compared to 10% treatment coverage, the incremental cost per QALY ranged from $497-$569 (2-months LOS), -$280–$323 (6-months LOS), -$432–$426 (24-months LOS), and -$245–$477 (36-months LOS). Treating more than 25% of HCV-infected prisoners with DAA therapy is highly cost-effective. This study shows that treating HCV-infected prisoners is highly cost-effective and should be a government priority for the global HCV elimination effort.
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Affiliation(s)
- Jisoo A. Kwon
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Georgina M. Chambers
- National Perinatal Epidemiology and Statistics Unit (NPESU), Centre for Big Data Research in Health and School of Women’s and Children’s Health, UNSW Sydney, Sydney, NSW, Australia
- * E-mail:
| | - Fabio Luciani
- School of Medical Sciences, Faculty of Medicine, UNSW, Sydney, NSW, Australia
| | - Lei Zhang
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
- The Melbourne Sexual Health Centre, Alfred Health, Carlton, Melbourne, VIC, Australia
| | | | - Dennis Kim
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Hla-Hla Thein
- Toronto Health Economics and Technology Assessment Collaborative (THETA), Toronto General Hospital Research Institute, University of Toronto and University Health Network, Toronto, ON, Canada
| | - Willings Botha
- RTI Health Solutions, Research Triangle Park, NC, United States of America
| | - Sandra Thompson
- Combined Universities of Rural Health, Geraldton, WA, Australia
| | - Andrew Lloyd
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Lorraine Yap
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | | | - Tony Butler
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
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Falade-Nwulia O, Sulkowski MS. Hepatitis C Virus Treatment: Simplifying the Simple and Optimizing the Difficult. J Infect Dis 2020; 222:S745-S757. [PMID: 33245350 PMCID: PMC8171802 DOI: 10.1093/infdis/jiaa534] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The availability of safe, efficacious, oral direct-acting antivirals (DAAs) have ushered in a new era of hepatitis C treatment with potential to eliminate hepatitis C as a public health threat. To achieve population-level effectiveness of these oral DAAs, hepatitis C treatment by a wide range of providers in different settings will be essential to increase the number of persons treated. We provide a clinical review of hepatitis C treatment with a focus on practical tools for management of hepatitis C in majority of currently infected individuals who can be easily cured and optimization of treatment for those in whom treatment may not be as simple.
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Affiliation(s)
| | - Mark S Sulkowski
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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34
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Martinello M, Orkin C, Cooke G, Bhagani S, Gane E, Kulasegaram R, Shaw D, Tu E, Petoumenos K, Marks P, Grebely J, Dore GJ, Nelson M, Matthews GV. Short-Duration Pan-Genotypic Therapy With Glecaprevir/Pibrentasvir for 6 Weeks Among People With Recent Hepatitis C Viral Infection. Hepatology 2020; 72:7-18. [PMID: 31652357 DOI: 10.1002/hep.31003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 10/21/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND AIMS Among treatment-naive individuals with chronic hepatitis C viral (HCV) infection and without cirrhosis, glecaprevir/pibrentasvir for 8 weeks is recommended. The aim of this analysis was to evaluate the efficacy of glecaprevir/pibrentasvir for 6 weeks in people with acute and recent HCV infection. APPROACH AND RESULTS In this open-label, single-arm, multicenter, international pilot study, adults with recent HCV (duration of infection < 12 months) received glecaprevir/pibrentasvir 300/120 mg daily for 6 weeks. Primary infection was defined by first positive anti-HCV antibody and/or HCV RNA within 6 months of enrollment and either acute clinical hepatitis within the past 12 months (symptomatic seroconversion illness or alanine aminotransferase > 10 × upper limit of normal) or anti-HCV antibody seroconversion within 18 months. Reinfection was defined as new positive HCV RNA within 6 months of enrollment and evidence of prior spontaneous or treatment-induced clearance. The primary endpoint was sustained virologic response at 12 weeks posttreatment (SVR12). Thirty men (median age 43 years, 90% men who have sex with men) received treatment, of whom 77% (n = 23) were human immunodeficiency virus-positive, 47% (n = 14) had ever injected drugs, and 13% (n = 4) had HCV reinfection. The majority had HCV genotype 1 (83%, n = 25), followed by genotype 4 (10%, n = 3) and genotype 3 (7%, n = 2). At baseline, median estimated duration of infection was 29 weeks (range 13, 52) and median HCV RNA was 6.2 log10 IU/mL (range 0.9, 7.7). SVR12 in the intention-to-treat and per-protocol populations was achieved in 90% (27/30) and 96% (27/28), respectively. There was one case of relapse, and there were two cases of nonvirological failure (death, n = 1; loss to follow-up, n = 1). No treatment-related serious adverse events were seen. CONCLUSIONS Glecaprevir/pibrentasvir for 6 weeks was highly effective among people with acute and recent HCV infection, supporting further evaluation of shortened-duration pan-genotypic therapy in this setting.
