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Treloar C, Lancaster K, Rhodes T, Lafferty L, Bryant J, Rance J. The 'missing' in the 'endgame' of hepatitis C elimination: A qualitative study in New South Wales, Australia. Drug Alcohol Rev 2024; 43:1256-1263. [PMID: 38596845 DOI: 10.1111/dar.13845] [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: 01/24/2024] [Revised: 03/04/2024] [Accepted: 03/19/2024] [Indexed: 04/11/2024]
Abstract
INTRODUCTION After a promising start in Australia, elimination efforts for hepatitis C are not on track. Following the global campaign to 'find the missing' in hepatitis C response, this qualitative study explores stakeholder perspectives on the 'missing' in the 'endgame' of hepatitis elimination in the state of New South Wales, Australia. METHOD Twenty-eight key informants working in New South Wales, elsewhere in Australia and internationally in high income countries participated in a semi-structured qualitative interview. Analysis examined key informant accounts of the 'missing' in efforts to eliminate hepatitis C. RESULTS Participants' accounts framed the missing in relation to epidemiological knowledge, making-up four population categories 'missing' or 'missed' in hepatitis C response. In turn, accounts situated the missing in relation to where and how individuals were presumed to connect, or not, with existing health-care infrastructures. This gave rise to concerns about the capacity of health services to be made available for those at risk or in need, with systems said to create opportunities for people to 'miss out' on hepatitis C services. DISCUSSION AND CONCLUSIONS The 'missing' in the 'endgame' of hepatitis C elimination effort is not simply a function of who-populations missed-but of where and how, that is, situation and context. Our findings encourage a focus on how services, systems and contexts may create situations in which people become missed or are 'made missing' from care. We therefore advocate for a systemic, and not only population-based, approach in the final push towards hepatitis C's elimination.
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Affiliation(s)
- Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Kari Lancaster
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
- Goldsmiths University of London, London, UK
| | - Tim Rhodes
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
- London School of Hygiene and Tropical Medicine, London, UK
| | - Lise Lafferty
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
- Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Joanne Bryant
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Jake Rance
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
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Lin TY, Jen HH, Hu TH, Yao YC, Chen THH, Yen AMF, Yeh YP. Planning, implementing, and evaluating Hepatitis C virus elimination via collaborative community-based care cascade: age-period-cohort model for estimating demand from antecedent anti-HCV survey. Hepatol Int 2024; 18:476-485. [PMID: 37987951 PMCID: PMC11014808 DOI: 10.1007/s12072-023-10605-x] [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: 07/16/2023] [Accepted: 09/29/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Estimating the demand for HCV care cascade plays an important role in planning, monitoring, and assessing the performance of introducing a new community-based hepatitis C virus (HCV) elimination program but such an analytic and systematic approach has been barley addressed. METHODS A new collaborative care program for HCV elimination in the Changhua Community of Taiwan has been offered to a total of 895,353 residents since 2018. To grasp the variation of demand for HCV care cascade across demographic and geographic features in the planning stage, we applied the age-period-cohort spatial model to the antecedent anti-HCV survey enrolling 123,617 participants aged 30 years or older between 2005 and 2018. Based on this precise denominator, we then employed a "before-and-after" study design to routinely evaluate whether the WHO criteria of 90% RNA positive diagnosis and 80% successful treatments could be reached. RESULTS The overall demand for HCV care cascade was 4.28% (HCV infection) of the underlying population but a declining trend was noted. The early cohort had a higher demand, whereas the demand of the young cohort decreased with each passing year. The demand also differed by township. The demand, allowing for these variations, for antiviral treatment was 22,362, yielding the WHO target of 12,880 for achieving HCV elimination. With 11,844 successful treatments, the effectiveness of elimination has already reached 92% (11,844/12,880) by the end of 2022. CONCLUSIONS The demand for HCV care cascade allows health care decision-makers to timely and properly assess the performance of a novel community-based collaborative care program in achieving HCV elimination.
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Affiliation(s)
- Ting-Yu Lin
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | | | - Tsung-Hui Hu
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung,, 804,, Taiwan
| | - Yu-Chin Yao
- Changhua County Public Health Bureau, No.162, Sec. 2, Jhongshan Rd, Changhua City, Changhua County, 500, Taiwan
| | - Tony Hsiu-Hsi Chen
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Amy Ming-Fang Yen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, No. 250, Wu-Hsin Street, Taipei, 110, Taiwan.
| | - Yen-Po Yeh
- Changhua County Public Health Bureau, No.162, Sec. 2, Jhongshan Rd, Changhua City, Changhua County, 500, Taiwan.
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Wegener M, Brooks R, Speers S, Nichols L, Villanueva M. Implementing a Surveillance-Based Approach to Create a Statewide Viral Clearance Cascade for Hepatitis C Among People With HIV and HCV Coinfection in Connecticut. Public Health Rep 2024; 139:208-217. [PMID: 37232422 PMCID: PMC10851907 DOI: 10.1177/00333549231172173] [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: 05/27/2023] Open
Abstract
OBJECTIVES Highly effective direct-acting antiviral medications have made it feasible to achieve elimination of hepatis C virus (HCV), including for people with HIV and HCV coinfection. The Centers for Disease Control and Prevention offers guidance for a laboratory surveillance-based HCV viral clearance cascade, which allows public health departments to track the outcomes of people with HCV based on the following steps: ever infected, virally tested, initial infection, and cured or cleared. We examined the feasibility of this approach among people with HIV and HCV coinfection in Connecticut. METHODS We matched an HIV surveillance database, which included cases from the enhanced HIV/AIDS Reporting System as of December 31, 2019, and the HCV surveillance database, the Connecticut Electronic Disease Surveillance System, to define a cohort of coinfected people. We used HCV laboratory results obtained from January 1, 2016, through August 3, 2020, to determine HCV status. RESULTS Of 1361 people who were ever infected with HCV as of December 31, 2019, 1256 (92.3%) received HCV viral testing, 865 of 1256 people tested (68.9%) were HCV infected, and 336 of 865 infected people (38.8%) were cleared or cured. People who had undetectable HIV viral loads at most recent HIV test (<200 copies/mL) were more likely than those with detectable HIV viral loads to achieve HCV cure (P = .02). CONCLUSIONS A surveillance-based approach that includes data based on the Centers for Disease Control and Prevention HCV viral clearance cascade is feasible to implement, can help track population-level outcomes longitudinally, and can help identify gaps to inform HCV elimination strategies.
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Affiliation(s)
| | - Ralph Brooks
- School of Medicine, Yale University, New Haven, CT, USA
| | - Suzanne Speers
- Connecticut Department of Public Health, Hartford, CT, USA
| | - Lisa Nichols
- School of Medicine, Yale University, New Haven, CT, USA
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Piselli P, Boschini A, Gianfreda R, Nappo A, Cimaglia C, Scarfò G, Smacchia C, Paoletti R, Duehren S, Girardi E. Integration of Hepatitis C and Addiction Treatment in People Who Inject Drugs: The San Patrignano HCV-Free and Drug-Free Experience. Viruses 2024; 16:375. [PMID: 38543741 PMCID: PMC10974793 DOI: 10.3390/v16030375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/19/2024] [Accepted: 02/21/2024] [Indexed: 05/23/2024] Open
Abstract
Injection drug use represents an important contributor to hepatitis C virus (HCV) transmission, hence therapeutic communities (TCs) are promising points of care for the identification and treatment of HCV-infected persons who inject drugs (PWIDs). We evaluated the effectiveness and efficacy of an HCV micro-elimination program targeting PWIDs in the context of a drug-free TC; we applied the cascade of care (CoC) evaluation by calculating frequencies of infection diagnosis, confirmation, treatment and achievement of a sustained virological response (SVR). We also evaluated the risk of reinfection of PWIDs achieving HCV eradication by collecting follow-up virologic information of previously recovered individuals and eventual relapse in drug use, assuming the latter as a potential source of reinfection. We considered 811 PWIDs (aged 18+ years) residing in San Patrignano TC at the beginning of the observation period (January 2018-March 2022) or admitted thereafter, assessing for HCV and HIV serology and viral load by standard laboratory procedures. Ongoing infections were treated with direct-acting antivirals (DAA), according to the current national guidelines. Out of the 792 individuals tested on admission, 503 (63.5%) were found to be seropositive for antibodies against HCV. A total of 481 of these 503 individuals (95.6%) underwent HCV RNA testing. Out of the 331 participants positive for HCV RNA, 225 were ultimately prescribed a DAA treatment with a sustained viral response (SVR), which was achieved by 222 PWIDs (98.7%). Of the 222 PWIDs, 186 (83.8%) with SVR remained HCV-free on follow-up (with a median follow-up of 2.73 years after SVR ascertainment). The CoC model in our TC proved efficient in implementing HCV micro-elimination, as well as in preventing reinfection and promoting retention in the care of individuals, which aligns with the therapeutic goals of addiction treatment.
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Affiliation(s)
- Pierluca Piselli
- Clinical Epidemiology Unit, Department of Epidemiology and Preclinical Research, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, 00149 Rome, Italy; (A.N.); (C.C.); (G.S.); (E.G.)
| | - Antonio Boschini
- Medical Center, Comunità di S. Patrignano, 47853 Coriano, RN, Italy; (A.B.); (C.S.); (R.P.); (S.D.)
| | - Romina Gianfreda
- Infectious Disease Unit, Hospital of Rimini “Gli Infermi”, 47923 Rimini, Italy;
| | - Alessandra Nappo
- Clinical Epidemiology Unit, Department of Epidemiology and Preclinical Research, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, 00149 Rome, Italy; (A.N.); (C.C.); (G.S.); (E.G.)
| | - Claudia Cimaglia
- Clinical Epidemiology Unit, Department of Epidemiology and Preclinical Research, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, 00149 Rome, Italy; (A.N.); (C.C.); (G.S.); (E.G.)
| | - Gianpaolo Scarfò
- Clinical Epidemiology Unit, Department of Epidemiology and Preclinical Research, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, 00149 Rome, Italy; (A.N.); (C.C.); (G.S.); (E.G.)
| | - Camillo Smacchia
- Medical Center, Comunità di S. Patrignano, 47853 Coriano, RN, Italy; (A.B.); (C.S.); (R.P.); (S.D.)
| | - Raffaella Paoletti
- Medical Center, Comunità di S. Patrignano, 47853 Coriano, RN, Italy; (A.B.); (C.S.); (R.P.); (S.D.)
| | - Sarah Duehren
- Medical Center, Comunità di S. Patrignano, 47853 Coriano, RN, Italy; (A.B.); (C.S.); (R.P.); (S.D.)
| | - Enrico Girardi
- Clinical Epidemiology Unit, Department of Epidemiology and Preclinical Research, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, 00149 Rome, Italy; (A.N.); (C.C.); (G.S.); (E.G.)
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Montgomery MP, Randall LM, Morrison M, Gupta N, Doshani M, Teshale E. Hepatitis C Cascades: Data to Inform Hepatitis C Elimination in the United States. Public Health Rep 2023:333549231193508. [PMID: 37667621 DOI: 10.1177/00333549231193508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023] Open
Abstract
The United States has a goal to eliminate hepatitis C as a public health threat by 2030. To accomplish this goal, hepatitis C virus (HCV) care cascades (hereinafter, HCV cascades) can be used to measure progress toward HCV elimination and identify disparities in HCV testing and care. In this topical review of HCV cascades, we describe common definitions of cascade steps, review the application of HCV cascades in health care and public health settings, and discuss the strengths and limitations of data sources used. We use examples from the Massachusetts Department of Public Health as a case study to illustrate how multiple data sources can be leveraged to produce HCV cascades for public health purposes. HCV cascades in health care settings provide actionable data to improve health care quality and delivery of services in a single health system. In public health settings at jurisdictional and national levels, HCV cascades describe HCV diagnosis and treatment for populations, which can be challenging in the absence of a single data source containing complete, comprehensive, and timely data representing all steps of a cascade. Use of multiple data sources and strategies to improve interoperability of health care and public health data systems can advance the use of HCV cascades and speed progress toward HCV elimination.
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Affiliation(s)
- Martha P Montgomery
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Now with Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Liisa M Randall
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Jamaica Plain, MA, USA
| | - Monica Morrison
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Jamaica Plain, MA, USA
| | - Neil Gupta
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mona Doshani
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Eyasu Teshale
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Kim J, Newcomb CW, Carbonari DM, Torgersen J, Althoff KN, Kitahata MM, Klein MB, Moore RD, Reddy KR, Silverberg MJ, Mayor AM, Horberg MA, Cachay ER, Lim JK, Gill MJ, Chew K, Sterling TR, Hull M, Seaberg EC, Kirk GD, Coburn SB, Lang R, McGinnis KA, Gebo KA, Napravnik S, Kim HN, Lo Re V. Hepatitis B care cascade among people with HIV/HBV coinfection in the North American AIDS Cohort Collaboration on Research and Design, 2012-2016. PLoS One 2023; 18:e0290889. [PMID: 37656704 PMCID: PMC10473492 DOI: 10.1371/journal.pone.0290889] [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: 05/08/2023] [Accepted: 08/15/2023] [Indexed: 09/03/2023] Open
Abstract
A care cascade is a critical tool for evaluating delivery of care for chronic infections across sequential stages, starting with diagnosis and ending with viral suppression. However, there have been few data describing the hepatitis B virus (HBV) care cascade among people living with HIV infection who have HBV coinfection. We conducted a cross-sectional study among people living with HIV and HBV coinfection receiving care between January 1, 2012 and December 31, 2016 within 13 United States and Canadian clinical cohorts contributing data to the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD). We evaluated each of the steps in this cascade, including: 1) laboratory-confirmed HBV infection, 2) tenofovir-based or entecavir-based HBV therapy prescribed, 3) HBV DNA measured during treatment, and 4) viral suppression achieved via undetectable HBV DNA. Among 3,953 persons with laboratory-confirmed HBV (median age, 50 years; 6.5% female; 43.8% were Black; 7.1% were Hispanic), 3,592 (90.9%; 95% confidence interval, 90.0-91.8%) were prescribed tenofovir-based antiretroviral therapy or entecavir along with their antiretroviral therapy regimen, 2,281 (57.7%; 95% confidence interval, 56.2-59.2%) had HBV DNA measured while on therapy, and 1,624 (41.1%; 95% confidence interval, 39.5-42.6) achieved an undetectable HBV DNA during HBV treatment. Our study identified significant gaps in measurement of HBV DNA and suppression of HBV viremia among people living with HIV and HBV coinfection in the United States and Canada. Periodic evaluation of the HBV care cascade among persons with HIV/HBV will be critical to monitoring success in completion of each step.
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Affiliation(s)
- Jessica Kim
- Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Craig W. Newcomb
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Dena M. Carbonari
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Jessie Torgersen
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Keri N. Althoff
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Mari M. Kitahata
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Marina B. Klein
- Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Richard D. Moore
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - K. Rajender Reddy
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Michael J. Silverberg
- Division of Research, Kaiser Permanente Northern California, Oakland, California, United States of America
| | - Angel M. Mayor
- Retrovirus Research Center, Universidad Central del Caribe, Bayamon, Puerto Rico
| | - Michael A. Horberg
- Mid-Atlantic Permanente Research Institute, Mid-Atlantic Permanente Medical Group, Rockville, Maryland, United States of America
| | - Edward R. Cachay
- Department of Medicine, University of California San Diego, La Jolla, California, United States of America
| | - Joseph K. Lim
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
- VA Connecticut Healthcare System, West Haven, Connecticut, United States of America
| | - M. John Gill
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kara Chew
- Department of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Timothy R. Sterling
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Mark Hull
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Eric C. Seaberg
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Gregory D. Kirk
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Sally B. Coburn
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Raynell Lang
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kathleen A. McGinnis
- VA Connecticut Healthcare System, West Haven, Connecticut, United States of America
| | - Kelly A. Gebo
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Sonia Napravnik
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - H. Nina Kim
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Vincent Lo Re
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
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Vaucher MB, Silva CU, Varella IRS, Kim AYS, Kliemann DA. Stages of care for patients with chronic hepatitis C at a hospital in southern Brazil. World J Hepatol 2023; 15:973-984. [PMID: 37701918 PMCID: PMC10494563 DOI: 10.4254/wjh.v15.i8.973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 06/19/2023] [Accepted: 07/19/2023] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) is defined as a public health problem by the World Health Organization (WHO) and since then has defined targets through the HCV elimination. The HCV cascade of care highlights the progress towards these goals and essential interventions that need to be delivered along this continuum care. AIM To document the treatment cascade for patients with HCV infection at the Hospital Nossa Senhora da Conceição (HNSC), defining the percentage of antibody-positive patients who collected molecular biology tests (polymerase chain reaction), attended outpatient clinic assistance, underwent treatment, and achieved a virologic cure termed sustained virologic response (SVR). METHODS With the retrospective cohort design, patients diagnosed with HCV infection in the period between January 1, 2015 and December 31, 2020 were included. Data from HCV notification forms, electronic medical records, Computerized Laboratory Environment Manager System, and Medicine Administration System (evaluation of special medications) were collected in 2022 and all information up to that period was considered. The data were analyzed with IBM SPSS version 25, and Poisson regression with robust simple variance was performed for analysis of variables in relation to each step of the cascade. Variables with P < 0.20 were included in the multivariate analysis with P < 0.05 considered significant. Pearson's chi-square test was applied to compare the groups of patients who persisted in follow-up at the HNSC and who underwent follow-up at other locations. RESULTS Results were lower than expected by the WHO with only 49% of candidates receiving HCV treatment and only 29% achieving SVR, despite the 98% response rate to direct acting antivirals documented by follow-up examination. The city of origin and the place of follow-up were the variables associated with SVR and all other endpoints. When comparing the cascade of patients who remained assisted by the HNSC vs external patients, we observed superior data for HNSC patients in the SVR. Patients from the countryside and metropolitan region were mostly assisted at the HNSC and the specialized and continuous care provided at the HNSC was associated with superior results, although the outcomes remain far from the goals set by the WHO. CONCLUSION With the elaboration of the HCV cascade of care using local data, it was possible to stratify and evaluate risk factors associated with losses between each step of the cascade, to inform new strategies to guide elimination efforts in the future.
