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Hall EW, Bradley H, Barker LK, Lewis KC, Shealey J, Valverde E, Sullivan P, Gupta N, Hofmeister MG. Estimating hepatitis C prevalence in the United States, 2017-2020. Hepatology 2024:01515467-990000000-00878. [PMID: 38739849 DOI: 10.1097/hep.0000000000000927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 05/02/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND AND AIMS The National Health and Nutrition Examination Survey (NHANES) underestimates the true prevalence of HCV infection. By accounting for populations inadequately represented in NHANES, we created 2 models to estimate the national hepatitis C prevalence among US adults during 2017-2020. APPROACH AND RESULTS The first approach (NHANES+) replicated previous methodology by supplementing hepatitis C prevalence estimates among the US noninstitutionalized civilian population with a literature review and meta-analysis of hepatitis C prevalence among populations not included in the NHANES sampling frame. In the second approach (persons who injected drugs [PWID] adjustment), we developed a model to account for the underrepresentation of PWID in NHANES by incorporating the estimated number of adult PWID in the United States and applying PWID-specific hepatitis C prevalence estimates. Using the NHANES+ model, we estimated HCV RNA prevalence of 1.0% (95% CI: 0.5%-1.4%) among US adults in 2017-2020, corresponding to 2,463,700 (95% CI: 1,321,700-3,629,400) current HCV infections. Using the PWID adjustment model, we estimated HCV RNA prevalence of 1.6% (95% CI: 0.9%-2.2%), corresponding to 4,043,200 (95% CI: 2,401,800-5,607,100) current HCV infections. CONCLUSIONS Despite years of an effective cure, the estimated prevalence of hepatitis C in 2017-2020 remains unchanged from 2013 to 2016 when using a comparable methodology. When accounting for increased injection drug use, the estimated prevalence of hepatitis C is substantially higher than previously reported. National action is urgently needed to expand testing, increase access to treatment, and improve surveillance, especially among medically underserved populations, to support hepatitis C elimination goals.
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Affiliation(s)
- Eric W Hall
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, Oregon, USA
| | - Heather Bradley
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Laurie K Barker
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Karon C Lewis
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jalissa Shealey
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Eduardo Valverde
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Patrick Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Neil Gupta
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Megan G Hofmeister
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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2
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Wurcel AG, Guardado R, Grussing ED, Koutoujian PJ, Siddiqi K, Senst T, Assoumou SA, Freund KM, Beckwith CG. Racial differences in testing for infectious diseases: An analysis of jail intake data. PLoS One 2023; 18:e0288254. [PMID: 38117818 PMCID: PMC10732427 DOI: 10.1371/journal.pone.0288254] [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: 12/05/2022] [Accepted: 06/11/2023] [Indexed: 12/22/2023] Open
Abstract
HIV and hepatitis C virus (HCV) testing for all people in jail is recommended by the CDC. In the community, there are barriers to HIV and HCV testing for minoritized people. We examined the relationship between race and infectious diseases (HIV, HCV, syphilis) testing in one Massachusetts jail, Middlesex House of Corrections (MHOC). This is a retrospective analysis of people incarcerated at MHOC who opted-in to infectious diseases testing between 2016-2020. Variables of interest were race/ethnicity, self-identified history of psychiatric illness, and ever having experienced restrictive housing. Twenty-three percent (1,688/8,467) of people who were incarcerated requested testing at intake. Of those, only 38% received testing. Black non-Hispanic (25%) and Hispanic people (30%) were more likely to request testing than white people (19%). Hispanic people (16%, AOR 1.69(1.24-2.29) were more likely to receive a test result compared to their white non-Hispanic (8%, AOR 1.54(1.10-2.15)) counterparts. Black non-Hispanic and Hispanic people were more likely to opt-in to and complete infectious disease testing than white people. These findings could be related to racial disparities in access to care in the community. Additionally, just over one-third of people who requested testing received it, underscoring that there is room for improvement in ensuring testing is completed. We hope our collaborative efforts with jail professionals can encourage other cross-disciplinary investigations.
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Affiliation(s)
- Alysse G. Wurcel
- Department of Medicine Tufts Medical Center, Division of Geographic Medicine and Infectious Diseases, Boston, MA, United States of America
- Tufts University School of Medicine, Boston, MA, United States of America
| | - Rubeen Guardado
- Department of Medicine Tufts Medical Center, Division of Geographic Medicine and Infectious Diseases, Boston, MA, United States of America
| | - Emily D. Grussing
- Department of Medicine Tufts Medical Center, Division of Geographic Medicine and Infectious Diseases, Boston, MA, United States of America
- Tufts University School of Medicine, Boston, MA, United States of America
| | | | - Kashif Siddiqi
- Middlesex Sheriff’s Office, Medford, MA, United States of America
| | - Thomas Senst
- Middlesex Sheriff’s Office, Medford, MA, United States of America
| | - Sabrina A. Assoumou
- Boston University School of Medicine, Boston, MA, United States of America
- Boston Medical Center, Boston, MA, United States of America
| | - Karen M. Freund
- Tufts University School of Medicine, Boston, MA, United States of America
- Department of Medicine, Tufts Medical Center, Boston, MA, United States of America
| | - Curt G. Beckwith
- The Miriam Hospital/Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
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3
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Huang CF, Chen GJ, Hung CC, Yu ML. HCV Microelimination for High-risk Special Populations. J Infect Dis 2023; 228:S168-S179. [PMID: 37703340 DOI: 10.1093/infdis/jiac446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023] Open
Abstract
The World Health Organization has set tremendous goals to eliminate viral hepatitis by 2030. However, most countries are currently off the track for achieving these goals. Microelimination is a more effective and practical approach that breaks down national elimination targets into goals for smaller and more manageable key populations. These key populations share the characteristics of being highly prevalent for and vulnerable to hepatitis C virus (HCV) infection. Microelimination allows for identifying HCV-infected people and linking them to care more cost-effectively and efficiently. In this review, we discuss the current obstacles to and progress in HCV microelimination in special populations, including uremic patients undergoing hemodialysis, people who inject drugs, incarcerated people, people living in hyperendemic areas, men who have sex with men with or without human immunodeficiency virus (HIV) infection, transgender and gender-diverse populations, and sex workers. Scaling up testing and treatment uptake to achieve HCV microelimination may facilitate global HCV elimination by 2030.
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Affiliation(s)
- Chung-Feng Huang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital and College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan
- PhD Program in Translational Medicine, College of Medicine, Kaohsiung Medical University, Academia Sinica, Kaohsiung, Taiwan
- Faculty of Internal Medicine and Hepatitis Research Center, College of Medicine, and Center for Cohort Study, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Guan-Jhou Chen
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College Medicine, Taipei, Taiwan
- Min-Sheng General Hospital, Taoyuan, Taiwan
| | - Chien-Ching Hung
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College Medicine, Taipei, Taiwan
- Department of Tropical Medicine and Parasitology, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
- Department of Medicine, China Medical University, Taichung, Taiwan
| | - Ming-Lung Yu
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital and College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan
- School of Medicine, College of Medicine and Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-sen University, Kaohsiung, Taiwan
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4
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Bhattacharya D, Aronsohn A, Price J, Lo Re V. Hepatitis C Guidance 2023 Update: AASLD-IDSA Recommendations for Testing, Managing, and Treating Hepatitis C Virus Infection. Clin Infect Dis 2023:ciad319. [PMID: 37229695 DOI: 10.1093/cid/ciad319] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 05/11/2023] [Accepted: 05/23/2023] [Indexed: 05/27/2023] Open
Abstract
The Infectious Diseases Society of America and the American Association for the Study of Liver Diseases have collaboratively developed evidence-based guidance regarding the diagnosis, management, and treatment of hepatitis C virus (HCV) infection since 2013. A panel of clinicians and investigators with extensive infectious diseases or hepatology expertise specific to HCV infection periodically review evidence from the field and update existing recommendations or introduce new recommendations as evidence warrants. This update focuses on changes to the guidance since the previous 2020 published update, including ongoing emphasis on recommended universal screening; management recommendations for incomplete treatment adherence; expanded eligibility for simplified chronic HCV infection treatment in adults with minimal monitoring; updated treatment and retreatment recommendations for children as young as 3 years old; management and treatment recommendations in the transplantation setting; and screening, treatment, and management recommendations for unique and key populations.
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Affiliation(s)
- Debika Bhattacharya
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA
| | - Andrew Aronsohn
- Department of Medicine, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago
| | - Jennifer Price
- Division of Medicine, Department of Gastroenterology and Hepatology, University of California, San Francisco
| | - Vincent Lo Re
- Department of Medicine, Division of Infectious Diseases and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine
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5
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Kamat S, Kondapalli S, Syed S, Price G, Danias G, Gorbenko K, Cantor J, Valera P, Shah AK, Akiyama MJ. Access to Hepatitis C Treatment during and after Incarceration in New Jersey, United States: A Qualitative Study. Life (Basel) 2023; 13:life13041033. [PMID: 37109562 PMCID: PMC10146294 DOI: 10.3390/life13041033] [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: 03/10/2023] [Revised: 04/08/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
Despite effective antiviral therapy for hepatitis C virus (HCV), people who are incarcerated and those returning to the community face challenges in obtaining HCV treatment. We aimed to explore facilitators and barriers to HCV treatment during and after incarceration. From July-November 2020 and June-July 2021, we conducted 27 semi-structured interviews with residents who were formerly incarcerated in jail or prison. The interviews were audio-recorded and professionally transcribed. We used descriptive statistics to characterize the study sample and analyzed qualitative data thematically using an iterative process. Participants included five women and 22 men who self-identified as White (n = 14), Latinx (n = 8), and Black (n = 5). During incarceration, a key facilitator was having sufficient time to complete HCV treatment, and the corresponding barrier was delaying treatment initiation. After incarceration, a key facilitator was connecting with reentry programs (e.g., halfway house or rehabilitation program) that coordinated the treatment logistics and provided support with culturally sensitive staff. Barriers included a lack of insurance coverage and higher-ranking priorities (e.g., managing more immediate reentry challenges such as other comorbidities, employment, housing, and legal issues), low perceived risk of harm related to HCV, and active substance use. Incarceration and reentry pose distinct facilitators and challenges to accessing HCV treatment. These findings signal the need for interventions to improve engagement in HCV care both during and after incarceration to assist in closing the gap of untreated people living with HCV.
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Affiliation(s)
- Samir Kamat
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | | | - Shumayl Syed
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Gabrielle Price
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - George Danias
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Ksenia Gorbenko
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Institute for Healthcare Delivery Science, Mount Sinai Health System, New York, NY 10016, USA
| | - Joel Cantor
- Center for State Health Policy, Rutgers University, New Brunswick, NJ 08901, USA
| | - Pamela Valera
- Department of Urban-Global Public Health, Rutgers University School of Public Health, Newark, NJ 07102, USA
- Community Health Justice Lab, Newark, NJ 07107, USA
| | - Aakash K Shah
- Department of Emergency Medicine, Department of Psychiatry and Behavioral Health, Hackensack Meridian School of Medicine, Nutley, NJ 07110, USA
| | - Matthew J Akiyama
- Department of Medicine, Divisions of General Internal Medicine and Infectious Disease, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
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6
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Hoff E, Warden A, Taylor R, Nijhawan AE. Hepatitis C Epidemiology in a Large Urban Jail: A Changing Demographic. Public Health Rep 2023; 138:248-258. [PMID: 35238249 PMCID: PMC10031839 DOI: 10.1177/00333549221076546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Abstract
OBJECTIVES Nearly 1 in 3 people with hepatitis C virus (HCV) infection pass through the criminal justice system annually; the system is a crucial location for HCV screening, education, and linkage to care. We aimed to (1) determine the prevalence and incidence of HCV antibody positivity and (2) evaluate the demographic characteristics of people with HCV in a large urban jail. METHODS We offered universal opt-out HCV testing to any person undergoing a routine blood test at the Dallas County Jail from June 2015 through December 2019 (N = 14 490). We extracted data on demographic characteristics from the electronic medical record and collected data on risk factors from people with HCV antibody positivity. We performed univariate and multivariate analyses. RESULTS The prevalence of HCV antibody positivity was 16.7%; the incidence was 13.5 cases per 1000 person-years. HCV antibody positivity was significantly associated with older age (P < .001), female sex (P = .004), non-Hispanic White race versus non-Hispanic Black race (P < .001), and being released to prison versus not (P < .001). Among people born after 1965, those who were HCV antibody-positive were more frequently non-Hispanic White and Hispanic women, whereas among those born in 1965 or before, those who were HCV antibody-positive were more frequently non-Hispanic Black men. CONCLUSIONS The high prevalence and incidence of HCV antibody positivity in a large county jail argue for routine, universal HCV testing and prevention counseling in criminal justice settings. Changing demographic characteristics mirror those of the national injection drug use epidemic and shed insight into designing interventions for risk reduction, education, linkage to care, and treatment.