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Affiliation(s)
- Marianne Martinello
- Kirby Institute, University of New South Wales Sydney, Sydney, Australia.,St. Vincent's Hospital, Sydney, Australia.,Department of Infectious Diseases, Blacktown Mt. Druitt Hospital, Sydney, Australia
| | | | - Graham Cooke
- Department of Infectious Diseases, Imperial College NHS Trust, St. Mary's Hospital, London, UK
| | - Sanjay Bhagani
- Department of Infectious Diseases/HIV Medicine, Royal Free Hospital, London, UK
| | - Edward Gane
- New Zealand Liver Transplant Unit, Auckland City Hospital, Auckland, New Zealand
| | | | - David Shaw
- Department of Infectious Diseases, Royal Adelaide Hospital, Adelaide, Australia
| | - Elise Tu
- Kirby Institute, University of New South Wales Sydney, Sydney, Australia
| | - Kathy Petoumenos
- Kirby Institute, University of New South Wales Sydney, Sydney, Australia
| | - Philippa Marks
- Kirby Institute, University of New South Wales Sydney, Sydney, Australia
| | - Jason Grebely
- Kirby Institute, University of New South Wales Sydney, Sydney, Australia
| | - Gregory J Dore
- Kirby Institute, University of New South Wales Sydney, Sydney, Australia.,St. Vincent's Hospital, Sydney, Australia
| | - Mark Nelson
- Chelsea and Westminster Hospital, London, UK
| | - Gail V Matthews
- Kirby Institute, University of New South Wales Sydney, Sydney, Australia.,St. Vincent's Hospital, Sydney, Australia
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Jiang X, Tan J, Wang Y, Chen J, Li J, Jiang Z, Quan Y, Jin J, Li Y, Cen S, Li Y, Peng Z, Li Z. 2-((4-Arylpiperazin-1-yl)methyl)benzonitrile Derivatives as Orally Available Inhibitors of Hepatitis C Virus with a Novel Mechanism of Action. J Med Chem 2020; 63:5972-5989. [PMID: 32378892 DOI: 10.1021/acs.jmedchem.0c00232] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Although the direct-acting antivirals revolutionized the hepatitis C virus (HCV) infection treatment in the last decade, more efforts are needed to reach the elimination of HCV in the absence of a vaccine. 4-(Piperazin-1-yl)-2-((p-tolylamino)methyl)-benzonitrile (1) is a modest HCV inhibitor identified from an in-house screening using a HCV-infected Huh7.5 cell culture. Starting from it, the chemical optimization afforded a new 2-((4-arylpiperazin-1-yl)methyl)benzonitrile scaffold with significantly increased antiviral activity against HCV. A highly effective HCV inhibitor, 35 (L0909, EC50 = 0.022 μM, SI > 600), was identified by the structure-activity relationship study. The biological study revealed that L0909 could block HCV replication by acting on the HCV entry stage. The high sensitivity to clinical resistant HCV mutants and synergistic effect with clinical drugs were observed for this compound. The further pharmaceutical studies demonstrated that L0909 is long-lasting, is orally available, and has low toxicity in vivo. These results show L0909 as a promising HCV entry inhibitor for single or combinational therapeutic potential.
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Affiliation(s)
- Xinbei Jiang
- CAMS Key Laboratory of Antiviral Drug Research, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China
| | - Jiali Tan
- CAMS Key Laboratory of Antiviral Drug Research, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China
| | - Yixuan Wang
- CAMS Key Laboratory of Antiviral Drug Research, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China
| | - Jinhua Chen
- CAMS Key Laboratory of Antiviral Drug Research, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China
| | - Jianrui Li
- CAMS Key Laboratory of Antiviral Drug Research, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China.,Beijing Key Laboratory of Antimicrobial Agents, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China
| | - Zhi Jiang
- CAMS Key Laboratory of Antiviral Drug Research, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China
| | - Yanni Quan
- CAMS Key Laboratory of Antiviral Drug Research, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China
| | - Jie Jin
- CAMS Key Laboratory of Antiviral Drug Research, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China
| | - Yuhuan Li
- CAMS Key Laboratory of Antiviral Drug Research, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China.,Beijing Key Laboratory of Antimicrobial Agents, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China
| | - Shan Cen
- CAMS Key Laboratory of Antiviral Drug Research, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China
| | - Yanping Li
- CAMS Key Laboratory of Antiviral Drug Research, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China
| | - Zonggen Peng
- CAMS Key Laboratory of Antiviral Drug Research, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China.,Beijing Key Laboratory of Antimicrobial Agents, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China
| | - Zhuorong Li
- CAMS Key Laboratory of Antiviral Drug Research, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China
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Brener L, Murphy DA, Ellard J, Cama E, Fraser N, Murray J. Knowledge, attitudes and practices related to hepatitis C among gay and bisexual men in the era of direct-acting antivirals: implications for treatment and prevention. CULTURE, HEALTH & SEXUALITY 2020; 22:551-567. [PMID: 31131720 DOI: 10.1080/13691058.2019.1615125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 05/01/2019] [Indexed: 06/09/2023]
Abstract
Increases in hepatitis C (HCV) infections among gay and bisexual men have recently been reported in a number of countries, with sexual transmission being the primary route of infection. Given that in countries such as Australia most gay and bisexual men living with HIV are already engaged in clinical care - as are an increasing number of HIV-negative men - there is potential for reducing onward HCV transmission through proactive testing and treatment. This study explored knowledge, attitudes and practices related to HCV among 194 gay and bisexual men collected through an online survey in Australia. Overall, respondents had high levels of HCV knowledge; however, only 76% knew about the availability of new treatments for HCV. Men's knowledge of their own HCV testing history was uncertain, with one in six unaware if they had ever been tested. Among men who reported recent drug injecting, one-third had been injected by someone else, and two-thirds had injected someone else, indicating a subculture of cross-administering within sexualised drug-use networks. We argue that the robust sexual, socio-cultural and clinical infrastructure that has been developed by - and for - gay and bisexual men around HIV care and prevention creates the potential for reducing HCV in this group.