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Affiliation(s)
- Manoela Badinelli Vaucher
- Department of Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre 90050-170, Rio Grande do Sul, Brazil
- Department of Medicine, Universidade do Vale do Taquari, Lajeado 95914-014, RS, Brazil.
| | - Camila Ubirajara Silva
- Department of Application and Monitoring of Injectable Drugs, Hospital Sanatório Partenon, Porto Alegre 90650-000, RS, Brazil
| | | | - Arthur Yu-Shin Kim
- Department of Infectious Diseases, Massachusetts General Hospital, Boston, MA 02114, United States
- Department of Medicine, Harvard Medical School, Boston, MA 02114, United States
| | - Dimas Alexandre Kliemann
- Departament of Infectious Diseases, Hospital Nossa Senhora da Conceição, Porto Alegre 91350-200, Rio Grande do Sul, Brazil
- Department of Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre 90050-170, Rio Grande do Sul, Brazil
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Ross J, Rupasinghe D, Avihingsanon A, Lee MP, Pujari S, Sharp G, Kumarasamy N, Khusuwan S, Khol V, Agus Somia IK, Pham TN, Kiertiburanakul S, Choi JY, Duy Do C, Sohn AH, Jiamsakul A. Trends in hepatitis C virus coinfection and its cascade of care among adults living with HIV in Asia between 2010 and 2020. PLoS One 2023; 18:e0287909. [PMID: 37379314 PMCID: PMC10306215 DOI: 10.1371/journal.pone.0287909] [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: 02/16/2023] [Accepted: 06/14/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Chronic hepatitis C virus (HCV) infection contributes to substantial morbidity and mortality among adults living with HIV. Cascades of HCV care support monitoring of program performance, but data from Asia are limited. We assessed regional HCV coinfection and cascade outcomes among adults living with HIV in care from 2010-2020. METHODS Patients ≥18 years old with confirmed HIV infection on antiretroviral therapy (ART) at 11 clinical sites in Cambodia, China, India, Indonesia, South Korea, Thailand and Vietnam were included. HCV- and HIV-related treatment and laboratory data were collected from those with a positive HCV antibody (anti-HCV) test after January 2010. An HCV cascade was evaluated, including proportions positive for anti-HCV, tested for HCV RNA or HCV core antigen (HCVcAg), initiated on HCV treatment, and achieved sustained virologic response (SVR). Factors associated with screening uptake, treatment initiation, and treatment response were analyzed using Fine and Gray's competing risk regression model. RESULTS Of 24,421 patients, 9169 (38%) had an anti-HCV test, and 971 (11%) had a positive result. The proportion with positive anti-HCV was 12.1% in 2010-2014, 3.9% in 2015-2017, and 3.8% in 2018-2020. From 2010 to 2014, 34% with positive anti-HCV had subsequent HCV RNA or HCVcAg testing, 66% initiated HCV treatment, and 83% achieved SVR. From 2015 to 2017, 69% with positive anti-HCV had subsequent HCV RNA or HCVcAg testing, 59% initiated HCV treatment, and 88% achieved SVR. From 2018 to 2020, 80% had subsequent HCV RNA or HCVcAg testing, 61% initiated HCV treatment, and 96% achieved SVR. Having chronic HCV in later calendar years and in high-income countries were associated with increased screening, treatment initiation or achieving SVR. Older age, injecting drug use HIV exposure, lower CD4 and higher HIV RNA were associated with reduced HCV screening or treatment initiation. CONCLUSIONS Our analysis identified persistent gaps in the HCV cascade of care, highlighting the need for focused efforts to strengthen chronic HCV screening, treatment initiation, and monitoring among adult PLHIV in the Asia region.
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Affiliation(s)
- Jeremy Ross
- TREAT Asia, amfAR, The Foundation for AIDS Research, Bangkok, Thailand
| | | | - Anchalee Avihingsanon
- HIV-NAT/ Thai Red Cross AIDS Research Centre and Tuberculosis Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Man Po Lee
- Queen Elizabeth Hospital, Hong Kong SAR, China
| | | | - Gerald Sharp
- National Institute of Allergy and Infectious Diseases (NIAID), Bethesda, Maryland, United States of America
| | | | | | - Vohith Khol
- National Center for HIV/AIDS, Dermatology & STDs, Phnom Penh, Cambodia
| | - I. Ketut Agus Somia
- Faculty of Medicine, Prof. Dr. I.G.N.G. Ngoerah Hospital, Udayana University, Bali, Indonesia
| | | | | | - Jun Yong Choi
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | | | - Annette H. Sohn
- TREAT Asia, amfAR, The Foundation for AIDS Research, Bangkok, Thailand
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Essex W, Feder M, Mera J. Evaluation of the Cherokee Nation Hepatitis C Virus Elimination Program - Cherokee Nation, Oklahoma, 2015-2020. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2023; 72:597-600. [PMID: 37262000 DOI: 10.15585/mmwr.mm7222a2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Approximately 2.4 million persons in the United States have hepatitis C virus (HCV) infection, and 66,700 acute HCV infection cases were estimated for 2020 (1,2). American Indian or Alaska Native (AI/AN) persons are disproportionately affected by HCV infection and experienced the highest rates of acute HCV infection (2.1 cases per 100,000 persons) and HCV-associated mortality (10.17 per 100,000 persons) in the United States during 2020 (1). During 2015, Cherokee Nation Health Services (CNHS) in Oklahoma implemented an HCV elimination program, which includes universal HCV screening, primary HCV workforce expansion, and harm reduction services (3). To assess progress 5 years after program initiation, CNHS analyzed deidentified health record data. During November 1, 2015-October 31, 2020, a total of 1,423 persons received a diagnosis of HCV infection. Among these persons, 1,227 (86.2%) were linked to HCV care, and 871 (61.2%) initiated HCV treatment; 702 (49.3%) returned for their 12-week post treatment completion visit, at which time 698 (49.1%) had achieved laboratory-confirmed sustained virologic response (SVR), defined as undetectable HCV RNA at ≥12 weeks after completion of treatment (SVR12). Although CNHS has linked the majority of persons diagnosed with HCV infection to care, and those who returned for the SVR12 visit had high cure rates (99.4%), treatment initiation was lower than expected. Future activities should prioritize addressing gaps in treatment initiation after linkage to care and confirmation of hepatitis C cure with SVR12 testing.
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10
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Baliashvili D, Blumberg HM, Gandhi NR, Averhoff F, Benkeser D, Shadaker S, Gvinjilia L, Turdziladze A, Tukvadze N, Chincharauli M, Butsashvili M, Sharvadze L, Tsertsvadze T, Zarkua J, Kempker RR. Hepatitis C care cascade among patients with and without tuberculosis: Nationwide observational cohort study in the country of Georgia, 2015-2020. PLoS Med 2023; 20:e1004121. [PMID: 37141386 PMCID: PMC10194957 DOI: 10.1371/journal.pmed.1004121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 05/18/2023] [Accepted: 04/13/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND The Eastern European country of Georgia initiated a nationwide hepatitis C virus (HCV) elimination program in 2015 to address a high burden of infection. Screening for HCV infection through antibody testing was integrated into multiple existing programs, including the National Tuberculosis Program (NTP). We sought to compare the hepatitis C care cascade among patients with and without tuberculosis (TB) diagnosis in Georgia between 2015 and 2019 and to identify factors associated with loss to follow-up (LTFU) in hepatitis C care among patients with TB. METHODS AND FINDINGS Using national ID numbers, we merged databases of the HCV elimination program, NTP, and national death registry from January 1, 2015 to September 30, 2020. The study population included 11,985 adults (aged ≥18 years) diagnosed with active TB from January 1, 2015 through December 31, 2019, and 1,849,820 adults tested for HCV antibodies between January 1, 2015 and September 30, 2020, who were not diagnosed with TB during that time. We estimated the proportion of patients with and without TB who were LTFU at each step of the HCV care cascade and explored temporal changes. Among 11,985 patients with active TB, 9,065 (76%) patients without prior hepatitis C treatment were tested for HCV antibodies, of which 1,665 (18%) had a positive result; LTFU from hepatitis C care was common, with 316 of 1,557 (20%) patients with a positive antibody test not undergoing viremia testing and 443 of 1,025 (43%) patients with viremia not starting treatment for hepatitis C. Overall, among persons with confirmed viremic HCV infection, due to LTFU at various stages of the care cascade only 28% of patients with TB had a documented cure from HCV infection, compared to 55% among patients without TB. LTFU after positive antibody testing substantially decreased in the last 3 years, from 32% among patients diagnosed with TB in 2017 to 12% among those diagnosed in 2019. After a positive HCV antibody test, patients without TB had viremia testing sooner than patients with TB (hazards ratio [HR] = 1.46, 95% confidence intervals [CI] [1.39, 1.54], p < 0.001). After a positive viremia test, patients without TB started hepatitis C treatment sooner than patients with TB (HR = 2.05, 95% CI [1.87, 2.25], p < 0.001). In the risk factor analysis adjusted for age, sex, and case definition (new versus previously treated), multidrug-resistant (MDR) TB was associated with an increased risk of LTFU after a positive HCV antibody test (adjusted risk ratio [aRR] = 1.41, 95% CI [1.12, 1.76], p = 0.003). The main limitation of this study was that due to the reliance on existing electronic databases, we were unable to account for the impact of all confounding factors in some of the analyses. CONCLUSIONS LTFU from hepatitis C care after a positive antibody or viremia test was high and more common among patients with TB than in those without TB. Better integration of TB and hepatitis C care systems can potentially reduce LTFU and improve patient outcomes both in Georgia and other countries that are initiating or scaling up their nationwide hepatitis C control efforts and striving to provide personalized TB treatment.
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Affiliation(s)
- Davit Baliashvili
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, United States of America
| | - Henry M. Blumberg
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, United States of America
- Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, United States of America
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Neel R. Gandhi
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, United States of America
- Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, United States of America
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Francisco Averhoff
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - David Benkeser
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, Georgia, United States of America
| | - Shaun Shadaker
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Lia Gvinjilia
- Eastern Europe and Central Asia Regional Office, Centers for Disease Control and Prevention, Tbilisi, Georgia
| | | | - Nestani Tukvadze
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
| | | | | | - Lali Sharvadze
- Clinic “Hepa”, Tbilisi, Georgia
- The University of Georgia, Tbilisi, Georgia
| | - Tengiz Tsertsvadze
- Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
| | | | - Russell R. Kempker
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America
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11
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Dröse S, Hansen JF, Røge BT, Øvrehus ALH, Christensen PB. Retrieval of patients with hepatitis C who were lost to follow-up in Southern Denmark. Infect Dis (Lond) 2023; 55:361-369. [PMID: 36930953 DOI: 10.1080/23744235.2023.2189298] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND The goal of the C-Free-South project is to eliminate hepatitis C (HCV) in the Region of Southern Denmark (1.2 million inhabitants). One target group consists of people with HCV who had received care but were lost to follow-up. The study aim was to evaluate program efficacy in locating these patients and getting them into care. METHODS Patients were contacted if they were HCV-RNA positive and age 18+ years, registered in the clinical hepatitis database as of November 1, 2019, and had no scheduled HCV-related appointment. They were contacted at 2-month intervals by phone or letter. For patients who did not respond, we asked their general practitioner to refer them, if possible. RESULTS We identified 69 (7%) patients in the database who were listed as untreated and not being followed up. We successfully contacted 54 (78%), and the remaining 15 (22%) did not respond to our contacts. To date, 45 (65%) had initiated treatment, one (1%) had rejected treatment, and eight (12%) did not show up to their appointments. Among those receiving treatment, 20 (44%) responded after the first contact, 18 (40%) after the second contact, and 7 (16%) after informing the general practitioner. CONCLUSION An intensified and persistent effort made it possible to reach most HCV patients lost to follow-up. All new contact attempts increased the possibility that patients would receive treatment. Nevertheless, 22% of HCV patients lost to follow-up did not respond to repeated contact attempts.
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Affiliation(s)
- Sandra Dröse
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | | | | | - Anne Lindebo Holm Øvrehus
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Peer Brehm Christensen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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12
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Nakayama J, Hertzberg VS, Ho JC, Simpson RL, Cartwright EJ. Hepatitis C care cascade in a large academic healthcare system, 2012 to 2018. Medicine (Baltimore) 2023; 102:e32859. [PMID: 36897716 PMCID: PMC9997763 DOI: 10.1097/md.0000000000032859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/17/2023] [Indexed: 03/11/2023] Open
Abstract
To determine the hepatitis C virus (HCV) care cascade among persons who were born during 1945 to 1965 and received outpatient care on or after January 2014 at a large academic healthcare system. Deidentified electronic health record data in an existing research database were analyzed for this study. Laboratory test results for HCV antibody and HCV ribonucleic acid (RNA) indicated seropositivity and confirmatory testing. HCV genotyping was used as a proxy for linkage to care. A direct-acting antiviral (DAA) prescription indicated treatment initiation, an undetectable HCV RNA at least 20 weeks after initiation of antiviral treatment indicated a sustained virologic response. Of the 121,807 patients in the 1945 to 1965 birth cohort who received outpatient care between January 1, 2014 and June 30, 2017, 3399 (3%) patients were screened for HCV; 540 (16%) were seropositive. Among the seropositive, 442 (82%) had detectable HCV RNA, 68 (13%) had undetectable HCV RNA, and 30 (6%) lacked HCV RNA testing. Of the 442 viremic patients, 237 (54%) were linked to care, 65 (15%) initiated DAA treatment, and 32 (7%) achieved sustained virologic response. While only 3% were screened for HCV, the seroprevalence was high in the screened sample. Despite the established safety and efficacy of DAAs, only 15% initiated treatment during the study period. To achieve HCV elimination, improved HCV screening and linkage to HCV care and DAA treatment are needed.
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Affiliation(s)
- Jasmine Nakayama
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA
| | - Vicki S. Hertzberg
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA
- Emory University Department of Computer Science, Atlanta, GA
| | - Joyce C. Ho
- Emory University Department of Computer Science, Atlanta, GA
| | - Roy L. Simpson
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA
| | - Emily J. Cartwright
- Emory University School of Medicine, Atlanta, GA
- Atlanta VA Medical Center, Atlanta, GA
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13
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Bollerup S, Wessman M, Hansen JF, Nielsen S, Hay G, Cowan S, Krarup H, Omland L, Jepsen P, Weis N, Christensen PB. Increasing prevalence of chronic hepatitis B virus infection and low linkage to care in Denmark on 31 December 2016 - an update based on nationwide registers. Infect Dis (Lond) 2023; 55:17-26. [PMID: 36221255 DOI: 10.1080/23744235.2022.2125065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES We aimed to update the estimated prevalence of both diagnosed and undiagnosed chronic hepatitis B virus infection in Denmark. Moreover, we aimed to determine the number of people with chronic hepatitis B virus infection in specialised care and to assess the completeness of reporting to the national register of communicable diseases. METHODS Using four registers with national coverage, we identified all individuals registered with chronic hepatitis B virus infection, aged 16 years or older, and alive in Denmark on 31 December 2016. The diagnosed population was then estimated using capture-recapture analysis. The undiagnosed population was estimated using data from the Danish pregnancy screening program. RESULTS We estimated that 14,548 individuals were living with chronic hepatitis B virus infection corresponding to 0.3% of the Danish population. Of them, 13,530 (93%) were diagnosed and 7942 (55%) were registered in one or more of the source registers. Only 4297 (32%) diagnosed individuals had attended specialised care and only 3289 cases (24%) were reported to the Danish communicable disease register. CONCLUSION The prevalence of chronic hepatitis B virus infection increased from 2007 to 2017. The majority that had been diagnosed did not receive care as recommended by national guidelines and were not reported to the communicable diseases register responsible for hepatitis B virus surveillance. Future efforts should focus on linking individuals diagnosed with chronic hepatitis B virus infection to specialised care and improving reporting to the hepatitis B virus surveillance system.