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Affiliation(s)
- Emily Hoff
- Division of Infectious Diseases,
Department of Internal Medicine, University of Texas Southwestern Medical Center,
Dallas, TX, USA
| | - Andrea Warden
- Parkland Health and Hospital Systems,
Dallas, TX, USA
| | - Ruby Taylor
- Parkland Health and Hospital Systems,
Dallas, TX, USA
| | - Ank E. Nijhawan
- Division of Infectious Diseases,
Department of Internal Medicine, University of Texas Southwestern Medical Center,
Dallas, TX, USA
- Parkland Health and Hospital Systems,
Dallas, TX, USA
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7
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Busschots D, Kremer C, Bielen R, Koc ÖM, Heyens L, Nevens F, Hens N, Robaeys G. Hepatitis C prevalence in incarcerated settings between 2013–2021: a systematic review and meta-analysis. BMC Public Health 2022; 22:2159. [PMID: 36419013 PMCID: PMC9685883 DOI: 10.1186/s12889-022-14623-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 11/14/2022] [Indexed: 11/25/2022] Open
Abstract
Background The introduction of highly effective direct-acting antiviral therapy has changed the hepatitis C virus (HCV) treatment paradigm. However, a recent update on HCV epidemiology in incarcerated settings is necessary to accurately determine the extent of the problem, provide information to policymakers and public healthcare, and meet the World Health Organization's goals by 2030. This systematic review and meta-analysis were performed to determine the prevalence of HCV Ab and RNA in incarcerated settings. Methods For this systematic review and meta-analysis, we searched PubMed, Embase, Scopus, and Web of Science for papers published between January 2013 and August 2021. We included studies with information on the prevalence of HCV Ab or RNA in incarcerated settings. A random-effects meta-analysis was done to calculate the pooled prevalence and meta-regression to explore heterogeneity. Results Ninety-two unique sources reporting data for 36 countries were included. The estimated prevalence of HCV Ab ranged from 0.3% to 74.4%. HCV RNA prevalence (available in 46 sources) ranged from 0% to 56.3%. Genotypes (available in 19 sources) 1(a) and 3 were most frequently reported in incarcerated settings. HCV/HIV coinfection (available in 36 sources) was highest in Italy, Estonia, Pakistan, and Spain. Statistical analysis revealed that almost all observed heterogeneity reflects real differences in prevalence between studies, considering I2 was very high in the meta-analysis. Conclusions HCV in incarcerated settings is still a significant problem with a higher prevalence than in the general population. It is of utmost importance to start screening for HCV (Ab and RNA) in incarcerated settings to give clear, reliable and recent figures to plan further treatment. This is all in the context of meeting the 2030 WHO targets which are only less than a decade away. Trial registration PROSPERO: CRD42020162616 Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14623-6.
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8
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Kamis KF, Wyles DL, Minturn MS, Scott T, McEwen D, Hurley H, Prendergast SJ, Gunter J, Rowan SE. A retrospective, descriptive study of hepatitis C testing, prevalence, and care continuum among adults on probation. HEALTH & JUSTICE 2022; 10:26. [PMID: 35947313 PMCID: PMC9363270 DOI: 10.1186/s40352-022-00191-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/30/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Despite constituting the largest segment of the correctional population, individuals on court-ordered probation remain largely unstudied with respect to hepatitis C virus (HCV) testing and linkage-to-care. We conducted a retrospective, descriptive analysis to estimate prevalence of diagnosed HCV and the subsequent HCV care cascade among a cohort of individuals enrolled in an adult probation program over a 25-month period in Denver, Colorado. METHODS We utilized probabilistic matching with first and last name, sex, and birthdate to identify individuals enrolled in probation between July 1, 2016 and July 30, 2018 who had a medical record at the participating safety-net healthcare institution as of December 31, 2019. Electronic medical record data were queried for evidence of HCV testing and care through June 30, 2021. The state HCV registry was also queried for prevalence of reported HCV cases among the cohort. RESULTS This cohort included 8,903 individuals; 6,920 (78%) individuals had a medical record at the participating institution, and of these, 1,037 (15%) had ever been tested for HCV (Ab or RNA) and 308 (4% of those with a medical record, 30% of those tested) had detectable HCV RNA. Of these, 105 (34%) initiated HCV treatment, 89 (29%) had a subsequent undetectable HCV viral load, and 65 (21%) had documentation of HCV cure. Eleven percent of the total cohort had records of positive HCV Ab or RNA tests in the state HCV registry. CONCLUSIONS This study demonstrates the importance of HCV screening and linkage-to-care for individuals enrolled in probation programs. A focus on this population could enhance progress towards HCV elimination goals.
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Affiliation(s)
- Kevin F Kamis
- Public Health Institute at Denver Health, Denver Health and Hospital Authority, 601 Broadway, 8th floor, MC 2800, Denver, CO, 80203-3407, USA.
| | - David L Wyles
- Division of Infectious Diseases, Denver Health Medical Center and University of Colorado School of Medicine, Aurora, CO, USA
| | - Matthew S Minturn
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Tracy Scott
- LGBTQ+ Health Services, Denver Health and Hospital Authority, Denver, CO, USA
| | - Dean McEwen
- Public Health Institute at Denver Health, Denver Health and Hospital Authority, 601 Broadway, 8th floor, MC 2800, Denver, CO, 80203-3407, USA
| | - Hermione Hurley
- Public Health Institute at Denver Health, Denver Health and Hospital Authority, 601 Broadway, 8th floor, MC 2800, Denver, CO, 80203-3407, USA
- Division of Infectious Diseases, Denver Health Medical Center and University of Colorado School of Medicine, Aurora, CO, USA
- Center for Addiction Medicine, Denver Health and Hospital Authority, Denver, CO, USA
| | | | - Jessie Gunter
- Colorado Department of Public Health & Environment, Denver, CO, USA
| | - Sarah E Rowan
- Public Health Institute at Denver Health, Denver Health and Hospital Authority, 601 Broadway, 8th floor, MC 2800, Denver, CO, 80203-3407, USA.
- Division of Infectious Diseases, Denver Health Medical Center and University of Colorado School of Medicine, Aurora, CO, USA.
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Papaluca T, Craigie A, McDonald L, Edwards A, Winter R, Hoang A, Pappas A, Waldron A, McCoy K, Stoove M, Doyle J, Hellard M, Holmes J, MacIsaac M, Desmond P, Iser D, Thompson A. Care navigation increases initiation of hepatitis C treatment following release from prison in a prospective randomised controlled trial: The C-LINK Study. Open Forum Infect Dis 2022; 9:ofac350. [PMID: 35949401 PMCID: PMC9356682 DOI: 10.1093/ofid/ofac350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 07/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background Prison-based hepatitis C treatment is safe and effective; however, many individuals are released untreated due to time or resource constraints. On community re-entry, individuals face a number of immediate competing priorities, and in this context, linkage to hepatitis C care is low. Interventions targeted at improving healthcare continuity after prison release have yielded positive outcomes for other health diagnoses; however, data regarding hepatitis C transitional care are limited. Methods We conducted a prospective randomized controlled trial comparing a hepatitis C care navigator intervention with standard of care for individuals released from prison with untreated hepatitis C infection. The primary outcome was prescription of hepatitis C direct-acting antivirals (DAA) within 6 months of release. Results Forty-six participants were randomized. The median age was 36 years and 59% were male. Ninety percent (n = 36 of 40) had injected drugs within 6 months before incarceration. Twenty-two were randomized to care navigation and 24 were randomized to standard of care. Individuals randomized to the intervention were more likely to commence hepatitis C DAAs within 6 months of release (73%, n = 16 of 22 vs 33% n = 8 of 24, P < .01), and the median time between re-entry and DAA prescription was significantly shorter (21 days [interquartile range {IQR}, 11–42] vs 82 days [IQR, 44–99], P = .049). Conclusions Care navigation increased hepatitis C treatment uptake among untreated individuals released from prison. Public policy should support similar models of care to promote treatment in this high-risk population. Such an approach will help achieve hepatitis C elimination as a public health threat.
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Affiliation(s)
- T Papaluca
- Department of Gastroenterology, St Vincent’s Hospital and the University of Melbourne , Victoria , Australia
| | - A Craigie
- Department of Gastroenterology, St Vincent’s Hospital and the University of Melbourne , Victoria , Australia
| | - L McDonald
- Department of Gastroenterology, St Vincent’s Hospital and the University of Melbourne , Victoria , Australia
| | - A Edwards
- Department of Gastroenterology, St Vincent’s Hospital and the University of Melbourne , Victoria , Australia
| | - R Winter
- Department of Gastroenterology, St Vincent’s Hospital and the University of Melbourne , Victoria , Australia
- Burnet Institute , Melbourne, Victoria , Australia
| | - A Hoang
- Department of Gastroenterology, St Vincent’s Hospital and the University of Melbourne , Victoria , Australia
| | - A Pappas
- Department of Gastroenterology, St Vincent’s Hospital and the University of Melbourne , Victoria , Australia
| | - A Waldron
- Department of Gastroenterology, St Vincent’s Hospital and the University of Melbourne , Victoria , Australia
| | - K McCoy
- Department of Gastroenterology, St Vincent’s Hospital and the University of Melbourne , Victoria , Australia
| | - M Stoove
- Burnet Institute , Melbourne, Victoria , Australia
- Department of Epidemiology and Preventative Medicine, Monash University , Victoria , Australia
| | - J Doyle
- Burnet Institute , Melbourne, Victoria , Australia
- Department of Epidemiology and Preventative Medicine, Monash University , Victoria , Australia
- Department of Infectious Diseases, The Alfred and Monash University , Melbourne, Victoria , Australia
| | - M Hellard
- Burnet Institute , Melbourne, Victoria , Australia
- Department of Epidemiology and Preventative Medicine, Monash University , Victoria , Australia
- Department of Infectious Diseases, The Alfred and Monash University , Melbourne, Victoria , Australia
| | - J Holmes
- Department of Gastroenterology, St Vincent’s Hospital and the University of Melbourne , Victoria , Australia
| | - M MacIsaac
- Department of Gastroenterology, St Vincent’s Hospital and the University of Melbourne , Victoria , Australia
| | - P Desmond
- Department of Gastroenterology, St Vincent’s Hospital and the University of Melbourne , Victoria , Australia
| | - D Iser
- Department of Gastroenterology, St Vincent’s Hospital and the University of Melbourne , Victoria , Australia
| | - A Thompson
- Department of Gastroenterology, St Vincent’s Hospital and the University of Melbourne , Victoria , Australia
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10
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Jacka BP, Bazerman LB, Dickerson C, Moody M, Martin J, Patry E, Cady T, Compere H, Boudreau M, Beckwith CG. Feasibility of hepatitis C virus testing and linkage in community supervision offices: Great potential but persistent challenges. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 103:103668. [PMID: 35367903 PMCID: PMC9070602 DOI: 10.1016/j.drugpo.2022.103668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 03/16/2022] [Accepted: 03/18/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Persons involved with the justice system have an elevated risk of hepatitis C virus (HCV) yet remain marginalized from treatment. Efforts to eliminate HCV will require targeted interventions within the justice system effective at providing diagnosis and treatment. METHODS We implemented a novel HCV screening and treatment intervention for persons under community supervision in Rhode Island, USA during April 2018--March 2020. Participants received rapid point-of-care HCV antibody testing onsite and referral to community laboratory and treatment services as indicated. We assessed the HCV care cascade to identify areas for improvement. RESULTS Overall, 483 individuals were screened for HCV antibody; 85 (18%) were positive. A minority of participants with positive HCV antibody tests (n=25/85, 29%) presented to community laboratories for confirmatory testing. Among participants that received HCV viral load results and linked to a treatment provider (n=12), four initiated treatment, three had record of completing treatment, and two were confirmed to have achieved cure. CONCLUSION Linkage to HCV viral load testing and treatment was challenging in this community supervision population, with substantial loss to follow-up at each step of the HCV cascade. Community supervision remains an important venue for case identification but substantial barriers to accessing HCV treatment exist. Innovative HCV diagnosis and treatment strategies are needed for community supervision populations.
