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Frye K, Davis A, Darby R, McDaniel K, Quairoli K, Liu Z, Miller LS, Fluker SA. A contactless cure: Leveraging telehealth to improve hepatitis C treatment at a safety-net hospital. J Viral Hepat 2024; 31:176-180. [PMID: 38369695 DOI: 10.1111/jvh.13913] [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: 09/26/2023] [Accepted: 12/15/2023] [Indexed: 02/20/2024]
Abstract
Hepatitis C virus (HCV) causes significant mortality worldwide. HCV is highly curable but access to care is limited for many patients. The Grady Liver Clinic (GLC), a primary care-based HCV clinic, utilizes a multidisciplinary team to provide comprehensive care for a medically underserved patient population in Atlanta, Georgia. The GLC added a telehealth option for HCV treatment at the start of the COVID-19 pandemic. We describe the outcomes of utilizing telehealth in this population. We performed a retrospective chart review of patients who initiated HCV treatment from March 2019 to February 2020 (pre-pandemic) and March 2020 to February 2021 (pandemic). Charts were abstracted for patient demographics and characteristics, treatment regimen, and treatment outcomes. Our primary outcome was HCV cure rate of the pre-pandemic compared to the pandemic cohorts and within the different pandemic cohort visit types. We performed an intention-to-treat (ITT) analysis for all patients who took at least one dose of a direct-acting antiviral (DAA) regardless of therapy completion, and a per-protocol (PP) analysis of those who completed treatment and were tested for HCV cure. SVR12 rates were >95% on ITT analysis, with no significant difference between pre-pandemic and pandemic cohorts. There was also no significant difference within the pandemic group when treatment was provided traditionally, via telehealth, or via a hybrid of these. Our findings support the use of telehealth as a tool to expand access to HCV treatment in a medically underserved patient population.
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Affiliation(s)
- Krysta Frye
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Andrew Davis
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Kathryn McDaniel
- Department of Pharmacy, Grady Health System, Atlanta, Georgia, USA
| | - Kristi Quairoli
- Department of Pharmacy, Grady Health System, Atlanta, Georgia, USA
| | - Zhanxu Liu
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Lesley S Miller
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Shelly-Ann Fluker
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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Engstrom T, Lobo EH, Watego K, Nelson C, Wang J, Wong H, Kim SL, Oh SI, Lawley M, Gorse AD, Ward J, Sullivan C. Indigenous data governance approaches applied in research using routinely collected health data: a scoping review. NPJ Digit Med 2024; 7:68. [PMID: 38491156 PMCID: PMC10943072 DOI: 10.1038/s41746-024-01070-3] [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: 10/09/2023] [Accepted: 02/29/2024] [Indexed: 03/18/2024] Open
Abstract
Globally, there is a growing acknowledgment of Indigenous Peoples' rights to control data related to their communities. This is seen in the development of Indigenous Data Governance standards. As health data collection increases, it's crucial to apply these standards in research involving Indigenous communities. Our study, therefore, aims to systematically review research using routinely collected health data of Indigenous Peoples, understanding the Indigenous Data Governance approaches and the associated advantages and challenges. We searched electronic databases for studies from 2013 to 2022, resulting in 85 selected articles. Of these, 65 (77%) involved Indigenous Peoples in the research, and 60 (71%) were authored by Indigenous individuals or organisations. While most studies (93%) provided ethical approval details, only 18 (21%) described Indigenous guiding principles, 35 (41%) reported on data sovereignty, and 28 (33%) addressed consent. This highlights the increasing focus on Indigenous Data Governance in utilising health data. Leveraging existing data sources in line with Indigenous data governance principles is vital for better understanding Indigenous health outcomes.
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Affiliation(s)
- Teyl Engstrom
- Queensland Digital Health Centre, Centre for Health Services Research, The University of Queensland, Herston, QLD, Australia.
| | - Elton H Lobo
- Queensland Digital Health Centre, Centre for Health Services Research, The University of Queensland, Herston, QLD, Australia.
