1
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Surguladze S, Armstrong PA, Beckett GA, Shadaker S, Gamkrelidze A, Tsereteli M, Getia V, Asamoah BO. Hepatitis C virus attributable liver cancer in the country of Georgia, 2015-2019: a case-control study. BMC Infect Dis 2024; 24:1045. [PMID: 39333949 PMCID: PMC11429595 DOI: 10.1186/s12879-024-09916-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/10/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) infection can lead to a type of primary liver cancer called hepatocellular carcinoma (HCC). Georgia, a high HCV prevalence country, started an HCV elimination program in 2015. In addition to tracking incidence and mortality, surveillance for the HCV-attributable fraction of HCC is an important indicator of the program's impact. This study assesses HCV infection-attributable HCC in the Georgian population. METHODS This case-control study utilized HCV programmatic and Georgian Cancer Registry data from 2015-2019. Bivariate logistic regression and age- and sex-stratified analyses assessed HCV and liver cancer association. HCV-attributable liver cancer proportions for the HCV-exposed and total population were calculated. A sub-analysis was performed for HCC cases specifically. RESULTS The total study population was 3874 with 496 liver cancer cases and 3378 controls. The odds for HCV-infected individuals developing liver cancer was 20.1 (95% confidence interval [CI] 15.97-25.37), and the odds of developing HCC was 16.84 (95% CI 12.01-23.83) compared to the HCV-negative group. Odds ratios varied across strata, with HCV-infected older individuals and women having higher odds of developing both liver cancer and HCC. A large proportion of liver cancer and HCC can be attributed to HCV in HCV-infected individuals; however, in the general population, the burden of liver cancer and HCC cannot be explained by HCV alone. CONCLUSION HCV was significantly associated with a higher risk of developing liver cancer and HCC in the Georgian population. In addition, given Georgia's high HCV burden, increased HCC monitoring in HCV-infected patients is needed.
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Affiliation(s)
| | | | | | - Shaun Shadaker
- Centers for Disease Control and Prevention, Atlanta, USA
| | | | - Maia Tsereteli
- National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Vladimer Getia
- National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Benedict Oppong Asamoah
- Division of Social Medicine and Global Health, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
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2
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Tao Y, Tang W, Fajardo E, Cheng M, He S, Bissram JS, Hiebert L, Ward JW, Chou R, Rodríguez-Frías F, Easterbrook P, Tucker JD. Reflex Hepatitis C Virus Viral Load Testing Following an Initial Positive Hepatitis C Virus Antibody Test: A Global Systematic Review and Meta-analysis. Clin Infect Dis 2023; 77:1137-1156. [PMID: 37648655 DOI: 10.1093/cid/ciad126] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Many people who have a positive hepatitis C virus (HCV) antibody (Ab) test never receive a confirmatory HCV RNA viral load (VL) test. Reflex VL testing may help address this problem. We undertook a systematic review to evaluate the effectiveness of reflex VL testing compared with standard nonreflex approaches on outcomes across the HCV care cascade. METHODS We searched 4 databases for studies that examined laboratory-based reflex or clinic-based reflex VL testing approaches, with or without a nonreflex comparator, and had data on the uptake of HCV RNA VL test and treatment initiation and turnaround time between Ab and VL testing. Both laboratory- and clinic-based reflex VL testing involve only a single clinic visit. Summary estimates were calculated using random-effects meta-analyses. RESULTS Fifty-one studies were included (32 laboratory-based and 19 clinic-based reflex VL testing). Laboratory-based reflex VL testing increased HCV VL test uptake versus nonreflex testing (RR: 1.35; 95% CI: 1.16-1.58) and may improve linkage to care among people with a positive HCV RNA test (RR: 1.47; 95% CI: .81-2.67) and HCV treatment initiation (RR: 1.03; 95% CI: .46-2.32). The median time between Ab and VL test was <1 day for all laboratory-based reflex studies and 0-5 days for 13 clinic-based reflex testing. CONCLUSIONS Laboratory-based and clinic-based HCV reflex VL testing increased uptake and reduced time to HCV VL testing and may increase HCV linkage to care. The World Health Organization now recommends reflex VL testing as an additional strategy to promote access to HCV VL testing and treatment. CLINICAL TRIALS REGISTRATION PROSPERO CRD42021283822.
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Affiliation(s)
- Yusha Tao
- Dermatology Hospital of South Medical University, Guangzhou, China
- University of North Carolina Project-China, Guangzhou, China
| | - Weiming Tang
- Dermatology Hospital of South Medical University, Guangzhou, China
- University of North Carolina Project-China, Guangzhou, China
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Emmanuel Fajardo
- Department of Global HIV, Hepatitis, and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Mengyuan Cheng
- Dermatology Hospital of South Medical University, Guangzhou, China
- University of North Carolina Project-China, Guangzhou, China
| | - Shiyi He
- China-Australia Joint Research Centre for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, China
| | - Jennifer S Bissram
- Health Sciences Library, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lindsey Hiebert
- Coalition for Global Hepatitis Elimination, Task Force for Global Health, Decatur, Georgia, USA
| | - John W Ward
- Coalition for Global Hepatitis Elimination, Task Force for Global Health, Decatur, Georgia, USA
| | - Roger Chou
- Departments of Medicine and Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Francisco Rodríguez-Frías
- Liver Pathology Unit, Biochemistry and Microbiology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- CIBER Hepatic and Digestive Diseases (CIBERehd), Instituto Carlos III, Madrid, Spain
| | - Philippa Easterbrook
- Department of Global HIV, Hepatitis, and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Joseph D Tucker
- University of North Carolina Project-China, Guangzhou, China
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
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3
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Gamkrelidze A, Shadaker S, Tsereteli M, Alkhazashvili M, Chitadze N, Tskhomelidze I, Gvinjilia L, Khetsuriani N, Handanagic S, Averhoff F, Cloherty G, Chakhunashvili G, Drobeniuc J, Imnadze P, Zakhashvili K, Armstrong PA. Nationwide Hepatitis C Serosurvey and Progress Towards Hepatitis C Virus Elimination in the Country of Georgia, 2021. J Infect Dis 2023; 228:684-693. [PMID: 36932731 PMCID: PMC10506179 DOI: 10.1093/infdis/jiad064] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/07/2023] [Accepted: 03/15/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND The country of Georgia initiated its hepatitis C virus (HCV) elimination program in 2015, at which point a serosurvey showed the adult prevalence of HCV antibody (anti-HCV) and HCV RNA to be 7.7% and 5.4%, respectively. This analysis reports hepatitis C results of a follow-up serosurvey conducted in 2021, and progress towards elimination. METHODS The serosurvey used a stratified, multistage cluster design with systematic sampling to include adults and children (aged 5-17 years) providing consent (or assent with parental consent). Blood samples were tested for anti-HCV and if positive, HCV RNA. Weighted proportions and 95% confidence intervals (CI) were compared with 2015 age-adjusted estimates. RESULTS Overall, 7237 adults and 1473 children were surveyed. Among adults, the prevalence of anti-HCV was 6.8% (95% CI, 5.9-7.7). The HCV RNA prevalence was 1.8% (95% CI, 1.3-2.4), representing a 67% reduction since 2015. HCV RNA prevalence decreased among those reporting risk factors of ever injecting drugs (51.1% to 17.8%), and ever receiving a blood transfusion (13.1% to 3.8%; both P < .001). No children tested positive for anti-HCV or HCV RNA. CONCLUSIONS These results demonstrate substantial progress made in Georgia since 2015. These findings can inform strategies to meet HCV elimination targets.
