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Ezell JM, Pho MT, Simek E, Ajayi BP, Shetty N, Walters SM. How do people who use opioids express their qualities and capacities? An assessment of attitudes, behaviors, and opportunities. Harm Reduct J 2024; 21:79. [PMID: 38589920 PMCID: PMC11000313 DOI: 10.1186/s12954-024-00981-4] [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: 11/22/2023] [Accepted: 03/04/2024] [Indexed: 04/10/2024] Open
Abstract
People who nonmedically use drugs (PWUD) face intricate social issues that suppress self-actualization, communal integration, and overall health and wellness. "Strengths-based" approaches, an under-used pedagogy and practice in addiction medicine, underscore the significance of identifying and recognizing the inherent and acquired skills, attributes, and capacities of PWUD. A strengths-based approach engenders client affirmation and improves their capacity to reduce drug use-related harms by leveraging existing capabilities. Exploring this paradigm, we conducted and analyzed interviews with 46 PWUD who were clients at syringe services programs in New York City and rural southern Illinois, two areas with elevated rates of opioid-related morbidity and mortality, to assess respondents' perceived strengths. We located two primary thematic modalities in which strengths-based ethos is expressed: individuals (1) being and advocate and resource for harm reduction knowledge and practices and (2) engaging in acts of continuous self-actualization. These dynamics demonstrate PWUD strengths populating and manifesting in complex ways that both affirm and challenge humanist and biomedical notions of individual agency, as PWUD refract enacted, anticipated, and perceived stigmas. In conclusion, programs that blend evidence-based, systems-level interventions on drug use stigma and disenfranchisement with meso and micro-level strengths-based interventions that affirm and leverage personal identity, decision-making capacity, and endemic knowledge may help disrupt health promotion cleavages among PWUD.
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Affiliation(s)
- Jerel M Ezell
- Community Health Sciences, Berkeley Center for Cultural Humility, School of Public Health, University of California Berkeley, Berkeley, CA, USA.
- Berkeley Center for Cultural Humility, University of California Berkeley, Berkeley, CA, USA.
| | - Mai T Pho
- Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago Medicine, Chicago, IL, USA
| | - Elinor Simek
- Community Health Sciences, Berkeley Center for Cultural Humility, School of Public Health, University of California Berkeley, Berkeley, CA, USA
- Berkeley Center for Cultural Humility, University of California Berkeley, Berkeley, CA, USA
| | | | - Netra Shetty
- Biology and Society, Cornell University, Ithaca, NY, USA
| | - Suzan M Walters
- Department of Population Health at NYU Grossman School of Medicine, New York, NY, USA
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Wissel K, Vernazza P, Kuster S, Hensel-Koch K, Bregenzer A. Hepatitis C prevalence and cascade of care among patients in the decentralised opioid agonist therapy programme of the canton of St Gallen, Switzerland: a cross-sectional study. Swiss Med Wkly 2024; 154:3352. [PMID: 38579293 DOI: 10.57187/s.3352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND To eliminate chronic hepatitis C virus (HCV) infection by 2030, 90% of those infected must be diagnosed and 80% treated. In Switzerland, >40% of the estimated 32,000 infected people are still undiagnosed. In the canton of St Gallen, HCV prevalence and cascade of care have only been studied in the centralised opioid agonist therapy (OAT) setting (institutions), although about 80% of OAT patients are treated decentrally (general practitioner [GP] or pharmacy). AIM To describe HCV prevalence and cascade of care among patients in the decentralised OAT programme of the canton of St Gallen, Switzerland, and compare it to contemporaneous data from the centralised setting. METHODS For each patient receiving his/her OAT from a GP or pharmacy on 1 April 2021, the cantonal medical office sent a questionnaire to the prescribing GP. Patient characteristics, HCV antibody (Ab)/RNA screening uptake, HCV Ab/RNA prevalence and HCV treatment uptake were obtained and compared to those of patients of the Medizinisch-soziale Hilfsstelle 1 in St Gallen (centralised setting). RESULTS Of the 563 OAT patients under the care of 127 GPs, 107 patients from 41 GPs could be analysed (median age: 48 years [IQR: 40-56]; ongoing intravenous drug use: 25%; OAT provider: 66% GP, 34% pharmacy). HCV Ab screening uptake was 68% (73/107) with an HCV Ab prevalence of 68% (50/73) among those tested. Of the HCV Ab-positive patients, 84% (42/50) were HCV RNA-tested, among whom 57% (24/42) were viraemic. HCV treatment uptake was 83% (20/24), with 95% (19/20) achieving a sustained virological response. Non-uptake of HCV screening and treatment tended to be higher among patients receiving OAT at the pharmacy vs at the GP's office: 37% vs 26% (p = 0.245) for screening and 30% vs 7% (p = 0.139) for treatment. The proportion never HCV Ab-tested and the proportion of HCV Ab-positives never HCV RNA-tested was significantly higher in the decentralised compared to the centralised setting: 32% vs 3% (p <0.001) never Ab-tested and 16% vs 0% (p = 0.002) never RNA-tested. In contrast, HCV treatment uptake (83% vs 78%), sustained virological response rate (95% vs 100%) and residual HCV RNA prevalence among the HCV Ab-positive (12% vs 14%) were comparable for both settings. CONCLUSION In the decentralised OAT setting of the canton of St Gallen, HCV Ab prevalence is high. Since HCV Ab and RNA screening uptake are markedly lower than in the centralised setting, potentially >40% of patients with chronic HCV are not diagnosed yet. HCV screening in the decentralised setting needs improvement, e.g. by increasing awareness and simplifying testing. High HCV treatment uptake and cure rates are possible in centralised and decentralised settings.