| | - Kristie Watego
- Institute for Urban Indigenous Health, Windsor, QLD, Australia
| | - Carmel Nelson
- Institute for Urban Indigenous Health, Windsor, QLD, Australia
| | - Jinxiang Wang
- Poche Centre for Indigenous Health, The University of Queensland, Herston, QLD, Australia
| | - Howard Wong
- Queensland Digital Health Centre, Centre for Health Services Research, The University of Queensland, Herston, QLD, Australia
| | - Sungkyung Linda Kim
- Queensland Digital Health Centre, Centre for Health Services Research, The University of Queensland, Herston, QLD, Australia
| | - Soo In Oh
- Queensland Digital Health Centre, Centre for Health Services Research, The University of Queensland, Herston, QLD, Australia
| | | | | | - James Ward
- Poche Centre for Indigenous Health, The University of Queensland, Herston, QLD, Australia
| | - Clair Sullivan
- Queensland Digital Health Centre, Centre for Health Services Research, The University of Queensland, Herston, QLD, Australia
- Royal Brisbane and Women's Hospital, Herston, QLD, Australia
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Corcorran MA, Thornton K, Struminger B, Easterbrook P, Scott JD. Training the healthcare workforce: the global experience with telementorship for hepatitis B and hepatitis C. BMC Health Serv Res 2023; 23:824. [PMID: 37533025 PMCID: PMC10394928 DOI: 10.1186/s12913-023-09849-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 07/26/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Telementorship has emerged as an innovative strategy to decentralise medical knowledge and increase healthcare capacity across a wide range of disease processes. We report the global experience with telementorship to support healthcare workers delivering hepatitis B virus (HBV) and hepatitis C virus (HCV) care and treatment. METHODS In early 2020, we conducted a survey of HBV and HCV telementorship programmes, followed by an in-depth interview with programme leads. Programmes were eligible to participate if they were located outside of the United States (U.S.), focused on support to healthcare workers in management of HBV and/or HCV, and were affiliated with or maintained adherence to the Project ECHO model, a telementorship programme pioneered at the University of New Mexico. One programme in the U.S., focused on HCV treatment in the Native American community, was purposively sampled and invited to participate. Surveys were administered online, and all qualitative interviews were performed remotely. Descriptive statistics were calculated for survey responses, and qualitative interviews were assessed for major themes. RESULTS Eleven of 18 eligible programmes completed the survey and follow up interview. Sixty-four percent of programmes were located at regional academic medical centers. The majority of programmes (64%) were led by hepatologists. Most programmes (82%) addressed both HBV and HCV, and the remainder focused on HCV only. The median number of participating clinical spoke sites per programme was 22, and most spoke site participants were primary care providers. Most ECHO sessions were held monthly (36%) or bimonthly (27%), with sessions ranging from 45 min to 2 h in length. Programme leaders identified collective learning, empowerment and collaboration to be key strengths of their telementorship programme, while insufficient funding and a lack of protected time for telementorship leaders and participants were identified as major barriers to success. CONCLUSION The Project ECHO model for telementorship can be successfully implemented across high and low-and-middle-income countries to improve provider knowledge and experience in management of viral hepatitis. There is a tremendous opportunity to further expand upon the existing experience with telementorship to support non-specialist healthcare workers and promote elimination of viral hepatitis.
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Affiliation(s)
- Maria A Corcorran
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA.
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington School of Medicine, Harborview Medical Center, 325 9th Ave, Box 359782, Seattle, WA, 98104, USA.
| | - Karla Thornton
- Division of Infectious Diseases, Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
- Project ECHO, University of New Mexico, Albuquerque, NM, USA
| | - Bruce Struminger
- Division of Infectious Diseases, Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
- Project ECHO, University of New Mexico, Albuquerque, NM, USA
| | - Philippa Easterbrook
- Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - John D Scott
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
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Facilitating Real-Time, Multidirectional Learning for Clinicians in a Low-Evidence Pandemic Response. Disaster Med Public Health Prep 2022; 17:e246. [PMID: 36128645 DOI: 10.1017/dmp.2022.182] [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: 02/08/2023]
Abstract
As COVID-19 was declared a health emergency in March 2020, there was immense demand for information about the novel pathogen. This paper examines the clinician-reported impact of Project ECHO COVID-19 Clinical Rounds on clinician learning. Primary sources of study data were Continuing Medical Education (CME) Surveys for each session from the dates of March 24, 2020 to July 30, 2020 and impact surveys conducted in November 2020, which sought to understand participants' overall assessment of sessions. Quantitative analyses included descriptive statistics and Mann-Whitney testing. Qualitative data were analyzed through inductive thematic analysis. Clinicians rated their knowledge after each session as significantly higher than before that session. 75.8% of clinicians reported they would 'definitely' or 'probably' use content gleaned from each attended session and clinicians reported specific clinical and operational changes made as a direct result of sessions. 94.6% of respondents reported that COVID-19 Clinical Rounds helped them provide better care to patients. 89% of respondents indicated they 'strongly agree' that they would join ECHO calls again.COVID-19 Clinical Rounds offers a promising model for the establishment of dynamic peer-to-peer tele-mentoring communities for low or no-notice response where scientifically tested or clinically verified practice evidence is limited.