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Affiliation(s)
| | - Shaun Shadaker
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Maia Tsereteli
- National Center for Disease Control and Public Health, Tbilisi, Georgia
| | | | | | | | - Lia Gvinjilia
- Eastern Europe and Central Asia Regional Office, Centers for Disease Control and Prevention, Tbilisi, Georgia
| | - Nino Khetsuriani
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Senad Handanagic
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Francisco Averhoff
- Abbott Diagnostics, Abbott Park, IL, USA
- Abbott Pandemic Defense Coalition, Abbott Park, IL, USA
| | - Gavin Cloherty
- Abbott Diagnostics, Abbott Park, IL, USA
- Abbott Pandemic Defense Coalition, Abbott Park, IL, USA
| | | | - Jan Drobeniuc
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Paata Imnadze
- National Center for Disease Control and Public Health, Tbilisi, Georgia
| | | | - Paige A. Armstrong
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
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4
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Gvinjilia L, Baliashvili D, Shadaker S, Averhoff F, Kandelaki L, Kereselidze M, Tsertsvadze T, Chkhartishvili N, Butsashvili M, Metreveli D, Gamkrelidze A, Armstrong PA. Impact of Hepatitis C Virus Infection and Treatment on Mortality in the Country of Georgia, 2015-2020. Clin Infect Dis 2023; 77:405-413. [PMID: 37099136 PMCID: PMC10527899 DOI: 10.1093/cid/ciad182] [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: 12/26/2022] [Revised: 03/17/2023] [Accepted: 03/24/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Mortality related to hepatitis C virus (HCV) infection is a key indicator for elimination. We assessed the impact of HCV infection and treatment on mortality in the country of Georgia during 2015-2020. METHODS We conducted a population-based cohort study using data from Georgia's national HCV Elimination Program and death registry. We calculated all-cause mortality rates in 6 cohorts: (1) Negative for anti-HCV; (2) anti-HCV positive, unknown viremia status; (3) current HCV infection and untreated; (4) discontinued treatment; (5) completed treatment, no sustained virologic response (SVR) assessment; (6) completed treatment and achieved SVR. Cox proportional hazards models were used to calculate adjusted hazards ratios and confidence intervals. We calculated the cause-specific mortality rates attributable to liver-related causes. RESULTS After a median follow-up of 743 days, 100 371 (5.7%) of 1 764 324 study participants died. The highest mortality rate was observed among HCV infected patients who discontinued treatment (10.62 deaths per 100 PY, 95% confidence interval [CI]: 9.65, 11.68), and untreated group (10.33 deaths per 100 PY, 95% CI: 9.96, 10.71). In adjusted Cox proportional hazards model, the untreated group had almost 6-times higher hazard of death compared to treated groups with or without documented SVR (adjusted hazard ratio [aHR] = 5.56, 95% CI: 4.89, 6.31). Those who achieved SVR had consistently lower liver-related mortality compared to cohorts with current or past exposure to HCV. CONCLUSIONS This large population-based cohort study demonstrated the marked beneficial association between hepatitis C treatment and mortality. The high mortality rates observed among HCV infected and untreated persons highlights the need to prioritize linkage to care and treatment to achieve elimination goals.
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Affiliation(s)
- Lia Gvinjilia
- Eastern Europe and Central Asia Regional Office, Centers for Disease Control and Prevention, Tbilisi, Georgia
| | | | - Shaun Shadaker
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Francisco Averhoff
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Levan Kandelaki
- Department of Medical Statistics, National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Maia Kereselidze
- Department of Medical Statistics, National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Tengiz Tsertsvadze
- Clinic "Hepa," Tbilisi, Georgia
- Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
| | | | | | | | - Amiran Gamkrelidze
- Department of Medical Statistics, National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Paige A Armstrong
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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5
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Tskhomelidze I, Shadaker S, Kuchuloria T, Gvinjilia L, Butsashvili M, Nasrullah M, Gabunia T, Gamkrelidze A, Getia V, Sharvadze L, Tsertsvadze T, Zarqua J, Tsanava S, Handanagic S, Armstrong PA, Averhoff F, Vickerman P, Walker JG. Economic evaluation of the Hepatitis C virus elimination program in the country of Georgia, 2015 to 2017. Liver Int 2023; 43:558-568. [PMID: 36129625 PMCID: PMC10227952 DOI: 10.1111/liv.15431] [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: 05/06/2022] [Revised: 08/02/2022] [Accepted: 09/20/2022] [Indexed: 02/13/2023]
Abstract
BACKGROUND AND AIMS In 2015, the country of Georgia launched an elimination program aiming to reduce the prevalence of Hepatitis C virus (HCV) infection by 90% from 5.4% prevalence (~150 000 people). During the first 2.5 years of the program, 770 832 people were screened, 48 575 were diagnosed with active HCV infection, and 41 483 patients were treated with direct-acting antiviral (DAA)-based regimens, with a >95% cure rate. METHODS We modelled the incremental cost-effectiveness ratio (ICER) of HCV screening, diagnosis and treatment between April 2015 and November 2017 compared to no treatment, in terms of cost per quality-adjusted life year (QALY) gained in 2017 US dollars, with a 3% discount rate over 25 years. We compared the ICER to willingness-to-pay (WTP) thresholds of US$4357 (GDP) and US$871 (opportunity cost) per QALY gained. RESULTS The average cost of screening, HCV viremia testing, and treatment per patient treated was $386 to the provider, $225 to the patient and $1042 for generic DAAs. At 3% discount, 0.57 QALYs were gained per patient treated. The ICER from the perspective of the provider including generic DAAs was $2285 per QALY gained, which is cost-effective at the $4357 WTP threshold, while if patient costs are included, it is just above the threshold at $4398/QALY. All other scenarios examined in sensitivity analyses remain cost-effective except for assuming a shorter time horizon to the end of 2025 or including the list price DAA cost. Reducing or excluding DAA costs reduced the ICER below the opportunity-cost WTP threshold. CONCLUSIONS The Georgian HCV elimination program provides valuable evidence that national programs for scaling up HCV screening and treatment for achieving HCV elimination can be cost-effective.
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Affiliation(s)
- Irina Tskhomelidze
- Task Force for Global Health, Tbilisi, Georgia
- Ivane Javakhishvili Tbilisi State University, Tbilisi, Georgia
| | - Shaun Shadaker
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, USA
| | | | | | | | - Muazzam Nasrullah
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, USA
| | - Tamar Gabunia
- Ministry of Internally Displaced Persons from the Occupied Territories, Labour Health and Social Affairs of Georgia, Tbilisi, Georgia
| | | | - Vladimer Getia
- National Center for Disease Control and Public Health, Tbilisi, Georgia
| | | | - Tengiz Tsertsvadze
- Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
| | | | - Shota Tsanava
- National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Senad Handanagic
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, USA
| | - Paige A. Armstrong
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, USA
| | - Francisco Averhoff
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, USA
| | - Peter Vickerman
- Population Health Sciences, University of Bristol, Bristol, UK
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6
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Baliashvili D, Blumberg HM, Benkeser D, Kempker RR, Shadaker S, Averhoff F, Gvinjilia L, Adamashvili N, Magee M, Kamkamidze G, Zakalashvili M, Tsertsvadze T, Sharvadze L, Chincharauli M, Tukvadze N, Gandhi NR. Association of Treated and Untreated Chronic Hepatitis C With the Incidence of Active Tuberculosis Disease: A Population-Based Cohort Study. Clin Infect Dis 2023; 76:245-251. [PMID: 36134743 PMCID: PMC10194043 DOI: 10.1093/cid/ciac786] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 09/12/2022] [Accepted: 09/19/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) infection causes dysregulation and suppression of immune pathways involved in the control of tuberculosis (TB) infection. However, data on the role of chronic hepatitis C as a risk factor for active TB are lacking. We sought to evaluate the association between HCV infection and the development of active TB. METHODS We conducted a cohort study in Georgia among adults tested for HCV antibodies (January 2015-September 2020) and followed longitudinally for the development of newly diagnosed active TB. Data were obtained from the Georgian national programs of hepatitis C and TB. The exposures of interest were untreated and treated HCV infection. A Cox proportional hazards model was used to calculate adjusted hazard ratios (aHRs). RESULTS A total of 1 828 808 adults were included (median follow-up time: 26 months; IQR: 13-39 months). Active TB was diagnosed in 3163 (0.17%) individuals after a median of 6 months follow-up (IQR: 1-18 months). The incidence rate per 100 000 person-years was 296 among persons with untreated HCV infection, 109 among those with treated HCV infection, and 65 among HCV-negative persons. In multivariable analysis, both untreated (aHR = 2.9; 95% CI: 2.4-3.4) and treated (aHR = 1.6; 95% CI: 1.4-2.0) HCV infections were associated with a higher hazard of active TB, compared with HCV-negative persons. CONCLUSIONS Adults with HCV infection, particularly untreated individuals, were at higher risk of developing active TB disease. Screening for latent TB infection and active TB disease should be part of clinical evaluation of people with HCV infection, especially in high-TB-burden areas.