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Affiliation(s)
- Loren Brener
- Centre for Social Research in Health, UNSW Sydney, NSW, Australia
| | - Dean A Murphy
- Centre for Social Research in Health, UNSW Sydney, NSW, Australia
- Department of Gender and Cultural Studies, University of Sydney, Sydney, NSW, Australia
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, NSW, Australia
| | - Jeanne Ellard
- Australian Federation of AIDS Organisations, Newtown, NSW, Australia
| | - Elena Cama
- Centre for Social Research in Health, UNSW Sydney, NSW, Australia
| | - Neil Fraser
- Positive Life NSW, Surry Hills, NSW, Australia
| | - Joel Murray
- Positive Life NSW, Surry Hills, NSW, Australia
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Abstract
Hepatitis C virus is a global public health threat, affecting 71 million people worldwide. Increasing recognition of the impact of this epidemic and recent advances in biomedical and technical approaches to hepatitis C prevention and cure have provided impetus for the World Health Organization (WHO) to call for global elimination of hepatitis C as a public health threat by 2030. This work reviews the feasibility of hepatitis C elimination and pathways to overcome existing and potential future barriers to elimination. Drawing on cost-effectiveness modeling and providing examples of successful implementation efforts across the globe, we highlight the resources and strategies needed to achieve hepatitis C elimination. A timely, multipronged response is required if the 2030 WHO elimination targets are to be achieved. Importantly, achieving hepatitis C elimination will also benefit the community well beyond 2030.
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38
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Feld JJ. HCV elimination: It will take a village and then some. J Hepatol 2020; 72:601-603. [PMID: 32057492 DOI: 10.1016/j.jhep.2020.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 01/03/2020] [Accepted: 01/03/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Jordan J Feld
- Toronto Centre for Liver Disease, Sandra Rotman Centre for Global Health, Toronto General Hospital, University of Toronto, Toronto, Canada.
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39
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Lazarus JV, Roel E, Elsharkawy AM. Hepatitis C Virus Epidemiology and the Impact of Interferon-Free Hepatitis C Virus Therapy. Cold Spring Harb Perspect Med 2020; 10:cshperspect.a036913. [PMID: 31570385 DOI: 10.1101/cshperspect.a036913] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The public health impact of hepatitis C virus (HCV) infection has been realized only recently. Globally, 71 million people are living with HCV chronic infection. HCV prevalence is higher in some regions and countries, as well as in some subpopulations such as people who inject drugs, prisoners, or people living with HIV. In 2017, an estimated 580,000 people died from HCV, largely because of long-term complications of the disease. The advent of direct-acting antivirals (DAAs), which are highly effective in treating the infection and are well tolerated, led the World Health Organization (WHO) in 2016 to call for the elimination of HCV by 2030, which would be possible by meeting the numerical targets laid down by the organization. However, at present, only 12 countries are on track. Overall, only 20% of people with HCV have been diagnosed and only 7% of people diagnosed have initiated treatment, with major differences among countries. Underdiagnoses, a general lack of awareness, poor surveillance, and the prices of diagnostics and treatment remain major barriers to achieving the elimination goals. Comprehensive strategies, which include innovative models of care and the removal of reimbursement restrictions for treatment, are needed to overcome these public health and health system obstacles.