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Affiliation(s)
| | - Pietro Vernazza
- Division of Infectious Diseases, Infection Prevention and Travel Medicine, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Stefan Kuster
- Division of Infectious Diseases, Infection Prevention and Travel Medicine, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | | | - Andrea Bregenzer
- Division of Infectious Diseases, Infection Prevention and Travel Medicine, Cantonal Hospital St Gallen, St Gallen, Switzerland
- Department of Infectious Diseases and Infection Prevention, Cantonal Hospital Aarau, Aarau, Switzerland
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Ho N, Vandyk A, Horvath C, Magboo Cahill T, O'Byrne P. The experiences of people who use injection drugs with accessing hepatitis c testing and diagnosis in western countries: A scoping review. Public Health Nurs 2024; 41:37-56. [PMID: 37712447 DOI: 10.1111/phn.13254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 07/28/2023] [Accepted: 08/29/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND The purpose of this scoping review was to summarize the literature that reported on the experiences of people who use injection drugs' access to hepatitis C testing and diagnosis in Western countries. METHODS The initial search was conducted in 2020 and an updated review was completed in 2022. Seven electronic databases were searched using a peer-reviewed search strategy and included: full-text, peer-reviewed studies with people who inject(ed) drugs, hepatitis C testing or diagnosis, conducted in Western countries. Excluded were studies published prior to 2014 and intervention studies. Two-step screening was conducted in duplicate. Conventional content analysis was used. RESULTS Six studies were found from the search. The studies were published between 2014 and 2021 in Australia, United Kingdom, and United States. A total of 19 participant characteristics were extracted to contextualize their experiences, demonstrating a lack of demographic data. Four themes were found: Awareness and Knowledge, Stigma, Healthcare Service, and Psychological Responses. There were 58 occurrences of client quotes where participants described their experiences, 29 occurrences of quotes describing client-identified barriers, and 14 occurrences of quotes describing client-identified facilitators. CONCLUSION A scoping review was conducted to present the experiences, barriers, and facilitators of people who use injection drugs to hepatitis C testing. The lack of demographic data and connection to client quotes further exacerbates the inequities among the population by overlooking their intragroup identities. Understanding their experiences of accessing hepatitis C testing and collecting demographic data will help advance health policies and interventions targeting people who use injection drugs.
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Affiliation(s)
- Nikki Ho
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Amanda Vandyk
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Cynthia Horvath
- Ottawa Public Health, Health Protection Service, Ottawa, Ontario, Canada
| | - Taliesin Magboo Cahill
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Patrick O'Byrne
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Public Health, Health Protection Service, Ottawa, Ontario, Canada
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Anwar I, Donadille C, Protopopescu C, Michels D, Herin J, Pladys A, Bader D, Carrieri P, Roux P. Non-disclosure of drug injection practices as a barrier to HCV testing: results from the PrebupIV community-based research study. Harm Reduct J 2023; 20:98. [PMID: 37516889 PMCID: PMC10387207 DOI: 10.1186/s12954-023-00841-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 07/22/2023] [Indexed: 07/31/2023] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) infection prevalence is particularly high in people who inject drugs (PWID), a population that faces many barriers to HCV testing and care. A better understanding of the determinants of access to HCV testing is needed to improve their engagement in the HCV care cascade. We used data from a cross-sectional survey of people who inject drugs, mainly opioids, to identify factors associated with recent HCV testing. METHODS Self-reported data on HCV antibody testing were analyzed for 550 of the 557 PWID enrolled in PrebupIV, a French cross-sectional community-based survey which assessed PWID acceptability of injectable buprenorphine as a treatment. Factors associated with recent (i.e., in the previous six months) HCV antibody testing were identified performing multivariable logistic regression. RESULTS Among the study sample, 79% were men and 31% reported recent HCV antibody testing. Multivariable analysis found that PWID who did not disclose their injection practices to anyone (aOR [95% CI] 0.31 [0.12,0.82], p = 0.018), older PWID (aOR [95% CI] 0.97 [0.95,1.00], p = 0.030) and employed respondents (aOR [95% CI] 0.58 [0.37,0.92], p = 0.019) were all less likely to report recent HCV testing. No association was found between opioid agonist therapy and HCV testing. CONCLUSIONS Our findings suggest that non-disclosure of injection practices, employment and age were all barriers to HCV antibody testing. Preventing stigma around injection practices, developing the HCV testing offer in primary care and addiction care services, and training healthcare providers in HCV care management could improve HCV testing and therefore, the HCV care cascade in PWID.