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Affiliation(s)
- Davit Baliashvili
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Henry M Blumberg
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - David Benkeser
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Russell R Kempker
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Shaun Shadaker
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Francisco Averhoff
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Lia Gvinjilia
- Eastern Europe and Central Asia Regional Office, Centers for Disease Control and Prevention, Tbilisi, Georgia
| | | | - Matthew Magee
- Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | | | | | - Tengiz Tsertsvadze
- Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
| | - Lali Sharvadze
- Clinic “Hepa”, Tbilisi, Georgia
- The University of Georgia, Tbilisi, Georgia
| | | | - Nestan Tukvadze
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
| | - Neel R Gandhi
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
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7
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Tan C, Luo X, Ong BS, Lin L, Ng K. Real-world impact of a subsidy decision of sofosbuvir-velpatasvir for treatment of chronic hepatitis C on clinical practice and patient outcomes. JGH Open 2022; 7:48-54. [PMID: 36660045 PMCID: PMC9840192 DOI: 10.1002/jgh3.12850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 11/08/2022] [Accepted: 11/18/2022] [Indexed: 12/02/2022]
Abstract
Background and Aim Sofosbuvir-velpatasvir was recommended for subsidy to treat chronic hepatitis C in Singapore in 2018. We measured the impact of the subsidy decision on clinical practice and patient outcomes. Specifically, we looked at pre- and post-subsidy changes in the utilization and prescribing pattern of chronic hepatitis C treatment and the real-world clinical effectiveness. Method Utilization trends and prescribing patterns were assessed using aggregated drug utilization data from public hospitals' dispensing systems and clinical data from the national electronic health record database, respectively. An audit was conducted to evaluate sustained virological response rate 12 weeks post treatment (SVR12). Results Use of sofosbuvir-velpatasvir increased sharply since its subsidy listing and dropped subsequently, whereas the utilization of comparator drugs remained low. Prescribing rate of sofosbuvir-velpatasvir increased from 13.7% in the pre-subsidy period to 90.2% in the post-subsidy period; 39.1% of patients previously on pegylated interferon and ribavirin switched to sofosbuvir-velpatasvir following its subsidy listing. In the audit, 365 out of 375 patients (97.3% [95% confidence interval: 95.1-98.6%]) achieved SVR12. Conclusion The subsidy decision led to increased accessibility to patients and intended changes in clinical practice. Sofosbuvir-velpatasvir was also clinically effective in the real world. These findings augur well for the continued eradication of chronic hepatitis C infection in Singapore.
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Affiliation(s)
- Chee‐Kiat Tan
- Department of Gastroenterology and HepatologySingapore General HospitalSingapore
| | - Xue‐Shi Luo
- Agency for Care Effectiveness, Ministry of HealthSingapore
| | | | - Liang Lin
- Agency for Care Effectiveness, Ministry of HealthSingapore
| | - Kwong‐Hoe Ng
- Agency for Care Effectiveness, Ministry of HealthSingapore
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8
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Dolmazashvili E, Sharvadze L, Abutidze A, Chkhartishvili N, Todua M, Adamia E, Gabunia T, Shadaker S, Gvinjilia L, Arora S, Thornton K, Armstrong PA, Tsertsvadze T. Treatment of hepatitis C in primary health care in the country of Georgia. Clin Liver Dis (Hoboken) 2022; 20:175-178. [PMID: 36447909 PMCID: PMC9700050 DOI: 10.1002/cld.1260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 06/12/2022] [Accepted: 07/24/2022] [Indexed: 11/27/2022] Open
Abstract
Content available: Audio Recording.
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Affiliation(s)
- Ekaterine Dolmazashvili
- Hepatology DepartmentHepatology Clinic “HEPA”TbilisiGeorgia
- European UniversityTbilisiGeorgia
| | - Lali Sharvadze
- Hepatology DepartmentHepatology Clinic “HEPA”TbilisiGeorgia
- Ivane Javakhishvili Tbilisi State UniversityTbilisiGeorgia
| | - Akaki Abutidze
- Ivane Javakhishvili Tbilisi State UniversityTbilisiGeorgia
- AIDS Outpatient DepartmentInfectious Diseases, AIDS & Clinical Immunology Research CenterTbilisiGeorgia
| | - Nikoloz Chkhartishvili
- AIDS Outpatient DepartmentInfectious Diseases, AIDS & Clinical Immunology Research CenterTbilisiGeorgia
| | - Manana Todua
- Ivane Javakhishvili Tbilisi State UniversityTbilisiGeorgia
| | - Ekaterine Adamia
- Health Policy DepartmentMinistry of Labour, Health and Social Affairs of GeorgiaTbilisiGeorgia
| | - Tamar Gabunia
- Health Policy DepartmentMinistry of Labour, Health and Social Affairs of GeorgiaTbilisiGeorgia
| | - Shaun Shadaker
- Division of Viral HepatitisNational Center for HIV, Hepatitis, STD, and TB PreventionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | | | | | | | - Paige A. Armstrong
- Division of Viral HepatitisNational Center for HIV, Hepatitis, STD, and TB PreventionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Tengiz Tsertsvadze
- Hepatology DepartmentHepatology Clinic “HEPA”TbilisiGeorgia
- Ivane Javakhishvili Tbilisi State UniversityTbilisiGeorgia
- AIDS Outpatient DepartmentInfectious Diseases, AIDS & Clinical Immunology Research CenterTbilisiGeorgia
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9
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Morgan JR, Marsh E, Savinkina A, Shilton S, Shadaker S, Tsertsvadze T, Kamkamidze G, Alkhazashvili M, Morgan T, Belperio P, Backus L, Doss W, Esmat G, Hassany M, Elsharkawy A, Elakel W, Mehrez M, Foster GR, Wose Kinge C, Chew KW, Chasela CS, Sanne IM, Thanung YM, Loarec A, Aslam K, Balkan S, Easterbrook PJ, Linas BP. Determining the lower limit of detection required for HCV viral load assay for test of cure following direct-acting antiviral-based treatment regimens: Evidence from a global data set. J Viral Hepat 2022; 29:474-486. [PMID: 35278339 PMCID: PMC9248016 DOI: 10.1111/jvh.13672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/15/2022] [Indexed: 12/09/2022]
Abstract
Achieving global elimination of hepatitis C virus requires a substantial scale-up of testing. Point-of-care HCV viral load assays are available as an alternative to laboratory-based assays to promote access in hard to reach or marginalized populations. The diagnostic performance and lower limit of detection are important attributes of these new assays for both diagnosis and test of cure. Therefore, our objective was to determine an acceptable LLoD for detectable HCV viraemia as a test for cure, 12 weeks post-treatment (SVR12). We assembled a global data set of patients with detectable viraemia at SVR12 from observational databases from 9 countries (Egypt, the United States, United Kingdom, Georgia, Ukraine, Myanmar, Cambodia, Pakistan, Mozambique) and two pharmaceutical-sponsored clinical trial registries. We examined the distribution of HCV viral load at SVR12 and presented the 90th, 95th, 97th and 99th percentiles. We used logistic regression to assess characteristics associated with low-level virological treatment failure (defined as <1000 IU/mL). There were 5973 cases of detectable viraemia at SVR12 from the combined data set. Median detectable HCV RNA at SVR12 was 287,986 IU/mL. The level of detection for the 95th percentile was 227 IU/mL (95% CI 170-276). Females and those with minimal fibrosis were more likely to experience low-level viraemia at SVR12 compared to men (adjusted odds ratio AOR = 1.60 95% confidence interval [CI] 1.30-1.97 and those with cirrhosis (AOR = 1.49 95% CI 1.15-1.93). In conclusion, an assay with a level of detection of 1000 IU/mL or greater may miss a proportion of those with low-level treatment failure.