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Affiliation(s)
- Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain
| | - Elena Roel
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain.,Preventive Medicine and Epidemiology, Hospital Clínic, 08036 Barcelona, Spain
| | - Ahmed M Elsharkawy
- Liver Unit, University Hospitals Birmingham, Edgbaston, Birmingham B15 2TH, United Kingdom
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Lafferty L, Rance J, Grebely J, Dore GJ, Lloyd AR, Treloar C. Perceptions and concerns of hepatitis C reinfection following prison-wide treatment scale-up: Counterpublic health amid hepatitis C treatment as prevention efforts in the prison setting. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 77:102693. [PMID: 32045828 DOI: 10.1016/j.drugpo.2020.102693] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 01/28/2020] [Accepted: 01/28/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Hepatitis C (HCV) infection is highly prevalent within the prison setting. Direct-acting antiviral (DAA) therapies have changed the HCV treatment landscape, offering simple treatment (with minimal side-effects) and high efficacy. These advances have enabled the first real-world study of HCV treatment as prevention (TasP), the Surveillance and Treatment of Prisoners with hepatitis C (SToP-C) study. This paper draws on data from qualitative interviews completed with SToP-C participants following prison-wide DAA treatment scale-up. METHODS Semi-structured interviews were undertaken with 23 men in prison following HCV treatment completion to identify ongoing risk practices, perceptions of strategies for HCV prevention within the prison setting, experiences of HCV treatment (as prevention), and perceptions of reinfection following cure. Analysis was undertaken using a counterpublic health lens to identify risks and perceptions of reinfection among people treated for HCV within the prison setting. RESULTS Participants identified a number of challenges of meaningful HCV 'cure' in the absence of increased access to prevention strategies (e.g., opioid agonist therapy and prison needle syringe programs) along with concerns that 'cure' was only temporary whilst incarcerated. 'Cure' status included self-perceptions of being "clean", while also imposing responsibility on the individual to maintain their 'cure' status. CONCLUSION HCV DAA treatment is provided somewhat under the guise of 'cure is easy', but fails to address the ongoing risk factors experienced by people who inject drugs in prisons, as well as other people in prison who may be at risk of blood-to-blood exposure. Health messaging regarding HCV treatment and treatment for reinfection should be tailored to ensure patient-centred care. Health interventions in prison must address the whole person and the circumstances in which they live, not just the illness.
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Affiliation(s)
- Lise Lafferty
- Centre for Social Research in Health, UNSW Sydney, Level 2, Goodsell Building, Sydney NSW 2052, Australia.
| | - Jake Rance
- Centre for Social Research in Health, UNSW Sydney, Level 2, Goodsell Building, Sydney NSW 2052, Australia
| | - Jason Grebely
- The Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth Building, Sydney NSW 2052, Australia
| | - Gregory J Dore
- The Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth Building, Sydney NSW 2052, Australia
| | - Andrew R Lloyd
- The Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth Building, Sydney NSW 2052, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Level 2, Goodsell Building, Sydney NSW 2052, Australia
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Outcomes of a tertiary-based innovative approach to engage primary care providers in provision of hepatitis C treatment in community settings. BMC Public Health 2019; 19:1335. [PMID: 31640625 PMCID: PMC6805662 DOI: 10.1186/s12889-019-7604-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 09/06/2019] [Indexed: 12/26/2022] Open
Abstract
Background Australia is committed to eliminating the hepatitis C virus (HCV) by 2030. Despite regulations in Australia that enable the prescription of subsidised direct acting antiviral (DAA) by primary health care providers, the number of providers who treat patients for HCV remains low and this limits the prospect of HCV elimination. The Prince Charles Hospital, Brisbane, Australia, implemented an innovative program called Cure-It aimed at engaging primary care providers in community-based HCV treatment. This paper aims to describe initial experiences and short-term patient outcomes of this program. Methods A formative evaluation was conducted using program data for the period March 2016 to April 2018. Descriptive statistics were used to report the number of engaged primary care providers, patients’ baseline characteristics, treatment plans, and treatment outcomes. Results Thirty primary care providers from different settings were engaged in HCV treatment. Among 331 patients eligible for community-based treatment, 315 (95.2%) commenced treatment, the completion rate was 92.4 and 66.5% achieved sustained virological response at 12 weeks (SVR12). The SVR12 had not been documented for 26.8% of patients. Among patients whose SVR12 was documented, 98.2% achieved SVR12. Only 1.3% of patients experienced treatment failure. Conclusion A flexible tertiary-led model can improve primary care providers and patients’ engagement with provision of HCV treatment. Tertiary centres need to play their role to improve the accessibility of HCV treatment through providing training and on-going support for primary care providers while enabling those providers to become more confident in providing treatment independently.
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Spearman CW, Dusheiko GM, Hellard M, Sonderup M. Hepatitis C. Lancet 2019; 394:1451-1466. [PMID: 31631857 DOI: 10.1016/s0140-6736(19)32320-7] [Citation(s) in RCA: 251] [Impact Index Per Article: 50.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/30/2019] [Accepted: 08/09/2019] [Indexed: 02/06/2023]
Abstract
Hepatitis C is a global health problem, and an estimated 71·1 million individuals are chronically infected with hepatitis C virus (HCV). The global incidence of HCV was 23·7 cases per 100 000 population (95% uncertainty interval 21·3-28·7) in 2015, with an estimated 1·75 million new HCV infections diagnosed in 2015. Globally, the most common infections are with HCV genotypes 1 (44% of cases), 3 (25% of cases), and 4 (15% of cases). HCV transmission is most commonly associated with direct percutaneous exposure to blood, via blood transfusions, health-care-related injections, and injecting drug use. Key high-risk populations include people who inject drugs, men who have sex with men, and prisoners. Approximately 10-20% of individuals who are chronically infected with HCV develop complications, such as cirrhosis, liver failure, and hepatocellular carcinoma over a period of 20-30 years. Direct-acting antiviral therapy is now curative, but it is estimated that only 20% of individuals with hepatitis C know their diagnosis, and only 15% of those with known hepatitis C have been treated. Increased diagnosis and linkage to care through universal access to affordable point-of-care diagnostics and pangenotypic direct-acting antiviral therapy is essential to achieve the WHO 2030 elimination targets.