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Affiliation(s)
- Ilhame Anwar
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information Médicale, ISSPAM, Marseille, France.
| | - Cécile Donadille
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Camelia Protopopescu
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - David Michels
- AIDES, Pantin, France
- Laboratoire de Recherche Communautaire, Coalition PLUS, Pantin, France
| | | | - Adélaïde Pladys
- Coordination Nationale des Réseaux de Microstructures (CNRMS), Strasbourg, France
| | - Danièle Bader
- Coordination Nationale des Réseaux de Microstructures (CNRMS), Strasbourg, France
| | - Patrizia Carrieri
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Perrine Roux
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information Médicale, ISSPAM, Marseille, France
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Simmons R, Plunkett J, Cieply L, Ijaz S, Desai M, Mandal S. Blood-borne virus testing in emergency departments - a systematic review of seroprevalence, feasibility, acceptability and linkage to care. HIV Med 2023; 24:6-26. [PMID: 35702813 DOI: 10.1111/hiv.13328] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/09/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Blood-borne viruses (BBVs) cause significant morbidity and mortality worldwide. Emergency departments (EDs) offer a point of contact for groups at increased risk of BBVs who may be less likely to engage with primary care. We reviewed the literature to evaluate whether BBV testing in this setting might be a viable option to increase case finding and linkage to care. METHODS We searched PubMed database for English language articles published until June 2019 on BBV testing in EDs. Studies reporting seroprevalence surveys, feasibility, linkage to care, enablers and barriers to testing were included. Additional searches for grey literature were performed. RESULTS Eight-nine articles met inclusion criteria, of which 14 reported BBV seroprevalence surveys in EDs, 54 investigated feasibility and acceptability, and 36 investigated linkage to care. Most studies were HIV-focused and conducted in the USA. Seroprevalence rates were in the range 1.5-17% for HCV, 0.7-1.6% for HBV, and 0.8-13% for HIV. For studies that used an opt-in study design, testing uptake ranged from 2% to 98% and for opt-out it ranged from 16% to 91%. There was a wide range of yield: 13-100% of patients received their test result, 21-100% were linked to care, and 50-91% were retained in care. Compared with individuals diagnosed with HIV, linkage to and retention in care were lower for those diagnosed with hepatitis C. Predictors of linkage to care was associated with certain patient characteristics. CONCLUSIONS Universal opt-out BBV testing in EDs may be feasible and acceptable, but linkage to care needs to be improved by optimizing implementation. Further economic evaluations of hepatitis testing in EDs are needed.
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Affiliation(s)
- Ruth Simmons
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STIs) and HIV Division, UK Health Security Agency, London, UK.,The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College, London, UK
| | - James Plunkett
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STIs) and HIV Division, UK Health Security Agency, London, UK
| | - Lukasz Cieply
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STIs) and HIV Division, UK Health Security Agency, London, UK
| | - Samreen Ijaz
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College, London, UK.,Blood Borne Virus Unit, Virus Reference Department, UK Health Security Agency, London, UK
| | - Monica Desai
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STIs) and HIV Division, UK Health Security Agency, London, UK.,The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College, London, UK
| | - Sema Mandal
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STIs) and HIV Division, UK Health Security Agency, London, UK.,The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College, London, UK
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Vallejo A, Moldes LM, Trigo M, Ordoñez P, Rodriguez-Otero L, Cabrera JJ, Gude MJ, Navarro D, Cañizares A, García-Campello M, Agulla A, Aguilera A. Generalized implementation of reflex testing of hepatitis C in Galicia: Results for reflection. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2022; 40:483-488. [PMID: 35729051 DOI: 10.1016/j.eimce.2022.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/11/2020] [Accepted: 12/18/2020] [Indexed: 06/15/2023]
Abstract
INTRODUCTION The implementation of reflex testing of active hepatitis C virus (HCV) infection, together with the incorporation of informative alerts in the reports, has shown that it significantly reduces the number of patients who were not referred for therapeutic evaluation. METHODS Since the implementation in 2018 of the DUSP in the Microbiology Services of the Galician Health Service hospitals (SERGAS), new diagnoses of active HCV infection have been retrospectively identified and characterized. RESULTS In 2018, a total of 258 patients with unknown active HCV infection (70,2% men, middle age 52 years) were identified through by reflex testing from consultations of primary and specialized care units in 54.8% and 39.8% respectively, as well as from other locations by 5.4%. Of the 258 patients, 81.0% were referred for therapeutic evaluation, with a median of 54 days from their diagnosis. In 58.3% of the cases the reflex testing was determined by viral load, the predominant genotype was 1a (30,7%) and 52,1% were treated, observing sustained viral response (SVR) in 93.7 % of these. CONCLUSION The generalized implementation of the HCV reflex testing together with informative alerts in Galicia has allowed us to obtain referral rates for treatment similar to those obtained in other studies. However, there is a wide variability between the different centers that require the incorporation of improvements, such as training or the use of rescue measures for optimization.