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Smith CM, Kennedy JL, Evans ME, Person MK, Haverkate R, Apostolou A. Mental Illness in Adults With HIV and HCV Infection: Indian Health Service, 2001-2020. Am J Prev Med 2022; 63:e77-e86. [PMID: 35589441 PMCID: PMC9887638 DOI: 10.1016/j.amepre.2022.03.023] [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: 12/14/2021] [Revised: 02/20/2022] [Accepted: 03/21/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Mental health disorders (MHDs) and substance use disorders (SUDs) in people living with HIV, hepatitis C virus (HCV) infection, and HIV/HCV coinfection are common and result in significant morbidity. However, there are no national prevalence estimates of these comorbidities in American Indian and Alaska Native (AI/AN) adults with HIV, HCV infection, or HIV/HCV coinfection. This study estimates the prevalence of MHD and SUD diagnoses in AI/AN adults diagnosed with HIV, HCV infection, or HIV/HCV coinfection within the Indian Health Service (IHS). METHODS In 2021, a cross-sectional study using data from the National Patient Information Reporting System was completed to identify MHD or SUD diagnoses in AI/AN adults with HIV, HCV infection, or HIV/HCV coinfection within the IHS during fiscal years 2001‒2020. Logistic regression was used to compare the odds of MHD or SUD diagnoses, adjusting for age and sex. RESULTS Of AI/AN adults diagnosed with HIV, hepatitis C virus infection, or HIV/HCV coinfection, the period prevalence of MHD or SUD diagnoses ranged from 57.2% to 81.1%. Adjusting for age and sex, individuals with HCV infection had higher odds of receiving a MHD diagnosis (AOR=1.57; 95% CI=1.47, 1.68) or SUD diagnosis (AOR=3.40; 95% CI=3.18, 3.65) than those with HIV, and individuals with HIV/HCV coinfection had higher odds of receiving a MHD diagnosis (AOR=1.60; 95% CI=1.35, 1.89) or SUD diagnosis (AOR=2.81; 95% CI=2.32, 3.41) than those with HIV. CONCLUSIONS MHD and SUD diagnoses were common in AI/AN adults diagnosed with HIV, HCV infection, or HIV/HCV coinfection, highlighting the need for culturally appropriate screening and treatment programs sensitive to the diverse strengths of AI/AN populations and structural challenges they endure.
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Affiliation(s)
- Colin M Smith
- Department of Medicine, Duke University Medical Center, Durham, North Carolina; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina; Indian Health Service, Rockville, Maryland.
| | - Jordan L Kennedy
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mary E Evans
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Marissa K Person
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
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Alvarez CS, Petrick JL, Parisi D, McMahon BJ, Graubard BI, McGlynn KA. Racial/ethnic disparities in hepatocellular carcinoma incidence and mortality rates in the United States, 1992-2018. Hepatology 2022; 76:589-598. [PMID: 35124828 PMCID: PMC9352816 DOI: 10.1002/hep.32394] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 01/25/2022] [Accepted: 01/26/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS HCC is characterized by racial/ethnic disparities in rates. Recent USA reports suggest that incidence has begun to decline, but it is not clear whether the declines have occurred among all groups, nor whether mortality has declined. Thus, the current study examined USA incidence and mortality between 1992 and 2018. APPROACH & RESULTS HCC incidence and incidence-based mortality data from the Surveillance, Epidemiology, and End Results program were used to calculate age-standardized rates by race/ethnicity, sex, and age. Trends were analyzed using joinpoint regression to estimate annual percent change (APC). Age-period-cohort models assessed the effects on trends of age, calendar period, and birth cohort. Overall, HCC incidence significantly declined between 2015 and 2018 (APC, -5.6%). Whereas most groups experienced incidence declines, the trends were most evident among Asians/Pacific Islanders, women, and persons <50 years old. Exceptions were the rates among non-Hispanic Black persons, which did not significantly decline (APC, -0.7), and among American Indians/Alaska Natives, which significantly increased (APC, +4.3%). Age-period-cohort modeling found that birth cohort had a greater effect on rates than calendar period. Among the baby boom cohorts, the 1950-1954 cohort had the highest rates. Similar to the overall incidence decline, HCC mortality rates declined between 2013 and 2018 (APC, -2.2%). CONCLUSIONS HCC incidence and mortality rates began to decline for most groups in 2015, but persistent differences in rates continued to exist. Rates among non-Hispanic Black persons did not decline significantly, and rates among American Indians/Alaska Natives significantly increased, suggesting that greater effort is needed to reduce the HCC burden among these vulnerable groups.