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Affiliation(s)
- Jake R. Morgan
- Department of Health Law, Policy, and ManagementBoston University School of Public HealthBostonMassachusettsUSA
| | - Elizabeth Marsh
- Department of MedicineSection of Infectious DiseasesBoston Medical CenterBostonMassachusettsUSA
| | - Alexandra Savinkina
- Department of MedicineSection of Infectious DiseasesBoston Medical CenterBostonMassachusettsUSA
| | | | - Shaun Shadaker
- Division of Viral HepatitisNational Center for HIV/AIDSViral HepatitisSTD and TB PreventionCDCAtlantaGeorgiaUSA
| | - Tengiz Tsertsvadze
- Infectious Diseases, AIDS and Clinical Immunology Research CenterTbilisiGeorgia
| | | | | | - Timothy Morgan
- United States Department of Veteran’s AffairsLong BeachCaliforniaUSA
| | - Pam Belperio
- United States Department of Veteran’s AffairsLong BeachCaliforniaUSA
| | - Lisa Backus
- United States Department of Veteran’s AffairsLong BeachCaliforniaUSA
| | - Waheed Doss
- National Committee for Control of Viral Hepatitis NCCVHCairoEgypt
| | - Gamal Esmat
- Endemic Medicine and Hepatogastroentrology Department, Cairo UniversityCairoEgypt
| | - Mohamed Hassany
- Tropical Medicine and Hepatology DepartmentNational Hepatology and Tropical Medicine Research InstituteCairoEgypt
| | - Aisha Elsharkawy
- Endemic Medicine and Hepatogastroentrology Department, Cairo UniversityCairoEgypt
| | - Wafaa Elakel
- Endemic Medicine and Hepatogastroentrology Department, Cairo UniversityCairoEgypt
| | - Mai Mehrez
- Tropical Medicine and Hepatology DepartmentNational Hepatology and Tropical Medicine Research InstituteCairoEgypt
| | | | | | - Kara W. Chew
- Department of MedicineDivision of Infectious DiseasesDavid Geffen School of Medicine at University of California Los AngelesLos AngelesCaliforniaUSA
| | - Charles S. Chasela
- Implementation Science UnitRight to CareCenturion. South AfricaDepartment of Epidemiology and BiostatisticsSchool of Public HealthFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Ian M. Sanne
- Right to CareCenturion. South Africa, and Clinical HIV Research UnitSchool of Clinical MedicineFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | | | | | | | | | - Philippa J. Easterbrook
- Department of Global HIV, Hepatitis and STI ProgrammesWorld Health OrganizationGenevaSwitzerland
| | - Benjamin P. Linas
- Department of MedicineSection of Infectious DiseasesBoston Medical CenterBostonMassachusettsUSA
- Department of EpidemiologyBoston University School of Public HealthBostonMassachusettsUSA
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10
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Shilton S, Markby J, Japaridze M, Chihota V, Shadaker S, Gvinjilia L, Tsereteli M, Alkhazashvili M, Butsashvili M, Stvilia K, Ruiz RJ, Asatiani A, Adamia E, Easterbrook P, Khonelidze I, Gamkrelidze A. Feasibility and effectiveness of HCV viraemia testing at harm reduction sites in Georgia: A prospective three-arm study. Liver Int 2022; 42:775-786. [PMID: 35129278 PMCID: PMC9306782 DOI: 10.1111/liv.15191] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 12/03/2021] [Accepted: 01/25/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND AIMS In 2015, Georgia began a hepatitis C virus (HCV) elimination programme. Although screening programmes have been decentralized for high-risk groups, viraemic testing remains a bottleneck for people who inject drugs. Here, we describe two models of viraemic testing that aimed to address this gap. METHODS We assigned eight harm reduction sites (HRS) to one of three arms (2,1:1): Xpert HCV viral load testing on-site, blood draw on-site with centralized HCV core antigen testing (HCVcAg), or standard-of-care (SOC) referral with viremia testing performed at treatment centres. RESULTS 1671 HCV-seropositive participants were enrolled (Xpert, 37.1%; HCVcAg, 29.1%; referral, 33.8%). Participants were predominantly male (95.4%), mean age (IQR) 43 (37, 50) years and 1290 (77.2%) were currently injecting drugs. Significantly higher proportions of participants in the Xpert (100%) and HCVcAg (99.8%) arms received viraemia testing compared with the referral arm (91.3%) (Xpert vs referral, p < 0.0001; HCVcAg vs referral, p < 0.0001). Among viraemic participants, treatment uptake was similar (Xpert, 84.0%; HCVcAg, 79.5%; referral, 88.4%). The time between screening and sample collection for viraemia testing was significantly longer in the referral arm compared with both Xpert and HCVcAg arms (median 1 day compared with 0 days respectively), and the overall time between screening to treatment initiation was longer for the referral arm (median 67 days) compared with both Xpert and HCVcAg arms (median 57 and 50 days respectively). CONCLUSIONS Point-of-care viraemia testing and blood drawn on-site for HCVcAg testing yielded more HCV-seropositive patients receiving viraemic testing within a shorter timeframe compared with referrals.