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Affiliation(s)
- Aldara Vallejo
- Servicio de Microbiología, Complexo Hospitalario Universitario de Santiago, Santiago de Compostela (La Coruña), Spain; Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela (La Coruña), Spain
| | - Luz María Moldes
- Servicio de Microbiología, Complexo Hospitalario Universitario de A Coruña, La Coruña, Spain; Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela (La Coruña), Spain
| | - Matilde Trigo
- Servicio de Microbiología, Complexo Hospitalario de Pontevedra, Pontevedra, Spain; Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela (La Coruña), Spain
| | - Patricia Ordoñez
- Servicio de Microbiología, Complexo Hospitalario Arquitecto Marcide-Profesor Novoa Santos, Ferrol (La Coruña), Spain; Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela (La Coruña), Spain
| | - Luis Rodriguez-Otero
- Servicio de Microbiología, Complexo Hospitalario Universitario de Ourense, Ourense, Spain; Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela (La Coruña), Spain
| | - Jorge Julio Cabrera
- Servicio de Microbiología, Hospital Universitario Álvaro Cunqueiro, Vigo (Pontevedra), Spain; Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela (La Coruña), Spain
| | - María José Gude
- Servicio de Microbiología, Hospital Universitario Lucus Augusti, Lugo, Spain; Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela (La Coruña), Spain
| | - Daniel Navarro
- Servicio de Microbiología, Complexo Hospitalario Universitario de Santiago, Santiago de Compostela (La Coruña), Spain; Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela (La Coruña), Spain
| | - Angelina Cañizares
- Servicio de Microbiología, Complexo Hospitalario Universitario de A Coruña, La Coruña, Spain; Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela (La Coruña), Spain
| | - Marta García-Campello
- Servicio de Microbiología, Complexo Hospitalario de Pontevedra, Pontevedra, Spain; Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela (La Coruña), Spain
| | - Andrés Agulla
- Servicio de Microbiología, Complexo Hospitalario Arquitecto Marcide-Profesor Novoa Santos, Ferrol (La Coruña), Spain; Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela (La Coruña), Spain
| | - Antonio Aguilera
- Servicio de Microbiología, Complexo Hospitalario Universitario de Santiago, Santiago de Compostela (La Coruña), Spain; Departamento de Microbioloxia e Parasitoloxía, Universidade de Santiago de Compostela, Santiago de Compostela (La Coruña), Spain; Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela (La Coruña), Spain.
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Yuan JM, Croxford S, Viviani L, Emanuel E, Phipps E, Desai M. Investigating the sociodemographic and behavioural factors associated with hepatitis C virus testing amongst people who inject drugs in England, Wales and Northern Ireland: A quantitative cross-sectional analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 109:103821. [PMID: 35994940 DOI: 10.1016/j.drugpo.2022.103821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 08/01/2022] [Accepted: 08/05/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Hepatitis C virus (HCV) transmission in the UK is driven by injecting drug use. We explore HCV testing uptake amongst people who inject drugs (PWID) in England, Wales and Northern Ireland, and identify factors associated with i) ever having an HCV test amongst people who have ever injected drugs, and ii) recently having an HCV test (within the current or previous year) amongst people who currently inject drugs (reported injecting drugs within the last year). METHODS We analysed data from the 2019 'Unlinked Anonymous Monitoring Survey' of PWID, using logistic regression. RESULTS Of 3,127 PWID, 2,065 reported injecting drugs within the last year. Most (86.7%) PWID had a lifetime history of HCV testing. In multivariable analysis, higher odds of ever testing were associated with: female sex (aOR=1.54; 95%CI 1.11-2.14), injecting duration ≥3 years (aOR=2.94; 95%CI 2.13-4.05), ever receiving used needles/syringes (aOR=1.74; 95%CI 1.29-2.36), ever being on opioid agonist treatment (aOR=2.91; 95%CI 2.01-4.21), ever being imprisoned (aOR=1.86; 95%CI 1.40-2.48) and ever being homeless (aOR=1.54; 95%CI 1.14-2.07). Amongst PWID who had injected drugs within the last year, 49.9% had recently undertaken an HCV test. After adjustment, factors associated with higher odds of undertaking a recent HCV test included: injecting crack in the last year (aOR=1.29; 95%CI 1.03-1.61), experiencing a non-fatal overdose in the last year (aOR=1.39; 95%CI 1.05-1.85), ever being on opioid agonist treatment (aOR=1.48; 95%CI 0.97-2.25), receiving HCV information in the last year (aOR=1.99; 95%CI 1.49-2.65) and using a healthcare service in the last year (aOR=1.80; 95%CI 1.21-2.67). CONCLUSION Results suggest that PWID who have experienced homelessness and incarceration - amongst the most vulnerable and marginalised in the PWID population - are engaging with HCV testing, but overall there remain missed testing opportunities. Recent initiates to injecting have highest HCV infection risk but lower odds of testing, and peer-education may help target this group.
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Affiliation(s)
- Jin-Min Yuan
- UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK.