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Affiliation(s)
- Brendan P Jacka
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Laurie B Bazerman
- Division of Infectious Diseases, The Miriam Hospital, Providence, Rhode Island, USA
| | - Collin Dickerson
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Marc Moody
- Rhode Island Department of Corrections, Pawtucket, Rhode Island, USA
| | - Johanna Martin
- Division of Infectious Diseases, The Miriam Hospital, Providence, Rhode Island, USA
| | - Emily Patry
- Division of Infectious Diseases, The Miriam Hospital, Providence, Rhode Island, USA
| | - Treniece Cady
- Division of Infectious Diseases, The Miriam Hospital, Providence, Rhode Island, USA
| | - Hacheming Compere
- Division of Infectious Diseases, The Miriam Hospital, Providence, Rhode Island, USA
| | - Matthew Boudreau
- Division of Infectious Diseases, The Miriam Hospital, Providence, Rhode Island, USA
| | - Curt G Beckwith
- Division of Infectious Diseases, The Miriam Hospital, Providence, Rhode Island, USA; The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
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11
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Catlett B, Hajarizadeh B, Cunningham E, Wolfson-Stofko B, Wheeler A, Khandaker-Hussain B, Feld JJ, Martró E, Chevaliez S, Pawlotsky JM, Bharat C, Cunningham PH, Dore GJ, Applegate T, Grebely J. Diagnostic accuracy of assays using point-of-care testing or dried blood spot samples for the determination of HCV RNA: a systematic review. J Infect Dis 2022; 226:1005-1021. [PMID: 35150578 DOI: 10.1093/infdis/jiac049] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/10/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Fingerstick point-of-care and dried-blood-spot (DBS) HCV RNA testing increases testing uptake and linkage to care. This systematic review evaluated the diagnostic accuracy of point-of-care testing and DBS to detect HCV RNA. METHODS Bibliographic databases and conference presentations were searched for eligible studies. Meta-analysis was used to pool estimates. RESULTS Of 359 articles identified, 43 studies were eligible and included. When comparing the Xpert HCV Viral Load Fingerstick assay to venous blood samples (7 studies with 987 samples), the sensitivity and specificity for HCV RNA detection was 99% (95% CI:98%-100%) and 99% (95% CI:96%-100%) and for HCV RNA quantification was 100% (95% CI:93%-100%) and 100% (95% CI:94%-100%). The proportion of invalid results following Xpert HCV Viral Load Fingerstick testing was 6% (95% CI:3%-11%). When comparing DBS to venous blood samples (28 studies with 3988 samples), the sensitivity and specificity for HCV RNA detection was 97% (95% CI:95%-98%) and 100% (95% CI:98%-100%) and for HCV RNA quantification was 98% (95% CI:96%-99%) and 100% (95% CI:95%-100%). CONCLUSION Excellent diagnostic accuracy was observed across assays for detection of HCV RNA from fingerstick and DBS samples. The proportion of invalid results following Xpert HCV Viral Load Fingerstick testing highlights the importance of operator training and quality assurance programs.
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Affiliation(s)
- Beth Catlett
- The Kirby Institute, UNSW Sydney, Sydney, Australia.,St Vincent's Centre for Applied Medical Research, Sydney, Australia
| | | | | | - Brett Wolfson-Stofko
- Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Canada
| | | | | | - Jordan J Feld
- Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Canada
| | - Elisa Martró
- Microbiology Department, Laboratori Clínic Metropolitana Nord, Hospital Universitari Germans Trias I Pujol, Institut d'Investigació Germans Trias I Pujol (IGTP), Badalona (Barcelona), Spain.,Group 27, Biomedical Research Networking Centre in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Stéphane Chevaliez
- French National Reference Centre for viral hepatitis B, C and delta, Department of Virology, Hôpital Henri Mondor, Université Paris-Est, Créteil, France
| | - Jean-Michel Pawlotsky
- French National Reference Centre for viral hepatitis B, C and delta, Department of Virology, Hôpital Henri Mondor, Université Paris-Est, Créteil, France
| | - Chrianna Bharat
- National Drug and Alcohol Research Centre, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Philip H Cunningham
- The Kirby Institute, UNSW Sydney, Sydney, Australia.,St Vincent's Centre for Applied Medical Research, Sydney, Australia
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12
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Kamis KF, Wyles DL, Minturn MS, Scott T, McEwen D, Hurley H, Prendergast SJ, Rowan SE. Hepatitis C Testing and Linkage to Care Among Adults on Probation in a Large US City. Open Forum Infect Dis 2021; 9:ofab636. [PMID: 35111867 PMCID: PMC8802802 DOI: 10.1093/ofid/ofab636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 12/15/2021] [Indexed: 12/09/2022] Open
Abstract
Background Despite constituting the largest segment of the correctional population, individuals on probation remain largely unstudied with respect to hepatitis C virus (HCV) testing and linkage to care. We implemented an HCV testing and patient navigation program at an adult probation department. Methods Adults were tested at a local probation department with a rapid point-of-care HCV antibody (Ab) assay followed by a laboratory-based HCV ribonucleic acid (RNA) assay if anti-HCV positive. All individuals received counseling rooted in harm reduction principles. Individuals testing positive for HCV Ab were immediately linked to a patient navigator in person or via telephone. The patient navigator assisted patients through cure unless the patient was lost to follow-up. Study participation involved an optional survey and optional point-of-care human immunodeficiency virus test. Results Of 417 individuals tested, 13% were HCV Ab positive and 65% of those tested for HCV RNA (34 of 52) had detectable HCV RNA. Of the 14 individuals who linked to an HCV treatment provider, 4 completed treatment, as measured by pharmacy fill documentation in the electronic medical record, and 1 obtained sustained virologic response. One hundred ninety-three individuals tested for HIV; none tested positive. Conclusions The study cohort had a higher HCV seroprevalence than the general population (13% vs 2%), but linkage to care, completion of HCV treatment, and successful test-of-cure rates were all low. This study indicates that HCV disproportionately impacts adults on probation and prioritizing support for testing and linkage to care could improve health in this population. Colocalization of HCV treatment within probation programs would reduce the barrier of attending a new institution and could be highly impactful.
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Affiliation(s)
- Kevin F Kamis
- Public Health Institute at Denver Health, Denver Health and Hospital Authority, Denver, Colorado, USA
| | - David L Wyles
- Division of Infectious Diseases, Denver Health Medical Center and University of Colorado School of Medicine, Denver, Colorado, USA
| | - Matthew S Minturn
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Tracy Scott
- LGBTQ+ Health Services, Denver Health and Hospital Authority, Denver, Colorado, USA
| | - Dean McEwen
- Public Health Institute at Denver Health, Denver Health and Hospital Authority, Denver, Colorado, USA
| | - Hermione Hurley
- Public Health Institute at Denver Health, Denver Health and Hospital Authority, Denver, Colorado, USA
- Division of Infectious Diseases, Denver Health Medical Center and University of Colorado School of Medicine, Denver, Colorado, USA
- Center for Addiction Medicine, Denver Health and Hospital Authority, Denver, Colorado, USA
| | | | - Sarah E Rowan
- Public Health Institute at Denver Health, Denver Health and Hospital Authority, Denver, Colorado, USA
- Division of Infectious Diseases, Denver Health Medical Center and University of Colorado School of Medicine, Denver, Colorado, USA
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13
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Kronfli N, Dussault C, Bartlett S, Fuchs D, Kaita K, Harland K, Martin B, Whitten-Nagle C, Cox J. Disparities in hepatitis C care across Canadian provincial prisons: Implications for hepatitis C micro-elimination. CANADIAN LIVER JOURNAL 2021; 4:292-310. [PMID: 35992251 PMCID: PMC9202774 DOI: 10.3138/canlivj-2020-0035] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 11/26/2020] [Indexed: 04/06/2024]
Abstract
BACKGROUND Delivery of hepatitis C virus (HCV) care to people in prison is essential to HCV elimination. We aimed to describe current HCV care practices across Canada's adult provincial prisons. METHODS One representative per provincial prison health care team (except Ontario) was invited to participate in a web-based survey from January to June 2020. The outcomes of interest were HCV screening and treatment, treatment restrictions, and harm reduction services. The government ministry responsible for health care was determined. Non-nominal data were aggregated by province and ministry; descriptive statistical analyses were used to report outcomes. RESULTS The survey was completed by 59/65 (91%) prisons. On-demand, risk-based, opt-in, and opt-out screening are offered by 19 (32%), 10 (17%), 18 (31%), and 9 (15%) prisons, respectively; 3 prisons offer no HCV screening. Liver fibrosis assessments are rare (8 prisons access transient elastography, and 15 use aspartate aminotransferase to platelet ratio or Fibrosis-4); 20 (34%) prisons lack linkage to care programs. Only 32 (54%) prisons have ever initiated HCV treatment on site. Incarceration length and a fibrosis staging of ≥F2 are the most common eligibility restrictions for treatment. Opioid agonist therapy is available in 83% of prisons; needle and syringe programs are not available anywhere. Systematic screening and greater access to treatment and harm reduction services are more common where the Ministry of Health is responsible. CONCLUSIONS Tremendous variability exists in HCV screening and care practices across Canada's provincial prisons. To advance HCV care, adopting opt-out screening and removing eligibility restrictions may be important initial strategies.
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Affiliation(s)
- Nadine Kronfli
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University, Montreal, Quebec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Camille Dussault
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Sofia Bartlett
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Dennaye Fuchs
- ID Clinic, Saskatchewan Health Authority, Regina, Saskatchewan, Canada
| | - Kelly Kaita
- Department of Medicine, John Buhler Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kate Harland
- Centre for Research, Education and Clinical Care of At-Risk Populations, Saint John, New Brunswick, Canada
| | - Brandi Martin
- Department of Justice and Public Safety, Community and Correctional Services, Government of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - Cindy Whitten-Nagle
- Department of Justice and Public Safety, Adult Corrections, Government of Newfoundland and Labrador, St. John’s, Newfoundland and Labrador, Canada
| | - Joseph Cox
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University, Montreal, Quebec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
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Wurcel AG, Reyes J, Zubiago J, Koutoujian PJ, Burke D, Knox TA, Concannon T, Lemon SC, Wong JB, Freund KM, Beckwith CG, LeClair AM. "I'm not gonna be able to do anything about it, then what's the point?": A broad group of stakeholders identify barriers and facilitators to HCV testing in a Massachusetts jail. PLoS One 2021; 16:e0250901. [PMID: 34038430 PMCID: PMC8153419 DOI: 10.1371/journal.pone.0250901] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 04/15/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Despite national guidelines promoting hepatitis C virus (HCV) testing in prisons, there is substantial heterogeneity on the implementation of HCV testing in jails. We sought to better understand barriers and opportunities for HCV testing by interviewing a broad group of stakeholders involved in HCV testing and treatment policies and procedures in Massachusetts jails. METHODS We conducted semi-structured interviews with people incarcerated in Middlesex County Jail (North Billerica, MA), clinicians working in jail and community settings, corrections administrators, and representatives from public health, government, and industry between November 2018-April 2019. RESULTS 51/120 (42%) of people agreed to be interviewed including 21 incarcerated men (mean age 32 [IQR 25, 39], 60% non-White). Themes that emerged from these interviews included gaps in knowledge about HCV testing and treatment opportunities in jail, the impact of captivity and transience, and interest in improving linkage to HCV care after release. Many stakeholders discussed stigma around HCV infection as a factor in reluctance to provide HCV testing or treatment in the jail setting. Some stakeholders expressed that stigma often led decisionmakers to estimate a lower "worth" of incarcerated individuals living with HCV and therefore to decide against paying for HCV testing.". CONCLUSION All stakeholders agreed that HCV in the jail setting is a public health issue that needs to be addressed. Exploring stakeholders' many ideas about how HCV testing and treatment can be approached is the first step in developing feasible and acceptable strategies.