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Affiliation(s)
- C Wendy Spearman
- Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Geoffrey M Dusheiko
- Liver Unit, Kings College Hospital, London, UK; Division of Medicine, University College London Medical School, London, UK
| | - Margaret Hellard
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
| | - Mark Sonderup
- Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Martinello M, Yee J, Bartlett SR, Read P, Baker D, Post JJ, Finlayson R, Bloch M, Doyle J, Shaw D, Hellard M, Petoumenos K, Lin L, Marks P, Applegate T, Dore GJ, Matthews GV. Moving Towards Hepatitis C Microelimination Among People Living With Human Immunodeficiency Virus in Australia: The CEASE Study. Clin Infect Dis 2019; 71:1502-1510. [DOI: 10.1093/cid/ciz985] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 10/02/2019] [Indexed: 12/19/2022] Open
Abstract
Abstract
Background
Microelimination of hepatitis C virus (HCV) among people living with human immunodeficiency virus (HIV) may be feasible in Australia, given unrestricted access to direct-acting antiviral (DAA) therapy from 2016. Our aim was to evaluate progress towards elimination goals within HIV/HCV-coinfected adults in Australia following universal DAA access.
Methods
The CEASE prospective cohort study enrolled adults with HIV/HCV, irrespective of viremic status, from 14 primary and tertiary clinics in Australia. Annual and cumulative HCV treatment uptake, outcome, and HCV RNA prevalence were evaluated, with follow-up through May 2018 (median follow-up, 2.63 years). Factors associated with DAA uptake were analyzed.
Results
Between July 2014 and March 2017, 402 participants who were HIV/HCV antibody positive were enrolled (95% male [80% gay and bisexual men,], 13% cirrhosis, 80% history of injecting drug use [39% currently injecting]). Following universal DAA access, annual HCV treatment uptake in those eligible increased from 7% and 11% per year in 2014 and 2015, respectively, to 80% in 2016. By 2018, cumulative HCV treatment uptake in those ever eligible for treatment was 91% (336/371). HCV viremic prevalence declined from 82% (95% CI, 78–86%) in 2014 to 8% (95% CI, 6–12%) in 2018. Reinfection was reported in only 5 participants for a reinfection incidence of 0.81 per 100 person-years (95% CI, 0.34–1.94).
Conclusions
High uptake and effectiveness of unrestricted DAA therapy in Australia have permitted rapid treatment scale-up, with a dramatic reduction in HCV infection burden and low reinfection rate among people living with HIV, suggesting that microelimination is feasible.
Clinical Trials Registration
NCT02102451.
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Affiliation(s)
- Marianne Martinello
- The Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia
- St Vincent’s Hospital, Sydney, New South Wales, Australia
- Blacktown Mt Druitt Hospital, Blacktown, New South Wales, Australia
| | - Jasmine Yee
- The Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Sofia R Bartlett
- The Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Phillip Read
- Kirketon Road Clinic, Sydney, New South Wales, Australia
| | - David Baker
- East Sydney Doctors, Sydney, New South Wales, Australia
| | - Jeffrey J Post
- The Albion Centre, Sydney, New South Wales, Australia
- Prince of Wales Hospital, Sydney, New South Wales, Australia
- Prince of Wales Clinical School, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Robert Finlayson
- Taylor Square Private Clinic, Sydney, New South Wales, Australia
| | - Mark Bloch
- Holdsworth House Medical Practice, Sydney, New South Wales, Australia
| | - Joseph Doyle
- Burnet Institute, Melbourne, Victoria, Australia
| | - David Shaw
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Margaret Hellard
- Burnet Institute, Melbourne, Victoria, Australia
- Alfred Hospital, Melbourne, Victoria, Australia
| | - Kathy Petoumenos
- The Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Lanni Lin
- The Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Philippa Marks
- The Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Tanya Applegate
- The Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Gregory J Dore
- The Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia
- St Vincent’s Hospital, Sydney, New South Wales, Australia
| | - Gail V Matthews
- The Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia
- St Vincent’s Hospital, Sydney, New South Wales, Australia
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The change in the nationwide seroprevalence of hepatitis C virus and the status of linkage to care in South Korea from 2009 to 2015. Hepatol Int 2019; 13:599-608. [PMID: 31432446 DOI: 10.1007/s12072-019-09975-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 07/29/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hepatitis C virus (HCV) requires epidemiological monitoring to estimate its disease burden and to develop countermeasures. This study aimed to investigate the difference between the 2015 and 2009 nationwide anti-HCV seroprevalence and to determine linkage to care estimates in South Korea. METHODS A total 268,422 examinees ≥ 20 years old were included in 2015 from 33 medical institutions nationwide. Electronically extracted data were retrospectively analyzed to calculate the age-, sex-, and area-adjusted anti-HCV prevalence. Seroprevalence in 2015 was measured using the same method as that in 2009. For anti-HCV-positive subjects, medical records were reviewed to see whether HCV RNA testing or antiviral treatment was performed. RESULTS Adjusted anti-HCV prevalence was 