| | - Sara Croxford
- UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - Laura Viviani
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, UK
| | - Eva Emanuel
- UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - Emily Phipps
- UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - Monica Desai
- UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK
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Harris M, Guy D, Picchio CA, White TM, Rhodes T, Lazarus JV. Conceptualising hepatitis C stigma: A thematic synthesis of qualitative research. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 96:103320. [PMID: 34261587 DOI: 10.1016/j.drugpo.2021.103320] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/20/2021] [Accepted: 05/23/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Stigma is an important element in the experience of living with chronic viral hepatitis B (HBV) and C (HCV), impacting healthcare access and uptake as well as health outcomes. Conceptualisations of stigma in research are, however, often assumed and implicit. This study aimed to synthesise and critically engage with the qualitative literature to provide an overarching conceptualisation of stigma as it pertains to viral hepatitis. METHODS We critically reviewed qualitative literature that mobilised concepts or theories of stigma in relation to viral hepatitis. We searched seven electronic databases for peer-reviewed literature from 2000 to 2019. Given a dearth of conceptual literature on HBV stigma, we conducted a thematic analysis of concepts deployed to theorise stigma in relation to HCV. RESULTS We found 13 studies that conceptualised stigma in relation to HCV, yet none for HBV. We synthesise the analytical findings of these studies and explore how HCV is theorised in relation to four themes: 'identity', 'embodiment', 'institutionalisation', and 'structuration'. Taken together, these themes illustrate the way in which HCV stigma manifests as the confluence of normative assumptions of socially unacceptable practices relating to HCV, such as injecting drug use and sexual behaviours; attitudes towards socially excluded populations; and fears of contracting a contagious and chronic illness. As such, operating within political, social, and economic systems, HCV stigma can act to silence the needs of those with HCV through misrecognising the multifaceted identities of individuals with HCV and structural determinants of health. Stigma, which is built and perpetuated by institutional arrangements, as well as in social processes and policies, shapes deservedness to, as well as engagements with, health and social care. CONCLUSION While commonly employed as a framing concept, much research lacks explicit theoretical or critical engagement on how stigma is conceptualised. There is a tendency for qualitative, empirical research to focus on risk factors shaping individual behaviour change, rather than on risk contexts and socio-structural change. Approaches to address stigma in relation to HCV must consider how stigma operates throughout social processes and is embedded in systems of power and normalised in institutional operating systems.
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Affiliation(s)
- Magdalena Harris
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH
| | - Danielle Guy
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Calle del Rossellón 132, ES-08036 Barcelona, Spain
| | - Camila A Picchio
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Calle del Rossellón 132, ES-08036 Barcelona, Spain
| | - Trenton M White
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Calle del Rossellón 132, ES-08036 Barcelona, Spain
| | - Tim Rhodes
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Calle del Rossellón 132, ES-08036 Barcelona, Spain; Faculty of Medicine, University of Barcelona, Barcelona, Spain.
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Casas MDLP, García F, Freyre-Carrillo C, Montiel N, de la Iglesia A, Viciana I, Domínguez A, Guillot V, Muñoz A, Cantudo P, Franco-Álvarez F, Reguera JA, Romera MA, Cabezas T, Vargas J, Ramírez-Arcos M, Guerrero I, García-Navarrete Á, Pérez-Santos MJ, Clavijo E, Roldán C, Guzmán A, Palanca M, Torres E, Serrano MDC, Lozano MDC, Becerril B, Luzón P, Galán MÁ, Alados JC, García F. Towards the elimination of hepatitis C: implementation of reflex testing in Andalusia. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2021; 112:515-519. [PMID: 32188257 DOI: 10.17235/reed.2020.6370/2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM undiagnosed hepatitis C virus (HCV) infection and/or inadequate access to care are barriers to the elimination of HCV. Reflex testing has proven to facilitate referral to care, treatment and viral elimination. In this study, a reflex testing program was implemented in Andalusia and its impact on access to care was evaluated. PATIENTS AND METHODS an observational, retrospective and prospective study was performed across diagnostic laboratories responsible for HCV diagnosis in southern Spain. After surveying the barriers to performing reflex testing, the number of patients that were not referred for care in 2016 was retrospectively studied (pre-reflex cohort). Subsequently, several measures were proposed to overcome the identified barriers. Finally, reflex testing was implemented and its impact evaluated. RESULTS the pre-reflex cohort included information from 1,053 patients. Slightly more than half of the patients (n = 580; 55%) visited a specialist for treatment evaluation during a median period of 71 days (interquartile range = 35-134) since the date of diagnosis. The post-reflex cohort (September 2017 to March 2018) included 623 patients. Only 17% (n = 106) of the patients had not been referred for care or evaluated for treatment in a median period of 52 days (interquartile range = 28-86). CONCLUSIONS in 2016, nearly half of new HCV diagnoses in southern Spain were not referred for care. Barriers to the implementation of reflex testing were overcome in our study. Moreover, this strategy was effectively implemented in 2017. Reflex testing contributed to improving referral for care. This program will contribute to the micro-elimination of hepatitis C in Spain.