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Affiliation(s)
- Alysse G. Wurcel
- Division of Geographic Medicine and Infectious Diseases, Department of Medicine, Tufts Medical Center, Boston, MA, United States of America
- Tufts University School of Medicine, Boston, MA, United States of America
| | - Jessica Reyes
- Tufts University School of Medicine, Boston, MA, United States of America
| | - Julia Zubiago
- Division of Geographic Medicine and Infectious Diseases, Department of Medicine, Tufts Medical Center, Boston, MA, United States of America
| | | | - Deirdre Burke
- Division of Geographic Medicine and Infectious Diseases, Department of Medicine, Tufts Medical Center, Boston, MA, United States of America
| | - Tamsin A. Knox
- Tufts University School of Medicine, Boston, MA, United States of America
- Department of Medicine, Tufts Medical Center, Boston, MA, United States of America
| | - Thomas Concannon
- Department of Medicine, Tufts Medical Center, Boston, MA, United States of America
| | - Stephenie C. Lemon
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - John B. Wong
- Tufts University School of Medicine, Boston, MA, United States of America
- Department of Medicine, Tufts Medical Center, Boston, MA, United States of America
| | - Karen M. Freund
- Tufts University School of Medicine, Boston, MA, United States of America
- Department of Medicine, Tufts Medical Center, Boston, MA, United States of America
- Department of Medicine, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, United States of America
| | - Curt G. Beckwith
- Division of Infectious Diseases, Alpert Medical School of Brown University, The Miriam Hospital, Providence, Rhode Island, United States of America
| | - Amy M. LeClair
- Department of Medicine, Tufts Medical Center, Boston, MA, United States of America
- Department of Medicine, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, United States of America
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15
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Uusküla A, Talu A, Rannap J, Barnes DM, Jarlais DD. Rapid point-of-care (POC) testing for Hepatitis C antibodies in a very high prevalence setting: persons injecting drugs in Tallinn, Estonia. Harm Reduct J 2021; 18:39. [PMID: 33794927 PMCID: PMC8015736 DOI: 10.1186/s12954-021-00485-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 03/22/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Between December 2018 and January of 2019, we evaluated the accuracy of the point-of-care Hepatitis C (HCV) antibody test (POC; OraQuick HCV) used at a community-based needle and syringe exchange program serving persons who inject drugs in Tallinn, Estonia. METHODS We compared the results of screening for HCV antibodies by OraQuick (oral swab) and enzyme immunoassay (EIA; blood draw) and assessed test results implications in a high prevalence setting. Findings Of the 100 participants, 88 (88%) had reactive POC test results, and 93 were HCV antibody positive on EIA testing. Sensitivity, specificity and negative predictive value (NPV) for the POC assay with EIA as the relevant reference test were as follows: 94.6% (95% CI 90.0-99.2%), 100% and 58.3% (95% CI 30.4-86.2%). Of the 12 testing, HCV-negative with the POC only 7 (58.3%) were true negatives. CONCLUSIONS Oral swab rapid testing HCV screening in this nonclinical setting was sensitive and specific but had unacceptably low NPV. In high prevalence settings, POC tests with high sensitivity and that directly measure HCV RNA may be warranted.
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Affiliation(s)
- Anneli Uusküla
- Department of Family Medicine and Public Health, University of Tartu, Ravila 19, 50411, Tartu, Estonia.
| | - Ave Talu
- Department of Family Medicine and Public Health, University of Tartu, Ravila 19, 50411, Tartu, Estonia
| | - Jürgen Rannap
- Department of Family Medicine and Public Health, University of Tartu, Ravila 19, 50411, Tartu, Estonia
| | - David M Barnes
- School of Global Public Health, New York University, 665 Broadway, New York, NY, 10012, USA
| | - Don Des Jarlais
- School of Global Public Health, New York University, 665 Broadway, New York, NY, 10012, USA
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16
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Akiyama MJ, Ross J, Rimawi F, Fox A, Jordan AO, Wiersema J, Litwin AH, Kaba F, MacDonald R. Knowledge, attitudes, and acceptability of direct-acting antiviral hepatitis C treatment among people incarcerated in jail: A qualitative study. PLoS One 2020; 15:e0242623. [PMID: 33264311 PMCID: PMC7710033 DOI: 10.1371/journal.pone.0242623] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 11/03/2020] [Indexed: 01/27/2023] Open
Abstract
Introduction While U.S. jails are critical sites for engagement in HCV care, short lengths-of-stay often do not permit treatment in jail. Therefore, linkage to HCV care after incarceration is crucial. However, little is known about HCV treatment acceptability among justice-involved individuals in U.S. jails. The goal of this study was to understand knowledge, attitudes, and acceptability of HCV treatment among people living with HCV in the New York City (NYC) jail system. Methods We recruited 36 HCV-antibody-positive individuals in the NYC jails using clinical data reports and performed semi-structured interviews to explore participants’ attitudes toward HCV treatment in jail and following return to the community. We continued interviews until reaching thematic saturation and analyzed interviews using an inductive, thematic approach. Results Participants were mostly male, Latina/o, with a mean age of 40 years. Nearly all were aware they were HCV antibody-positive. Two thirds of participants had some awareness of the availability of new HCV therapies. Key themes included: 1) variable knowledge of new HCV therapies affecting attitudes toward HCV treatment, 2) the importance of other incarcerated individuals in communicating HCV-related knowledge, 3) vulnerability during incarceration and fear of treatment interruption, 4) concern for relapse to active drug use and HCV reinfection, 5) competing priorities (such as other medical comorbidities, ongoing substance use, and housing), 6) social support and the importance of family. Conclusions Patient-centered approaches to increase treatment uptake in jail settings should focus on promoting HCV-related knowledge including leveraging peers for knowledge dissemination. In addition, transitional care programs should ensure people living with HCV in jail have tailored discharge plans focused on competing priorities such as housing instability, social support, and treatment of substance use disorders.
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Affiliation(s)
- Matthew J. Akiyama
- Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, United States of America
- * E-mail:
| | - Jonathan Ross
- Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Fatimah Rimawi
- Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Aaron Fox
- Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Alison O. Jordan
- Correctional Health Services, New York City Health + Hospitals, New York, NY, United States of America
| | - Janet Wiersema
- Correctional Health Services, New York City Health + Hospitals, New York, NY, United States of America
| | - Alain H. Litwin
- Department of Medicine, University of South Carolina School of Medicine–Greenville, Greenville, South Carolina, United States of America
- Department of Medicine, Prisma Health, Greenville, South Carolina, United States of America
- Clemson University School of Health Research, Clemson, South Carolina, United States of America
| | - Fatos Kaba
- Correctional Health Services, New York City Health + Hospitals, New York, NY, United States of America
| | - Ross MacDonald
- Correctional Health Services, New York City Health + Hospitals, New York, NY, United States of America
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Hariri S, Sharafi H, Sheikh M, Merat S, Hashemi F, Azimian F, Tamadoni B, Ramazani R, Gouya MM, Abbasi B, Tashakorian M, Alasvand R, Alavian SM, Poustchi H, Malekzadeh R. Continuum of hepatitis C care cascade in prison and following release in the direct-acting antivirals era. Harm Reduct J 2020; 17:80. [PMID: 33081794 PMCID: PMC7576794 DOI: 10.1186/s12954-020-00431-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/13/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND People with criminal justice involvement contribute remarkably to the rising hepatitis C virus (HCV) burden; however, the continuum of care is a major barrier to prison-based programs. We aimed to evaluate a comprehensive HCV care model in an Iranian provincial prison. METHODS Between 2017-2018, in the Karaj Central Prison, newly admitted male inmates received HCV antibody testing and venipuncture for RNA testing (antibody-positive only). Participants with positive RNA underwent direct-acting antiviral (DAA) therapy (Sofosbuvir/Daclatasvir). Sustained virological response was evaluated at 12 weeks post-treatment (SVR12). RESULTS Overall, from 3485 participants, 182 (5.2%) and 117 (3.4%) tested positive for HCV antibody and RNA, respectively. Among 116 patients who were eligible for treatment, 24% (n = 28) were released before treatment and 72% (n = 83) initiated DAA therapy, of whom 81% (n = 67/83) completed treatment in prison, and the rest were released. Of total released patients, 68% (n = 30/44) were linked to care in community, and 70% (n = 21/30) completed treatment, including 60% (n = 12/20) and 90% (n = 9/10) among those who were released before and during treatment, respectively. The overall HCV treatment uptake and completion were 89% (n = 103/116) and 85% (n = 88/103), respectively. From people who completed treatment, 43% (n = 38/88) attended for response assessment and all were cured (SVR12 = 100%). CONCLUSIONS Integrated HCV care models are highly effective and can be significantly strengthened by post-release interventions. The close collaboration of community and prison healthcare systems is crucial to promote high levels of treatment adherence. Future studies should investigate the predictors of engagement with HCV care following release.
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Affiliation(s)
- Sanam Hariri
- Liver and Pancreatobiliary Diseases Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, N. Kargar St., 14117, Tehran, Iran
| | | | - Mahdi Sheikh
- Liver and Pancreatobiliary Diseases Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, N. Kargar St., 14117, Tehran, Iran
- Section of Genetics, International Agency for Research on Cancer, Lyon, France
| | - Shahin Merat
- Liver and Pancreatobiliary Diseases Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, N. Kargar St., 14117, Tehran, Iran
| | - Farnaz Hashemi
- Liver and Pancreatobiliary Diseases Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, N. Kargar St., 14117, Tehran, Iran
| | - Fatemeh Azimian
- Centre for Communicable Diseases Control, Ministry of Health and Medical Education, Tehran, Iran
| | - Babak Tamadoni
- Health and Treatment Directorate of Prisons and Security and Corrective Measures Organization, Tehran, Iran
| | - Rashid Ramazani
- Centre for Communicable Diseases Control, Ministry of Health and Medical Education, Tehran, Iran
| | - Mohammad Mehdi Gouya
- Centre for Communicable Diseases Control, Ministry of Health and Medical Education, Tehran, Iran
| | - Behzad Abbasi
- Liver and Pancreatobiliary Diseases Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, N. Kargar St., 14117, Tehran, Iran
| | - Mehrzad Tashakorian
- Health and Treatment Directorate of Prisons and Security and Corrective Measures Organization, Tehran, Iran
| | - Ramin Alasvand
- Health and Treatment Directorate of Prisons and Security and Corrective Measures Organization, Tehran, Iran
| | | | - Hossein Poustchi
- Liver and Pancreatobiliary Diseases Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, N. Kargar St., 14117, Tehran, Iran.
| | - Reza Malekzadeh
- Liver and Pancreatobiliary Diseases Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, N. Kargar St., 14117, Tehran, Iran
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18
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Kronfli N, Dussault C, Chalifoux S, Kavoukian H, Klein MB, Cox J. A randomized pilot study assessing the acceptability of rapid point-of-care hepatitis C virus (HCV) testing among male inmates in Montreal, Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 85:102921. [PMID: 32911319 DOI: 10.1016/j.drugpo.2020.102921] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/14/2020] [Accepted: 08/19/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The OraquickⓇ fingerprick point-of-care hepatitis C virus antibody (HCV-Ab) test is favoured to venipuncture among people who inject drugs; however, its acceptability in prison populations is unknown. We aimed to compare the acceptability of the OraquickⓇ versus standard venipuncture among people in prison. METHODS From October to December 2019, 280 sentenced male inmates at L'Établissement de Détention de Montréal (Quebec, Canada) were screened for participation, 150 excluded due to prior HCV screening, and 52 refused participation. The remaining 78 were randomized 1:1 to opt-out HCV-Ab screening with OraQuickⓇ or venipuncture (n = 39 each). Acceptability was determined by the proportion accepting to undergo screening. RESULTS The majority of participants (median age 33 years) reported a history of drug use (76%; 8% injection drug use); 47% perceived their HCV risk to be moderate/high. All inmates randomized to OraquickⓇ accepted testing while 87% accepted venipuncture. Among those who accepted OraquickⓇ vs. venipuncture, 100% vs. 97% were satisfied with the test, 97% vs. 94% would recommend the same test, and 100% vs. 76% would choose the same test again. CONCLUSION Adult incarcerated men in Canada were both more likely to accept OraquickⓇ compared to venipuncture, and to choose OraquickⓇ for future HCV screening.