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Affiliation(s)
- Signe Bollerup
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark
| | - Maria Wessman
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | | | - Stine Nielsen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - Gordon Hay
- Centre for Public Health, Liverpool John Moores University, Liverpool, United Kingdom
| | - Susan Cowan
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Henrik Krarup
- Department of Molecular Diagnostics, Aalborg University Hospital, Aalborg, Denmark.,Department of Medical Gastroenterology, Aalborg University Hospital, Aalborg, Denmark
| | - Lars Omland
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Peter Jepsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Nina Weis
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Peer Brehm Christensen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.,Clinical Institute, University of Southern Denmark, Odense, Denmark
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Christensen PB, Debrabant B, Cowan S, Debrabant K, Øvrehus A, Duberg AS. Hepatitis C time trends in reported cases and estimates of the hidden population born before 1965, Denmark and Sweden, 1990 to 2020. Euro Surveill 2022; 27:2200243. [PMID: 36695470 PMCID: PMC9808318 DOI: 10.2807/1560-7917.es.2022.27.50.2200243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BackgroundAccording to the World Health Organization, hepatitis C virus (HCV) infection should be under control by 2030.AimOur aim was to describe the size and temporal changes in reported cases of chronic HCV infection in Denmark and Sweden and to estimate the size of the hidden (undiagnosed) population born before 1965.MethodsWe extracted all HCV infections reported to national surveillance systems in Denmark and Sweden from 1990 to 2020. Prediction of the size of the hidden HCV-infected population was restricted to the cohort born before 1965 and cases reported up to 2017. We applied a model based on removal sampling from binomial distributions, estimated the yearly probability of diagnosis, and deducted the original HCV-infected population size.ResultsDenmark (clinician-based) reported 10 times fewer hepatitis C cases annually than Sweden (laboratory and clinician-based), peaking in 2007 (n = 425) and 1992 (n = 4,537), respectively. In Denmark, the birth year distribution was monophasic with little change over time. In recent years, Sweden has had a bimodal birth year distribution, suggesting ongoing infection in the young population. In 2017, the total HCV-infected population born before 1965 was estimated at 10,737 living persons (95% confidence interval (CI): 9,744-11,806), including 5,054 undiagnosed, in Denmark and 16,124 (95% CI: 13,639-18,978), including 10,580 undiagnosed, in Sweden.ConclusionsThe reporting of HCV cases in Denmark and Sweden was different. For Denmark, the estimated hidden population was larger than the current national estimate, whereas in Sweden the estimate was in line with the latest published numbers.
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Affiliation(s)
- Peer Brehm Christensen
- Department of Infectious Diseases Q, Odense University Hospital, Denmark,Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Birgit Debrabant
- Department of Mathematics and Computer Science, University of Southern Denmark, Odense, Denmark,Department of Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, Odense, Denmark
| | - Susan Cowan
- Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Kristian Debrabant
- Department of Mathematics and Computer Science, University of Southern Denmark, Odense, Denmark
| | - Anne Øvrehus
- Department of Infectious Diseases Q, Odense University Hospital, Denmark,Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Ann-Sofi Duberg
- Department of Infectious Diseases, Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Sweden
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15
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Bregenzer A, Krismer C, Wendel S, Roser P, Fux CA. HCV elimination in a Swiss opioid agonist therapy programme - a cohort study. Swiss Med Wkly 2022; 152:40009. [PMID: 36509421 DOI: 10.57187/smw.2022.40009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND In opioid agonist therapy (OAT) programmes, chronic hepatitis C is highly prevalent and directly observed therapy guarantees optimal adherence. Since 2017, all patients with chronic hepatitis C in Switzerland can be treated with pangenotypic direct-acting antivirals irrespective of liver fibrosis stage. Until the end of 2021, however, prescription was restricted to infectious disease specialists, gastroenterologists and certain addiction specialists. Difficult venous access after long-term intravenous drug use and, in the case of referral to a specialist, difficulties keeping appointments are barriers to HCV diagnosis and treatment. AIMS To assess whether minimally invasive point-of-care tests and a "test-and-treat / vaccinate on-site" approach can improve human immunodeficiency virus (HIV) / hepatitis C virus (HCV) screening, HCV treatment uptake and immunity against hepatitis A/B. METHODS Since September 2018, an infectious disease specialist and a study nurse performed 4-weekly visits in the OAT programme "HAG" (heroin dispensation of the canton Aargau), offering HIV/HCV antibody rapid testing (20 min) and HCV RNA quantification (GeneXpert®, 60 min) from capillary blood, noninvasive liver fibrosis assessment (Fibroscan®, 5-10 min) and HCV treatment prescription on-site. Recommended venous blood draws for HAV/HBV serology and HAV/HBV vaccinations were performed by the staff of the "HAG". Project performance was assessed by annual cross-sectional chart review. RESULTS Of the 128 patients registered in April 2018, 79 (62%) were still present in May 2021. With 72 newly registered, a total of 200 patients could be assessed, of whom 129 (65%) were still present in May 2021. Between April 2018 and May 2021, the proportion ever tested for HIV antibodies increased from 79% (101/128) to 91% (117/129), the proportion ever tested for HCV antibodies from 83% (106/128) to 93% (120/129) and the proportion of those HCV antibody positive ever tested for HCV RNA tested from 89% (47/53) to 98% (56/57). The proportion with adequate HCV management (last HCV antibody test ≤1 year ago, if HCV antibody negative or last HCV RNA test ≤1 year ago, if HCV antibody-positive and RNA-negative) improved from 23% ([15 + 15]/128) to 80% ([55 + 48]/129). Overall, HCV treatment uptake increased from 60% (21/35) to 92% (55/60) and HCV RNA prevalence among the HCV antibody positives decreased from 38% (18/47) to 7% (6/84). Between 2018 and 2021, 19 non-cirrhotic chronic hepatitis C patients were successfully treated on-site (18 sustained virological responses [SVR] 12, 1 SVR4), with excellent adherence (≥93%) and, so far, no reinfection. The proportion with known HAV/HBV serostatus increased from 38%/51% to 64%/76%. Immunity against HAV/HBV improved from 19%/23% to 50%/57%. CONCLUSION Capillary blood point-of-care tests and a "test-and-treat / vaccinate on-site" approach remove crucial barriers to diagnosis and treatment, making hepatitis elimination in OAT programmes achievable. A high fluctuation rate requires HIV/HCV/HAV/HBV testing at admission, but also allows more patients to be screened.
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Affiliation(s)
- Andrea Bregenzer
- Department of Infectious Diseases and Hospital Hygiene, Cantonal Hospital Aarau, Switzerland
| | - Cornelia Krismer
- Department of Infectious Diseases and Hospital Hygiene, Cantonal Hospital Aarau, Switzerland
| | - Stefanie Wendel
- Outpatient Centre for Opioid Agonist Therapy (HAG), Department of Addictive Disorders, Psychiatric Services Aargau, Brugg, Switzerland
| | - Patrik Roser
- Outpatient Centre for Opioid Agonist Therapy (HAG), Department of Addictive Disorders, Psychiatric Services Aargau, Brugg, Switzerland.,LVR-Hospital Essen, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Christoph A Fux
- Department of Infectious Diseases and Hospital Hygiene, Cantonal Hospital Aarau, Switzerland
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Ferrante ND, Newcomb CW, Forde KA, Leonard CE, Torgersen J, Linas BP, Rowan SE, Wyles DL, Kostman J, Trooskin SB, Lo Re V. The Hepatitis C Care Cascade During the Direct-Acting Antiviral Era in a United States Commercially-Insured Population. Open Forum Infect Dis 2022; 9:ofac445. [PMID: 36092829 PMCID: PMC9454032 DOI: 10.1093/ofid/ofac445] [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: 07/15/2022] [Accepted: 08/30/2022] [Indexed: 12/09/2022] Open
Abstract
Background Periodic surveillance of the hepatitis C virus (HCV) care cascade is important for tracking progress toward HCV elimination goals, identifying gaps in care, and prioritizing resource allocation. In the pre-direct-acting antiviral (DAA) era, it was estimated that 50% of HCV-infected individuals were diagnosed and that 16% had been prescribed interferon-based therapy. Since then, few studies utilizing nationally representative data from the DAA era have been conducted in the United States. Methods We performed a cross-sectional study to describe the HCV care cascade in the United States using the Optum de-identified Clinformatics® Data Mart Database to identify a nationally representative sample of commercially insured beneficiaries between January 1, 2014 and December 31, 2019. We estimated the number of HCV-viremic individuals in Optum based on national HCV prevalence estimates and determined the proportion who had: (1) recorded diagnosis of HCV infection, (2) recorded HCV diagnosis and underwent HCV RNA testing, (3) DAA treatment dispensed, and (4) assessment for cure. Results Among 120,311 individuals estimated to have HCV viremia in Optum during the study period, 109,233 (90.8%; 95% CI, 90.6%–91.0%) had a recorded diagnosis of HCV infection, 75,549 (62.8%; 95% CI, 62.5%–63.1%) had a recorded diagnosis of HCV infection and underwent HCV RNA testing, 41,102 (34.2%; 95% CI, 33.9%–34.4%) were dispensed DAA treatment, and 25,760 (21.4%; 95% CI, 21.2%–21.6%) were assessed for cure. Conclusions Gaps remain between the delivery of HCV-related care and national treatment goals among commercially insured adults. Efforts are needed to increase HCV treatment among people diagnosed with chronic HCV infection to achieve national elimination goals.
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Affiliation(s)
- Nicole D Ferrante
- Division of Gastroenterology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA
- Department of Biostatistics, Epidemiology, and Informatics, Center for Clinical Epidemiology and Biostatistics, Center for Real-World Effectiveness and Safety of Therapeutics, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA
| | - Craig W Newcomb
- Department of Biostatistics, Epidemiology, and Informatics, Center for Clinical Epidemiology and Biostatistics, Center for Real-World Effectiveness and Safety of Therapeutics, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA
| | - Kimberly A Forde
- Section of Hepatology, Department of Medicine, Temple University , Philadelphia, PA , USA
| | - Charles E Leonard
- Department of Biostatistics, Epidemiology, and Informatics, Center for Clinical Epidemiology and Biostatistics, Center for Real-World Effectiveness and Safety of Therapeutics, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania , Philadelphia, Pennsylvania , USA
| | - Jessie Torgersen
- Department of Biostatistics, Epidemiology, and Informatics, Center for Clinical Epidemiology and Biostatistics, Center for Real-World Effectiveness and Safety of Therapeutics, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine University of Pennsylvania , Philadelphia, PA , USA
| | - Benjamin P Linas
- Division of Infectious Diseases, Boston Medical Center, Boston University School of Medicine , Boston, MA , USA
| | - Sarah E Rowan
- Division of Infectious Diseases, Denver Health Medical Center, University of Colorado School of Medicine , Denver, CO , USA
| | - David L Wyles
- Division of Infectious Diseases, Denver Health Medical Center, University of Colorado School of Medicine , Denver, CO , USA
| | - Jay Kostman
- Philadelphia FIGHT Community Health Centers , Philadelphia, PA , USA
| | - Stacey B Trooskin
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine University of Pennsylvania , Philadelphia, PA , USA
- Philadelphia FIGHT Community Health Centers , Philadelphia, PA , USA
| | - Vincent Lo Re
- Department of Biostatistics, Epidemiology, and Informatics, Center for Clinical Epidemiology and Biostatistics, Center for Real-World Effectiveness and Safety of Therapeutics, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine University of Pennsylvania , Philadelphia, PA , USA
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17
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Burton HJ, Khatiwada A, Chung D, Meissner EG. Association of Referral Source and Substance Use with Hepatitis C Virus Outcomes at a Southern Academic Medical Center. South Med J 2022; 115:352-357. [PMID: 35649518 DOI: 10.14423/smj.0000000000001402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
OBJECTIVES Therapeutic advances make the cure of chronic hepatitis C virus (HCV) infection achievable for individuals aware of their diagnosis who can access care. Identifying barriers to accessing care is critical to achieve population-level HCV elimination and improve the cascade of care from diagnosis to cure. METHODS To identify barriers to HCV care, we performed a retrospective observational analysis of outcomes for patients with chronic HCV referred to an infectious diseases clinic at an academic medical center in Charleston, South Carolina between January 1, 2015 and January 1, 2020. We categorized outcomes in the cascade of care between "never presenting for evaluation" and "completed treatment with documented cure." Patient demographic factors, referral source, ZIP code of residence, insurance status, clinical characteristics, antiviral regimen, psychiatric and substance use history, and route of infection were assessed for associations with care outcomes. RESULTS Of 407 referrals, 32% of patients never presented for an initial evaluation, an outcome that was associated with active substance use, mental health disease, and referral from an emergency department or obstetrics-gynecology provider. Of the patients who presented for an initial evaluation, 78% of patients initiated treatment. Active substance use was the only variable associated with lack of therapy initiation after presenting for an initial evaluation (odds ratio 2.5, 95% confidence interval 1.07-5.84). Once treatment had been initiated, no clinical or demographic variables were associated with odds of achieving documented or presumed HCV cure. CONCLUSIONS Active substance use, mental health disease, and referral from an emergency department or obstetrics-gynecology provider were associated with a lower odds of presenting for evaluation and initiation of HCV treatment. Innovative models to improve access to care and increase outreach to vulnerable populations will be essential to eliminate HCV.
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Affiliation(s)
- H Jensie Burton
- From the Department of Medicine, Division of Infectious Diseases, Medical University of South Carolina, Charleston, the Division of Biostatistics and Bioinformatics, National Jewish Health, Denver, Colorado, and the Department of Biomedical Informatics, Ohio State University, Columbus
| | - Aastha Khatiwada
- From the Department of Medicine, Division of Infectious Diseases, Medical University of South Carolina, Charleston, the Division of Biostatistics and Bioinformatics, National Jewish Health, Denver, Colorado, and the Department of Biomedical Informatics, Ohio State University, Columbus
| | - Dongjun Chung
- From the Department of Medicine, Division of Infectious Diseases, Medical University of South Carolina, Charleston, the Division of Biostatistics and Bioinformatics, National Jewish Health, Denver, Colorado, and the Department of Biomedical Informatics, Ohio State University, Columbus
| | - Eric G Meissner
- From the Department of Medicine, Division of Infectious Diseases, Medical University of South Carolina, Charleston, the Division of Biostatistics and Bioinformatics, National Jewish Health, Denver, Colorado, and the Department of Biomedical Informatics, Ohio State University, Columbus
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Kondili LA, Craxì L, Andreoni M, Mennini FS, Razavi H. Opportunistic co-screening for HCV and COVID-19-related services: A creative response with a need for thoughtful reflection. Liver Int 2022; 42:960-962. [PMID: 35447008 PMCID: PMC9115188 DOI: 10.1111/liv.15243] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
| | - Lucia Craxì
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.)University of PalermoPalermoItaly
| | - Massimo Andreoni
- Infectious Disease Unit, Department of System MedicineTor Vergata University and HospitalRomeItaly
| | - Francesco S. Mennini
- Economic Evaluation and HTA (EEHTA), CEIS, Faculty of EconomicsUniversity of Rome "Tor Vergata" and Institute of Leadership and Management in Health, Kingston Business School, Kingston UniversityLondonUK
| | - Homie Razavi
- Center for Disease Analysis FoundationLafayetteColoradoUSA
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19
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Global change in hepatitis C virus prevalence and cascade of care between 2015 and 2020: a modelling study. Lancet Gastroenterol Hepatol 2022; 7:396-415. [PMID: 35180382 DOI: 10.1016/s2468-1253(21)00472-6] [Citation(s) in RCA: 211] [Impact Index Per Article: 105.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/08/2021] [Accepted: 12/09/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Since the release of the first global hepatitis elimination targets in 2016, and until the COVID-19 pandemic started in early 2020, many countries and territories were making progress toward hepatitis C virus (HCV) elimination. This study aims to evaluate HCV burden in 2020, and forecast HCV burden by 2030 given current trends. METHODS This analysis includes a literature review, Delphi process, and mathematical modelling to estimate HCV prevalence (viraemic infection, defined as HCV RNA-positive cases) and the cascade of care among people of all ages (age ≥0 years from birth) for the period between Jan 1, 2015, and Dec 31, 2030. Epidemiological data were collected from published sources and grey literature (including government reports and personal communications) and were validated among country and territory experts. A Markov model was used to forecast disease burden and cascade of care from 1950 to 2050 for countries and territories with data. Model outcomes were extracted from 2015 to 2030 to calculate population-weighted regional averages, which were used for countries or territories without data. Regional and global estimates of HCV prevalence, cascade of care, and disease burden were calculated based on 235 countries and territories. FINDINGS Models were built for 110 countries or territories: 83 were approved by local experts and 27 were based on published data alone. Using data from these models, plus population-weighted regional averages for countries and territories without models (n=125), we estimated a global prevalence of viraemic HCV infection of 0·7% (95% UI 0·7-0·9), corresponding to 56·8 million (95% UI 55·2-67·8) infections, on Jan 1, 2020. This number represents a decrease of 6·8 million viraemic infections from a 2015 (beginning of year) prevalence estimate of 63·6 million (61·8-75·8) infections (0·9% [0·8-1·0] prevalence). By the end of 2020, an estimated 12·9 million (12·5-15·4) people were living with a diagnosed viraemic infection. In 2020, an estimated 641 000 (623 000-765 000) patients initiated treatment. INTERPRETATION At the beginning of 2020, there were an estimated 56·8 million viraemic HCV infections globally. Although this number represents a decrease from 2015, our forecasts suggest we are not currently on track to achieve global elimination targets by 2030. As countries recover from COVID-19, these findings can help refocus efforts aimed at HCV elimination. FUNDING John C Martin Foundation, Gilead Sciences, AbbVie, ZeShan Foundation, and The Hepatitis Fund.