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Affiliation(s)
| | - Jessica Markby
- Foundation for Innovative New DiagnosticsGenevaSwitzerland
| | - Maia Japaridze
- Foundation for Innovative New DiagnosticsGenevaSwitzerland
| | - Violet Chihota
- Foundation for Innovative New DiagnosticsGenevaSwitzerland,Present address:
Aurum InstituteParktownSouth Africa,Present address:
School of Public HealthUniversity of WitwatersrandJohannesburgSouth Africa
| | - Shaun Shadaker
- US Centers for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Lia Gvinjilia
- Training Programs in Epidemiology and Public Health Interventions NetworkDecaturGeorgiaUSA
| | - Maia Tsereteli
- National Center for Disease Control and Public HealthTbilisiGeorgia
| | | | | | - Ketevan Stvilia
- National Center for Disease Control and Public HealthTbilisiGeorgia
| | - Ryan Jose Ruiz
- Foundation for Innovative New DiagnosticsGenevaSwitzerland
| | | | - Ekaterine Adamia
- Ministry of Health, Labour and Social Affairs of GeorgiaTbilisiGeorgia
| | - Philippa Easterbrook
- Department of Global HIV, Hepatitis and STI ProgrammesWorld Health OrganizationGenevaSwitzerland
| | - Irma Khonelidze
- National Center for Disease Control and Public HealthTbilisiGeorgia
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11
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Fung BM, Perumpail M, Patel YA, Tabibian JH. Telemedicine in Hepatology: Current Applications and Future Directions. Liver Transpl 2022; 28:294-303. [PMID: 34506686 DOI: 10.1002/lt.26293] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 09/02/2021] [Accepted: 09/06/2021] [Indexed: 12/13/2022]
Abstract
Telemedicine refers to the use of information and communication technologies for providing health care at a distance. Through the use of telecommunication technologies such as cell phones, computers, and other electronic devices, health care providers are able to conduct patient visits, mentor/train other providers, and monitor patients' chronic diseases remotely, potentially hundreds or thousands of miles away. Over the past 2 decades, the use of telemedicine has grown in the field of hepatology. In this review, we provide a focused primer on telemedicine and its current applications in hepatology. In particular, we discuss the use of telemedicine in the management of chronic hepatitis C, the complications of liver disease, as well as preliver transplantation evaluation and posttransplantation care. In addition, we provide a synopsis of the effect of the coronavirus disease 2019 (COVID-19) pandemic on the use of telemedicine in hepatology.
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Affiliation(s)
- Brian M Fung
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Arizona College of Medicine - Phoenix, Phoenix, AZ.,Banner - University Medical Center Phoenix, Phoenix, AZ
| | | | - Yuval A Patel
- Division of Gastroenterology, Department of Medicine, Duke University, Durham, NC
| | - James H Tabibian
- Division of Gastroenterology, Department of Medicine, Olive View - UCLA Medical Center, Sylmar, CA.,David Geffen School of Medicine at UCLA, Los Angeles, CA
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12
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The impact of COVID-19 pandemic on the 2020 hepatitis C cascade of care in the country of Georgia. Public Health 2022; 205:182-186. [PMID: 35305459 PMCID: PMC9004234 DOI: 10.1016/j.puhe.2022.01.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/19/2022] [Accepted: 01/26/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVES In 2015, the Republic of Georgia initiated a National Hepatitis C Elimination Program, with a goal of 90% reduction in prevalence of chronic hepatitis C virus (HCV) infections by 2020. In this article, we explore the impact of the COVID-19 pandemic on the 2020 hepatitis C cascade of care in Georgia. STUDY DESIGN Retrospective analytic study. METHODS We used a national screening registry that includes hospitals, blood banks, antenatal clinics, harm reduction sites, and other programs and services to collect data on hepatitis C screening. A separate national treatment database was used to collect data on viremia and diagnostic testing, treatment initiation, and outcome including testing for and achieving sustained virologic response (SVR). We used these databases to create hepatitis C care cascades for 2020 and 2019. Bivariate associations for demographic characteristics and screening locations per year and care cascade comparisons were assessed using a chi-squared test. RESULTS In 2020 compared to 2019, the total number of persons screened for HCV antibodies decreased by 25% (from 975,416 to 726,735), 59% fewer people with viremic infection were treated for HCV infection (3188 vs. 7868), 46% fewer achieved SVR (1345 vs. 2495), a significantly smaller percentage of persons with viremic infection initiated treatment for HCV (59% vs. 62%), while the percentage of persons who achieved SVR (99.2% vs. 99.3%) remained stable. CONCLUSIONS The COVID-19 pandemic had a negative impact on the hepatitis C elimination program in Georgia. To ensure Georgia reaches its elimination goals, mitigating unintended consequences of delayed diagnosis and treatment of hepatitis C due to the COVID-19 pandemic are paramount.
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13
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Djaogol T, Fontaine H, Baudoin M, Protopopescu C, Marcellin F, Dorival C, Simony M, Petrov-Sanchez V, Bourlière M, Delarocque-Astagneau E, Pol S, Carrat F, Carrieri P. Effectiveness of direct-acting antivirals for chronic hepatitis C treatment in migrant and non-migrant populations in France. Liver Int 2021; 41:2328-2340. [PMID: 33590608 DOI: 10.1111/liv.14823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/15/2020] [Accepted: 02/02/2021] [Indexed: 12/21/2022]
Abstract
Despite universal health coverage in France, migrants face specific socioeconomic barriers that increase the likelihood of a suboptimal cascade of care for chronic hepatitis C virus (HCV) infection and impaired treatment effectiveness in this sub-population. We selected data collected from 2012 to 2018 from the ANRS CO22 HEPATHER prospective cohort study for chronic HCV participants with available data on treatment failure (defined as the presence of a detectable HCV-RNA load 12 weeks after their first DAA treatment ended). We performed multivariable Poisson regression models to test whether treatment failure rates differed significantly between HCV-infected migrants and non-migrants receiving DAA in France (cross-sectional analysis), while taking into account the former's world region of birth and other potential social vulnerability factors. Among the study population's 7,879 patients, 5,829 (74%) were non-migrants and 2,050 (26%) migrants. Median [interquartile range] age was 57 [51-65] years, 4433 (56%) were men and 369 (5%) of the entire study population had treatment failure. After multivariable adjustment, only migrants from Central Asia were at higher risk of treatment failure than non-migrants (aIRR = 2.83; 95% CI [1.72, 4.65]). Results from this large-scale study performed in France suggest a higher risk of DAA treatment failure in migrants from Central Asia than in non-migrants and confirm the overall low treatment failure rate in chronic HCV patients treated with DAA (whether migrants or not). Simplified models of care taking into account language and cultural barriers are needed to improve DAA effectiveness in migrants from Central Asia.