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Affiliation(s)
- Christian S. Alvarez
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | | | | | - Brian J. McMahon
- Liver Diseases and Hepatitis Program, Alaska Native Tribal Health Consortium, Anchorage, AK
| | - Barry I. Graubard
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Katherine A. McGlynn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
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Xie Z, Deng K, Xia Y, Zhang C, Xu M, Li F, Liu J, Zhou Y, Chen X, Chen X, Yan Q, Huang J, Chen W, Wu S, Bai H, Li J, Guan Y. Efficacy and safety of direct-acting antiviral therapies and baseline predictors for treatment outcomes in hepatitis C patients: a multi-center, real-world study in Guangdong, China. J Med Virol 2022; 94:4459-4469. [PMID: 35545872 DOI: 10.1002/jmv.27851] [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: 01/18/2022] [Revised: 04/25/2022] [Accepted: 05/09/2022] [Indexed: 11/09/2022]
Abstract
: The data on direct acting antivirals (DAA) in chronic hepatitis C (CHC) patients in southern China with multiple genotypes circulating are limited. This study aims to evaluate the efficacy and safety of DAA regimens among CHC patients in Guangdong, China. A total of 220 patients receiving a variety of DAA were enrolled. The primary outcome was sustained virologic response (SVR) at 12 weeks. Resistance associated substations (RAS) were evaluated by deep sequencing. The overall SVR rate was 96.4%, and was 97.7% for genotype 1, 100% for genotype 2, 91.9% for genotype 3, 95.7% for genotype 6, and 100% for untyped. The overall incidence of adverse events (AEs) was 8.2% (18/220) and all the AEs were mild. Nonstructural protein 5A RAS, 30K/31M and Y93H, were most prevalent at baseline and the end of treatment in non-SVR patients, respectively. Logistics regression showed that elevated ALT and AST at baseline were specifically associated with non-SVR in patients with genotype 3 and 6 infections (P = 0.029 and P = 0.017) but not genotype 1 infection (P = 0.746 and P = 0.971), and baseline AST was the best predictor for SVR in genotype 3 and 6 patients (area under curve = 0.890). CONCLUSION: All DAA regimens achieved ideal SVR and were well tolerated. NS5A RAS were prevalent in non-SVR patients. ALT and AST as baseline predictors for non-SVR in genotype 3 and 6 infections warrant further research in a larger cohort. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Zhiwei Xie
- Department of Hepatology, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Kai Deng
- Infectious Disease Institute, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yang Xia
- Department of Hepatology, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Chunlan Zhang
- Department of Hepatology, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Min Xu
- Department of Hepatology, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Feng Li
- Infectious Disease Institute, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jinfeng Liu
- Institution of Clinical Research, the First People's Hospital of Foshan, Foshan, Guangdong, China
| | - Yuanping Zhou
- Department of Infectious Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaoping Chen
- Department of Infectious Disease, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Xuefu Chen
- Department of Infectious Disease, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Qin Yan
- Department of Hepatology, Shenzhen Union Hospital of Huazhong University of Science and Technology, Shenzhen, Guangdong, China
| | - Jing Huang
- Department of Infectious Disease, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Wenli Chen
- Department of Infectious Disease, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Shuduo Wu
- Department of Hepatology, Guangdong Province Hospital of Traditional Chinese Medicine, Guangzhou, China
| | - Honglian Bai
- Institution of Clinical Research, the First People's Hospital of Foshan, Foshan, Guangdong, China
| | - Jianping Li
- Department of Hepatology, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yujuan Guan
- Department of Hepatology, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