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20
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Tahsin F, Morin KA, Vojtesek F, Marsh DC. Measuring treatment attrition at various stages of engagement in Opioid Agonist Treatment in Ontario Canada using a cascade of care framework. BMC Health Serv Res 2022; 22:490. [PMID: 35413980 PMCID: PMC9004214 DOI: 10.1186/s12913-022-07877-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/31/2022] [Indexed: 11/29/2022] Open
Abstract
Background The cascade of care framework is an effective way to measure attrition at various stages of engagement in Opioid Agonist Treatment (OAT). The primary objective of the study was to describe the cascade of care for patients who have accessed OAT from a network of specialized addiction clinics in Ontario, Canada. The secondary objectives were to evaluate correlates associated with retention in OAT at various stages and the impact of patients’ location of the residence on retention in OAT. Design A multi-clinic retrospective cohort study was conducted using electronic medical record (EMR) data from the largest network of OAT clinics in Canada (70 clinics) from 2014 to 2020. Study participants included all patients who received OAT from the network of clinics during the study period. Measurements In this study, four stages of the cascade of care framework were operationalized to identify treatment engagement patterns, including patients retained within 90 days, 90 to 365 days, one to 2 years, and more than 2 years. Correlates associated with OAT retention for 90 days, 90 to 365 days, 1 to 2 years, and more than 2 years were also evaluated and compared across rural and urban areas in northern and southern Ontario. Results A total of 32,487 patients were included in the study. Compared to patients who were retained in OAT for 90 days, patients who were retained for 90 to 365 days, 1 to 2 years, or more than 2 years were more likely to have a higher number of treatment attempts, a higher number of average monthly urine drug screening and a lower proportion of positive urine drug screening results for other drug use. Conclusion Distinct sociodemographic and clinical factors are likely to influence treatment retention at various stages of engagement along the OAT continuum. Research is required to determine if tailored strategies specific to people at different stages of retention have the potential to improve outcomes of OAT.
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Affiliation(s)
| | - Kristen A Morin
- Northern Ontario School of Medicine, Sudbury, ON, P3E 2C6, Canada.,ICES North, Sudbury, Canada.,Health Sciences North Research Institute, Sudbury, Canada
| | - Frank Vojtesek
- Northern Ontario School of Medicine, Sudbury, ON, P3E 2C6, Canada
| | - David C Marsh
- Northern Ontario School of Medicine, Sudbury, ON, P3E 2C6, Canada. .,ICES North, Sudbury, Canada. .,Health Sciences North Research Institute, Sudbury, Canada. .,Canadian Addiction Treatment Centres, Markham, Canada.
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21
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Fursa O, Mocroft A, Lazarus JV, Amele S, Lundgren J, Matulionyte R, Rasmussen LD, Rockstroh JK, Parczewski M, Jilich D, Moreno S, Vassilenko A, Lacombe K, Wandeler G, Borodulina E, Brännström J, Wiese L, Orkin C, Behrens GMN, Mansinho K, Portu JJ, Peters L. The hepatitis C cascade of care in HIV/hepatitis C virus coinfected individuals in Europe: regional and intra-regional differences. AIDS 2022; 36:423-435. [PMID: 34690281 DOI: 10.1097/qad.0000000000003112] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Following the introduction of direct-acting antiviral therapy in 2013, WHO launched the first Global Health Sector Strategy on Viral Hepatitis. We describe a hepatitis C virus (HCV) cascade of care in people with HIV (PWH) across Europe in terms of reaching the WHO elimination targets of diagnosing 90% and treating 80% of HCV-infected individuals. METHODS HIV/HCV-coinfected participants in the EuroSIDA cohort under prospective follow-up at October 1, 2019, were described using a nine-stage cascade of care. Care cascades were constructed across Europe, on a regional (n = 5) and country (n = 21) level. RESULTS Of 4773 anti-HCV positive PWH, 4446 [93.1%, 95% confidence interval (CI) 92.4-93.9)] were ever tested for HCV RNA, and 19.0% (95% CI 16.4-21.6) were currently HCV RNA positive, with the highest prevalence in Eastern and Central-Eastern Europe (33.7 and 29.6%, respectively). In Eastern Europe, 78.1% of the estimated number of chronic infections have been diagnosed, whereas this proportion was above 95% in the other four regions. Overall, 3116 persons have ever started treatment (72.5% of the ever chronically infected, 95% CI 70.9-74.0) and 2404 individuals (55.9% of the ever chronically infected, 95% CI 53.9-57.9) were cured. Cure proportion ranged from 11.2% in Belarus to 87.2% in Austria. CONCLUSION In all regions except Eastern Europe, more than 90% of the study participants have been tested for HCV-RNA. In Southern and Central-Western regions, more than 80% ever chronically HCV-infected PWH received treatment. The proportion with cured HCV infection did not exceed 80% in any region, with significant heterogeneity between countries. SUMMARY In a pan-European cohort of PWH, all regions except Eastern Europe achieved the WHO target of diagnosing 90% of chronic HCV infections, while the target of treating 80% of eligible persons was achieved in none of the five regions.
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Affiliation(s)
- Olga Fursa
- Centre of Excellence for Health, Immunity and Infections, Rigshospitalet, Copenhagen, Denmark
| | - Amanda Mocroft
- Centre of Excellence for Health, Immunity and Infections, Rigshospitalet, Copenhagen, Denmark
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, UCL, London, UK
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Sarah Amele
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, UCL, London, UK
| | - Jens Lundgren
- Centre of Excellence for Health, Immunity and Infections, Rigshospitalet, Copenhagen, Denmark
| | - Raimonda Matulionyte
- Vilnius University, Faculty of Medicine, Department of Infectious Diseases and Dermatovenerology, Vilnius, Lithuania
| | - Line D Rasmussen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | | | - Milosz Parczewski
- Department of Infectious, Tropical Diseases and Immune Deficiency, Pomeranian Medical University, Szczecin, Poland
| | - David Jilich
- Charles University in Prague and Na Bulovce Hospital, Prague, Czech Republic
| | - Santiago Moreno
- Servicio Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Karine Lacombe
- Sorbonne Université, IPLESP Inserm UMR-S1136, AP-HP, Paris, France
| | - Gilles Wandeler
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland
| | | | - Johanna Brännström
- Department of Infectious Diseases/Venhälsan, Södersjukhuset, Stockholm, Sweden
| | - Lothar Wiese
- Sjællands Universitetshospital, Roskilde, Denmark
| | | | - Georg M N Behrens
- Department for Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
| | | | | | - Lars Peters
- Centre of Excellence for Health, Immunity and Infections, Rigshospitalet, Copenhagen, Denmark
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22
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Dröse S, Øvrehus ALH, Holm DK, Madsen LW, Mössner BK, Søholm J, Hansen JF, Røge BT, Christensen PB. A multi-level intervention to eliminate hepatitis C from the Region of Southern Denmark: the C-Free-South project. BMC Infect Dis 2022; 22:202. [PMID: 35232372 PMCID: PMC8889755 DOI: 10.1186/s12879-022-07196-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 02/22/2022] [Indexed: 11/16/2022] Open
Abstract
Denmark has signed the WHO strategy to eliminate hepatitis C virus (HCV). In the absence of a national strategy for elimination, a local action plan was developed in the Region of Southern Denmark (RSD). The aim of the strategy is to diagnose 90% of HCV-infected persons and treat 80% of those diagnosed by 2025. The strategy was developed by reviewing Danish data on HCV epidemiology and drug use to identify key populations for screening, linkage to care, and treatment. Based on available published data from 2016, an estimated 3028 persons in the RSD were HCV-RNA positive (population prevalence 0.21%). Of these, 1002 were attending clinical care, 1299 were diagnosed but not in clinical care, and 727 were undiagnosed. Three different interventions targeting the HCV-infected population and two interventions for HCV surveillance are planned to achieve elimination. The “C-Free-South” strategy aims to eliminate HCV in our region by identifying (90%) and treating (80%) of infected persons by the end of 2025, 5 years earlier than the WHO elimination target date.
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Affiliation(s)
- Sandra Dröse
- Department of Infectious Diseases, Odense University Hospital, J. B. Winsloews Vej 4, Indgang 18 Penthouse 2. sal, 5000, Odense C, Denmark. .,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Winsløwparken 19, 3. sal, 5000, Odense, Denmark.
| | - Anne Lindebo Holm Øvrehus
- Department of Infectious Diseases, Odense University Hospital, J. B. Winsloews Vej 4, Indgang 18 Penthouse 2. sal, 5000, Odense C, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Winsløwparken 19, 3. sal, 5000, Odense, Denmark
| | - Dorte Kinggaard Holm
- Department of Clinical Immunology, Odense University Hospital, 29 J. B. Winsloews Vej 4, Indgang 8, Odense C, 5000, Odense, Denmark
| | - Lone Wulff Madsen
- Department of Infectious Diseases, Odense University Hospital, J. B. Winsloews Vej 4, Indgang 18 Penthouse 2. sal, 5000, Odense C, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Winsløwparken 19, 3. sal, 5000, Odense, Denmark
| | - Belinda Klemmensen Mössner
- Department of Infectious Diseases, Odense University Hospital, J. B. Winsloews Vej 4, Indgang 18 Penthouse 2. sal, 5000, Odense C, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Winsløwparken 19, 3. sal, 5000, Odense, Denmark
| | - Jacob Søholm
- Department of Infectious Diseases, Odense University Hospital, J. B. Winsloews Vej 4, Indgang 18 Penthouse 2. sal, 5000, Odense C, Denmark
| | - Janne Fuglsang Hansen
- Department of Infectious Diseases, Odense University Hospital, J. B. Winsloews Vej 4, Indgang 18 Penthouse 2. sal, 5000, Odense C, Denmark
| | - Birgit Thorup Røge
- Department of Medicine, Lillebaelt Hospital, Sygehusvej 24, 6000, Kolding, Denmark
| | - Peer Brehm Christensen
- Department of Infectious Diseases, Odense University Hospital, J. B. Winsloews Vej 4, Indgang 18 Penthouse 2. sal, 5000, Odense C, Denmark. .,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Winsløwparken 19, 3. sal, 5000, Odense, Denmark.
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23
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Valencia J, Lazarus JV, Ceballos FC, Troya J, Cuevas G, Resino S, Torres-Macho J, Ryan P. Differences in the hepatitis C virus cascade of care and time to initiation of therapy among vulnerable subpopulations using a mobile unit as point-of-care. Liver Int 2022; 42:309-319. [PMID: 34767680 DOI: 10.1111/liv.15095] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 10/31/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS People who inject drugs (PWID) and other marginalized populations with high hepatitis C virus (HCV) infection rates represent a unique challenge for treatment initiation due to health, administrative and social barriers. We analysed the HCV cascade of care (CoC) in some vulnerable subpopulations in Madrid, Spain, when using a mobile point-of-care (PoC). METHODS From 2019 to 2021, a mobile unit was used to screen active HCV using a linkage-to-care and two-step PoC-based strategy. Viremic participants were grouped into four subgroups: PWID, homeless individuals and people with a mental health disorder (MHD) and alcohol use disorder (AUD). Logistic regression, and Cox and Aalen's additive models were used to analyse associated factors and differences between groups. RESULTS A prospectively recruited cohort of 214 HCV-infected individuals (73 PWID, 141 homeless, 57 with a MHD and 91 with AUD) participated in the study. The overall HCV CoC analysis found that 178 (83.1%) attended a hospital, 164 (76.6%) initiated direct-acting antiviral therapy and 141 (65.8%) completed therapy, of which 99 (95.2%) achieved sustained virological response (SVR). PWID were significantly less likely to initiate treatment, whereas individuals with AUD waited longer before starting the treatment. Both people with AUD and PWID were significantly less likely to complete HCV treatment. CONCLUSIONS Overall, SVR was achieved in the majority of the participants treated. However, PWID need better linkage to care and treatment, whereas PWID and AUD need more support for treatment completion.
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Affiliation(s)
- Jorge Valencia
- Internal Medicine Service, University Hospital Infanta Leonor, Madrid, Spain.,Harm Reduction Unit 'SMASD', Addictions and Mental Health Department, Madrid, Spain
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain.,Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Francisco C Ceballos
- Viral Infection and Immunity Unit, National Centre for Microbiology, Health Institute Carlos III, Madrid, Spain
| | - Jesús Troya
- Internal Medicine Service, University Hospital Infanta Leonor, Madrid, Spain
| | - Guillermo Cuevas
- Internal Medicine Service, University Hospital Infanta Leonor, Madrid, Spain
| | - Salvador Resino
- Viral Infection and Immunity Unit, National Centre for Microbiology, Health Institute Carlos III, Madrid, Spain
| | - Juan Torres-Macho
- Internal Medicine Service, University Hospital Infanta Leonor, Madrid, Spain
| | - Pablo Ryan
- Internal Medicine Service, University Hospital Infanta Leonor, Madrid, Spain.,School of Medicine, Complutense University of Madrid, Madrid, Spain.,Gregorio Marañón Health Research Institute, Madrid, Spain
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24
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Santos M, Protopopescu C, Delarocque-Astagneau E, Bourlière M, Petrov-Sanchez V, Di Beo V, Larrey D, Baudoin M, Dorival C, Bureau M, Fontaine H, Carrat F, Marcellin F, Pol S, Carrieri P. Late presentation for HCV care: Time to target people with diabetes and/or hazardous alcohol use (ANRS CO22 HEPATHER cohort). Liver Int 2022; 42:38-49. [PMID: 34520614 DOI: 10.1111/liv.15056] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 08/16/2021] [Accepted: 08/27/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS Late presentation for care of hepatitis C virus (HCV) infection - defined as having severe liver fibrosis when first consulting a specialist for HCV care - increases morbidity and mortality. Identifying the socio-behavioural correlates of late presentation is essential to improve HCV strategies to optimize HCV cascade of care. We investigated clinical and socio-behavioural correlates of late presentation for care in HCV mono-infected individuals. METHODS This study included chronic HCV mono-infected patients participating in the French national cohort ANRS CO22 HEPATHER, starting in 2012. The correlates of late presentation were estimated using a Heckman probit selection model, which takes into account the possible selection bias because of missing data in the outcome. RESULTS Among the 9174 study patients, 1236 had available data on liver fibrosis stage at first presentation for HCV care. Of these, 591 (47.8%) were late presenters. In a multivariable analysis adjusted for age, sex and HCV genotype, having diabetes (adjusted coefficient [95% confidence interval]: 0.55 [0.30; 0.80]), current hazardous alcohol use (0.36 [0.03; 0.69]) and current abstinence but past hazardous alcohol use (0.42 [0.19; 0.64]) (vs. current abstinence and no past hazardous use) were all independently associated with late presentation for HCV care. CONCLUSIONS As late presentation severely affects HCV cascade of care, our findings bring important new evidence about the need to promptly identify and target people with diabetes and/or past or current hazardous alcohol use for HCV screening and treatment within the wider context of the WHO goal to eliminate HCV by 2030.