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Affiliation(s)
- María de la Paz Casas
- Servicio de Microbiología, Hospital Universitario San Cecilio. Instituto de Investigación Ibs, España
| | - Fernando García
- Servicio de Microbiología, Hospital Universitario San Cecilio. Instituto de I
| | | | | | | | - Isabel Viciana
- Servicio de Microbiología, Hospital Universitario Virgen de la Victoria
| | - Ana Domínguez
- Servicio de Microbiología, Hospital Juan Ramón Jiménez
| | | | - Aurora Muñoz
- Servicio de Microbiología, Hospital San Juan de la Cruz
| | | | | | | | | | - Teresa Cabezas
- Servicio de Microbiología, Hospital Universitario Torrecárdenas
| | - Julio Vargas
- Servicio de Microbiología, Hospital Universitario Virgen de Valme
| | | | | | | | | | | | | | | | | | - Eva Torres
- Servicio de Microbiología, Hospital Universitario de Jerez de la Frontera
| | | | | | | | - Pilar Luzón
- Servicio de Microbiología, Hospital La Inmaculada
| | | | - Juan Carlos Alados
- Servicio de Microbiología, Hospital Universitario de Jerez de la Frontera
| | - Federico García
- Servicio de Microbiología, Hospital Universitario San Cecilio. Instituto de Investigación Ibs
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10
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Exploring and understanding HCV patient journeys- HEPCARE Europe project. BMC Infect Dis 2021; 21:239. [PMID: 33673828 PMCID: PMC7934512 DOI: 10.1186/s12879-021-05928-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 02/11/2021] [Indexed: 02/05/2023] Open
Abstract
Background Hepatitis C Virus (HCV) is a leading cause for chronic liver diseases worldwide. The European Union and World Health Organization aspire to eliminate HCV by 2030. However, among at-risk populations, including, homeless people, prisoners and People Who Inject Drugs, access to diagnosis and treatment is challenging. Hepcare Europe is an integrated model of care developed to address this by assessing potential reasons for these restrictions and determining measures needed to improve HCV diagnosis, treatment and access to care within different communities. Objectives HepCare Europe is an EU-supported project involving collaboration between five institutions in: Ireland, United Kingdom, Spain and Romania. We aim to explore the journey of care experienced by those living with HCV with a focus on previous care disruptions (loss to follow up) and the new HepCare Europe Programme. Methods Research teams conducted semi-structured interviews with patients who accessed services through HepCare Europe thus, patients were recruited by purposeful sampling. Patients interviewed had received, or were in the final weeks of receiving, treatment. The interviews were audio recorded, transcribed and translated into English, and sent to the Dublin team for inductive thematic analysis. Researchers from the HepCare Europe research team coded the data separately, then together. Results Common themes are introduced to present similarities, following individual site themes to highlight the importance of tailored interventions for each country. Key themes are: 1) Hepatitis C patients lost to follow up 2) HepCare improved access to treatment and 3) the need for improved HCV education. Individual themes also emerged for each site. These are: Ireland: New opportunities associated with achieving Sustained Virologic Responses (SVR). Romania: HCV is comparatively less crucial in light of Human Immunodeficiency Viruses (HIV) coinfections. UK: Patients desire support to overcome social barriers and Spain: Improved awareness of HCV, treatment and alcohol use. Conclusion This study identified how the tailored HepCare interventions enabled improved HCV testing and linkage to care outcomes for these patients. Tailored interventions that targeted the needs of patients, increased the acceptability and success of treatment by patients. HepCare demonstrated the need for flexibility in treatment delivery, and provided additional supports to keep patients engaged and educated on new treatment therapies.
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11
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Vallejo A, Moldes LM, Trigo M, Ordoñez P, Rodriguez-Otero L, Cabrera JJ, Gude MJ, Navarro D, Cañizares A, García-Campello M, Agulla A, Aguilera A. Generalized implementation of reflex testing of hepatitis C in Galicia: Results for reflection. Enferm Infecc Microbiol Clin 2021; 40:S0213-005X(21)00025-2. [PMID: 33632540 DOI: 10.1016/j.eimc.2020.12.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/11/2020] [Accepted: 12/18/2020] [Indexed: 01/18/2023]
Abstract
INTRODUCTION The implementation of reflex testing of active hepatitis C virus (HCV) infection, together with the incorporation of informative alerts in the reports, has shown that it significantly reduces the number of patients who were not referred for therapeutic evaluation. METHODS Since the implementation in 2018 of the DUSP in the microbiology services of the Galician Health Service hospitals (SERGAS), new diagnoses of active HCV infection have been retrospectively identified and characterized. RESULTS In 2018, a total of 258 patients with unknown active HCV infection (70,2% men, middle age 52 years) were identified through by reflex testing from consultations of primary and specialized care units in 54.8% and 39.8% respectively, as well as from other locations by 5.4%. Of the 258 patients, 81.0% were referred for therapeutic evaluation, with a median of 54 days from their diagnosis. In 58.3% of the cases the reflex testing was determined by viral load, the predominant genotype was 1a (30,7%) and 52,1% were treated, observing sustained viral response in 93.7% of these. CONCLUSION The generalized implementation of the HCV reflex testing together with informative alerts in Galicia has allowed us to obtain referral rates for treatment similar to those obtained in other studies. However, there is a wide variability between the different centers that require the incorporation of improvements, such as training or the use of rescue measures for optimization.