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Affiliation(s)
- Nadine Kronfli
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University, Montreal, Quebec, Canada; Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.
| | - Camille Dussault
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Sylvie Chalifoux
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Hasmig Kavoukian
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Marina B Klein
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University, Montreal, Quebec, Canada; Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; CIHR Canadian HIV Trials Network, Vancouver, Canada
| | - Joseph Cox
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University, Montreal, Quebec, Canada; Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
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Hariri S, Sharafkhah M, Alavi M, Roshandel G, Fazel A, Amiriani T, Motamed-Gorji N, Bazazan A, Merat S, Poustchi H, Malekzadeh R. A simple risk-based strategy for hepatitis C virus screening among incarcerated people in a low- to middle-income setting. Harm Reduct J 2020; 17:56. [PMID: 32795371 PMCID: PMC7427767 DOI: 10.1186/s12954-020-00400-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/28/2020] [Indexed: 12/16/2022] Open
Abstract
Background Hepatitis C virus (HCV) is among the highest priority diseases in custodial settings; however, the diagnosis remains suboptimal among people in custody. This study aimed to validate a short survey for identifying people with HCV infection in a provincial prison in Iran. Methods Between July and December 2018, residents and newly admitted inmates of Gorgan central prison completed a questionnaire, including data on the history of HCV testing, drug use, injecting drug use, sharing injecting equipment, and imprisonment. Participants received rapid HCV antibody testing, followed by venipuncture for RNA testing (antibody-positive only). Each enrollment question (yes/no) was compared with the testing results (positive/negative). Results Overall, 1892 people completed the questionnaire, including 621 (34%) who were currently on opioid agonist therapy (OAT); 30% of participants had been tested for HCV previously. About 71% had a history of drug use, of whom 13% had ever injected drugs; 52% had ever shared injecting equipment. The prevalence of HCV antibody and RNA was 6.9% (n = 130) and 4.8% (n = 90), respectively. The antibody prevalence was higher among people on OAT compared to those with no history of OAT (11.4% vs. 4.0%). History of drug use was the most accurate predictor of having a positive HCV antibody (sensitivity: 95.2%, negative predictive value: 98.9%) and RNA testing (sensitivity: 96.7%, negative predictive value: 99.5%). The sensitivity of the drug use question was lowest among people with no OAT history and new inmates (87% and 89%, respectively). Among all participants, sensitivity and negative predictive value of the other questions were low and ranged from 34 to 54% and 94 to 97%, respectively. Conclusions In resource-limited settings, HCV screening based on having a history of drug use could replace universal screening in prisons to reduce costs. Developing tailored screening strategies together with further cost studies are crucial to address the current HCV epidemic in low- to middle-income countries.
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Affiliation(s)
- Sanam Hariri
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Sharafkhah
- Digestive Disease Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Alavi
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Gholamreza Roshandel
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Abdolreza Fazel
- Cancer Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Taghi Amiriani
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Nazgol Motamed-Gorji
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Abolfazl Bazazan
- Department of Health, Golestan State Prisons and Security and Corrective Measures Organization, Gorgan, Iran
| | - Shahin Merat
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Poustchi
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Reza Malekzadeh
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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20
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Kronfli N, Buxton JA, Jennings L, Kouyoumdjian F, Wong A. Hepatitis C virus (HCV) care in Canadian correctional facilities: Where are we and where do we need to be? CANADIAN LIVER JOURNAL 2019; 2:171-183. [PMID: 35992759 PMCID: PMC9202815 DOI: 10.3138/canlivj.2019-0007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 03/26/2019] [Indexed: 07/29/2023]
Abstract
Approximately 25% of people in Canadian correctional facilities have been previously exposed to hepatitis C virus (HCV). Despite being a high-prevalence setting, most Canadian prisons have thus far failed to engage the majority of those with chronic HCV infection in care. Several factors, including the lack of systematic screening programs, lack of on-site and trained health care personnel to improve access to care and treatment during incarceration, and the absence of standardized procedures needed to facilitate linkage to care following release likely contribute to poor engagement along the HCV care cascade for people in prison. HCV screening and engagement in care for people in prison can be improved through the implementation of universal opt-out screening upon admission and consideration of multidisciplinary care models for the provision of care. As well, the dissemination of prison-based needle and syringe programs to avert new HCV infections and re-infections should be considered. To meet the World Health Organization (WHO) 2030 HCV elimination goals, engaging researchers, clinicians and other health care providers, policy makers, correctional officials, and members of community in dialogue will be an essential first step going forward.
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Affiliation(s)
- Nadine Kronfli
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University, Montreal, Quebec, Canada
| | - Jane A Buxton
- BC Centre of Disease Control and School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lindsay Jennings
- Prisoners with HIV/AIDS Support Action Network, Toronto, Ontario, Canada
| | - Fiona Kouyoumdjian
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Alexander Wong
- Department of Medicine, University of Saskatchewan, Regina, Saskatchewan, Canada
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21
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Abe CM, Aguwa M, Zhao M, Sullivan J, Porsa E, Nijhawan AE. Hepatitis C Virus Infection in the Dallas County Jail: Implications for Screening, Prevention, and Linkage to Care. Public Health Rep 2019; 134:626-633. [PMID: 31530093 PMCID: PMC6832085 DOI: 10.1177/0033354919874081] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES Screening for hepatitis C virus (HCV) infection in jail provides an opportunity to educate and offer care to a high-risk population. We aimed to (1) estimate the prevalence of HCV infection in jail; (2) describe the demographic characteristics, risk factors, and pre-incarceration health insurance status associated with HCV infection; and (3) examine the implementation of HCV screening in jail. METHODS We conducted a retrospective analysis of an opt-out HCV screening program with HCV RNA confirmation and patient education at the Dallas County Jail from April 1 through November 2, 2017. We extracted data on test results, demographic characteristics, and release destination from electronic medical records. A nurse navigator recorded data on patient self-reported risk factors and pre-incarceration health insurance status. RESULTS Of 4089 incarcerated persons screened, 708 (17.3%) had a positive HCV antibody result. Of these, 641 (90.5%) had an HCV RNA test ordered; 576 (89.9%) had RNA tests completed, of whom 413 (71.7%) had a positive HCV RNA result. Of these 413, 352 (85.2%) received patient education. Half of HCV RNA-positive incarcerated persons (n = 207, 50.1%) were born outside the birth cohort (1945-1965). Among those with HCV infection, commonly reported risk factors were injection drug use (168 of 352; 47.8%) and tattoos (82 of 352; 23.4%). Most incarcerated persons with HCV infection (284 of 350; 81.1%) did not have health insurance. HCV antibody prevalence was higher among incarcerated persons released to prison (232 of 961; 24.1%) than to outside agencies (38 of 403; 9.4%) or the community (178 of 1026; 17.4%). CONCLUSIONS Screening for HCV with RNA confirmation in jail provides an opportunity for disease education, transmission prevention, and navigation to HCV treatment. Future efforts should examine post-incarceration linkage to care.
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Affiliation(s)
- Caroline M. Abe
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Michelle Zhao
- Parkland Health and Hospital Systems, Dallas, TX, USA
| | - Jacqueline Sullivan
- Office of Strategy and Integration, Parkland Health and Hospital System,
Dallas, TX, USA
| | - Esmaeil Porsa
- Office of Strategy and Integration, Parkland Health and Hospital System,
Dallas, TX, USA
| | - Ank E. Nijhawan
- Division of Infectious Diseases, Department of Internal Medicine, University
of Texas Southwestern Medical Center, Dallas, TX, USA
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22
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Litwin AH, Drolet M, Nwankwo C, Torrens M, Kastelic A, Walcher S, Somaini L, Mulvihill E, Ertl J, Grebely J. Perceived barriers related to testing, management and treatment of HCV infection among physicians prescribing opioid agonist therapy: The C-SCOPE Study. J Viral Hepat 2019; 26:1094-1104. [PMID: 31074167 PMCID: PMC6771477 DOI: 10.1111/jvh.13119] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/18/2019] [Accepted: 04/09/2019] [Indexed: 12/15/2022]
Abstract
The aim of this analysis was to evaluate perceived barriers related to HCV testing, management and treatment among physicians practicing in clinics offering opioid agonist treatment (OAT). C-SCOPE was a study consisting of a self-administered survey among physicians practicing at clinics providing OAT in Australia, Canada, Europe and the United States between April and May 2017. A 5-point Likert scale (1 = not a barrier, 3 = moderate barrier, 5 = extreme barrier) was used to measure responses to perceived barriers for HCV testing, evaluation and treatment across the domains of the health system, clinic and patient. Among the 203 physicians enrolled (40% USA, 45% Europe, 14% Australia/Canada), 21% were addiction medicine specialists, 29% psychiatrists and 69% were metro/urban. OAT physicians in this study reported poor access to on-site venepuncture (35%), point-of-care HCV testing (16%), and noninvasive liver disease assessment (25%). Only 30% of OAT physicians reported personally treating HCV infection. Major perceived health system barriers to HCV management included the lack of funding for noninvasive liver disease testing, long wait times to see an HCV specialist, lack of funding for new HCV therapies, and reimbursement restrictions based on drug/alcohol use. Major perceived clinic barriers included the lack of peer support programmes and/or HCV case managers to facilitate linkage to care, the need to refer people off-site for noninvasive liver disease staging, the lack of support for on-site phlebotomy and the lack of on-site delivery of HCV therapy. This study highlights several important modifiable barriers to enhance HCV testing, evaluation and treatment among PWID attending OAT clinics.
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Affiliation(s)
- Alain H. Litwin
- Department of MedicineUniversity of South Carolina School of Medicine ‐ Greenville and Prisma HealthGreenvilleSouth Carolina,Clemson University School of Health ResearchClemsonSouth Carolina
| | | | | | - Martha Torrens
- Department of PsychiatryInstitut de Neuropsiquiatria i AddiccionsHospital del Mar BarcelonaIMIM (Institut Hospital del Mar d'Investigacions Mediques)Universitat Autònoma de BarcelonaBarcelonaSpain
| | - Andrej Kastelic
- National Centre for the Treatment of Drug Addiction in LjubljanaLjubljanaSlovenia
| | | | - Lorenzo Somaini
- Addiction Treatment Centre ‐ Ser.D ASL BI ‐ Local Health UnitBiellaItaly
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Akiyama MJ, Columbus D, MacDonald R, Jordan AO, Schwartz J, Litwin AH, Eckhardt B, Carmody E. Linkage to hepatitis C care after incarceration in jail: a prospective, single arm clinical trial. BMC Infect Dis 2019; 19:703. [PMID: 31395019 PMCID: PMC6686449 DOI: 10.1186/s12879-019-4344-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 07/31/2019] [Indexed: 12/13/2022] Open
Abstract
Background Hepatitis C virus (HCV) is a major public health problem in correctional settings. HCV treatment is often not possible in U.S. jails due to short lengths of stay. Linkage to care is crucial in these settings, but competing priorities complicate community healthcare engagement and retention after incarceration. Methods We conducted a single arm clinical trial of a combined transitional care coordination (TCC) and patient navigation intervention and assessed the linkage rate and factors associated with linkage to HCV care after incarceration. Results During the intervention, 84 participants returned to the community after their index incarceration. Most participants were male and Hispanic, with a history of mental illness and a mean age of 45 years. Of those who returned to the community, 26 (31%) linked to HCV care within a median of 20.5 days; 17 (20%) initiated HCV treatment, 15 (18%) completed treatment, 9 (11%) had a follow-up lab drawn to confirm sustained virologic response (SVR), and 7 (8%) had a documented SVR. Among those with follow-up labs the known SVR rate was (7/9) 78%. Expressing a preference to be linked to the participant’s existing health system, being on methadone prior to incarceration, and feeling that family or a loved one were concerned about the participant’s wellbeing were associated with linkage to HCV care. Reporting drinking alcohol to intoxication prior to incarceration was negatively associated with linkage to HCV care. Conclusion We demonstrate that an integrated strategy with combined TCC and patient navigation may be effective in achieving timely linkage to HCV care. Additional multicomponent interventions aimed at treatment of substance use disorders and increasing social support could lead to further improvement. Trial registration Clinicaltrials.gov NCT04036760 July 30th, 2019 (retrospectively registered).