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Affiliation(s)
- Melina Santos
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Camelia Protopopescu
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Elizabeth Delarocque-Astagneau
- UVSQ, Inserm, Anti-Infective Evasion and Pharmacoepidemiology, CESP, Université Paris-Saclay, Montigny, France.,Département Hospitalier d'Epidémiologie et de Santé Publique, AP-HP, GHU Université Paris Saclay, Hôpital Raymond Poincaré, Garches, France
| | - Marc Bourlière
- Department of Hepatology and Gastroenterology, Hôpital Saint Joseph, Marseille, France
| | - Ventizlava Petrov-Sanchez
- ANRS MIE (France Recherche Nord & Sud Sida-HIV Hépatites, Maladies Infectieuses Emergentes), Unit for Basic and Clinical Research on Viral Hepatitis, Paris, France
| | - Vincent Di Beo
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Dominique Larrey
- Service des maladies de l'appareil digestif, Hôpital Saint Eloi, IBR-Inserm Montpellier, Montpellier, France
| | - Maël Baudoin
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Céline Dorival
- Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France
| | - Morgane Bureau
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Hélène Fontaine
- Département d'Hépatologie, AP-HP, Hôpital Cochin, Paris, France.,INSERM U1223, Institut Pasteur, Université Paris Descartes, Paris, France
| | - Fabrice Carrat
- Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France.,Hôpital Saint-Antoine, Unité de Santé Publique, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Fabienne Marcellin
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Stanislas Pol
- Département d'Hépatologie, AP-HP, Hôpital Cochin, Paris, France.,INSERM U1223, Institut Pasteur, Université Paris Descartes, Paris, France
| | - Patrizia Carrieri
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
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25
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Gibbs D, Price O, Grebely J, Larney S, Sutherland R, Read P, Butler K, Degenhardt L, Peacock A. Hepatitis C virus cascade of care among people who inject drugs in Australia: Factors associated with testing and treatment in a universal healthcare system. Drug Alcohol Depend 2021; 228:109050. [PMID: 34607193 DOI: 10.1016/j.drugalcdep.2021.109050] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND Understanding factors associated with engagement across the hepatitis C virus (HCV) cascade of care (CoC) among people who inject drugs (PWID) is critical for developing targeted interventions to enhance engagement and further HCV elimination efforts. We describe the CoC among Australian PWID, and identify factors associated with engagement at each stage. METHODS As part of the 2018 and 2019 Illicit Drug Reporting System, Australians who regularly inject drugs reported lifetime HCV antibody and RNA testing, treatment uptake and completion. Multivariable logistic regression identified characteristics associated with outcomes. RESULTS Of 1499 participants, 87% reported antibody testing. Of those, 70% reported RNA testing, of whom 60% reported being RNA positive. Among those, 76% reported initiating treatment, 78% of whom completed. Incarceration history (adjusted odds ratio 1.90; 95% confidence interval 1.28-2.82), current opioid agonist treatment (OAT) (1.99; 1.14-3.47), and recent alcohol and other drug (AOD) counselling (2.22; 1.27-3.88) were associated with antibody testing. Incarceration history (1.42; 1.07-1.87), and current OAT (2.07; 1.51-2.86) were associated with RNA testing. Current OAT (1.92; 1.22-3.03) and recent AOD counselling (1.91; 1.16-3.13) were associated with treatment uptake. Methamphetamine as drug injected most often in the last month was associated with reduced odds of antibody (0.41; 0.25-0.66) and RNA testing (0.54; 0.40-0.74), compared to heroin. CONCLUSION CoC engagement amongst Australian PWID is encouraging, with AOD service engagement associated with testing and treatment. Further efforts to reach those not service engaged, particularly those not receiving OAT or who predominantly inject methamphetamine, are needed to achieve HCV elimination targets.
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Affiliation(s)
- Daisy Gibbs
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia.
| | - Olivia Price
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | | | - Sarah Larney
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia; Département de médecine famille et de médecine d'urgence/Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
| | - Rachel Sutherland
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Phillip Read
- Kirketon Road Centre, South Eastern Sydney Local Health District, NSW, Australia
| | - Kerryn Butler
- Discipline of Addiction Medicine, University of Sydney, Sydney, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Amy Peacock
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia; School of Psychology, University of Tasmania, Hobart, TAS, Australia
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26
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Hepatitis C Treatment Among Commercially or Medicaid-Insured Individuals, 2014-2018. Am J Prev Med 2021; 61:716-723. [PMID: 34362617 DOI: 10.1016/j.amepre.2021.05.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 04/29/2021] [Accepted: 05/05/2021] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The proportion of individuals infected with hepatitis C virus that receive direct-acting antiviral treatment is unclear. METHODS The proportion of commercially or Medicaid-insured patients receiving hepatitis C virus treatment was estimated using administrative claims data obtained from MarketScan and Multi-State Medicaid obtained on January 6, 2020. Validated algorithms derived from standardized procedures and International Classification of Diseases diagnosis codes were used to identify enrollees with chronic hepatitis C; analysis (performed November 30, 2020) was restricted to adults continuously enrolled with prescription drug coverage for >6 months before and after their index hepatitis C viral load test claim date from January 2014 through December 2018. Prescription drug claims using National Drug Codes were used for hepatitis C virus drugs. The proportion of treated patients by demographic and clinical characteristics was described, and associations with treatment were modeled using multivariable-adjusted hazard ratios and 95% CIs by insurance status. RESULTS Of patients with chronic hepatitis C, 12,090 of 17,562 (69%) with commercial insurance and 8,112 of 27,328 (30%) with Medicaid were treated. Commercially insured patients with opioid use disorder (hazard ratio=0.78, 95% CI=0.72, 0.85), alcohol use disorder (hazard ratio=0.85, 95% CI=0.79, 0.91), severe mental illness (hazard ratio=0.92, 95% CI=0.87, 0.98), chronic kidney disease (hazard ratio=0.75, 95% CI=0.69, 0.82), or HIV infection (hazard ratio=0.74, 95% CI=0.66, 0.82) were less likely to be treated. Medicaid patients with opioid (hazard ratio=0.64, 95% CI=0.61, 0.68) or alcohol use disorders (hazard ratio=0.83, 95% CI=0.79, 0.88) were less likely to be treated. CONCLUSIONS Hepatitis C virus treatment gaps were identified using administrative claims data among patients with commercial and Medicaid insurance.
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Yousafzai MT, Bajis S, Alavi M, Grebely J, Dore GJ, Hajarizadeh B. Global cascade of care for chronic hepatitis C virus infection: A systematic review and meta-analysis. J Viral Hepat 2021; 28:1340-1354. [PMID: 34310812 DOI: 10.1111/jvh.13574] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 05/22/2021] [Accepted: 06/26/2021] [Indexed: 12/14/2022]
Abstract
The World Health Organization 2030 targets for hepatitis C virus (HCV) elimination include diagnosing 90% of people with HCV and treating 80% of people diagnosed with HCV. This systematic review assessed reported data on the HCV care cascade in various countries and populations, with a focus on direct-acting antiviral (DAA) treatment uptake. Bibliographic databases and conference presentations were searched for studies reporting the HCV care cascade (DAA treatment uptake was a requirement) among the overall population with HCV or sub-populations at greater risk of HCV. Population-based studies, with participants representative of a city, province/state or country were eligible. Twenty eligible studies were included, reporting HCV care cascade in 28 populations/sub-populations from 11 countries. DAA treatment uptake at national levels was reported from Iceland (95%), Egypt (92%), Georgia (79%), Norway (18%) and Sweden (8%), and at sub-national levels from the Netherlands (52%), Canada (50%), the United States (29%) and Denmark (5%). Among people with HIV-HCV co-infection, DAA treatment uptake was 62% in Canada, 44% in the Netherlands, 21% in Switzerland and 18% in the United States. Among people who inject drugs, DAA treatment uptake was 50% in Georgia, 40% in Canada, 37% in Australia and 13% in the United States. Data among people experiencing homelessness were only available from the United States (treatment uptake: 12%-14%). We found no eligible study reporting HCV care cascade data in prisons. Relatively few countries reported HCV care cascade at the national level. DAA treatment uptake was widely varied across populations/sub-populations, with higher rates reported in recent years.
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Affiliation(s)
| | - Sahar Bajis
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Maryam Alavi
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Gregory J Dore
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
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Ryan P, Valencia J, Cuevas G, Torres-Macho J, Troya J, Pueyo Á, José Muñoz-Gómez M, Muñoz-Rivas N, Vázquez-Morón S, Martinez I, Lazarus JV, Resino S. Detection of active hepatitis C in a single visit and linkage to care among marginalized people using a mobile unit in Madrid, Spain. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 96:103424. [PMID: 34429222 DOI: 10.1016/j.drugpo.2021.103424] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 07/22/2021] [Accepted: 08/11/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND The burden of hepatitis C virus (HCV) infection among marginalized people in Spain is high, despite the fact that HCV prevalence has decreased in recent years. We aimed to assess the effectiveness of a simplified point-of-care (PoC) model for screening for active HCV infection via a mobile unit and subsequent linkage to care with the assistance of navigators. METHODS We carried out a prospective study on 2001 participants from Madrid, Spain. A nurse and a navigator/educator screened for hepatitis C in a mobile unit, using the OraQuick HCV Rapid Antibody Test and Xpert HCV VL Fingerstick assay. Participants with active HCV were referred to the hospital the same day with a navigator for evaluation and treatment of HCV. RESULTS Overall, 1621 (81%) participants had not been exposed to HCV, 380 (18.9%) were positive for HCV antibodies, and 136 (6.8%) had active hepatitis C. Among the latter, 134 (98.5%) received the HCV screening results, 133 (97.8%) had an appointment at the hospital, 126 (92.8%) were seen by a physician once they were at the hospital, and 105 (77.2%) started HCV treatment. Being over 50 years old and a person who uses drugs, particularly people who inject drugs (PWID), was directly associated with active hepatitis C (p<0.05). PWID were the only patients with HCV reinfection (4.3% in people without recent injecting drug use and 5.9% in people with recent injecting drug use). Among PWID, no income and daily alcohol intake were also directly associated with active hepatitis C. People with recent injecting drug use showed the lowest rates of attendance at the hospital (91.8%) and starting HCV treatment (70.4%). CONCLUSION HCV screening using a two-step PoC-based strategy and its linkage to care was extremely efficient for identifying and treating marginalized people with active hepatitis C, thanks to the use of a mobile unit with personnel and technical equipment, an interdisciplinary team, and collaboration between institutions.
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Affiliation(s)
- Pablo Ryan
- University Hospital Infanta Leonor, Madrid, Spain; Complutense University of Madrid (UCM), Madrid, Spain; Gregorio Marañón Health Research Institute (IiSGM), Madrid, Spain
| | - Jorge Valencia
- University Hospital Infanta Leonor, Madrid, Spain; Harm Reduction Unit "SMASD", Madrid, Spain
| | | | - Juan Torres-Macho
- University Hospital Infanta Leonor, Madrid, Spain; Complutense University of Madrid (UCM), Madrid, Spain
| | - Jesús Troya
- University Hospital Infanta Leonor, Madrid, Spain
| | - Ángel Pueyo
- Foundation for Biomedical Research and Innovation of University Hospital Infanta Leonor and University Hospital Southeast, Madrid, Spain; Heath Science PhD Program. UCAM Universidad Católica San Antonio de Murcia. 30107 Guadalupe de Maciascoque, Murcia, Spain
| | - María José Muñoz-Gómez
- Viral Infection and Immunity Unit, National Centre for Microbiology, Health Institute Carlos III, Majadahonda, Madrid, Spain
| | | | - Sonia Vázquez-Morón
- Viral Infection and Immunity Unit, National Centre for Microbiology, Health Institute Carlos III, Majadahonda, Madrid, Spain
| | - Isidoro Martinez
- Viral Infection and Immunity Unit, National Centre for Microbiology, Health Institute Carlos III, Majadahonda, Madrid, Spain
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Salvador Resino
- Viral Infection and Immunity Unit, National Centre for Microbiology, Health Institute Carlos III, Majadahonda, Madrid, Spain.
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Yasseen AS, Kwong JC, Feld JJ, Janjua NZ, Greenaway C, Lapointe-Shaw L, Sherman M, Mazzulli T, Kustra R, MacDonald L, Sander B, Crowcroft NS. Viral hepatitis C cascade of care: A population-level comparison of immigrant and long-term residents. Liver Int 2021; 41:1775-1788. [PMID: 33655665 DOI: 10.1111/liv.14840] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/27/2021] [Accepted: 02/18/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Viral hepatitis C represents a major global burden, particularly among immigrant-receiving countries such as Canada, where knowledge of disparities in hepatitis C virus among immigrant groups for micro-elimination efforts is lacking. We quantify the hepatitis C cascades of care among immigrants and long-term residents prior to the introduction of direct-acting antiviral medications. METHODS Using laboratory and health administrative records, we described the hepatitis C virus cascades of care in terms of diagnosis, engagement with care, treatment initiation, and clearance in Ontario, Canada (1997-2014). We stratified the cascade by immigrant and long-term resident groups and identify drivers at each stage using multivariable Poisson regression. RESULTS We included 940 245 individuals in the study with an estimated hepatitis C prevalence of 167 923 (1.4%) overall, 23 759 (0.7%) among all immigrants, and 6019 (1.1%) among immigrants from hepatitis C endemic countries. Overall there were 104 616 individuals with reactive antibody results, 73 861 tested for viral RNA, 52 388 with viral RNA detected, 50 805 genotyped, 13 159 on treatment and 3919 with evidence of viral clearance. Compared to long-term residents, immigrants showed increased nucleic-acid testing (aRR: 1.09 [95%CI: 1.08, 1.10]), treatment initiation (aRR: 1.46 [95%CI: 1.38, 1.54]), and higher clearance rates (aRR: 1.07 [95%CI: 1.03, 1.11]). CONCLUSIONS Hepatitis C virus is more prevalent among long-term residents compared to immigrants overall, however, immigrants from endemic countries are an important subgroup to consider for future screening and linkage to care initiatives. These findings are prior to the introduction of newer medications and provide a population-based benchmark for follow-up studies and evaluation of treatment programs and surveillance activities.
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Affiliation(s)
- Abdool S Yasseen
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,Public Health Ontario, Toronto, ON, Canada
| | - Jeffrey C Kwong
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,Public Health Ontario, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada
| | - Jordan J Feld
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada
| | - Naveed Z Janjua
- BC Centre for Disease Control - Hepatitis Testers Cohort, Vancouver, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Christina Greenaway
- Division of Infectious Diseases, SMBD-Jewish General Hospital, McGill University Montreal, Montreal, Canada.,Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Canada
| | - Lauren Lapointe-Shaw
- ICES, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Tony Mazzulli
- Public Health Ontario, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada.,Mount Sinai Hospital/University Health Network Department of Microbiology, Toronto, ON, Canada
| | - Rafal Kustra
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Liane MacDonald
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Public Health Ontario, Toronto, ON, Canada
| | - Beate Sander
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,Public Health Ontario, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada
| | - Natasha S Crowcroft
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada
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Metsch LR, Feaster DJ, Gooden LK, Masson C, Perlman DC, Jain MK, Matheson T, Nelson CM, Jacobs P, Tross S, Haynes L, Lucas GM, Colasanti JA, Rodriguez A, Drainoni ML, Osorio G, Nijhawan AE, Jacobson JM, Sullivan M, Metzger D, Vergara-Rodriguez P, Lubelchek R, Duan R, Batycki JN, Matthews AG, Munoz F, Jelstrom E, Mandler R, Del Rio C. Care Facilitation Advances Movement Along the Hepatitis C Care Continuum for Persons With Human Immunodeficiency Virus, Hepatitis C, and Substance Use: A Randomized Clinical Trial (CTN-0064). Open Forum Infect Dis 2021; 8:ofab334. [PMID: 34377726 PMCID: PMC8339611 DOI: 10.1093/ofid/ofab334] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/24/2021] [Indexed: 12/13/2022] Open
Abstract
Background Direct-acting antivirals can cure hepatitis C virus (HCV). Persons with HCV/HIV and living with substance use are disadvantaged in benefiting from advances in HCV treatment. Methods In this randomized controlled trial, participants with HCV/HIV were randomized between February 2016 and January 2017 to either care facilitation or control. Twelve-month follow-up assessments were completed in January 2018. Care facilitation group participants received motivation and strengths-based case management addressing retrieval of HCV viral load results, engagement in HCV/HIV care, and medication adherence. Control group participants received referral to HCV evaluation and an offer of assistance in making care appointments. Primary outcome was number of steps achieved along a series of 8 clinical steps (eg, receiving HCV results, initiating treatment, sustained virologic response [SVR]) of the HCV/HIV care continuum over 12 months postrandomization. Results Three hundred eighty-one individuals were screened and 113 randomized. Median age was 51 years; 58.4% of participants were male and 72.6% were Black/African American. Median HIV-1 viral load was 27 209 copies/mL, with 69% having a detectable viral load. Mean number of steps completed was statistically significantly higher in the intervention group vs controls (2.44 vs 1.68 steps; χ 2 [1] = 7.36, P = .0067). Men in the intervention group completed a statistically significantly higher number of steps than controls. Eleven participants achieved SVR with no difference by treatment group. Conclusions The care facilitation intervention increased progress along the HCV/HIV care continuum, as observed for men and not women. Study findings also highlight continued challenges to achieve individual-patient SVR and population-level HCV elimination. Clinical Trials Registration NCT02641158.