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Affiliation(s)
- Aldara Vallejo
- Servicio de Microbiología, Complexo Hospitalario Universitario de Santiago, Santiago de Compostela (La Coruña), España; Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela (La Coruña), España
| | - Luz María Moldes
- Servicio de Microbiología, Complexo Hospitalario Universitario de A Coruña, La Coruña, España; Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela (La Coruña), España
| | - Matilde Trigo
- Servicio de Microbiología, Complexo Hospitalario de Pontevedra, Pontevedra, España; Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela (La Coruña), España
| | - Patricia Ordoñez
- Servicio de Microbiología, Complexo Hospitalario Arquitecto Marcide-Profesor Novoa Santos, Ferrol (La Coruña), España; Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela (La Coruña), España
| | - Luis Rodriguez-Otero
- Servicio de Microbiología, Complexo Hospitalario Universitario de Ourense, Orense, España; Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela (La Coruña), España
| | - Jorge Julio Cabrera
- Servicio de Microbiología, Hospital Universitario Álvaro Cunqueiro, Vigo (Pontevedra), España; Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela (La Coruña), España
| | - María José Gude
- Servicio de Microbiología, Hospital Universitario Lucus Augusti, Lugo, España; Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela (La Coruña), España
| | - Daniel Navarro
- Servicio de Microbiología, Complexo Hospitalario Universitario de Santiago, Santiago de Compostela (La Coruña), España; Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela (La Coruña), España
| | - Angelina Cañizares
- Servicio de Microbiología, Complexo Hospitalario Universitario de A Coruña, La Coruña, España; Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela (La Coruña), España
| | - Marta García-Campello
- Servicio de Microbiología, Complexo Hospitalario de Pontevedra, Pontevedra, España; Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela (La Coruña), España
| | - Andrés Agulla
- Servicio de Microbiología, Complexo Hospitalario Arquitecto Marcide-Profesor Novoa Santos, Ferrol (La Coruña), España; Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela (La Coruña), España
| | - Antonio Aguilera
- Servicio de Microbiología, Complexo Hospitalario Universitario de Santiago, Santiago de Compostela (La Coruña), España; Departamento de Microbioloxia e Parasitoloxía, Universidade de Santiago de Compostela, Santiago de Compostela (La Coruña), España; Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela (La Coruña), España.
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12
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Nápoles TM, Batchelder AW, Lin A, Moran L, Johnson MO, Shumway M, Luetkemeyer AF, Peters MG, Eagen KV, Riley ED. HCV treatment barriers among HIV/HCV co-infected patients in the US: a qualitative study to understand low uptake among marginalized populations in the DAA era. J Public Health (Oxf) 2020; 41:e283-e289. [PMID: 31044248 DOI: 10.1093/pubmed/fdz045] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 03/26/2019] [Accepted: 04/04/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Well-tolerated, highly effective HCV treatment, known as direct-acting antivirals (DAAs), is now recommended for all people living with HCV, providing the tools for HCV elimination. We sought to understand treatment barriers among low-income HIV/HCV coinfected patients and providers with the goal of increasing uptake. METHODS In 2014, we conducted 26 interviews with HIV/HCV co-infected patients and providers from a San Francisco clinic serving underinsured and publically-insured persons to explore barriers impacting treatment engagement and completion. Interview transcripts were coded, and a thematic analysis was conducted to identify emerging patterns. RESULTS Conditions of poverty-specifically, meeting basic needs for food, shelter, and safety-undermined patient perceptions of self-efficacy to successfully complete HCV treatment programs. While patient participants expressed interest in HCV treatment, the perceived burden of taking daily medications without strong social support was an added challenge. This need for support contradicted provider assumptions that, due to the shorter-course regimens, support is unnecessary in the DAA era. CONCLUSIONS Interferon-free treatments alone are not sufficient to overcome social-structural barriers to HCV treatment and care among low-income HIV/HCV co-infected patients. Support for patients with unmet social needs may facilitate treatment initiation and completion, particularly among those in challenging socioeconomic situations.
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Affiliation(s)
- Tessa M Nápoles
- Department of Medicine, Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco (UCSF), San Francisco, CA, USA.,Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Abigail W Batchelder
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Ada Lin
- Department of Medicine, Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Lissa Moran
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, USA
| | - Mallory O Johnson
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, USA
| | - Martha Shumway
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
| | - Anne F Luetkemeyer
- Department of Medicine, Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Marion G Peters
- Department of Medicine, Division of Gastroenterology, University of California, San Francisco, San Francisco, CA, USA
| | - Kellene V Eagen
- San Francisco Department of Public Health, Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Elise D Riley
- Department of Medicine, Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco (UCSF), San Francisco, CA, USA
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13
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Haines AG, Mendlowitz AB, Wong WWL, Krahn M. Strategies to achieve population control of HCV infection: results of a multidisciplinary focus group. CANADIAN LIVER JOURNAL 2020; 3:224-231. [PMID: 35991858 PMCID: PMC9202787 DOI: 10.3138/canlivj-2019-0017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 11/11/2019] [Indexed: 08/20/2023]
Abstract
BACKGROUND To meet the World Health Organization's ambitious target to eradicate hepatitis C virus (HCV) by 2030, a comprehensive strategy is needed in Canada to ensure everyone infected with HCV is identified, diagnosed, and treated. The purpose of this study was to highlight the barriers to any strategy aimed at achieving this goal. METHODS A focus group was formed (N = 11) that consisted of clinicians, patients, drug program budget managers, industry representatives, and individuals from provincial public health and federal agencies in Canada. The group met in person for a half-day focus group session. Two discussions were held: one on future barriers related to HCV treatment and one related to HCV screening. A grounded theory approach was used to elicit key themes from the day's discussion. RESULTS Nine themes were identified. Four themes related to HCV screening: public awareness and engagement, resource infrastructure and capacity, heterogeneity between provinces, and mechanisms of screening. Three themes related to HCV treatment: access to treatment and illicit drug use, linkage to care, and predicting post-treatment outcomes. Two overarching themes that contributed to most discussions were a focus on baby boomers versus persons who inject drugs and the need for further education and training. CONCLUSION The views and findings extracted from this qualitative research complement proposals of national strategies from organizations such as the Canadian Network on Hepatitis C. This work highlights the financial, logistical, and ethical constraints that need to be tackled to make HCV elimination proposals a reality.