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Affiliation(s)
- Tchadine Djaogol
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France
| | - Hélène Fontaine
- Université Paris Descartes, AP-HP, Unité d'Hépatologie, Hôpital Cochin, INSERM U-818 et USM20, Institut Pasteur, Paris, France
| | - Maël Baudoin
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Camelia Protopopescu
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Fabienne Marcellin
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Céline Dorival
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Mélanie Simony
- ANRS (France Recherche Nord & Sud Sida-HIV Hépatites), Unit for Basic and Clinical Research on Viral Hepatitis, Paris, France
| | - Ventzislava Petrov-Sanchez
- ANRS (France Recherche Nord & Sud Sida-HIV Hépatites), Unit for Basic and Clinical Research on Viral Hepatitis, Paris, France
| | - Marc Bourlière
- Department of Hepatology and Gastroenterology, Hôpital Saint Joseph, Marseille, France
| | - Elisabeth Delarocque-Astagneau
- UMR1181 Biostatistique, Biomathématique, Pharmaco-épidémiologie et Maladies Infectieuses (B2PHI), Institut Pasteur, Inserm, Université de Versailles-Saint-Quentin-en-Yvelines (UVSQ), Paris, France
| | - Stanislas Pol
- Université Paris Descartes, AP-HP, Unité d'Hépatologie, Hôpital Cochin, INSERM U-818 et USM20, Institut Pasteur, Paris, France
| | - Fabrice Carrat
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France.,AP-HP, Hôpital Saint Antoine, Unité de Santé Publique, Paris, France
| | - Patrizia Carrieri
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
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14
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Shahid I, Alzahrani AR, Al-Ghamdi SS, Alanazi IM, Rehman S, Hassan S. Hepatitis C Diagnosis: Simplified Solutions, Predictive Barriers, and Future Promises. Diagnostics (Basel) 2021; 11:1253. [PMID: 34359335 PMCID: PMC8305142 DOI: 10.3390/diagnostics11071253] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/02/2021] [Accepted: 07/05/2021] [Indexed: 12/14/2022] Open
Abstract
The simplification of current hepatitis C diagnostic algorithms and the emergence of digital diagnostic devices will be very crucial to achieving the WHO's set goals of hepatitis C diagnosis (i.e., 90%) by 2030. From the last decade, hepatitis C diagnosis has been revolutionized by the advent and approval of state-of-the-art HCV diagnostic platforms which have been efficiently implemented in high-risk HCV populations in developed nations as well as in some low-to-middle income countries (LMICs) to identify millions of undiagnosed hepatitis C-infected individuals. Point-of-care (POC) rapid diagnostic tests (RDTs; POC-RDTs), RNA reflex testing, hepatitis C self-test assays, and dried blood spot (DBS) sample analysis have been proven their diagnostic worth in real-world clinical experiences both at centralized and decentralized diagnostic settings, in mass hepatitis C screening campaigns, and hard-to-reach aboriginal hepatitis C populations in remote areas. The present review article overviews the significance of current and emerging hepatitis C diagnostic packages to subvert the public health care burden of this 'silent epidemic' worldwide. We also highlight the challenges that remain to be met about the affordability, accessibility, and health system-related barriers to overcome while modulating the hepatitis C care cascade to adopt a 'test and treat' strategy for every hepatitis C-affected individual. We also elaborate some key measures and strategies in terms of policy and progress to be part of hepatitis C care plans to effectively link diagnosis to care cascade for rapid treatment uptake and, consequently, hepatitis C cure.
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Affiliation(s)
- Imran Shahid
- Department of Pharmacology and Toxicology, Faculty of Medicine, Umm Al-Qura University, Al-Abidiyah, P.O. Box 13578, Makkah 21955, Saudi Arabia; (A.R.A.); (S.S.A.-G.); (I.M.A.)
| | - Abdullah R. Alzahrani
- Department of Pharmacology and Toxicology, Faculty of Medicine, Umm Al-Qura University, Al-Abidiyah, P.O. Box 13578, Makkah 21955, Saudi Arabia; (A.R.A.); (S.S.A.-G.); (I.M.A.)
| | - Saeed S. Al-Ghamdi
- Department of Pharmacology and Toxicology, Faculty of Medicine, Umm Al-Qura University, Al-Abidiyah, P.O. Box 13578, Makkah 21955, Saudi Arabia; (A.R.A.); (S.S.A.-G.); (I.M.A.)
| | - Ibrahim M. Alanazi
- Department of Pharmacology and Toxicology, Faculty of Medicine, Umm Al-Qura University, Al-Abidiyah, P.O. Box 13578, Makkah 21955, Saudi Arabia; (A.R.A.); (S.S.A.-G.); (I.M.A.)
| | - Sidra Rehman
- Functional Genomics Laboratory, Department of Biosciences, COMSATS University Islamabad (CUI), Islamabad 45550, Pakistan;
| | - Sajida Hassan
- Viral Hepatitis Program, Laboratory of Medicine, University of Washington, Seattle, WA 98195, USA;
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15
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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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16
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Falade-Nwulia O. Hepatitis C Virus Elimination Requires More Than Good Drugs. Clin Infect Dis 2021; 71:1269-1270. [PMID: 31563937 DOI: 10.1093/cid/ciz963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 09/25/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
- Oluwaseun Falade-Nwulia
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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17
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Zakalashvili M, Zarkua J, Gish RG, Zhamutashvili M, Sartania V, Weizenegger M, Bartel J, Raabe M, Gvinjilia L, Metreveli S, Barnova M, Abramishvili N, Rtskhiladze I, Metreveli D. Assessment of treatment options for patients with hepatitis C virus recombinant form 2k/1b. Hepatol Res 2021; 51:156-165. [PMID: 33207029 DOI: 10.1111/hepr.13587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/21/2020] [Accepted: 10/24/2020] [Indexed: 12/12/2022]
Abstract
AIM Hepatitis C virus (HCV) intergenotype recombinant form (RF) 2k/1b has been actively circulating in HCV-infected patients, and the prevalence of this RF virus in the Republic of Georgia is one of the highest reported worldwide. The aim of this study was to define the optimal treatment regimen for patients with RF_2k/1b. METHODS We analyzed the data of 2735 patients who started treatment at the Medical Center Mrcheveli within Georgia's hepatitis C elimination program from May 2015 through December 2019. The patients were treated with sofosbuvir (SOF)-based regimens. For identification of RF_2k/1b variants, refinement of standard (INNO-LiPA) genotyping results for all patient samples assigned the unspecific HCV genotypes (GT) 2a/2c was carried out by sequencing of core and non-structural protein 5B genes. RESULTS Overall, 444 patients, representing 66% of GT2 and 16% of the total samples, were RF_2k/1b. Treatment of patients with RF_2k/1b with SOF/ledipasvir and SOF/velpatasvir was highly effective and viral cure rates did not differ among genotypes treated with the same regimen: RF_2k/1b, 99% (343/346); GT1, 99% (876/885); GT2, 96% (156/162); and GT3, 99% (545/552). A separate comparison analysis of sustained virologic response rate, treated with SOF plus ribavirin, showed significantly higher sustained virologic response (96%) in patients with confirmed GT2 (by sequencing) compared to unspecified GT2 (by INNO-LiPA) (79%) (P < 0.05). CONCLUSION Sofosbuvir-based regimens are highly effective for treatment of RF 2k/1b patients, and with availability of new pan-genotypic direct-acting antivirals, genotyping to identify RF 2k/1b patients might not be necessary.
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Affiliation(s)
- Mamuka Zakalashvili
- Hepatology and Gastroenterology Department, Medical Center Mrcheveli, Tbilisi, Georgia
| | - Jaba Zarkua
- Hepatology and Gastroenterology Department, Medical Center Mrcheveli, Tbilisi, Georgia
| | - Robert G Gish
- Hepatitis B Foundation, Doylestown, Pennsylvania, USA
| | - Maia Zhamutashvili
- Hepatology and Gastroenterology Department, Medical Center Mrcheveli, Tbilisi, Georgia
| | - Vakhtang Sartania
- Hepatology and Gastroenterology Department, Medical Center Mrcheveli, Tbilisi, Georgia
| | | | - Jan Bartel
- Medical Service Center Dr. Limbach & colleagues, Heidelberg, Germany
| | - Monika Raabe
- Medical Service Center Dr. Limbach & colleagues, Heidelberg, Germany
| | - Lia Gvinjilia
- TEPHINET independent contractor for Georgia Hepatitis C Elimination Program, Atlanta, Georgia, USA
| | - Sophia Metreveli
- Hepatology and Gastroenterology Department, Medical Center Mrcheveli, Tbilisi, Georgia
| | - Maka Barnova
- Hepatology and Gastroenterology Department, Medical Center Mrcheveli, Tbilisi, Georgia
| | - Nikoloz Abramishvili
- Hepatology and Gastroenterology Department, Medical Center Mrcheveli, Tbilisi, Georgia
| | - Irakli Rtskhiladze
- Hepatology and Gastroenterology Department, Medical Center Mrcheveli, Tbilisi, Georgia
| | - David Metreveli
- Hepatology and Gastroenterology Department, Medical Center Mrcheveli, Tbilisi, Georgia
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18
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Alshuwaykh O, Kwo PY. Current and future strategies for the treatment of chronic hepatitis C. Clin Mol Hepatol 2020; 27:246-256. [PMID: 33317245 PMCID: PMC8046635 DOI: 10.3350/cmh.2020.0230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/17/2020] [Indexed: 12/31/2022] Open
Abstract
Chronic hepatitis C infection is a major cause of liver disease and hepatocellular carcinoma worldwide. While hepatitis C has been treated for decades with some success, the introduction of direct acting antiviral agents has revolutionized the treatment of hepatitis C with finite, highly effective, well-tolerated therapy and there are few populations that cannot be successfully treated now or are complicated to manage. The World Health Organization has released elimination targets in an effort to eliminate viral hepatitis and reduce dramatically the morbidity and mortality caused by both viral hepatitis. While hepatitis C is straightforward to treat, it remains problematic to eliminate on a global scale. Diagnosis of hepatitis C remains the major gap in the cascade of care and numerous screening strategies will be required to reduce this gap. While historically, treatment of hepatitis C has been centralized, decentralized approaches will be required to diagnose, evaluate, and link to care the large population of individuals worldwide with hepatitis C across low-, middle-, and high-income countries. With the introduction of multiple pangenotypic treatment options and reduced cost for these therapies, assessment and treatment for those with hepatitis C has been simplified and made more accessible worldwide. There are multiple populations for whom care models are being developed and refined, including those when inject drugs, those who are incarcerated, those who present with sexually transmitted disease including the men who have sex with men population, amongst many others. While a vaccine for hepatitis C remains elusive these efforts continue. Multiple successful elimination efforts have been reported.