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Affiliation(s)
- Lisa R Metsch
- Department of Sociomedical Sciences, Columbia University, New York, New York, USA
| | - Daniel J Feaster
- Department of Public Health Sciences, University of Miami, Miami, Florida, USA
| | - Lauren K Gooden
- Department of Sociomedical Sciences, Columbia University, New York, New York, USA
| | - Carmen Masson
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - David C Perlman
- Division of Infectious Diseases, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mamta K Jain
- Division of Infectious Diseases, University of Texas Southwestern Medical Center and Parkland Health & Hospital System, Dallas, Texas, USA
| | - Tim Matheson
- Center on Substance Use and Health, San Francisco Department of Public Health, San Francisco, California, USA
| | - C Mindy Nelson
- Department of Public Health Sciences, University of Miami, Miami, Florida, USA
| | - Petra Jacobs
- Center for Clinical Trials Network, National Institute on Drug Abuse, Rockville, Maryland, USA
| | - Susan Tross
- Department of Psychiatry, Columbia University, New York, New York, USA
| | - Louise Haynes
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Gregory M Lucas
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Allan Rodriguez
- Infectious Disease, University of Miami, Miami, Florida, USA
| | - Mari-Lynn Drainoni
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Georgina Osorio
- Division of Infectious Diseases, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ank E Nijhawan
- Division of Infectious Diseases, University of Texas Southwestern Medical Center and Parkland Health & Hospital System, Dallas, Texas, USA
| | - Jeffrey M Jacobson
- Division of Infectious Diseases and HIV Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Meg Sullivan
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - David Metzger
- HIV/AIDS Prevention Research Division, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Pamela Vergara-Rodriguez
- Mental Health and Substance Abuse Division, John H. Stroger, Jr Hospital of Cook County, Chicago, Illinois, USA
| | - Ronald Lubelchek
- Infectious Diseases, John H. Stroger, Jr Hospital of Cook County, Chicago, Illinois, USA
| | - Rui Duan
- Department of Public Health Sciences, University of Miami, Miami, Florida, USA
| | - Jacob N Batycki
- Department of Public Health Sciences, University of Miami, Miami, Florida, USA
| | - Abigail G Matthews
- Data Statistical Center, The Emmes Company, LLC, Rockville, Maryland, USA
| | - Felipe Munoz
- Data Statistical Center, The Emmes Company, LLC, Rockville, Maryland, USA
| | - Eve Jelstrom
- Clinical Coordinating Center, The Emmes Company, LLC, Rockville, Maryland, USA
| | - Raul Mandler
- Clinical/Medical Branch, National Institute on Drug Abuse, Rockville, Maryland, USA
| | - Carlos Del Rio
- Division of Infectious Diseases, Emory University, Atlanta, Georgia, USA
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Olafsson S, Fridriksdottir RH, Love TJ, Tyrfingsson T, Runarsdottir V, Hansdottir I, Bergmann OM, Björnsson ES, Johannsson B, Sigurdardottir B, Löve A, Baldvinsdottir GE, Hernandez UB, Gudnason T, Heimisdottir M, Hellard M, Gottfredsson M. Cascade of care during the first 36 months of the treatment as prevention for hepatitis C (TraP HepC) programme in Iceland: a population-based study. Lancet Gastroenterol Hepatol 2021; 6:628-637. [PMID: 34171267 DOI: 10.1016/s2468-1253(21)00137-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/31/2021] [Accepted: 04/07/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND WHO has set targets to eliminate hepatitis C virus (HCV) infection as a global health threat by 2030 through a 65% reduction in HCV-related deaths and 80% reduction in HCV incidence. To achieve these goals, WHO set service coverage targets of 90% of the infected population being diagnosed and 80% of eligible patients being treated. In February, 2016, Iceland initiated a nationwide HCV elimination programme known as treatment as prevention for hepatitis C (TraP HepC), which aimed to maximise diagnosis and treatment access. This analysis reports on the HCV cascade of care in the first 3 years of the programme. METHODS This population-based study was done between Feb 10, 2016, and Feb 10, 2019. Participants aged 18 years or older with permanent residence in Iceland and PCR-confirmed HCV were offered direct-acting antiviral (DAA) therapy. The programme used a multidisciplinary team approach in which people who inject drugs were prioritised. Nationwide awareness campaigns, improved access to testing, and harm reduction services were scaled up simultaneously. The number of infected people in the national HCV registry was used in combination with multiple other data sources, including screening of low-risk groups and high-risk groups, to estimate the total number of HCV infections. The number of people diagnosed, linked to care, initiated on treatment, and cured were recorded during the study. This study is registered with ClinicalTrials.gov, NCT02647879. FINDINGS In February, 2016, at the onset of the programme, 760 (95% CI 690-851) individuals were estimated to have HCV infection, with 75 (95% CI 6-166) individuals undiagnosed. 682 individuals were confirmed to be HCV PCR positive. Over the next 3 years, 183 new infections (including 42 reinfections) were diagnosed, for a total of 865 infections in 823 individuals. It was estimated that more than 90% of all domestic HCV infections had been diagnosed as early as January, 2017. During the 3 years, 824 (95·3%) of diagnosed infections were linked to care, and treatment was initiated for 795 (96·5%) of infections linked to care. Cure was achieved for 717 (90·2%) of 795 infections. INTERPRETATION By using a multidisciplinary public health approach, involving tight integration with addiction treatment services, the core service coverage targets for 2030 set by WHO have been reached. These achievements position Iceland to be among the first nations to subsequently achieve the WHO goal of eliminating HCV as a public health threat. FUNDING The Icelandic Government and Gilead Sciences.
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Affiliation(s)
- Sigurdur Olafsson
- Department of Gastroenterology and Hepatology, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland; Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland.
| | - Ragnheidur H Fridriksdottir
- Department of Gastroenterology and Hepatology, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Thorvardur J Love
- Department of Science, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland; Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland
| | | | | | - Ingunn Hansdottir
- Faculty of Psychology, School of Health Sciences, University of Iceland, Reykjavík, Iceland; SAA National Center for Addiction Medicine, Reykjavik, Iceland
| | - Ottar M Bergmann
- Department of Gastroenterology and Hepatology, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Einar S Björnsson
- Department of Gastroenterology and Hepatology, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland; Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland
| | - Birgir Johannsson
- Department of Infectious Diseases, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Bryndis Sigurdardottir
- Department of Infectious Diseases, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Arthur Löve
- Department of Virology, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland; Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland
| | - Gudrun E Baldvinsdottir
- Department of Virology, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Ubaldo Benitez Hernandez
- Department of Science, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | | | - Maria Heimisdottir
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland; Icelandic Health Insurance, Reykjavik, Iceland
| | - Margaret Hellard
- Burnet Institute, Melbourne, VIC, Australia; Department of Infectious Diseases, The Alfred Hospital, Melbourne, VIC, Australia
| | - Magnus Gottfredsson
- Department of Infectious Diseases, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland; Department of Science, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland; Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland
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Schmidbauer C, Schwarz M, Schütz A, Schubert R, Schwanke C, Gutic E, Pirker R, Lang T, Reiberger T, Haltmayer H, Gschwantler M. Directly observed therapy at opioid substitution facilities using sofosbuvir/velpatasvir results in excellent SVR12 rates in PWIDs at high risk for non-adherence to DAA therapy. PLoS One 2021; 16:e0252274. [PMID: 34086708 PMCID: PMC8177501 DOI: 10.1371/journal.pone.0252274] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 05/14/2021] [Indexed: 12/30/2022] Open
Abstract
Background & aims We evaluated the effectiveness of sofosbuvir/velpatasvir (SOF/VEL) in difficult-to-treat PWIDs with presumed high risk for non-adherence to antiviral therapy using an innovative concept involving their opioid agonist therapy (OAT) facility. Methods N = 221 patients (m/f: 168/53; median age: 44.7 years (IQR 16.9); HCV-genotype 3: 45.2%; cirrhosis: 33.9%) treated with SOF/VEL were included. PWIDs at high risk for non-adherence to DAA therapy (n = 122) received HCV treatment alongside OAT under the supervision of medical staff ("directly observed therapy", DOT). These patients were compared to patients with presumed excellent drug compliance, who were treated in a "standard setting" (SS) of SOF/VEL prescription at a tertiary care center (n = 99). Results DOT-patients (n = 122/221; 55.2%) were younger than SS-patients (median age: 41.3 vs. 53.0 years), all had psychiatric comorbidities and most had a poor socioeconomic status. 83/122 (68.0%) reported ongoing intravenous drug use. Within the DOT-group, SVR12 was achieved in 99.1% (95% CI: 95.0–100; n = 109/110) with one patient experiencing treatment failure, while n = 12/122 (9.8%) patients were excluded due to loss of follow-up (FU). 5 patients showed HCV reinfection after achieving SVR12. SS-patients achieved SVR in 96.6% (95% CI: 90.3–99.3%; n = 84/87) after exclusion of 10/99 (10.1%) patients who were lost to FU and 2 patients who died prior to SVR12 due to reasons not related to DAA therapy. Conclusions SOF/VEL given as DOT along with OAT in PWIDs at high risk of non-adherence to antiviral therapy including those with ongoing intravenous drug use resulted in excellent SVR rates similar to patients with presumed “excellent compliance” under standard drug intake.
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Affiliation(s)
- Caroline Schmidbauer
- Department of Internal Medicine IV, Klinik Ottakring, Vienna, Austria
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Vienna HIV & Liver Study Group, Vienna, Austria
| | - Michael Schwarz
- Department of Internal Medicine IV, Klinik Ottakring, Vienna, Austria
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Vienna HIV & Liver Study Group, Vienna, Austria
| | - Angelika Schütz
- Ambulatorium Suchthilfe Wien, Suchthilfe Wien gGmbH, Vienna, Austria
| | - Raphael Schubert
- Ambulatorium Suchthilfe Wien, Suchthilfe Wien gGmbH, Vienna, Austria
| | - Cornelia Schwanke
- Ambulatorium Suchthilfe Wien, Suchthilfe Wien gGmbH, Vienna, Austria
| | - Enisa Gutic
- Department of Internal Medicine IV, Klinik Ottakring, Vienna, Austria
| | - Roxana Pirker
- Department of Internal Medicine IV, Klinik Ottakring, Vienna, Austria
| | - Tobias Lang
- Department of Internal Medicine IV, Klinik Ottakring, Vienna, Austria
| | - Thomas Reiberger
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Vienna HIV & Liver Study Group, Vienna, Austria
| | - Hans Haltmayer
- Ambulatorium Suchthilfe Wien, Suchthilfe Wien gGmbH, Vienna, Austria
| | - Michael Gschwantler
- Department of Internal Medicine IV, Klinik Ottakring, Vienna, Austria
- Sigmund Freud University, Vienna, Austria
- * E-mail:
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Baiano CX, Caven M, Robinson EM, Dillon JF. Evaluating and communicating hepatitis C cascades of care data in Tayside, Scotland: A journey towards elimination. J Viral Hepat 2021; 28:909-915. [PMID: 33759258 DOI: 10.1111/jvh.13505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/15/2021] [Accepted: 03/08/2021] [Indexed: 12/09/2022]
Abstract
Chronic hepatitis C virus (HCV) is one of the leading causes of liver cirrhosis and hepatocellular carcinoma. The WHO 2030 Elimination Goals require each country to evaluate their response to their epidemics. This can be achieved by visualization of cascades of care, depicting how infected cases move through disease control stages. However, methods of displaying data are debated and lack practical application. This project proposes a new way of codifying and displaying HCV data using Tayside as a case study. 1464 cases of active HCV infections in Tayside from 2015 to 2019 were analysed from NHS Tayside's HCV Database. Variables were evaluated to create a systematic coding framework that was then used to code each patient's diagnosis, treatment and cure status each year from 2015 to 2019. Graphical representation of the data in the form of a stacked clustered bar chart demonstrates general trends and conversion rates. For example, Tayside has seen an increase in diagnosis-to-cure rates from 18% to 49% (2015-2019). This method also demonstrates the portion of newly and previously diagnosed people accessing treatment, those with unsuccessful or incomplete treatments, completed treatments with unconfirmed cure, and the number of deaths and relocations. In conclusion, this project proposes a novel way of displaying cascades of care data that relays yearly snapshots of an epidemic, cumulative progression over time, nuanced information of each stage and progression towards elimination targets. This method can be meaningfully used to improve local service planning, knowledge exchange across health systems and reporting to bodies like the WHO.
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Affiliation(s)
- Cassandra X Baiano
- Ninewells Hospital, University of Dundee Medical School, Dundee, Scotland
| | - Madeleine Caven
- Gut Group, Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, Scotland
| | - Emma M Robinson
- Gut Group, Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, Scotland.,Department of Gastroenterology, NHS Tayside, Ninewells Hospital, Dundee, Scotland
| | - John F Dillon
- Gut Group, Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, Scotland.,Department of Gastroenterology, NHS Tayside, Ninewells Hospital, Dundee, Scotland
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Huiban L, Stanciu C, Muzica CM, Cuciureanu T, Chiriac S, Zenovia S, Burduloi VM, Petrea O, Sîngeap AM, Gîrleanu I, Sfarti C, Cojocariu C, Trifan A. Hepatitis C Virus Prevalence and Risk Factors in a Village in Northeastern Romania-A Population-Based Screening-The First Step to Viral Micro-Elimination. Healthcare (Basel) 2021; 9:healthcare9060651. [PMID: 34072635 PMCID: PMC8229891 DOI: 10.3390/healthcare9060651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 05/26/2021] [Accepted: 05/27/2021] [Indexed: 02/05/2023] Open
Abstract
(1) Background: The World Health Organization adopted a strategy for the Global Health Sector on Viral Hepatitis in 2016, with the main objective of eliminating hepatitis C virus (HCV) by 2030. In this work, we aimed to evaluate the prevalence of HCV infection and risk factors in a Romanian village using population-based screening as part of the global C virus eradication program. (2) Methods: We conducted a prospective study from March 2019 to February 2020, based on a strategy as part of a project designed to educate, screen, treat and eliminate HCV infection in all adults in a village located in Northeastern Romania. (3) Results: In total, 3507 subjects were invited to be screened by rapid diagnostic orientation tests (RDOT). Overall, 2945 (84%) subjects were tested, out of whom 78 (2.64%) were found to have positive HCV antibodies and were scheduled for further evaluation in a tertiary center of gastroenterology/hepatology in order to be linked to care. In total, 66 (85%) subjects presented for evaluation and 55 (83%) had detectable HCV RNA. Of these, 54 (98%) completed antiviral treatment and 53 (99%) obtained a sustained virological response. (4) Conclusions: The elimination of hepatitis C worldwide has a higher chance of success if micro-elimination strategies based on mass screening are adopted.
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Affiliation(s)
- Laura Huiban
- Department of Gastroenterology “Grigore T. Popa”, University of Medicine and Pharmacy, 700115 Iasi, Romania; (L.H.); (C.S.); (C.M.M.); (T.C.); (S.C.); (S.Z.); (O.P.); (A.M.S.); (I.G.); (C.S.); (C.C.)
| | - Carol Stanciu
- Department of Gastroenterology “Grigore T. Popa”, University of Medicine and Pharmacy, 700115 Iasi, Romania; (L.H.); (C.S.); (C.M.M.); (T.C.); (S.C.); (S.Z.); (O.P.); (A.M.S.); (I.G.); (C.S.); (C.C.)
- Institute of Gastroenterology and Hepatology, “St. Spiridon” Emergency Hospital, 700111 Iasi, Romania
| | - Cristina Maria Muzica
- Department of Gastroenterology “Grigore T. Popa”, University of Medicine and Pharmacy, 700115 Iasi, Romania; (L.H.); (C.S.); (C.M.M.); (T.C.); (S.C.); (S.Z.); (O.P.); (A.M.S.); (I.G.); (C.S.); (C.C.)
| | - Tudor Cuciureanu
- Department of Gastroenterology “Grigore T. Popa”, University of Medicine and Pharmacy, 700115 Iasi, Romania; (L.H.); (C.S.); (C.M.M.); (T.C.); (S.C.); (S.Z.); (O.P.); (A.M.S.); (I.G.); (C.S.); (C.C.)
- Institute of Gastroenterology and Hepatology, “St. Spiridon” Emergency Hospital, 700111 Iasi, Romania
| | - Stefan Chiriac
- Department of Gastroenterology “Grigore T. Popa”, University of Medicine and Pharmacy, 700115 Iasi, Romania; (L.H.); (C.S.); (C.M.M.); (T.C.); (S.C.); (S.Z.); (O.P.); (A.M.S.); (I.G.); (C.S.); (C.C.)
- Institute of Gastroenterology and Hepatology, “St. Spiridon” Emergency Hospital, 700111 Iasi, Romania
| | - Sebastian Zenovia
- Department of Gastroenterology “Grigore T. Popa”, University of Medicine and Pharmacy, 700115 Iasi, Romania; (L.H.); (C.S.); (C.M.M.); (T.C.); (S.C.); (S.Z.); (O.P.); (A.M.S.); (I.G.); (C.S.); (C.C.)
| | - Vladut Mirel Burduloi
- Department of Anatomy “Grigore T. Popa”, University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Oana Petrea
- Department of Gastroenterology “Grigore T. Popa”, University of Medicine and Pharmacy, 700115 Iasi, Romania; (L.H.); (C.S.); (C.M.M.); (T.C.); (S.C.); (S.Z.); (O.P.); (A.M.S.); (I.G.); (C.S.); (C.C.)
- Institute of Gastroenterology and Hepatology, “St. Spiridon” Emergency Hospital, 700111 Iasi, Romania
| | - Ana Maria Sîngeap
- Department of Gastroenterology “Grigore T. Popa”, University of Medicine and Pharmacy, 700115 Iasi, Romania; (L.H.); (C.S.); (C.M.M.); (T.C.); (S.C.); (S.Z.); (O.P.); (A.M.S.); (I.G.); (C.S.); (C.C.)