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Affiliation(s)
- Matthew J Akiyama
- Montefiore Medical Center/Albert Einstein College of Medicine, 3300 Kossuth Ave, Bronx, NY, 10467, USA. .,New York University School of Medicine, New York, NY, USA.
| | - Devin Columbus
- New York University School of Medicine, New York, NY, USA
| | - Ross MacDonald
- New York City Health + Hospitals, Correctional Health Services, New York, NY, USA
| | - Alison O Jordan
- New York City Health + Hospitals, Correctional Health Services, New York, NY, USA
| | - Jessie Schwartz
- New York City Department of Health and Mental Hygiene, Queens, NY, USA
| | - Alain H Litwin
- University of South Carolina School of Medicine, Greenville, South Carolina, USA.,Clemson University School of Health Research, Clemson, South Carolina, USA.,Prisma Health - Upstate, Greenville, South Carolina, USA
| | | | - Ellie Carmody
- New York University School of Medicine, New York, NY, USA
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24
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Williams N, Bossert N, Chen Y, Jaanimägi U, Markatou M, Talal AH. Influence of social determinants of health and substance use characteristics on persons who use drugs pursuit of care for hepatitis C virus infection. J Subst Abuse Treat 2019; 102:33-39. [PMID: 31202286 PMCID: PMC10530640 DOI: 10.1016/j.jsat.2019.04.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 04/21/2019] [Accepted: 04/22/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Social determinants of health (SDOH), i.e., social, behavioral and environmental factors, are increasingly recognized for their important influence on health outcomes. Data are limited on the influence of SDOH, substance use characteristics, and their interactions on pursuit of hepatitis C virus (HCV) care among individuals with opioid use disorder (OUD). Linkage to HCV care remains low in this population despite high HCV prevalence and incidence. AIMS To investigate the influence of SDOH, substance use factors, and their interactions on HCV treatment uptake among OUD patients in a methadone treatment program. METHODS Information on patient demographics, SDOH, substance use characteristics, and co-morbid medical conditions were obtained from the paper and electronic medical records of OUD patients on methadone. We applied multiple correspondence analysis, k-means algorithm, and logistic regression with least absolute shrinkage and selection operator penalty to identify variables and clusters associated with pursuit of HCV care. RESULTS Data from 161 patients (57% male, 60% Caucasian, mean age 45 years) were evaluated. Being employed, the absence of support systems, and a history of foster care were the strongest positive predictors of treatment pursuit. The use of crack/cocaine as the initial illicit substance, criminal activity without incarceration, and the absence of a family history of chemical dependency were the strongest negative predictors. We identified clusters among persons with OUD based upon their likelihood to pursue HCV management. CONCLUSION Utilizing data from the medical record, we were able to identify factors positively and negatively associated with linkage-to-care for HCV. We were also able to divide patients into clusters of factors associated with linkage-to-care for HCV. These results could be used to identify individuals with OUD based upon their readiness for HCV care.
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Affiliation(s)
- Narissa Williams
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University at Buffalo, Buffalo, NY, USA
| | - Nicholas Bossert
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University at Buffalo, Buffalo, NY, USA
| | - Yang Chen
- Department of Biostatistics, University at Buffalo, Buffalo, NY, USA.
| | - Urmo Jaanimägi
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University at Buffalo, Buffalo, NY, USA
| | | | - Andrew H Talal
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University at Buffalo, Buffalo, NY, USA.
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25
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Harrison GI, Murray K, Gore R, Lee P, Sreedharan A, Richardson P, Hughes AJ, Wiselka M, Gelson W, Unitt E, Ratcliff K, Orton A, Trinder K, Simpson C, Ryder SD, Oelbaum S, Foster GR, Christian A, Smith S, Thomson BJ, Reynolds R, Harris M, Hickman M, Irving WL. The Hepatitis C Awareness Through to Treatment (HepCATT) study: improving the cascade of care for hepatitis C virus-infected people who inject drugs in England. Addiction 2019; 114:1113-1122. [PMID: 30694582 DOI: 10.1111/add.14569] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 09/17/2018] [Accepted: 01/24/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND AND AIMS Previous studies have shown low rates of diagnosis and treatment of hepatitis C virus (HCV) infection in people who inject drugs (PWID). Our aims were to test the effect of a complex intervention [Hepatitis C Awareness Through to Treatment (HepCATT)] in drug and alcohol clinics-primarily, on engagement of HCV-positive PWID with therapy and, secondarily, on testing for HCV, referral to hepatology services and start of HCV treatment. DESIGN AND SETTING A non-randomized pilot study in three specialist addiction clinics in England comparing an intervention year (starting between September 2015 and February 2016) with a baseline year (2014), together with three control clinics. PARTICIPANTS Analysis included all attendees at the intervention and control specialist addiction clinics identified as PWID. INTERVENTION The intervention comprised the placement of a half-time facilitator in each clinic for 12 months with the brief to increase diagnosis of HCV infection within clients at those services and the engagement of diagnosed individuals with an appropriate care pathway. The facilitator undertook various activities, which could include training of key workers, direct interaction with clients, streamlining and support for hepatology appointments and introduction of dried blood-spot testing. MEASUREMENTS For each clinic and period, we obtained the total number of clients and, as relevant, their status as PWID, tested for HCV, known HCV-positive, engaged with HCV therapy or treated. FINDINGS Compared with baseline, there was strong evidence that engagement with HCV therapy in the intervention year increased (P < 0.001) more in the HepCATT centres than controls, up + 31 percentage points [95% confidence interval (CI) = 19-43] versus -12 (CI = -31 to + 6) and odds ratio (OR) = 9.99 (CI = 4.42-22.6) versus 0.35 (CI = 0.08-1.56). HepCATT centres also had greater increases in HCV testing (OR = 3.06 versus 0.78, P < 0.001), referral to hepatology (OR = 9.60 versus 0.56, P < 0.001) and treatment initiation (OR = 9.5 versus 0.74, P < 0.001). CONCLUSIONS Introducing a half-time facilitator into drug and alcohol clinics in England increased engagement of HCV-positive people who inject drugs with hepatitis C virus care pathways, with increased uptake also of testing, referral to hepatology and initiation of treatment.
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Affiliation(s)
- Graham I Harrison
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - Karen Murray
- United Lincolnshire Hospitals Lincoln County Hospital, Lincoln, UK
| | - Roxanne Gore
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | | | | | - Paul Richardson
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | | | - Martin Wiselka
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Will Gelson
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
| | - Esther Unitt
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | | | | | | | | | | | | | | | | | | | | | - Rosy Reynolds
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Magdalena Harris
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Matthew Hickman
- Population Health Sciences, University of Bristol, Bristol, UK
| | - William L Irving
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
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26
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Williams B, Howell J, Doyle J, Thompson AJ, Draper B, Layton C, Latham N, Bramwell F, Membrey D, Mcpherson M, Roney J, Stoové M, Hellard ME, Pedrana A. Point-of-care hepatitis C testing from needle and syringe programs: An Australian feasibility study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 72:91-98. [PMID: 31129023 DOI: 10.1016/j.drugpo.2019.05.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 05/10/2019] [Accepted: 05/11/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Achieving hepatitis C elimination requires novel approaches to engage people at highest risk of infection into care pathways. Point-of-care-tests may help to overcome some of the barriers preventing people who inject drugs (PWID) accessing testing and progressing to treatment for hepatitis C virus (HCV). We assessed the feasibility and acceptability of HCV point-of-care testing at needle and syringe exchange programs (NSPs) co-located in three community health clinics in Melbourne, Australia. METHODS NSP clients were offered an oral fluid point-of-care test for HCV antibody by NSP staff. Positive HCV antibody tests were followed by a point-of-care test for HCV RNA alongside standard-of-care laboratory testing for hepatitis C treatment work-up. Participants were offered same-day point-of-care results on site, via phone or text message, or upon return to the service. Participants were scheduled for follow-up review with the study nurse for assessment and linkage to treatment. RESULTS A total of 174 participants completed HCV antibody point-of-care test; 150 (86%) had a reactive result. Of these, 140 (93%) underwent a HCV RNA point-of-care test and 76 (54%) tested positive; few participants (5%) waited on site for results delivery, but the majority of RNA positive (63%) attended a follow-up visit for treatment work-up (median time to follow-up visit = 11 days; IQR = 7-20 days). The majority of participants reported a preference for point-of-care tests (66%) and supported NSP staff involvement in testing (90%). CONCLUSION Provision of HCV point-of-care tests, follow-up and linkage to treatment services through NSPs was feasible and acceptable to PWID. Despite few participants waiting to receive same-day results, there was effective linkage to care, suggesting value in further evaluation of this approach.
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Affiliation(s)
- Bridget Williams
- Disease Elimination Program, Burnet Institute, Melbourne, Australia.
| | - Jessica Howell
- Disease Elimination Program, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Department of Gastroenterology, St Vincent's Hospital, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Joseph Doyle
- Disease Elimination Program, Burnet Institute, Melbourne, Australia; Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Australia
| | - Alexander J Thompson
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Bridget Draper
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
| | - Chloe Layton
- Cohealth, General Practice, Melbourne, Australia
| | - Ned Latham
- Disease Elimination Program, Burnet Institute, Melbourne, Australia; Department of Infectious Diseases, Monash University, Melbourne, Australia
| | | | - Dean Membrey
- Cohealth, General Practice, Melbourne, Australia
| | - Maggie Mcpherson
- North Richmond Community Health, General Practice, Melbourne, Australia
| | - Janine Roney
- Department of Infectious Diseases, The Alfred, Melbourne, Australia
| | - Mark Stoové
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
| | - Margaret E Hellard
- Disease Elimination Program, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Australia
| | - Alisa Pedrana
- Disease Elimination Program, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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27
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Strickland JC, Staton M, Leukefeld CG, Oser CB, Webster JM. Hepatitis C antibody reactivity among high-risk rural women: opportunities for services and treatment in the criminal justice system. Int J Prison Health 2019; 14:89-100. [PMID: 29869584 DOI: 10.1108/ijph-03-2017-0012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Purpose The purpose of this paper is to examine the drug use and criminal justice factors related to hepatitis C virus (HCV) antibody reactivity among rural women in the USA recruited from local jails. Design/methodology/approach Analyses included 277 women with a history of injection drug use from three rural jails in Kentucky. Participants completed health and drug use questionnaires and received antibody testing for HCV. Findings The majority of women tested reactive to the HCV antibody (69 percent). Reactivity was associated with risk factors, such as unsterile needle use. Criminal justice variables, including an increased likelihood of prison incarceration, an earlier age of first arrest, and a longer incarceration history, were associated with HCV reactive tests. Participants also endorsed several barriers to seeking healthcare before entering jail that were more prevalent in women testing HCV reactive regardless of HCV status awareness before entering jail. Originality/value Injection and high-risk sharing practices as well as criminal justice factors were significantly associated with HCV reactivity. Future research and practice could focus on opportunities for linkages to HCV treatment during incarceration as well as during community re-entry to help overcome real or perceived treatment barriers. The current study highlights the importance of the criminal justice system as a non-traditional, real-world setting to examine drug use and related health consequences such as HCV by describing the association of high-risk drug use and criminal justice consequences with HCV among rural women recruited from local jails.
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Affiliation(s)
- Justin C Strickland
- Department of Psychology, College of Arts and Sciences, University of Kentucky , Lexington, Kentucky, USA
| | - Michele Staton
- Department of Behavioral Science, College of Medicine, University of Kentucky , Lexington, Kentucky, USA.,Center on Drug and Alcohol Research, University of Kentucky , Lexington, Kentucky, USA
| | - Carl G Leukefeld
- Department of Behavioral Science, College of Medicine, University of Kentucky , Lexington, Kentucky, USA.,Center on Drug and Alcohol Research, University of Kentucky , Lexington, Kentucky, USA
| | - Carrie B Oser
- Center on Drug and Alcohol Research, University of Kentucky , Lexington, Kentucky, USA.,Department of Sociology, College of Arts and Sciences, University of Kentucky , Lexington, Kentucky, USA
| | - J Matthew Webster
- Department of Behavioral Science, College of Medicine, University of Kentucky , Lexington, Kentucky, USA.,Center on Drug and Alcohol Research, University of Kentucky , Lexington, Kentucky, USA
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28
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Day E, Hellard M, Treloar C, Bruneau J, Martin NK, Øvrehus A, Dalgard O, Lloyd A, Dillon J, Hickman M, Byrne J, Litwin A, Maticic M, Bruggmann P, Midgard H, Norton B, Trooskin S, Lazarus JV, Grebely J. Hepatitis C elimination among people who inject drugs: Challenges and recommendations for action within a health systems framework. Liver Int 2019; 39:20-30. [PMID: 30157316 PMCID: PMC6868526 DOI: 10.1111/liv.13949] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 08/22/2018] [Accepted: 08/24/2018] [Indexed: 12/19/2022]
Abstract
The burden of hepatitis C infection is considerable among people who inject drugs (PWID), with an estimated prevalence of 39%, representing an estimated 6.1 million people who have recently injected drugs living with hepatitis C infection. As such, PWID are a priority population for enhancing prevention, testing, linkage to care, treatment and follow-up care in order to meet World Health Organization (WHO) hepatitis C elimination goals by 2030. There are many barriers to enhancing hepatitis C prevention and care among PWID including poor global coverage of harm reduction services, restrictive drug policies and criminalization of drug use, poor access to health services, low hepatitis C testing, linkage to care and treatment, restrictions for accessing DAA therapy, and the lack of national strategies and government investment to support WHO elimination goals. On 5 September 2017, the International Network of Hepatitis in Substance Users (INHSU) held a roundtable panel of international experts to discuss remaining challenges and future priorities for action from a health systems perspective. The WHO health systems framework comprises six core components: service delivery, health workforce, health information systems, medical procurement, health systems financing, and leadership and governance. Communication has been proposed as a seventh key element which promotes the central role of affected community engagement. This review paper presents recommended strategies for eliminating hepatitis C as a major public health threat among PWID and outlines future priorities for action within a health systems framework.