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Affiliation(s)
- Omar Alshuwaykh
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Paul Y Kwo
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
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19
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Ward JW. The Nobel Prize for discovery of HCV is a call to end hepatitis. Lancet 2020; 396:1733. [PMID: 33129372 DOI: 10.1016/s0140-6736(20)32282-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 10/23/2020] [Indexed: 02/07/2023]
Affiliation(s)
- John W Ward
- Coalition for Global Hepatitis Elimination, The Task Force for Global Health, Decatur, GA 30030, USA.
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20
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French hepatitis C care cascade: substantial impact of direct-acting antivirals, but the road to elimination is still long. BMC Infect Dis 2020; 20:759. [PMID: 33059617 PMCID: PMC7559725 DOI: 10.1186/s12879-020-05478-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 10/05/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) elimination by 2030, as targeted by the World Health Organization (WHO), requires that 90% of people with chronic infection be diagnosed and 80% treated. We estimated the cascade of care (CoC) for chronic HCV infection in mainland France in 2011 and 2016, before and after the introduction of direct-acting antivirals (DAAs). METHODS The numbers of people (1) with chronic HCV infection, (2) aware of their infection, (3) receiving care for HCV and (4) on antiviral treatment, were estimated for 2011 and 2016. Estimates for 1) and 2) were based on modelling studies for 2011 and on a virological sub-study nested in a national cross-sectional survey among the general population for 2016. Estimates for 3) and 4) were made using the National Health Data System. RESULTS Between 2011 and 2016, the number of people with chronic HCV infection decreased by 31%, from 192,700 (95% Credibility interval: 150,900-246,100) to 133,500 (95% Confidence interval: 56,900-312,600). The proportion of people aware of their infection rose from 57.7 to 80.6%. The number of people receiving care for HCV increased by 22.5% (representing 25.7% of those infected in 2016), while the number of people on treatment increased by 24.6% (representing 12.1% of those infected in 2016). CONCLUSIONS This study suggests that DAAs substantially impact CoC. However, access to care and treatment for infected people remained insufficient in 2016. Updating CoC estimates will help to assess the impact of new measures implemented since 2016 as part of the goal to eliminate HCV.
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The role of barriers to care on the propensity for hepatitis C virus nonreferral among people living with HIV. AIDS 2020; 34:1681-1683. [PMID: 32769765 DOI: 10.1097/qad.0000000000002610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
: Twenty-five percent of HIV/hepatitis C virus (HCV) coinfected patients were not referred for HCV treatment despite unrestricted access in California to direct-acting antivirals (DAA) in 2018. Having unstable housing and ongoing drug use directly affected HCV treatment nonreferral. However, psychiatric history and alcohol use impacted HCV treatment nonreferral through the mediation of not being engaged in HIV care. Achieving HCV elimination requires DAA treatment outside conventional health settings, including substance rehabilitation centers, mental health crisis houses, and homeless shelters.
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Arora S, Thornton K. Novel Models of Hepatitis C Virus Care Delivery: Telemedicine, Project ECHO, and Integrative Care. Clin Liver Dis (Hoboken) 2020; 16:5-7. [PMID: 32714515 PMCID: PMC7373769 DOI: 10.1002/cld.912] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 12/05/2019] [Indexed: 02/04/2023] Open
Abstract
Watch an interview with the author.
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Affiliation(s)
- Sanjeev Arora
- Department of Internal MedicineUniversity of New Mexico Health Sciences CenterAlbuquerqueNM,Project ECHO, University of New Mexico Health Sciences CenterAlbuquerqueNM
| | - Karla Thornton
- Department of Internal MedicineUniversity of New Mexico Health Sciences CenterAlbuquerqueNM,Project ECHO, University of New Mexico Health Sciences CenterAlbuquerqueNM
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Bloch EM, Kipiani E, Shadaker S, Alkhazashvili M, Gvinjilia L, Kuchuloria T, Chitadze N, Keating SM, Gamkrelidze A, Turdziladze A, Getia V, Nasrullah M, Averhoff F, Izoria M, Skaggs B. Blood transfusion safety in the country of Georgia: collateral benefit from a national hepatitis C elimination program. Transfusion 2020; 60:1243-1252. [PMID: 32542715 DOI: 10.1111/trf.15815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/14/2020] [Accepted: 03/23/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND In April 2015, the government of Georgia (country) initiated the world's first national hepatitis C elimination program. An analysis of blood donor infectious screening data was conducted to inform a strategic plan to advance blood transfusion safety in Georgia. STUDY DESIGN AND METHODS Descriptive analysis of blood donation records (2015-2017) was performed to elucidate differences in demographics, donor type, remuneration status, and seroprevalence for infectious markers (hepatitis C virus antibody [anti-HCV], human immunodeficiency virus [HIV], hepatitis B virus surface antigen [HBsAg], and Treponema pallidum). For regression analysis, final models included all variables associated with the outcome in bivariate analysis (chi-square) with a p value of less than 0.05. RESULTS During 2015 to 2017, there were 251,428 donations in Georgia, representing 112,093 unique donors; 68.5% were from male donors, and 51.2% of donors were paid or replacement (friends or family of intended recipient). The overall seroprevalence significantly declined from 2015 to 2017 for anti-HCV (2.3%-1.4%), HBsAg (1.5%-1.1%), and T. pallidum (1.1%-0.7%) [p < 0.0001]; the decline was not significant for HIV (0.2%-0.1%). Only 41.0% of anti-HCV seropositive donors underwent additional testing to confirm viremia. Infectious marker seroprevalence varied by age, sex, and geography. In multivariable analysis, first-time and paid donor status were associated with seropositivity for all four infectious markers. CONCLUSION A decline during the study period in infectious markers suggests improvement in blood safety in Georgia. Areas that need further improvement are donor recruitment, standardization of screening and diagnostic follow-up, quality assurance, and posttransfusion surveillance.