- Institute of Gastroenterology and Hepatology, “St. Spiridon” Emergency Hospital, 700111 Iasi, Romania
| | - Irina Gîrleanu
- Department of Gastroenterology “Grigore T. Popa”, University of Medicine and Pharmacy, 700115 Iasi, Romania; (L.H.); (C.S.); (C.M.M.); (T.C.); (S.C.); (S.Z.); (O.P.); (A.M.S.); (I.G.); (C.S.); (C.C.)
- Institute of Gastroenterology and Hepatology, “St. Spiridon” Emergency Hospital, 700111 Iasi, Romania
| | - Cătălin Sfarti
- Department of Gastroenterology “Grigore T. Popa”, University of Medicine and Pharmacy, 700115 Iasi, Romania; (L.H.); (C.S.); (C.M.M.); (T.C.); (S.C.); (S.Z.); (O.P.); (A.M.S.); (I.G.); (C.S.); (C.C.)
- Institute of Gastroenterology and Hepatology, “St. Spiridon” Emergency Hospital, 700111 Iasi, Romania
| | - Camelia Cojocariu
- Department of Gastroenterology “Grigore T. Popa”, University of Medicine and Pharmacy, 700115 Iasi, Romania; (L.H.); (C.S.); (C.M.M.); (T.C.); (S.C.); (S.Z.); (O.P.); (A.M.S.); (I.G.); (C.S.); (C.C.)
- Institute of Gastroenterology and Hepatology, “St. Spiridon” Emergency Hospital, 700111 Iasi, Romania
| | - Anca Trifan
- Department of Gastroenterology “Grigore T. Popa”, University of Medicine and Pharmacy, 700115 Iasi, Romania; (L.H.); (C.S.); (C.M.M.); (T.C.); (S.C.); (S.Z.); (O.P.); (A.M.S.); (I.G.); (C.S.); (C.C.)
- Institute of Gastroenterology and Hepatology, “St. Spiridon” Emergency Hospital, 700111 Iasi, Romania
- Correspondence: ; Tel.: +40-726108428
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Stvilia K, Vephkvadze N, Gamkrelidze A, Khonelidze I, Getia V, Tsereteli M, Gvinjilia L, Kuchuloria T. Hepatitis C treatment uptake among patients who have received methadone substitution treatment in the Republic of Georgia. Public Health 2021; 195:42-50. [PMID: 34051674 DOI: 10.1016/j.puhe.2021.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/16/2021] [Accepted: 03/21/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES There is a dearth of research on hepatitis C virus (HCV) treatment uptake among people who inject drugs (PWIDs) and receive methadone substitution treatment (MST) in Eastern Europe and Central Asia countries. This study contributed to addressing that gap. We examined and identified factors that may affect HCV treatment uptake among PWID who received MST in the Republic of Georgia. STUDY DESIGN The design of the study is retrospective cohort study. METHODS We conducted HCV care cascade analysis by matching the data from the web-based national hepatitis C program registry (ELIM C) and the MST treatment database between January 1, 2015, and December 31, 2018. Using the World Health Organization's (WHO) Consensus HCV cascade of care (CoC) global instrument, we assessed the progress made toward the country's 2020 and WHO's 2030 hepatitis C elimination targets for the subpopulation of MST patients. RESULTS Overall, 10,498 individuals have been dispensed methadone during the study period. A total of 6828 MST beneficiaries had HCV screening, of whom 5843 (85.6%) tested positive; 5476 (93.7%) were tested for HCV viremia, and 5275 (96.3%) were confirmed with chronic HCV infection. More than 75% (n = 4000) of HCV-infected MST patients initiated HCV treatment, and 3772 (94.3%) completed the treatment. Of those eligible for sustained virologic response assessment, 71.0% (2641/3715) were evaluated, and the reported cure rate was 96.1% (2537). The study found the odds of patients starting HCV treatment differed by the type of facility they were screened at and whether they were registered as PWID at the screening sites. The patients screened at centers with integrated HCV treatment services had higher treatment uptake rates than those screened at other centers. CONCLUSIONS As the cumulative HCV treatment uptake and cure rates among MST patients with HCV infection are high (75.8% and 96.1%, respectively), the MST patients might become the first microelimination target population in which hepatitis C elimination will be achieved in Georgia. The study found the type of screening facility and whether MST patients registered themselves as PWID or not had significant effects on MST patients starting HCV treatment. At the same time, the study did not find gender and age to be significant predictors of MST patients starting HCV treatment. MST patients used different types of health facilities to get screened for HIV. Many of them did not register themselves as PWID when screened for HIV. The existence of only a few harm reduction sites with integrated HCV treatment services, a high level of stigma, and the criminalization of drug use might have incentivized MST patients to self-navigate across the HCV care continuum with the rest of the population. The implementation of focused, harm reduction, integrated HCV treatment with good peer and professional adherence support at treatment sites could help reach the hepatitis C elimination goals among MST patients.
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Affiliation(s)
- Ketevan Stvilia
- National Center for Disease Control and Public Health, Georgia.
| | | | | | - Irma Khonelidze
- National Center for Disease Control and Public Health, Georgia
| | - Vladimer Getia
- National Center for Disease Control and Public Health, Georgia
| | - Maia Tsereteli
- National Center for Disease Control and Public Health, Georgia
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Cachay ER, Torriani FJ, Hill L, Rajagopal A, Yin J, Bamford L, Mathews WC. Hepatitis C Knowledge and Recent Diagnosis Affect Hepatitis C Treatment Willingness in Persons Living With HIV. J Acquir Immune Defic Syndr 2021; 87:e159-e166. [PMID: 33587504 DOI: 10.1097/qai.0000000000002643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 01/11/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND We assessed the impact of health literacy and hepatitis C (HCV) knowledge on HCV treatment willingness among people living with HIV (PLWH) at an academic HIV clinic. METHODS Cross-sectional analysis of PLWH coinfected with HCV who completed health literacy, HIV literacy, and HCV knowledge inventories. We estimated the prevalence of low health literacy, HIV knowledge, and HCV knowledge sampled from 3-comparison groups: PLWH not referred for HCV, referred but who "not showed" to the HCV clinic, and referred and attended the HCV clinic. We used mixed-model linear and logistic regression to ascertain predictors of low health literacy, HIV knowledge, HCV knowledge, and predictors of willingness to start HCV treatment. RESULTS We enrolled 151 PLWH; 17% were female, 38% non-White, and 60% without a high-school education. Approximately, 68% were men who have sex with men, of whom 62% used intravenous drugs. The prevalence of low health, HIV knowledge, and HCV knowledge was 10%, 32%, and 29%, respectively. Predictors of low health literacy were being Hispanic, cirrhotic, and not completing high-school education. Low HCV knowledge was observed in female, non-White, and those diagnosed with HCV for a decade. In adjusted analyses, PLWH living with HCV for a decade (OR: 0.23) were less likely to be very willing to be treated for HCV. By contrast, those with high HCV knowledge were more likely to be very willing to receive treatment (OR: 1.27). CONCLUSION Low HCV knowledge and living with HCV for at least a decade are under-recognized negative predictors for PLWH's willingness to receive HCV treatment. CLINICAL TRIALS REGISTRATION ClinicaTrials.gov identifier: NCT20170991.
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Affiliation(s)
- Edward R Cachay
- Department of Medicine, Division of Infectious Diseases and Global Public Health, UC San Diego, San Diego, CA
| | - Francesca J Torriani
- Department of Medicine, Division of Infectious Diseases and Global Public Health, UC San Diego, San Diego, CA
| | - Lucas Hill
- Owen Clinic Unit, Skaggs School of Pharmacy and Pharmaceutical Sciences, UC San Diego, San Diego, CA; and
| | - Amutha Rajagopal
- Department of Medicine, Division of Infectious Diseases and Global Public Health, UC San Diego, San Diego, CA
| | - Jeffrey Yin
- Owen Clinic Unit, Skaggs School of Pharmacy and Pharmaceutical Sciences, UC San Diego, San Diego, CA; and
| | - Laura Bamford
- Department of Medicine, Division of Infectious Diseases and Global Public Health, UC San Diego, San Diego, CA
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Marcellin F, Jaquet A, Lazarus JV, Molina P, Carrieri P. Alcohol Use Disorder and Hepatitis C Prevention and Care in People Who Inject Drugs: The State of Play. Semin Liver Dis 2021; 41:109-116. [PMID: 32851613 DOI: 10.1055/s-0040-1716343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Safe and effective treatment with direct-acting antivirals (DAAs) has ushered in an era in which hepatitis C virus (HCV) elimination, as set out by the World Health Organization, is possible. However, alcohol use disorder (AUD) has the potential to reduce the benefits of prevention interventions and reduce access to and continuity of HCV care in at-risk populations, such as people who inject drugs (PWID). We review the literature on the consequences of AUD on the effectiveness of HCV prevention and the cascade of care in PWID and provide recommendations for future research in the field of alcohol use and HCV.
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Affiliation(s)
- Fabienne Marcellin
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France
| | - Antoine Jaquet
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France.,Inserm, ISPED, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Patricia Molina
- Department of Physiology and Alcohol and Drug Abuse Center of Excellence, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Patrizia Carrieri
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France
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Winetsky D, Burack D, Antoniou P, Garcia B, Gordon P, Scherer M. Psychosocial Factors and the Care Cascade for Hepatitis C Treatment Colocated at a Syringe Service Program. J Infect Dis 2021; 222:S392-S400. [PMID: 32877544 DOI: 10.1093/infdis/jiaa142] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV) is highly effective. However, people who inject drugs face significant barriers to DAA access. METHODS We describe a program that colocates HCV management within a syringe service program in New York City. We performed a retrospective chart review of all patients with confirmed HCV viremia. RESULTS From 2015 to 2018, 102 patients with viremia completed intake. Fifty-eight patients started DAAs. Nine patients discontinued treatment or were lost to follow-up before completion; 1 is continuing DAA treatment. Of 48 patients who completed therapy, sustained virologic response (SVR) was achieved in 43 (89.6%). Age and established mental health treatment at intake were associated with SVR. Regular cocaine use was negatively associated with SVR in univariate analysis, but this association was not significant after adjustment for age. Of 30 patients completing DAA therapy with active illicit opioid use at intake, 14 (46.4%) engaged in opioid use disorder (OUD) treatment during therapy, and 9 remained in OUD treatment after completion of DAA treatment. CONCLUSIONS Loss to follow-up is a challenge for people who inject drugs, but among those who completed treatment, SVR was achieved at a high rate. Mental health treatment may facilitate HCV cure. Conversely, HCV therapy may facilitate engagement in OUD treatment and other services.
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Affiliation(s)
- Daniel Winetsky
- Comprehensive Health Program, New York Presbyterian Hospital, New York, USA.,Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, USA.,HIV Center for Clinical and Behavioral Studies at Columbia University and New York State Psychiatric Institute, New York, USA
| | - Daniel Burack
- Department of Medicine, Columbia University Irving Medical Center, New York, USA
| | - Pantelis Antoniou
- Comprehensive Health Program, New York Presbyterian Hospital, New York, USA
| | - Bill Garcia
- Washington Heights Corner Project, New York, USA
| | - Peter Gordon
- Comprehensive Health Program, New York Presbyterian Hospital, New York, USA.,Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, USA
| | - Matthew Scherer
- Comprehensive Health Program, New York Presbyterian Hospital, New York, USA.,Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, USA
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Gamkrelidze I, Pawlotsky JM, Lazarus JV, Feld JJ, Zeuzem S, Bao Y, Gabriela Pires Dos Santos A, Sanchez Gonzalez Y, Razavi H. Progress towards hepatitis C virus elimination in high-income countries: An updated analysis. Liver Int 2021; 41:456-463. [PMID: 33389788 DOI: 10.1111/liv.14779] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/07/2020] [Accepted: 12/28/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Elimination of HCV by 2030, as defined by the World Health Organization (WHO), is attainable with the availability of highly efficacious therapies. This study reports progress made in the timing of HCV elimination in 45 high-income countries between 2017 and 2019. METHODS Disease progression models of HCV infection for each country were updated with latest data on chronic HCV prevalence, and annual diagnosis and treatment levels, assumed to remain constant in the future. Modelled outcomes were analysed to determine the year in which each country would meet the WHO 2030 elimination targets. RESULTS Of the 45 countries studied, 11 (Australia, Canada, France, Germany, Iceland, Italy, Japan, Spain, Sweden, Switzerland, and United Kingdom) are on track to meet WHO's elimination targets by 2030; five (Austria, Malta, Netherlands, New Zealand, and South Korea) by 2040; and two (Saudi Arabia and Taiwan) by 2050. The remaining 27 countries are not expected to achieve elimination before 2050. Compared to progress in 2017, South Korea is no longer on track to eliminate HCV by 2030, three (Canada, Germany, and Sweden) are now on track, and most countries (30) saw no change. CONCLUSIONS Assuming high-income countries will maintain current levels of diagnosis and treatment, only 24% are on track to eliminate HCV by 2030, and 60% are off track by at least 20 years. If current levels of diagnosis and treatment continue falling, achieving WHO's 2030 targets will be more challenging. With less than ten years remaining, screening and treatment expansion is crucial to meet WHO's HCV elimination targets.
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Affiliation(s)
| | | | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Jordan J Feld
- Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Stefan Zeuzem
- Medizinische Klinik 1, Universitätsklinikum Frankfurt am Main, Frankfurt, Germany
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Hepatitis C standards of care: A review of good practices since the advent of direct-acting antiviral therapy. Clin Res Hepatol Gastroenterol 2021; 45:101564. [PMID: 33740477 DOI: 10.1016/j.clinre.2020.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 11/02/2020] [Indexed: 02/04/2023]
Abstract
Significant steps must be taken to reduce the global incidence and prevalence of hepatitis C virus (HCV) and mortality from HCV infection to achieve the WHO goal of eliminating viral hepatitis as a public health threat by 2030. Proper epidemiological surveillance of the full continuum of care is essential for monitoring progress and identifying gaps that need to be addressed. The tools required for elimination have largely been established, and the issue at hand is more how they should best be implemented in different settings around the world. Documenting good practices allows for knowledge exchange to prevent transmission and improve health outcomes for people with HCV. This review found 13 well documented HCV good practices that have become the standard of care or that should become the standard of care as soon as possible. In 2013, highly effective direct-acting antiviral therapy became available, which has cure rates of over 95%. Together with this new therapy, evidence-based good practices can help countries eliminate viral hepatitis C.
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HCV screening based on dried blood samples and linkage to care in people who use drugs: A prospective study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 92:103134. [PMID: 33517130 DOI: 10.1016/j.drugpo.2021.103134] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 01/11/2021] [Accepted: 01/20/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND The burden of hepatitis C virus (HCV) infection among people who use drugs (PWUDs) is considerable. We aimed to screen for HCV infection using the fingerstick dried blood spot (DBS) test and to describe the cascade of hepatitis C care among PWUDs in Madrid, Spain. We also evaluated the prevalence of hepatitis B virus (HBV) and hepatitis D virus (HDV) in this population. METHODS We carried out a prospective study and collected samples and epidemiological data using a mobile unit. Viral infections were tested by immunoassay and RT-PCR assay. PWUDs with a positive result were contacted and referred to a specialized health center to confirm and treat the HCV infection. RESULTS We studied 529 PWUD samples; 49.7% were from persons who had previously used injection drugs (IDUs). Of these, 152 (28.7%) were positive for HCV antibodies, 122 (23.1%) for HCV RNA, 23 (4.3%) for HBsAg, and two (0.4%) for HDV antibodies (8.7% of those with hepatitis B). People who inject drugs (PWID) more frequently had positive HCV antibody titers (52% vs. 7.3%; p<0.001) and a positive HCV RNA test result (40.2% vs. 7.3%; p<0.001) than non-PWID. The time from sample collection to test results was 19 days. The next 104 individuals (85.2%) with active HCV infection were contacted to report their HCV test results. Of these, 63 (51.6%) had an appointment, 62 (50.8%) were evaluated in the hospital, and 56 (45.9%) started HCV therapy. CONCLUSION HCV screening using fingerstick DBS was an excellent tool for determining HCV prevalence and other chronic hepatitis viruses (HBV and HDV) in PWUDs. However, linkage to care was limited, mainly with respect to the initiation of HCV therapy.
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van Dijk M, Drenth JP. Loss to follow-up in the hepatitis C care cascade: A substantial problem but opportunity for micro-elimination. J Viral Hepat 2020; 27:1270-1283. [PMID: 32964615 PMCID: PMC7693174 DOI: 10.1111/jvh.13399] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/09/2020] [Accepted: 08/16/2020] [Indexed: 12/23/2022]
Abstract
Since the advent of direct-acting antivirals, elimination of hepatitis C viral (HCV) infections seems within reach. However, studies on the HCV cascade of care show suboptimal progression through each step for all patient groups. Loss to follow-up (LTFU) is a major issue and is a barrier to HCV elimination. This review summarizes the scale of the LTFU problem and proposes a micro-elimination approach. Retrieving LTFU patients and re-engaging them with care again has shown to be feasible in the Netherlands. Micro-elimination through retrieval can contribute to reaching the World Health Organization's viral hepatitis elimination targets by 2030.