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Townshend-Bulson L, Roik E, Barbour Y, Bruden DJT, Homan CE, Espera HGF, Stevenson TJ, Hewitt AM, Rhodes W, Gove JE, Plotnik JN, Snowball MM, McGilvray J, Simons BC, Johnston JM, McMahon BJ. The Alaska Native/American Indian experience of hepatitis C treatment with sofosbuvir-based direct-acting antivirals. PLoS One 2021; 16:e0260970. [PMID: 34855920 PMCID: PMC8639063 DOI: 10.1371/journal.pone.0260970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 11/20/2021] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND Direct-acting antiviral (DAA) drugs have been effective in the treatment of chronic hepatitis C virus (HCV) infection. Limited data are available on safety, tolerability, and efficacy in American Indian or Alaska Native people. We aim to evaluate the treatment outcomes of sofosbuvir- based regimens for treatment of HCV in a real life setting in Alaska Native/American Indian (AN/AI) people. METHODS AN/AI patients within the Alaska Tribal Health System with confirmed positive anti-HCV and HCV RNA, who were 18 years of age and older were included in the study. Pretreatment baseline patient characteristics, treatment efficacy based on sustained virologic response (SVR) 12 weeks after treatment completion, and adverse effects were assessed. The following treatments were given according to the American Association for the Study of Liver Diseases/Infectious Disease Society of America (AASLD/IDSA) HCV Guidance: ledipasvir/sofosbuvir, sofosbuvir plus weight-based ribavirin, and sofosbuvir/velpatasvir. RESULTS We included 501 patients with a mean age of 54.3 (range 21.3-78.3) in the study. Overall SVR was achieved in 95.2% of patients who received one of the three DAA regimens. For those with cirrhosis, overall SVR was 92.8% and for those with genotype 3 91.1% achieved SVR. The most common symptom experienced during treatment was headache. Joint pain was found to decrease during treatment. One person discontinued sofosbuvir plus ribavirin due to myocardial infarction and one discontinued sofosbuvir/velpatasvir due to urticaria. CONCLUSIONS In the real-world setting, sofosbuvir-based treatment is safe, effective, and well tolerated in AN/AI patients. Sustained virologic response was high regardless of HCV genotype or cirrhosis status.
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Affiliation(s)
- Lisa Townshend-Bulson
- Alaska Native Tribal Health Consortium, Liver Disease and Hepatitis Program, Anchorage, Alaska, United States of America
| | - Elena Roik
- Alaska Native Tribal Health Consortium, Liver Disease and Hepatitis Program, Anchorage, Alaska, United States of America
| | - Youssef Barbour
- Alaska Native Tribal Health Consortium, Liver Disease and Hepatitis Program, Anchorage, Alaska, United States of America
| | - Dana J. T. Bruden
- Centers for Disease Control and Prevention, Anchorage, Alaska, United States of America
| | - Chriss E. Homan
- Alaska Native Tribal Health Consortium, Liver Disease and Hepatitis Program, Anchorage, Alaska, United States of America
| | - Hannah G. F. Espera
- Alaska Native Tribal Health Consortium, Liver Disease and Hepatitis Program, Anchorage, Alaska, United States of America
| | | | - Annette M. Hewitt
- Alaska Native Tribal Health Consortium, Liver Disease and Hepatitis Program, Anchorage, Alaska, United States of America
| | - Wileina Rhodes
- Alaska Native Tribal Health Consortium, Liver Disease and Hepatitis Program, Anchorage, Alaska, United States of America
| | - James E. Gove
- Alaska Native Tribal Health Consortium, Liver Disease and Hepatitis Program, Anchorage, Alaska, United States of America
| | - Julia N. Plotnik
- Alaska Native Tribal Health Consortium, Liver Disease and Hepatitis Program, Anchorage, Alaska, United States of America
| | - Mary M. Snowball
- Alaska Native Tribal Health Consortium, Liver Disease and Hepatitis Program, Anchorage, Alaska, United States of America
| | - John McGilvray
- Pharmacy Department, Southcentral Foundation, Anchorage, Alaska, United States of America
| | - Brenna C. Simons
- Centers for Disease Control and Prevention, Anchorage, Alaska, United States of America
| | - Janet M. Johnston
- Alaska Native Tribal Health Consortium, Liver Disease and Hepatitis Program, Anchorage, Alaska, United States of America
| | - Brian J. McMahon
- Alaska Native Tribal Health Consortium, Liver Disease and Hepatitis Program, Anchorage, Alaska, United States of America
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Kulkeaw K, Pengsart W. Progress and Challenges in the Use of a Liver-on-a-Chip for Hepatotropic Infectious Diseases. MICROMACHINES 2021; 12:mi12070842. [PMID: 34357252 PMCID: PMC8306537 DOI: 10.3390/mi12070842] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/13/2021] [Accepted: 07/17/2021] [Indexed: 12/16/2022]