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Affiliation(s)
- Emma Day
- Australasian Society for HIV, Viral Hepatitis, and Sexual
Health Medicine, Sydney, New South Wales, Australia
| | - Margaret Hellard
- Disease Elimination Program, Burnet Institute, Melbourne,
Victoria, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney,
New South Wales, Australia
| | - Julie Bruneau
- CHUM Research Centre (CRCHUM), Centre Hospitalier de
l’Université de Montréal, Montréal, Canada
| | - Natasha K Martin
- Division of Global Public Health, University of California,
San Diego, California, United States
| | - Anne Øvrehus
- Department of Infectious Diseases, Odense University
Hospital, Denmark
| | - Olav Dalgard
- Department of Infectious Diseases, Akershus University
Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Andrew Lloyd
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales,
Australia
| | - John Dillon
- Division of Molecular and Clinical Medicine, School of
Medicine, University of Dundee, Dundee, United Kingdom
| | - Matt Hickman
- Population Health Sciences, Bristol Medical School,
University of Bristol, Bristol, United Kingdom
| | - Jude Byrne
- Australian Injecting & Illicit Drug Users League,
Canberra, Australian Capital Territory, Australia
| | - Alain Litwin
- Division of General Internal Medicine, Albert Einstein
College of Medicine, Montefiore Medical Center, New York, United States
| | - Mojca Maticic
- Clinic for Infectious Diseases and Febrile Illnesses,
University Medical Centre Ljubljana, and Faculty of Medicine, University of
Ljubljana, Ljubljana, Slovenia
| | | | - Havard Midgard
- Department of Gastroenterology, Oslo University Hospital,
Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Brianna Norton
- Division of General Internal Medicine, Albert Einstein
College of Medicine, Montefiore Medical Center, New York, United States
| | - Stacey Trooskin
- Philadelphia FIGHT, Philadelphia, Pennsylvania, United
States
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal),
Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales,
Australia
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Moazen B, Saeedi Moghaddam S, Silbernagl MA, Lotfizadeh M, Bosworth RJ, Alammehrjerdi Z, Kinner SA, Wirtz AL, Bärnighausen TW, Stöver HJ, Dolan KA. Prevalence of Drug Injection, Sexual Activity, Tattooing, and Piercing Among Prison Inmates. Epidemiol Rev 2018; 40:58-69. [PMID: 29860343 DOI: 10.1093/epirev/mxy002] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 01/17/2018] [Indexed: 12/14/2022] Open
Abstract
Prisoners engage in a range of risk behaviors that can lead to the transmission of viral infections, such as HIV, hepatitis B and hepatitis C. In this review, we summarize the epidemiologic literature from 2007 to 2017 on 4 key risk behaviors for human immunodeficiency virus and hepatitis C virus among prisoners globally: drug injection, sexual activity, tattooing, and piercing. Of 9,303 peer-reviewed and 4,150 gray literature publications, 140 and 14, respectively, met inclusion criteria covering 53 countries (28%). Regions with high levels of injection drug use were Asia Pacific (20.2%), Eastern Europe and Central Asia (17.3%), and Latin America and the Caribbean (11.3%), although the confidence interval for Latin America was high. Low levels of injection drug use in prison were found in African regions. The highest levels of sexual activity in prison were in Europe and North America (12.1%) and West and Central Africa (13.6%); low levels were reported from the Middle East and North African regions (1.5%). High levels of tattooing were reported from Europe and North America (14.7%), Asia Pacific (21.4%), and Latin America (45.4%). Prisons are burdened with a high prevalence of infectious diseases and risk behaviors for transmission of these diseases, and, commonly, a striking lack of evidence-based infection control measures, even when such measures are available in the surrounding community. Given that most prisoners return to these communities, failure to implement effective responses has repercussions not only prisoner health but also for public health.
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Affiliation(s)
- Babak Moazen
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Institute of Public Health, University of Heidelberg, Heidelberg, Germany
| | - Sahar Saeedi Moghaddam
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Masoud Lotfizadeh
- Social Determinants of Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran.,Department of Community Health, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Rebecca J Bosworth
- Program of International Research and Training, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Zahra Alammehrjerdi
- Program of International Research and Training, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Stuart A Kinner
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - Andrea L Wirtz
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Till W Bärnighausen
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Heino J Stöver
- Department of Health and Social Work, Institute of Addiction Research
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Tavoschi L, Vroling H, Madeddu G, Babudieri S, Monarca R, Vonk Noordegraaf-Schouten M, Beer N, Gomes Dias J, O’Moore É, Hedrich D, Oordt-Speets A. Active Case Finding for Communicable Diseases in Prison Settings: Increasing Testing Coverage and Uptake Among the Prison Population in the European Union/European Economic Area. Epidemiol Rev 2018; 40:105-120. [PMID: 29648594 PMCID: PMC5982719 DOI: 10.1093/epirev/mxy001] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 12/15/2017] [Accepted: 12/15/2017] [Indexed: 12/16/2022] Open
Abstract
Prison populations are disproportionally affected by communicable diseases when compared with the general community because of a complex mix of socioeconomic determinants and environmental factors. Tailored and adequate health care provision in prisons has the potential to reach vulnerable and underserved groups and address their complex needs. We investigated the available evidence on modalities and effectiveness of active case-finding interventions in prisons by searching PubMed, Embase, and the Cochrane Library for records on prison and active case finding with no language limit. Conference abstracts and unpublished research reports also were retrieved. We analyzed the findings by testing modality, outcomes, and study quality. The included 90 records-63 peer-reviewed, 26 from gray literature, and 1 systematic review-reported variously on viral hepatitis, human immunodeficiency virus, sexually transmitted infections, and tuberculosis. No records were retrieved for other communicable diseases. Provider-initiated opt-in testing was the most frequently investigated modality. Testing at entry and provider-initiated testing were reported to result in comparatively higher uptake ranges. However, no comparative studies were identified that reported statistically significant differences between testing modalities. Positivity rates among tested inmates ranged broadly but were generally high for all diseases. The evidence on active case finding in correctional facilities is limited, heterogeneous, and of low quality, making it challenging to draw conclusions on the effect of different testing modalities. Scale-up of provider-initiated testing in European correctional facilities could substantially reduce the undiagnosed fraction and, hence, prevent additional disease transmission in both prison settings and the community at large.
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Affiliation(s)
- Lara Tavoschi
- Surveillance and Response Unit, European Centre for Disease Prevention and Control, Solna, Sweden
| | - Hilde Vroling
- Pallas, Health Research and Consultancy B.V., Rotterdam, the Netherlands
| | - Giordano Madeddu
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Sergio Babudieri
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Roberto Monarca
- Health Without Barriers – European Federation for Prison Health, Viterbo, Italy
| | | | - Netta Beer
- Surveillance and Response Unit, European Centre for Disease Prevention and Control, Solna, Sweden
| | - Joana Gomes Dias
- Surveillance and Response Unit, European Centre for Disease Prevention and Control, Solna, Sweden
| | - Éamonn O’Moore
- Department of Health & Justice, Public Health England, London, UK
| | - Dagmar Hedrich
- Public Health Unit, European Monitoring Centre on Drugs and Drug Addiction, Lisbon, Portugal
| | - Anouk Oordt-Speets
- Pallas, Health Research and Consultancy B.V., Rotterdam, the Netherlands
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Kronfli N, Linthwaite B, Kouyoumdjian F, Klein MB, Lebouché B, Sebastiani G, Cox J. Interventions to increase testing, linkage to care and treatment of hepatitis C virus (HCV) infection among people in prisons: A systematic review. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 57:95-103. [PMID: 29715590 DOI: 10.1016/j.drugpo.2018.04.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 04/06/2018] [Accepted: 04/06/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND While the burden of chronic hepatitis C virus (HCV) infection is significantly higher among people in prisons compared to the general population, testing and treatment uptake remain suboptimal. The aim of this systematic review was to synthesize evidence on the effectiveness of interventions to increase HCV testing, linkage to care and treatment uptake among people in prisons. METHODS We searched Medline (Ovid 1996-present), Embase (Ovid 1996-present), and the Cochrane Central Register of Controlled Trials for English language articles published between January 2007 and November 2017. Studies evaluating interventions to enhance HCV testing, linkage to care and treatment uptake for people in prison were included. Two independent reviewers evaluated articles selected for full-text review. Disagreements were resolved by consensus. RESULTS A total of 475 unique articles were identified, 29 were eligible for full text review, and six studies were included. All but one study was conducted in the pre-direct-acting antiviral (DAA) era; no studies were conducted in low- or middle-income countries. Of the six studies, all but one focused on testing. Only two were randomised controlled trials; the remaining were single arm studies. Interventions to enhance HCV testing in prison settings included combination risk-based and birth-cohort screening strategies, on-site nurse-led opt-in screening clinics with pre-test counselling and education, and systematic dried blood spot testing. All interventions increased HCV testing, but risk of study bias was high in all studies. Interventions to enhance linkage to care included facilitated referral for HCV assessment and scheduling of specialist appointments; however, risk of study bias was critical. CONCLUSIONS There is a lack of recent data on interventions to improve the HCV care cascade in people in prisons. With the introduction of short-course, well-tolerated DAAs, rigorous controlled studies evaluating interventions to improve testing, linkage and treatment uptake for people in prison are necessary.
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Affiliation(s)
- Nadine Kronfli
- Chronic Viral Illness Services, McGill University Health Centre, Montreal, Quebec, Canada.