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Affiliation(s)
- Marleen van Dijk
- Department of Gastroenterology and HepatologyRadboud University Medical CentreNijmegenthe Netherlands
| | - Joost P.H. Drenth
- Department of Gastroenterology and HepatologyRadboud University Medical CentreNijmegenthe Netherlands
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Falade-Nwulia O, Gicquelais RE, Astemborski J, McCormick SD, Kirk G, Sulkowski M, Thomas DL, Mehta SH. Hepatitis C treatment uptake among people who inject drugs in the oral direct-acting antiviral era. Liver Int 2020; 40:2407-2416. [PMID: 32770638 PMCID: PMC7706292 DOI: 10.1111/liv.14634] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 06/22/2020] [Accepted: 07/20/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Increased uptake of hepatitis C virus (HCV) treatment among people who inject drugs (PWID) will be critical to achieve HCV elimination goals. There are limited data on HCV treatment uptake among PWID recruited from community-based settings in the HCV direct-acting antiviral (DAA) era. METHODS We analysed data from PWID with HCV newly recruited into the Baltimore, Maryland-based AIDS Linked to the IntraVenous Experience (ALIVE) cohort between 2015 and 2018. We characterized the HCV care continuum and evaluated factors associated with HCV treatment uptake. RESULTS Of the 418 PWID with HCV, the median age was 49 years and most (88%) reported recent injection drug use (IDU). Overall, 23% had ever been evaluated by a provider for HCV treatment, 17% ever initiated DAA treatment and 13% were cured of HCV infection. Treatment uptake approximately doubled between 2015 and 2018 (13% to 26%, P = .01). In multivariable analyses, HIV infection (adjusted Odds Ratio [aOR] 2.5 [95% Confidence Interval (CI) 1.3, 4.8]), current employment (aOR 4.1 [CI 1.2, 14.4]), having a primary care provider (aOR 4.3 [CI 1.2, 14.9) and longer duration of IDU (aOR 1.3 [CI 1.1, 1.6]) were positively associated with HCV treatment. PWID with a lower annual income (≤$5000) were less likely to have initiated HCV treatment (aOR 0.5 [CI 0.3, 0.98]). CONCLUSIONS Although HCV treatment uptake among PWID in this community-based setting in the DAA era remains suboptimal, it is encouraging that treatment uptake has increased in recent years. Innovative strategies are needed to reach all PWID infected with HCV.
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Affiliation(s)
| | - Rachel E. Gicquelais
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jacquie Astemborski
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sean D. McCormick
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Greg Kirk
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Mark Sulkowski
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - David L. Thomas
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Shruti H. Mehta
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Hasan F, Alfadhli A, Al-Gharabally A, Alkhaldi M, Colombo M, Lazarus JV. Accelerating the elimination of hepatitis C in Kuwait: An expert opinion. World J Gastroenterol 2020; 26:4415-4427. [PMID: 32874054 PMCID: PMC7438195 DOI: 10.3748/wjg.v26.i30.4415] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/04/2020] [Accepted: 07/23/2020] [Indexed: 02/06/2023] Open
Abstract
The hepatitis C virus (HCV) is estimated to affect 71 million people worldwide. In 2016, the World Health Organization adopted the first global health sector strategy to eliminate viral hepatitis as a public health threat by 2030. In December 2018, the European Association for the Study of the Liver, International Liver Foundation convened an expert panel to address the elimination of HCV in Kuwait. Several steps have already been taken to eliminate HCV in Kuwait, including free HCV treatment for Kuwait’s citizens, high blood safety standards, and the implementation of screening and awareness programs. The expert panel made several recommendations aimed at accelerating the elimination of HCV in Kuwait: The development of a national strategy and action plan to guide all HCV elimination activities; the formation of a coordination mechanism to support collaboration between hepatitis working committees; the prioritization of micro-elimination at primary, secondary or tertiary facilities, in prisons and rehabilitation centers; and ensuring the involvement of multiple stakeholders – including relevant civil society groups – in all activities. Enhanced screening and linkage to care should be prioritized in Kuwait, with the expansion of the prescriber base to primary healthcare providers and nurse practitioners to be considered. Raising awareness and educating people about HCV infection also remain essential to achieve the goal of HCV elimination. Lastly, a national HCV registry should be developed to help monitor the implementation of viral hepatitis plans and progress towards achieving national and international targets.
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Affiliation(s)
- Fuad Hasan
- Department of Internal Medicine, Faculty of Medicine, Kuwait University, Kuwait 12037, Kuwait
| | - Ahmad Alfadhli
- Department of Internal Medicine, Faculty of Medicine, Kuwait University, Kuwait 12037, Kuwait
| | | | - Mahmoud Alkhaldi
- Public Health Department, Ministry of Health, Kuwait 13110, Kuwait
| | - Massimo Colombo
- Head Center of Translational Research in Hepatology, Humanitas Clinical and Research Center, Rozzano 20089, Italy
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health, Barcelona Institute for Global Health (ISGlobal), University of Barcelona, Barcelona 08036, Spain
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Iversen J, Dore GJ, Starr M, Catlett B, Cunningham P, Geddes L, Maher L. Estimating the Consensus hepatitis C Cascade of Care among people who inject drugs in Australia: Pre and post availability of direct acting antiviral therapy. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 83:102837. [PMID: 32645585 DOI: 10.1016/j.drugpo.2020.102837] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 06/04/2020] [Accepted: 06/13/2020] [Indexed: 12/21/2022]
Abstract
Background Monitoring the hepatitis C virus (HCV) cascade of care (CoC) among people who inject drugs (PWID) is an essential component of the response to World Health Organisation's (WHO) hepatitis elimination goals. This study aimed to estimate the Consensus hepatitis C CoC among PWID using data collected in Australia prior to and after the introduction of unrestricted direct-acting antiviral (DAA) therapy in March 2016. Methods The Australian Needle Syringe Program Survey is a cross-sectional bio-behavioural surveillance system that recruits >2000 PWID annually. Using data from 2015 and 2019, HCV antibody and ribonucleic acid (RNA) test results from dried blood spots were combined with self-reported data on HCV diagnostic testing and treatment to project HCV Consensus CoC indicators at a population-level among Australian PWID. Results Among an estimated 75,000 people who inject drugs on a regular basis in Australia, the number with active HCV infection declined from 32,619 (44%) in October 2015 to 12,679 (17%) in October 2019. The majority (78% in 2015 and 2019) of PWID reported HCV diagnosis, while the proportion of those diagnosed who were treated increased from 3% in 2015 to 47% in 2019. Among those treated, the proportion who were HCV RNA negative and assumed to have been successfully treated (cured), increased from 27% in 2015 to 88% in 2019. Conclusion This study demonstrates remarkable HCV CoC progress among PWID in Australia following availability of DAA therapy. There was a substantial increase in the proportion of HCV diagnosed PWID who initiated treatment and were cured, while the number of PWID with active HCV infection more than halved over a 3.5 year period. Estimates of the Consensus hepatitis C CoC among PWID is required to monitor progress toward WHO HCV elimination goals.
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Affiliation(s)
- Jenny Iversen
- The Kirby Institute, UNSW Sydney, Sydney, Australia.
| | | | - Mitchell Starr
- NSW State Reference Laboratory for HIV, St Vincent's Centre for Applied Medical Research, St Vincent's Hospital Sydney, Australia
| | - Beth Catlett
- The Kirby Institute, UNSW Sydney, Sydney, Australia; NSW State Reference Laboratory for HIV, St Vincent's Centre for Applied Medical Research, St Vincent's Hospital Sydney, Australia
| | - Philip Cunningham
- NSW State Reference Laboratory for HIV, St Vincent's Centre for Applied Medical Research, St Vincent's Hospital Sydney, Australia
| | | | - Lisa Maher
- The Kirby Institute, UNSW Sydney, Sydney, Australia
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Traeger MW, Pedrana AE, van Santen DK, Doyle JS, Howell J, Thompson AJ, El-Hayek C, Asselin J, Polkinghorne V, Membrey D, Bramwell F, Carter A, Guy R, Stoové MA, Hellard ME. The impact of universal access to direct-acting antiviral therapy on the hepatitis C cascade of care among individuals attending primary and community health services. PLoS One 2020; 15:e0235445. [PMID: 32603349 PMCID: PMC7326180 DOI: 10.1371/journal.pone.0235445] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 06/15/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Hepatitis C elimination will require widespread access to treatment and responses at the health-service level to increase testing among populations at risk. We explored changes in hepatitis C testing and the cascade of care before and after the introduction of direct-acting antiviral treatments in Victoria, Australia. METHODS De-identified clinical data were retrospectively extracted from eighteen primary care clinics providing services targeted towards people who inject drugs. We explored hepatitis C testing within three-year periods immediately prior to (pre-DAA period) and following (post-DAA period) universal access to DAA treatments on 1st March 2016. Among ever RNA-positive individuals, we constructed two care cascades at the end of the pre-DAA and post-DAA periods. RESULTS The number of individuals HCV-tested was 13,784 (12.2% of those with a consultation) in the pre-DAA period and 14,507 (10.4% of those with a consultation) in the post-DAA period. The pre-DAA care cascade included 2,515 RNA-positive individuals; 1,977 (78.6%) were HCV viral load/genotype tested; 19 (0.8%) were prescribed treatment; and 12 had evidence of cure (0.5% of those RNA-positive and 63.6% of those eligible for cure). The post-DAA care cascade included 3,713 RNA-positive individuals; 3,276 (88.2%) were HCV viral load/genotype tested; 1,674 (45.1%) were prescribed treatment; and 863 had evidence of cure (23.2% of those RNA-positive and 94.9% of those eligible for cure). CONCLUSION Marked improvements in the cascade of hepatitis C care among patients attending primary care clinics were observed following the universal access of DAA treatments in Australia, although improvements in testing were less pronounced.
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Affiliation(s)
- Michael W. Traeger
- Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Alisa E. Pedrana
- Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Daniela K. van Santen
- Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Joseph S. Doyle
- Burnet Institute, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Victoria, Australia
| | - Jessica Howell
- Burnet Institute, Melbourne, Victoria, Australia
- Department of Gastroenterology, St Vincent’s Hospital, Melbourne, Victoria, Australia
| | - Alexander J. Thompson
- Department of Gastroenterology, St Vincent’s Hospital, Melbourne, Victoria, Australia
| | | | | | | | - Dean Membrey
- Cohealth, General Practice, Melbourne, Victoria, Australia
| | - Fran Bramwell
- Cohealth, General Practice, Melbourne, Victoria, Australia
| | - Allison Carter
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Rebecca Guy
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark A. Stoové
- Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Margaret E. Hellard
- Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Victoria, Australia
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Idilman R, Razavi H, Robbins-Scott S, Akarca US, Örmeci N, Kaymakoglu S, Aygen B, Tozun N, Güner R, Bodur H, Lazarus JV. A micro-elimination approach to addressing hepatitis C in Turkey. BMC Health Serv Res 2020; 20:249. [PMID: 32209103 PMCID: PMC7093960 DOI: 10.1186/s12913-020-5019-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 02/21/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In 2016, WHO passed the Global Health Sector Strategy on Viral Hepatitis (GHSS), calling for its elimination by 2030. Two years later, Turkey approved a strategy to reach the WHO targets. This study reports new national prevalence data, breaks it down by subpopulation, and models scenarios to reach HCV elimination. METHODS Literature was reviewed for estimates of HCV disease burden in Turkey. They were discussed with stakeholders and used as inputs to develop a disease burden model. The infected population was estimated by sequelae for the years 2015-2030. Three scenarios were developed to evaluate the disease burden in Turkey: a Base 2017 scenario, representing the current standard of care in Turkey; an increased treatment scenario, representing the impact of improved access to DAAs; and a WHO targets scenario, which meet the WHO GHSS viral hepatitis targets of a 65% reduction in mortality and 90% diagnosis rate of the infected population by 2030. RESULTS At the beginning of 2017, 271,000 viremic infections were estimated. Of these, 58,400 were diagnosed and 10,200 treated. Modelling results showed that, with the current treatment paradigm in Turkey, by 2030 the total number of viremic HCV infections would decline by 35%, while liver-related deaths, hepatocellular carcinoma (HCC), and decompensated cirrhosis would decrease by 10-25%. In the increased treatment scenario, by 2030 viremic HCV infections would decrease by 50%; liver-related deaths, HCC and decompensated cirrhosis would decrease by 45-70%. In the WHO targets scenario, HCV infections would decrease by 80%; sequelae would decrease by 80-85%. Data on disease burden in micro-elimination target subpopulations are largely unavailable. CONCLUSIONS To meet the WHO Global Health Sector Strategy targets for the elimination of HCV, Turkey needs to increase treatment. Better data are needed as well as countrywide access to DAAs.
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Affiliation(s)
- Ramazan Idilman
- Department of Gastroenterology, Ankara University Medical Faculty, Ankara, Turkey
| | - Homie Razavi
- Center for Disease Analysis, Lafayette, CO 80026 USA
| | | | - Ulus Salih Akarca
- Department of Gastroenterology, Ege University Medical Faculty, Izmir, Turkey
| | - Necati Örmeci
- Department of Gastroenterology, Ankara University Medical Faculty, Ankara, Turkey
| | - Sabahattin Kaymakoglu
- Department of Gastroenterology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Bilgehan Aygen
- Department of Infectious Diseases and Clinical Microbiology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Nurdan Tozun
- Department of Internal Medicine and Gastroenterology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Rahmet Güner
- Department of Infectious Diseases and Clinical Microbiology, Ankara Yildirim Beyazit University, Ataturk Training and Research Hospital, Ankara, Turkey
| | - Hurrem Bodur
- Department of Infectious Diseases, Ankara Numune Training and Research Hospital, University of Healthcare Sciences, Ankara, Turkey
| | - Jeffrey V. Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Calle del Rossellón 132, 4th Floor, ES-08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
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Kåberg M, Weiland O. Hepatitis C elimination - Macro-elimination. Liver Int 2020; 40 Suppl 1:61-66. [PMID: 32077600 DOI: 10.1111/liv.14352] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 12/26/2019] [Indexed: 12/11/2022]
Abstract
In 2016 the WHO set a goal to obtain an 80% reduction in new chronic HCV cases, requiring a level of diagnosis of 90%, treatment coverage of 80% and resulting in a 65% reduction in HCV-related deaths by 2030. This goal is easier to reach in specific populations such as people who inject drugs (PWID), men who have sex with men (MSM) or blood-transfusion recipients before screening for HCV became mandatory and in high-income regions. It is much more difficult to achieve macro-elimination throughout the population especially in low-income areas with underdeveloped infrastructures, a high prevalence of HCV and limited economic resources. To achieve the WHO goals by 2030, awareness of HCV must increase and the cascade of care must be improved and implemented. Diagnostic procedures and treatment should be affordable and universally available. At the end of 2017 fewer than 15 countries were on track to reach these goals by 2030.
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Affiliation(s)
- Martin Kåberg
- Department of Medicine Huddinge, Division of Infectious Diseases, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden.,The Stockholm Needle Exchange, Stockholm Centre for Dependency Disorders, Stockholm, Sweden
| | - Ola Weiland
- Department of Medicine Huddinge, Division of Infectious Diseases, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden
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Elimination of hepatitis C in Europe: can WHO targets be achieved? Clin Microbiol Infect 2020; 26:818-823. [PMID: 31978546 DOI: 10.1016/j.cmi.2020.01.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 01/04/2020] [Accepted: 01/11/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Chronic hepatitis C virus (HCV) infection affects 71 million people worldwide. The availability of highly efficient direct-acting antivirals has revolutionized the treatment landscape with over 95% cure rates. The WHO has launched a global programme to achieve rather ambitious HCV elimination targets for 2030. OBJECTIVES This article aims to provide a critical overview of the current HCV elimination programmes in Europe highlighting the elements that should be implemented to achieve elimination and those that are already in place to promote this process. SOURCES Review of the recently published literature and opinion of experts in the field. CONTENT Elimination of hepatitis C as a public health threat appears to be a difficult task, which should be subdivided into smaller targets, the so-called micro-elimination goals, to increase chances of success. Macro-elimination strategies based on mass-screening are difficult to implement. Evidence supporting the efficacy of micro-elimination comes from key populations, such as people who inject drugs. HCV elimination is proceeding at different speeds in Europe. Some countries are on target with the WHO's objectives whereas others lack economic support and political advocacy, and have insufficient infrastructures to achieve this. The absence of an effective prophylactic vaccine is hampering the process and should be overcome. IMPLICATIONS Elimination of hepatitis C worldwide appears plausible, but in several countries probably not within the time frame suggested by the WHO. In the absence of vaccination, universal access to HCV treatment would act as a 'therapeutic' option to reduce transmission, especially in high-risk populations.
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