0.60% (95% confidence interval, 0.57-0.63) based on general Korean population in 2015. It showed an increasing trend according to age; 0.23% in thirties, 0.38% in forties, 0.63% in fifties, 1.08% in sixties, and 1.65% in those aged ≥ 70 years. From 2009 to 2015, the adjusted anti-HCV prevalence decreased by 30%, with odds ratio of 0.70 (95% CI 0.70-0.71). There was significant intranational regional variation and changing pattern of seroprevalence. Among 1359 anti-HCV-positive subjects, HCV RNA test was performed in 60% and 25.4% had positivity. Treatment-initiated and cured rates in 2015 were 18.5% and 10.9%, respectively. CONCLUSIONS Anti-HCV prevalence in South Korea was 0.6% in 2015, showing a 30% decrease from that in 2009. Although the HCV RNA testing rate was increased since 2009, this remains suboptimal. Moreover, the treatment uptake rate should be improved in South Korea.
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Elimination of hepatitis C virus infection among people who use drugs: Ensuring equitable access to prevention, treatment, and care for all. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 72:1-10. [PMID: 31345644 DOI: 10.1016/j.drugpo.2019.07.016] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 07/05/2019] [Accepted: 07/06/2019] [Indexed: 12/12/2022]
Abstract
There have been major strides towards the World Health Organization goal to eliminate hepatitis C virus (HCV) infection as a global public health threat. The availability of simple, well-tolerated direct-acting antiviral therapies for HCV infection that can achieve a cure in >95% of people has provided an important tool to help achieve the global elimination targets. Encouragingly, therapy is highly effective among people receiving opioid agonist therapy and people who have recently injected drugs. Moving forward, major challenges include ensuring that new infections are prevented from occurring and that people who are living with HCV are tested, linked to care, treated, receive appropriate follow-up, and have equitable access to care. This editorial highlights key themes and articles in a special issue focusing on the elimination of HCV among people who inject drugs. An overarching consideration flowing from this work is how to ensure equitable access to HCV treatment and care for all. This special issue maps the field in relation to: HCV prevention; the cascade of HCV care; strategies to enhance testing, linkage to care, and treatment uptake; and HCV treatment and reinfection. In addition, papers draw attention to the 'risk environments' and socio-ecological determinants of HCV acquisition, barriers to HCV care, the importance of messaging around the side-effects of new direct-acting antiviral therapies, the positive transformative potential of treatment and cure, and the key role of community-based drug user organizations in the HCV response. While this special issue highlights some successful efforts towards HCV elimination among people who inject drugs, it also highlights the relative lack of attention to settings in which resources enabling elimination are scarce, and where elimination hopes and potentials are less clear, such as in many low and middle income countries. Strengthening capacity in areas of the world where resources are more limited will be a critical step towards ensuring equity for all so that global HCV elimination among PWID can be achieved.
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O'Neil CR, Buss E, Plitt S, Osman M, Coffin CS, Charlton CL, Shafran S. Achievement of hepatitis C cascade of care milestones: a population-level analysis in Alberta, Canada. Canadian Journal of Public Health 2019; 110:714-721. [PMID: 31222618 DOI: 10.17269/s41997-019-00234-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 05/27/2019] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Despite highly effective directly acting antiviral (DAA) therapy for hepatitis C virus (HCV), many patients do not receive treatment. We characterized the achievement of cascade of care milestones within 2 years of diagnosis among the Alberta population and evaluated variables associated with engagement at each stage. METHODS All Albertans with a first-time positive HCV antibody between 2009 and 2014 were included in this retrospective study. We determined which patients received follow-up testing (HCV RNA and HCV genotype), referral to hepatitis specialty care, and antiviral prescription, and achieved SVR within 2 years of diagnosis. Factors associated with achieving cascade milestones were identified by multivariable logistic regression analysis. RESULTS Of 6154 patients with HCV antibody and complete follow-up, 4238 (68.9%) had HCV RNA testing, 2360 (38.3%) had HCV genotyping, 2096 (34.1%) were assessed by a specialist, 711 (11.6%) were prescribed treatment and 207 (3.4%) achieved SVR within 2 years of diagnosis. Independent variables associated with reduced likelihood of achieving cascade milestones were Indigenous heritage (adjusted odds ratio (AOR) 0.53 (0.41-0.68) for HCV RNA testing), unstable housing (AOR 0.50 (0.32-0.79) for specialist assessment) and alcohol misuse (AOR 0.61 (0.38-0.99) for antiviral prescription). Men, older patients, patients with a higher income and patients with more advanced liver disease were more likely to achieve cascade of care milestones. CONCLUSION At each stage of patient engagement, opportunities for improvement were identified. Understanding the local cascade of care and factors associated with achieving cascade milestones will help prioritize initiatives to facilitate access to DAA therapy in Alberta.