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Affiliation(s)
- Evan M Bloch
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Eteri Kipiani
- National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Shaun Shadaker
- Division of Viral Hepatitis National Center for HIV, Hepatitis, STD&TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Lia Gvinjilia
- South Caucasus Office of the U.S. Centers for Disease Control (CDC), Tbilisi, Georgia
| | - Tinatin Kuchuloria
- South Caucasus Office of the U.S. Centers for Disease Control (CDC), Tbilisi, Georgia
| | | | - Sheila M Keating
- Vitalant Research Institute (formerly Blood Systems Research Institute), San Francisco, California, USA.,University of California San Francisco, San Francisco, California, USA
| | | | | | - Vladimer Getia
- National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Muazzam Nasrullah
- Division of Viral Hepatitis National Center for HIV, Hepatitis, STD&TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Francisco Averhoff
- Division of Viral Hepatitis National Center for HIV, Hepatitis, STD&TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mariam Izoria
- National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Beth Skaggs
- South Caucasus Office of the U.S. Centers for Disease Control (CDC), Tbilisi, Georgia
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Roingeard P, Beaumont E. Hepatitis C Vaccine: 10 Good Reasons for Continuing. Hepatology 2020; 71:1845-1850. [PMID: 32060946 DOI: 10.1002/hep.31182] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 02/11/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Philippe Roingeard
- Faculté de Médecine, INSERM U1259, Université de Tours and CHRU de Tours, Tours, France
| | - Elodie Beaumont
- Faculté de Médecine, INSERM U1259, Université de Tours and CHRU de Tours, Tours, France
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Averhoff F, Shadaker S, Gamkrelidze A, Kuchuloria T, Gvinjilia L, Sergeenko D, Butsashvili M, Tsertsvadze T, Sharvadze L, Zarkua J, Skaggs B, Nasrullah M, Nasrullah M. Progress and challenges of a pioneering hepatitis C elimination program in the country of Georgia. J Hepatol 2020; 72:680-687. [PMID: 31811882 PMCID: PMC7418146 DOI: 10.1016/j.jhep.2019.11.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/28/2019] [Accepted: 11/20/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND & AIMS Georgia, with a high prevalence of HCV infection, launched the world's first national hepatitis C elimination program in April 2015. A key strategy is the identification, treatment, and cure of the estimated 150,000 HCV-infected people living in the country. We report on progress and key challenges from Georgia's experience. METHODS We constructed a care cascade by analyzing linked data from the national hepatitis C screening registry and treatment databases during 2015-2018. We assessed the impact of reflex hepatitis C core antigen (HCVcAg) testing on rates of viremia testing and treatment initiation (i.e. linkage to care). RESULTS As of December 31, 2018, 1,101,530 adults (39.6% of the adult population) were screened for HCV antibody, of whom 98,430 (8.9%) tested positive. Of the individuals who tested positive, 78,484 (79.7%) received viremia testing, of whom 66,916 (85.3%) tested positive for active HCV infection. A total of 52,576 people with active HCV infection initiated treatment and 48,879 completed their course of treatment. Of the 35,035 who were tested for cure (i.e., sustained virologic response [SVR]), 34,513 (98.5%) achieved SVR. Reflex HCVcAg testing, implemented in March 2018, increased rates of monthly viremia testing by 97.5% among those who screened positive for anti-HCV, however, rates of treatment initiation decreased by 60.7% among diagnosed viremic patients. CONCLUSIONS Over one-third of people living with HCV in Georgia have been detected and linked to care and treatment, however, identification and linkage to care of the remaining individuals with HCV infection is challenging. Novel interventions, such as reflex testing with HCVcAg, can improve rates of viremia testing, but may result in unintended consequences, such as decreased rates of treatment initiation. Linked data systems allow for regular review of the care cascade, allowing for identification of deficiencies and development of corrective actions. LAY SUMMARY This report describes progress in Georgia's hepatitis C elimination program and highlights efforts to promote hepatitis C virus screening and treatment initiation on a national scale. Georgia has made progress towards eliminating hepatitis C, treating over 50,000 people, approximately one-third of the number infected, and achieving cure for 98.5% of those tested. However, identifying infected individuals and linking them to care remains challenging. Novel approaches to increase diagnostic testing can have unintended consequences further down the care cascade.
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Affiliation(s)
- Francisco Averhoff
- Centers for Disease Control and Prevention, Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD & TB Prevention, Atlanta, Georgia, USA.
| | - Shaun Shadaker
- Centers for Disease Control and Prevention, Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD & TB Prevention, Atlanta, USA
| | | | - Tatia Kuchuloria
- TEPHINET independent contractor for Georgia Hepatitis C Elimination Program
| | - Lia Gvinjilia
- TEPHINET independent contractor for Georgia Hepatitis C Elimination Program
| | - David Sergeenko
- Ministry of IDPs from the Occupied Territories, Labour, Health, and Social Affairs of Georgia, Tbilisi, Georgia
| | | | - Tengiz Tsertsvadze
- Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
| | | | - Jaba Zarkua
- Hepatology and Gastroenterology Department, Medical Center Mrcheveli, Tbilisi, Georgia
| | - Beth Skaggs
- Division of Global Health Protection, Center for Global Health, South Caucasus Regional Office, Tbilisi, Georgia
| | - Muazzam Nasrullah
- Centers for Disease Control and Prevention, Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD & TB Prevention, Atlanta, USA
| | - Muazzam Nasrullah
- Centers for Disease Control and Prevention, Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD & TB Prevention, Atlanta, Georgia, USA
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Evaluating the impact of Georgia's hepatitis C elimination plan: lessons learned for the global initiative. LANCET GLOBAL HEALTH 2020; 8:e163-e164. [DOI: 10.1016/s2214-109x(19)30537-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 12/03/2019] [Indexed: 12/20/2022]
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Mishkin K, Nugmanova Z, Urbaeva J, Nugumanova G, Abdumananova M, Kim E, Lazariu V, McNutt LA. Anxiety and depression among women living with HIV in Kazakhstan. AIDS Care 2020; 33:172-179. [PMID: 31983231 DOI: 10.1080/09540121.2020.1719277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
An increase in new HIV infections among women in Kazakhstan has motivated efforts to improve access to comprehensive health services. This study estimates anxiety and depression frequency among women seeking HIV services. A cross-sectional survey was administered to women seen at the Almaty AIDS Center. Bivariable analyses (e.g., Chi-square, means with 95% confidence intervals) were performed to assess the relationship between anxiety (score of 10 or more on the Generalized Anxiety Disorder-7 Scale (GAD-7)), major depression (Patient Health Questionnaire 8 (PHQ-8)), and comorbid anxiety and major depression with sociodemographic characteristics, health functioning, and medication history. Of the 410 participants, 62 (15.1%) had a GAD-7 ≥ 10; 52 (12.7%) met major depression criteria; 35 (8.5%) met both criteria, and 79 (19.3%) met GAD-7, major depression, or both criteria. Women reporting depression or anxiety were more likely to lack food security (p < 0.01), not finish secondary school (p < 0.01), speak Russian at home (p < 0.01), perceive their health to be poor (p < 0.01), and report poorer physical and mental health functioning (p < 0.05). No medications approved for the treatment of anxiety or depression were reported. The considerable number of women reporting major depression and anxiety symptoms suggests a need for improving access to mental health care.
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Affiliation(s)
- Kathryn Mishkin
- Department of Health Policy, Management, and Behavior, University at Albany, NY, USA
| | - Zhamilya Nugmanova
- Division of HIV Infection, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | | | - Gulnara Nugumanova
- Division of HIV Infection, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | | | - Elena Kim
- Division of HIV Infection, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - Victoria Lazariu
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, SUNY, NY, USA
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