Abstract
The liver is a target organ of life-threatening pathogens and prominently contributes to the variation in drug responses and drug-induced liver injury among patients. Currently available drugs significantly decrease the morbidity and mortality of liver-dwelling pathogens worldwide; however, emerging clinical evidence reveals the importance of host factors in the design of safe and effective therapies for individuals, known as personalized medicine. Given the primary adherence of cells in conventional two-dimensional culture, the use of these one-size-fit-to-all models in preclinical drug development can lead to substantial failures in assessing therapeutic safety and efficacy. Advances in stem cell biology, bioengineering and material sciences allow us to develop a more physiologically relevant model that is capable of recapitulating the human liver. This report reviews the current use of liver-on-a-chip models of hepatotropic infectious diseases in the context of precision medicine including hepatitis virus and malaria parasites, assesses patient-specific responses to antiviral drugs, and designs personalized therapeutic treatments to address the need for a personalized liver-like model. Second, most organs-on-chips lack a monitoring system for cell functions in real time; thus, the review discusses recent advances and challenges in combining liver-on-a-chip technology with biosensors for assessing hepatocyte viability and functions. Prospectively, the biosensor-integrated liver-on-a-chip device would provide novel biological insights that could accelerate the development of novel therapeutic compounds.
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Affiliation(s)
- Kasem Kulkeaw
- Department of Parasitology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
- Correspondence: ; Tel.: +66-2-419-6468 (ext. 96484)
| | - Worakamol Pengsart
- Faculty of Graduate Studies, Mahidol University, Nakhon Pathom 73170, Thailand;
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Varon ML, Baker E, Byers E, Cirolia L, Bogler O, Bouchonville M, Schmeler K, Hariprasad R, Pramesh CS, Arora S. Project ECHO Cancer Initiative: a Tool to Improve Care and Increase Capacity Along the Continuum of Cancer Care. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:25-38. [PMID: 34292501 DOI: 10.1007/s13187-021-02031-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/24/2021] [Indexed: 06/13/2023]
Abstract
Solving health problems requires not only the development of new medical knowledge but also its dissemination, particularly to underserved communities. The barriers to effective dissemination also contribute to the disparities in cancer care experienced most everywhere. This concern is particularly acute in low and middle-income countries which already bear a disproportionate burden of cancer, a situation that is projected to worsen. Project ECHO (Extension for Community Healthcare Outcomes) is a knowledge dissemination platform that can increase workforce capacity across many fields, including cancer care by scaling best practices. Here we describe how Project ECHO works and illustrate this with existing programs that span the cancer care continuum and the globe. The examples provided combined with the explanation of how to build effective Project ECHO communities provide an accessible guide on how this education strategy can be integrated into existing work to help respond to the challenge of cancer.
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Affiliation(s)
| | - Ellen Baker
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Emily Byers
- ECHO Institute, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
- UNM School of Medicine, Albuquerque, NM, USA
| | - Lucca Cirolia
- ECHO Institute, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
- UNM School of Medicine, Albuquerque, NM, USA
| | - Oliver Bogler
- Center for Cancer Training, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Matthew Bouchonville
- ECHO Institute, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | | | - Roopa Hariprasad
- Division of Clinical Oncology, National Institute of Cancer Prevention and Research, New Delhi, India
| | | | - Sanjeev Arora
- ECHO Institute, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
- UNM School of Medicine, Albuquerque, NM, USA.