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Affiliation(s)
- Conar R O'Neil
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada.
| | - Emily Buss
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Sabrina Plitt
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada.,Centre for Communicable Disease and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Mariam Osman
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada.,Alberta Health, Edmonton, Alberta, Canada
| | - Carla S Coffin
- Calgary Liver Unit, Division of Gastroenterology and Hepatology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Carmen L Charlton
- Provincial Laboratory for Public Health, Edmonton, Alberta, Canada.,Division of Diagnostic and Applied Microbiology, Department of Laboratory Medicine and Pathology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Stephen Shafran
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Schroeder SE, Higgs P, Winter R, Brown G, Pedrana A, Hellard M, Doyle J, Stoové M. Hepatitis C risk perceptions and attitudes towards reinfection among HIV-diagnosed gay and bisexual men in Melbourne, Australia. J Int AIDS Soc 2019; 22:e25288. [PMID: 31111671 PMCID: PMC6528066 DOI: 10.1002/jia2.25288] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 04/30/2019] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Gay and bisexual men (GBM) are at increased risk of hepatitis C/HIV co-infection. In Australia, the availability of subsidized direct-acting antiviral treatment for hepatitis C has rendered eliminating co-infection possible. High reinfection rates in subgroups with continued exposure may compromise elimination efforts. To inform the development of hepatitis C risk reduction support in GBM, we explored reinfection risk perceptions and attitudes among GBM living with HIV recently cured from hepatitis C. METHODS Between April and August 2017, 15 GBM living with diagnosed HIV were recruited from high caseload HIV primary care services in Melbourne following successful hepatitis C treatment. In-depth interviews were conducted exploring understandings of hepatitis C risks, experiences of co-infection and attitudes towards reinfection. Constructivist grounded theory guided data aggregation. RESULTS Participants' understandings of their hepatitis C infection and reinfection trajectories were captured in three categories. Hepatitis C and HIV disease dichotomies: Hepatitis C diagnosis was a shock to most participants and contrasted with feelings of inevitability associated with HIV seroconversion. While HIV was normalized, hepatitis C was experienced as highly stigmatizing. Despite injecting drug use, interviewees did not identify with populations typically at risk of hepatitis C. Risk environments and avoiding reinfection: Interviewees identified their social and sexual networks as risk-perpetuating environments where drug use was ubiquitous and higher risk sex was common. Avoiding these risk environments to avoid reinfection resulted in community disengagement, leaving many feeling socially isolated. Hepatitis C care as a catalyst for change: Engagement in hepatitis C care contributed to a better understanding of hepatitis C risks. Interviewees were committed to applying their improved competencies around transmission risk reduction to avoid reinfection. Interviewees also considered hepatitis C care as a catalyst to reduce their drug use. CONCLUSIONS Hepatitis C/HIV co-infection among GBM cannot be understood in isolation from co-occurring drug use and sex, nor as separate from their HIV infection. Hepatitis C prevention must address subcultural heterogeneity and the intersectionality between multiple stigmatized social identities. Hepatitis C care presents an opportunity to provide support beyond cure. Peer support networks could mitigate social capital loss following a commitment to behaviour change and reduce hepatitis C reinfection risks.