| | - Blake Linthwaite
- Chronic Viral Illness Services, McGill University Health Centre, Montreal, Quebec, Canada
| | - Fiona Kouyoumdjian
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada; Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Marina B Klein
- Chronic Viral Illness Services, McGill University Health Centre, Montreal, Quebec, Canada; CIHR Canadian HIV Trials Network, Vancouver, British Columbia, Canada
| | - Bertrand Lebouché
- Chronic Viral Illness Services, McGill University Health Centre, Montreal, Quebec, Canada; Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Giada Sebastiani
- Chronic Viral Illness Services, McGill University Health Centre, Montreal, Quebec, Canada
| | - Joseph Cox
- Chronic Viral Illness Services, McGill University Health Centre, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
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33
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Grebely J, Applegate TL, Cunningham P, Feld JJ. Hepatitis C point-of-care diagnostics: in search of a single visit diagnosis. Expert Rev Mol Diagn 2017; 17:1109-1115. [DOI: 10.1080/14737159.2017.1400385] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Jason Grebely
- Viral Hepatitis Clinical Research Program, The Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Tanya L. Applegate
- Viral Hepatitis Clinical Research Program, The Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Philip Cunningham
- St Vincent’s Centre for Applied Medical Research, Darlinghurst, Sydney, Australia
| | - Jordan J. Feld
- Toronto Centre for Liver Disease, Sandra Rotman Centre for Global Health, University of Toronto, Toronto, Canada
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Ishizaki A, Bouscaillou J, Luhmann N, Liu S, Chua R, Walsh N, Hess S, Ivanova E, Roberts T, Easterbrook P. Survey of programmatic experiences and challenges in delivery of hepatitis B and C testing in low- and middle-income countries. BMC Infect Dis 2017; 17:696. [PMID: 29143609 PMCID: PMC5688462 DOI: 10.1186/s12879-017-2767-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background There have been few reports on programmatic experience of viral hepatitis testing and treatment in resource-limited settings. To inform the development of the 2017 World Health Organization (WHO) viral hepatitis testing guidance and in particular the feasibility of proposed recommendations, we undertook a survey across a range of organisations engaged with hepatitis testing in low- and middle-income countries (LMICs). Our objective was to describe current hepatitis B and C testing practices across a range of settings in different countries, as well as key barriers or challenges encountered and proposed solutions to promote testing scale-up. Methods Hepatitis testing programmes in predominantly LMICs were identified from the WHO Global Hepatitis Programme contacts database and through WHO regional offices, and invited to participate. The survey comprised a six-part structured questionnaire: general programme information, description of hepatitis testing, treatment and care services, budget and funding, data on programme outcomes, and perceptions on key barriers encountered and strategies to address these. Results We interviewed 22 viral hepatitis testing programmes from 19 different countries. Nine were from the African region; 6 from the Western Pacific; 4 from South-East Asia; and 3 from Eastern Europe. All but four of the programmes were based in LMICs, and 10 (45.5%) were supported by non-governmental or international organizations. All but two programmes undertook targeted testing of specific affected populations such as people living with HIV, people who inject drugs, sex workers, health care workers, and pregnant women. Only two programmes focussed on routine testing in the general population. The majority of programmes were testing in hospital-based or other health facilities, particularly HIV clinics, and community-based testing was limited. Nucleic acid testing (NAT) for confirmation of HCV and HBV viraemia was available in only 30% and 18% of programmes, respectively. Around a third of programmes required some patient co-payment for diagnosis. The most commonly identified challenges in scale-up of hepatitis testing were: limited community awareness about viral hepatitis; lack of facilities or services for hepatitis testing; no access to low cost treatment, particularly for HCV; absence of national guidance and policies; no dedicated budget for hepatitis; and lack of trained health care and laboratory workers. Conclusions At this early stage in the global scale-up of testing for viral hepatitis, there is a wide variation in testing practices and approaches across different programmes. There remains limited access to NAT to confirm viraemia, and patient self-payment for testing and treatment is common. There was consensus from implementing organizations that scale-up of testing will require increased community awareness, health care worker training, development of national strategies and guidelines, and improved access to low cost NAT virological testing. Electronic supplementary material The online version of this article (10.1186/s12879-017-2767-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Azumi Ishizaki
- Global Hepatitis Programme, World Health Organization, 20 Avenue Appia, 1211, 27, Geneva, Switzerland
| | | | - Niklas Luhmann
- Médecins du Monde, 62 rue Marcadet, 75018, Paris, France
| | - Stephanie Liu
- World Health Organization, Regional Office of the Western Pacific, United Nations Avenue, 1000, Manila, Philippines
| | - Raissa Chua
- World Health Organization, Regional Office of the Western Pacific, United Nations Avenue, 1000, Manila, Philippines
| | - Nick Walsh
- World Health Organization, Regional Office of the Western Pacific, United Nations Avenue, 1000, Manila, Philippines
| | - Sarah Hess
- Global Hepatitis Programme, World Health Organization, 20 Avenue Appia, 1211, 27, Geneva, Switzerland
| | - Elena Ivanova
- Foundation for Innovative New Diagnostics, Campus Biotech, Building B2, Level 0, 9 Chemin des Mines, 1202, Geneva, Switzerland
| | - Teri Roberts
- Foundation for Innovative New Diagnostics, Campus Biotech, Building B2, Level 0, 9 Chemin des Mines, 1202, Geneva, Switzerland
| | - Philippa Easterbrook
- Global Hepatitis Programme, World Health Organization, 20 Avenue Appia, 1211, 27, Geneva, Switzerland.
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Grebely J, Hajarizadeh B, Dore GJ. Direct-acting antiviral agents for HCV infection affecting people who inject drugs. Nat Rev Gastroenterol Hepatol 2017; 14:641-651. [PMID: 28831184 DOI: 10.1038/nrgastro.2017.106] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Globally, 12 million people are estimated to have injected drugs in the past year, 50% of whom have chronic HCV infection, with people who have previously injected drugs presenting an additional large reservoir of infection. The availability of simple and tolerable interferon-free direct-acting antiviral agents (DAAs) for HCV infection, which have a cure rate of >95% represents one of the most exciting advances in clinical medicine in the past few decades. Adherence and response to DAA therapy among people who inject drugs (PWID) receiving opioid substitution therapy (OST) in clinical trials are comparable to populations without a history of injecting drugs. Further data are required among current PWID not receiving OST. Given the potential prevention benefits of treatment, DAAs have enhanced cost-effectiveness among PWID. As HCV therapy is expanded to populations of PWID with high-risk behaviours for re-exposure, acknowledgement that HCV reinfection will occur is crucial, and appropriate strategies must be in place to maximize prevention of reinfection and offer retreatment for reinfection. This Review will also discuss essential components for broadening access to HCV care for PWID as we strive for the global elimination of HCV infection.
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Affiliation(s)
- Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales 2052, Australia
| | - Behzad Hajarizadeh
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales 2052, Australia
| | - Gregory J Dore
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales 2052, Australia
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Grebely J, Bruneau J, Lazarus JV, Dalgard O, Bruggmann P, Treloar C, Hickman M, Hellard M, Roberts T, Crooks L, Midgard H, Larney S, Degenhardt L, Alho H, Byrne J, Dillon JF, Feld JJ, Foster G, Goldberg D, Lloyd AR, Reimer J, Robaeys G, Torrens M, Wright N, Maremmani I, Norton BL, Litwin AH, Dore GJ. Research priorities to achieve universal access to hepatitis C prevention, management and direct-acting antiviral treatment among people who inject drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 47:51-60. [PMID: 28683982 PMCID: PMC6049820 DOI: 10.1016/j.drugpo.2017.05.019] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 04/11/2017] [Accepted: 05/05/2017] [Indexed: 02/06/2023]
Abstract
Globally, it is estimated that 71.1 million people have chronic hepatitis C virus (HCV) infection, including an estimated 7.5 million people who have recently injected drugs (PWID). There is an additional large, but unquantified, burden among those PWID who have ceased injecting. The incidence of HCV infection among current PWID also remains high in many settings. Morbidity and mortality due to liver disease among PWID with HCV infection continues to increase, despite the advent of well-tolerated, simple interferon-free direct-acting antiviral (DAA) HCV regimens with cure rates >95%. As a result of this important clinical breakthrough, there is potential to reverse the rising burden of advanced liver disease with increased treatment and strive for HCV elimination among PWID. Unfortunately, there are many gaps in knowledge that represent barriers to effective prevention and management of HCV among PWID. The Kirby Institute, UNSW Sydney and the International Network on Hepatitis in Substance Users (INHSU) established an expert round table panel to assess current research gaps and establish future research priorities for the prevention and management of HCV among PWID. This round table consisted of a one-day workshop held on 6 September, 2016, in Oslo, Norway, prior to the International Symposium on Hepatitis in Substance Users (INHSU 2016). International experts in drug and alcohol, infectious diseases, and hepatology were brought together to discuss the available scientific evidence, gaps in research, and develop research priorities. Topics for discussion included the epidemiology of injecting drug use, HCV, and HIV among PWID, HCV prevention, HCV testing, linkage to HCV care and treatment, DAA treatment for HCV infection, and reinfection following successful treatment. This paper highlights the outcomes of the roundtable discussion focused on future research priorities for enhancing HCV prevention, testing, linkage to care and DAA treatment for PWID as we strive for global elimination of HCV infection.
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Affiliation(s)
- Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, Australia.
| | - Julie Bruneau
- CHUM Research Centre (CRCHUM), Centre Hospitalier de l'Université de Montréal, Montréal, Canada; Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montréal, Canada
| | - Jeffrey V Lazarus
- CHIP, Rigshospitalet, University of Copenhagen, Denmark; Barcelona Institute of Global Health (ISGlobal), Hospital Clínic, Barcelona, Spain
| | - Olav Dalgard
- Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway; University of Oslo, Oslo, Norway
| | | | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Matthew Hickman
- School of Social & Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Margaret Hellard
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
| | | | - Levinia Crooks
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia; Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine, Sydney, Australia
| | - Håvard Midgard
- Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway; Institute for Clinical Medicine, University of Oslo, Norway; Department of Gastroenterology, Oslo University Hospital, Norway
| | - Sarah Larney
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney, Australia
| | - Hannu Alho
- University of Helsinki, Helsinki, Finland; National Institute for Health and Welfare, Helsinki, Finland; Abdominal Center, Helsinki University Hospital, Helsinki, Finland
| | - Jude Byrne
- Australian Injecting & Illicit Drug Users League, Canberra, Australia
| | - John F Dillon
- Ninewells Hospital and Medical School, Dundee, United Kingdom
| | - Jordan J Feld
- Toronto Centre for Liver Disease, Sandra Rotman Centre for Global Health, University of Toronto, Toronto, Canada
| | - Graham Foster
- The Liver Unit, Queen Mary University of London, London, United Kingdom
| | - David Goldberg
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom; Health Protection Scotland, Glasgow, United Kingdom
| | | | - Jens Reimer
- Centre for Interdisciplinary Addiction Research, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Geert Robaeys
- Department of Gastroenterology and Hepatology, Ziekenhuis Oost Limburg, Genk, Belgium; Department of Hepatology, UZ Leuven, Leuven, Belgium; Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Marta Torrens
- Institute of Neuropsychiatry & Addictions-Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Icro Maremmani
- Santa Chiara University Hospital, University of Pisa, Italy
| | - Brianna L Norton
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, United States
| | - Alain H Litwin
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, United States
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Bajis S, Dore GJ, Hajarizadeh B, Cunningham EB, Maher L, Grebely J. Interventions to enhance testing, linkage to care and treatment uptake for hepatitis C virus infection among people who inject drugs: A systematic review. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 47:34-46. [DOI: 10.1016/j.drugpo.2017.07.002] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 06/17/2017] [Accepted: 07/10/2017] [Indexed: 12/26/2022]
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Grebely J, Lamoury FMJ, Hajarizadeh B, Mowat Y, Marshall AD, Bajis S, Marks P, Amin J, Smith J, Edwards M, Gorton C, Ezard N, Persing D, Kleman M, Cunningham P, Catlett B, Dore GJ, Applegate TL. Evaluation of the Xpert HCV Viral Load point-of-care assay from venepuncture-collected and finger-stick capillary whole-blood samples: a cohort study. Lancet Gastroenterol Hepatol 2017; 2:514-520. [DOI: 10.1016/s2468-1253(17)30075-4] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 02/27/2017] [Accepted: 02/27/2017] [Indexed: 01/10/2023]
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Barocas JA, Linas BP, Kim AY, Fangman J, Westergaard RP. Acceptability of Rapid Point-of-Care Hepatitis C Tests Among People Who Inject Drugs and Utilize Syringe-Exchange Programs. Open Forum Infect Dis 2016; 3:ofw075. [PMID: 27191007 PMCID: PMC4867657 DOI: 10.1093/ofid/ofw075] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
People who inject drugs may benefit from point-of-care hepatitis C virus (HCV) testing offered at syringe exchanges. We sought to understand whether this population would be willing to undergo rapid HCV testing. We found that there was broad support for rapid HCV testing, especially among younger people who inject drugs with high perceived risk.
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Affiliation(s)
- Joshua A Barocas
- Division of Infectious Disease , Massachusetts General Hospital , Boston
| | - Benjamin P Linas
- Division of Infectious Disease , HIV Epidemiology and Outcomes Research Unit, Boston University Medical Center , Massachusetts
| | - Arthur Y Kim
- Division of Infectious Disease , Massachusetts General Hospital , Boston
| | - John Fangman
- Division of Infectious Disease , Medical College of Wisconsin , Milwaukee
| | - Ryan P Westergaard
- Departments of Medicine; Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison
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Zaller ND, Patry EJ, Bazerman LB, Noska A, Kuo I, Kurth A, Beckwith CG. A Pilot Study of Rapid Hepatitis C Testing in Probation and Parole Populations in Rhode Island. J Health Care Poor Underserved 2016; 27:214-23. [PMID: 27133520 PMCID: PMC10916330 DOI: 10.1353/hpu.2016.0049] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Hepatitis C virus (HCV) affects between five and seven million individuals in the United States and chronic infection can lead to liver disease, cirrhosis, and hepatocellular carcinoma. Probation/parole offices are a novel setting for rapid HCV testing, providing outreach to populations at increased risk for HCV infection and/or transmitting HCV to others. While some correctional facilities offer HCV testing, many individuals who present to probation/parole offices are never or briefly incarcerated and may not access medical services. We conducted a rapid HCV testing pilot at probation/parole offices in Rhode Island. Overall, 130 people accepted rapid HCV testing, of whom 12 had reactive tests. Only four of these individuals presented to a community-based clinic for confirmatory testing, despite being offered a monetary incentive. Identifying and addressing barriers to HCV confirmatory testing and follow-up care is critical to increasing the uptake of HCV care and treatment in this vulnerable population.
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