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Xia H, Lu C, Wang Y, Zaongo SD, Hu Y, Wu Y, Yan Z, Ma P. Efficacy and Safety of Direct-Acting Antiviral Therapy in Patients With Chronic Hepatitis C Virus Infection: A Real-World Single-Center Experience in Tianjin, China. Front Pharmacol 2020; 11:710. [PMID: 32508646 PMCID: PMC7248196 DOI: 10.3389/fphar.2020.00710] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 04/29/2020] [Indexed: 12/13/2022] Open
Abstract
Objective Toward the limited real-world data concerning the treatment response to brand direct-acting antiviral agents (DAAs) therapy, we proposed to evaluate the efficacy and safety of DAAs for the treatment of chronic hepatitis C virus (HCV) in mainland China. Methods In this retrospective, single-center, cohort study, all HCV-infected adult patients treated with brand DAA drugs covered by Tianjin local health insurance (Apr 2018–Sept 2019) and responding to other specific inclusion criteria were recruited. The five available DAA regimens included sofosbuvir + ribavirin (SOF + RBV), elbasvir/grazoprevir (EBR/GZR), ombitasvir/paritaprevir/ritonavir/dasabuvir (OBV/PTV/r/DSV) ± RBV, daclatasvir + asunaprevir (DCV + ASV), and SOF + DCV ± RBV. Demographic, virologic, clinical, and adverse effects data obtained during and after DAAs treatment were collected. We evaluated the rate of sustained virological response at 12 weeks post-treatment (SVR12), the incidence of adverse effects, and assessed the factors associated with SVR12. Results Four hundred ninety-four patients finished the treatment and completed the 12-week post-treatment follow-up. The overall SVR12 rate was estimated at 96.96%. SVR rates greater than 95% were achieved in most of the HCV genotypes with the exception of GT1a (0%), GT3a (93.33%), and GT3b (88.24%). SVR12 for patients treated with DCV + ASV, EBR/GZR, OBV/PTV/r/DSV ± RBV, SOF + DCV ± RBV, and SOF + RBV for 12 or 24 weeks was 86.67%, 100%, 98.11%, 97.56%, and 95.06%, respectively. Subjects with compensated cirrhosis (92.73%) and prior treatment experience (77.78%) had significantly lower SVR rates when compared to chronic hepatitis C (98.15%) and treatment-naive (97.69%) groups. In Tianjin, the available DAA regimens were generally well-tolerated, and not a single serious adverse event was reported. Conclusion In this large real-life single-center HCV cohort from China, oral DAAs were highly effective and well-tolerated. Further and larger-scale studies are needed to evaluate their clinical safety and efficacy.
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Affiliation(s)
- Huan Xia
- Department of Infectious Disease, Tianjin Second People's Hospital, Tianjin, China
| | - Chengzhen Lu
- Department of Hepatology, Tianjin Second People's Hospital, Tianjin, China
| | - Yin Wang
- Department of Infectious Disease, Public Health Clinical Center of Chengdu, Chengdu, China
| | - Silvere D Zaongo
- Department of Infectious Disease, Tianjin Second People's Hospital, Tianjin, China.,International School of Medicine, Tianjin Medical University, Tianjin, China
| | - Yue Hu
- Department of Infectious Disease, Tianjin Second People's Hospital, Tianjin, China
| | - Yue Wu
- Department of Infectious Disease, Tianjin Second People's Hospital, Tianjin, China
| | | | - Ping Ma
- Department of Infectious Disease, Tianjin Second People's Hospital, Tianjin, China
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Leston J, Stephens D, Miller M, Moran B, Deming P, Mera J. Telehealth and hepatitis C treatment for indigenous communities in the United States. Rev Panam Salud Publica 2020; 44:e13. [PMID: 32165890 PMCID: PMC7055458 DOI: 10.26633/rpsp.2020.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jessica Leston
- Northwest Portland Area Indian Health Board Portland Northwest Portland Area Indian Health Board Portland Oregon United States Northwest Portland Area Indian Health Board Portland, Oregon, United States
| | - David Stephens
- Northwest Portland Area Indian Health Board Portland Northwest Portland Area Indian Health Board Portland Oregon United States Northwest Portland Area Indian Health Board Portland, Oregon, United States
| | - Matthew Miller
- US Indian Health Service US Indian Health Service RockvilleMaryland United States US Indian Health Service, Rockville, Maryland, United States
| | - Brad Moran
- US Indian Health Service US Indian Health Service RockvilleMaryland United States US Indian Health Service, Rockville, Maryland, United States
| | - Paulina Deming
- University of New Mexico Health Sciences Center ECHO Institute AlbuquerqueNew Mexico United States University of New Mexico Health Sciences Center, ECHO Institute, Albuquerque, New Mexico, United States
| | - Jorge Mera
- Cherokee Nation Health Services Cherokee Nation Health Services TahlequahOklahoma United States Cherokee Nation Health Services, Tahlequah, Oklahoma, United States
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