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Affiliation(s)
| | - Peter Higgs
- Disease Elimination ProgramBurnet InstituteMelbourneAustralia
- Department of Public HealthLa Trobe UniversityMelbourneAustralia
| | - Rebecca Winter
- Disease Elimination ProgramBurnet InstituteMelbourneAustralia
- Department of Gastroenterology and HepatologySt Vincent's HospitalMelbourneAustralia
| | - Graham Brown
- Department of Public HealthLa Trobe UniversityMelbourneAustralia
| | - Alisa Pedrana
- Disease Elimination ProgramBurnet InstituteMelbourneAustralia
- School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
| | - Margaret Hellard
- Disease Elimination ProgramBurnet InstituteMelbourneAustralia
- School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
- Department of Infectious DiseasesThe Alfred HospitalMelbourneAustralia
| | - Joseph Doyle
- Disease Elimination ProgramBurnet InstituteMelbourneAustralia
- School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
- Department of Infectious DiseasesThe Alfred HospitalMelbourneAustralia
| | - Mark Stoové
- Disease Elimination ProgramBurnet InstituteMelbourneAustralia
- Department of Infectious DiseasesThe Alfred HospitalMelbourneAustralia
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Dore GJ. HCV reinfection as a positive indication of high-risk population treatment access. J Viral Hepat 2019; 26:516-518. [PMID: 30803082 DOI: 10.1111/jvh.13092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 02/04/2019] [Indexed: 01/01/2023]
Affiliation(s)
- Gregory J Dore
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
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49
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Hahn JA, Tully DC, Evans JL, Morris MD, Briceno A, Bean DJ, Allen TM, Page K. Role of HCV Viremia in Corroborated HCV Transmission Events Within Young Adult Injecting Partnerships. Open Forum Infect Dis 2019; 6:ofz125. [PMID: 31041340 PMCID: PMC6483127 DOI: 10.1093/ofid/ofz125] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 04/05/2019] [Indexed: 12/31/2022] Open
Abstract
Background Hepatitis C virus (HCV), a major cause of morbidity and mortality, is common and rising among young persons who inject drugs (PWID). Reducing the level of viremia may be an intervention, yet the impact of viremia on HCV transmission is unknown. Methods We conducted a prospective study of injecting partnerships (Partner Study) of young adult (age < 30 years) PWID within the UFO Study, which enrolled those at risk for HCV or with seronegative viremic infection and up to 3 HCV RNA-positive regular injecting partners. We examined the level of HCV viremia and stage of infection in the HCV-positive partner in regression analyses of HCV transmission events that were corroborated via HCV phylogenetic linkage analyses. Results We enrolled 69 at-risk/acutely infected PWID. There were 25 new HCV infections (incidence rate, 35.9 per 100 person-years; 95% confidence interval [CI], 24.3-53.2 per 100 person-years); 12/25 (48%) were phylogenetically linked to at least 1 partner. We found no association between the infected partner's quantitative level of HCV viremia and likely transmission in multivariate analyses (adjusted odds ratio [AOR], 0.90; 95% confidence interval [CI], 0.55-1.46); however, seronegative viremic infection in the infected partner was associated with increased transmission (AOR, 28.02; 95% CI, 5.61-139.95). Conclusions The HCV viremia level was not associated with increased odds of transmission, yet acute HCV infection (seronegative viremic) was. Explanations include high-risk behavior during acute infection or missed fluctuations in viremia during acute infection. Both point to the need for frequent testing to detect new infection and attempt to prevent onward transmission.
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Affiliation(s)
- Judith A Hahn
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Damien C Tully
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Jennifer L Evans
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Meghan D Morris
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Alya Briceno
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - David J Bean
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts
| | - Todd M Allen
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts
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Pourmarzi D, Smirnov A, Hepworth J, Rahman T, FitzGerald G, Hall L. Elements of community-based models for treating hepatitis C virus in supporting HCV elimination in Australia: A Delphi study. Int J Health Plann Manage 2019; 34:e1247-e1256. [PMID: 30901129 DOI: 10.1002/hpm.2770] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 02/14/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND A key to achieving the goal of hepatitis C virus (HCV) elimination is the provision of its treatment in community settings. This study aimed to identify the important organisational and operational elements of community-based models for treating HCV and their feasibility in the Australian context. METHODS A Delphi study was conducted with 33 experts from Australia. The questionnaire included 13 elements drawn from the literature. Participants rated each element on a five-point Likert scale for importance and feasibility and suggested additional elements. Consensus was identified when the sum of categories 1 and 2 or 4 and 5 of the five-point Likert scale reached greater than or equal to 70%. RESULTS Eight elements reached consensus in regard to importance including "Safe and enabling environment," "Training and support for healthcare providers," "Open referral policy," "Linkage with or providing outreach services," "Person-centred approach," "On-site screening and assessment," "Linkage or co-location with harm reduction services," and "Linkage or co-location with drug and alcohol services." At least 65% of participants agreed implementing elements of open referral policy, Training and support for healthcare providers, and Person-centred approach are usually or always/very feasible. For the other five elements, this was agreed to by a range of 15.2%-57.6% of participants. CONCLUSION Successful community-based models for treating HCV in Australia are dependent on the integration and coordination of care and the support provided for both patients and healthcare providers. Substantial work is required across policy and health service planning to integrate these highly rated elements into Australian primary health care.
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Affiliation(s)
- Davoud Pourmarzi
- School of Public Health and Social Work, Faculty of Health, Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology, Brisbane, Australia
| | - Andrew Smirnov
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Julie Hepworth
- Mater Research Institute, The University of Queensland, Brisbane, Australia
| | - Tony Rahman
- School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Australia.,Department of Gastroenterology and Hepatology, The Prince Charles Hospital, Brisbane, Australia
| | - Gerrard FitzGerald
- School of Public Health and Social Work, Faculty of Health, Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology, Brisbane, Australia
| | - Lisa Hall
- School of Public Health and Social Work, Faculty of Health, Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology, Brisbane, Australia.,School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
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