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Affiliation(s)
- Alexander G Haines
- Toronto Health Economics and Technology Assessment Collaborative, Toronto, Ontario, Canada
| | - Andrew B Mendlowitz
- Toronto Health Economics and Technology Assessment Collaborative, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - William WL Wong
- School of Pharmacy, University of Waterloo, Kitchener, Ontario, Canada
| | - Murray Krahn
- Toronto Health Economics and Technology Assessment Collaborative, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
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Hepatitis C reflex testing in Spain in 2019: A story of success. Enferm Infecc Microbiol Clin 2020; 39:119-126. [PMID: 32451150 DOI: 10.1016/j.eimc.2020.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/12/2020] [Accepted: 03/22/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND Reflex testing is necessary to achieve the objectives of hepatitis C elimination. However, in 2017 only 31% of Spanish hospitals performed reflex test. As a consequence of that finding, reflex testing was recommended by scientific societies involved in the diagnosis and treatment of hepatitis C. OBJECTIVE To evaluate the degree of implementation of reflex testing in 2019 and to know the implementation of rapid diagnostic and/or dried blood spot testing (RDT and / or DBS) in Spanish hospitals. METHODS Cross-sectional study through a survey conducted in October 2019 to Spanish general hospitals with at least 200 beds, public or private with teaching accreditation. RESULTS 129 (80%) hospitals responded. Reflex testing is performed by 89% of the centers vs. 31% in 2017 (P<.001). From 2017 to 2019, centers using alerts to improve continuity of care increased from 69% to 86% (P=.002). In 2019, 11% of centers can determine anti-HCV in dried spot, 15% viremia in dried spot, 0.85% anti-HCV in saliva, and 37% of antibodies and/or viremia with point of care test. 43% of hospitals have at least one diagnostic method with RDT and/or DBS. CONCLUSION The implementation of reflex testing has increased significantly, reaching 89% of hospitals in 2019. The recommendations of scientific societies could have contributed to the implementation of reflex testing. On the other hand, access to RDT and/or DBS is insufficient and initiatives are needed to improve their implementation.
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Crespo J, Eiros Bouza JM, Blasco Bravo AJ, Lázaro de Mercado P, Aguilera Guirao A, García F, García-Samaniego Rey J, Calleja Panero JL. The efficiency of several one-step testing strategies for the diagnosis of hepatitis C. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 111:10-16. [PMID: 30561219 DOI: 10.17235/reed.2018.5810/2018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND implementing one-step strategies for hepatitis C diagnosis would help shorten the time to treatment access. Thus avoiding disease progression and complications, while facilitating hepatitis C virus (HCV) elimination. OBJECTIVE to assess the validity and certainty of potential one-step strategies for the diagnosis of HCV infection and their associated cost and efficiency. METHODS the study design is an economic appraisal of efficiency (cost/efficacy) using decision trees and deterministic sensitivity analysis. The analysis was performed from the payer perspective (Spanish National Health System), which exclusively considers the direct costs. Only the differential costs (diagnostic testing costs) were taken into account and the study was set in Spain. The efficacy of a diagnostic strategy was defined as the percentage of patients with an active HCV infection who received a positive diagnosis and the efficiency was defined as the cost per patient with a correctly diagnosed and active infection. RESULTS the one-step strategies evaluated for the diagnosis of HCV had an acceptable validity and certainty due to the high sensitivity and specificity of the considered tests. The Ab-Ag strategy was the most efficient, followed by Ab-Ag-VL and Ab-VL. Ab-Ag was the most efficient due to the lower cost per patient tested, although the efficacy was lower than the Ab-VL efficacy. CONCLUSION the study findings may help to establish more appropriate one-step diagnostic approaches whilst considering the efficacy and efficiency.
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Affiliation(s)
- Javier Crespo
- Servicio de Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Santander
| | | | | | | | | | - Federico García
- Servicio de Microbiología, Hospital Universitario San Cecilio. Granada
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Mason LMK, Veldhuijzen IK, Duffell E, van Ahee A, Bunge EM, Amato‐Gauci AJ, Tavoschi L. Hepatitis B and C testing strategies in healthcare and community settings in the EU/EEA: A systematic review. J Viral Hepat 2019; 26:1431-1453. [PMID: 31332919 PMCID: PMC6899601 DOI: 10.1111/jvh.13182] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/24/2019] [Accepted: 06/26/2019] [Indexed: 01/05/2023]
Abstract
An estimated 9 million individuals are chronically infected with hepatitis B virus (HBV) and hepatitis C virus (HCV) across the European Union/European Economic Area (EU/EEA), many of which are yet to be diagnosed. We performed a systematic review to identify interventions effective at improving testing offer and uptake in the EU/EEA. Original research articles published between 1 January 2008 and 1 September 2017 were retrieved from PubMed and EMBASE. Search strings combined terms for HBV/HCV, intervention, testing and geographic terms (EU/EEA). Out of 8331 records retrieved, 93 studies were selected. Included studies reported on testing initiatives in primary health care (9), hospital (12), other healthcare settings (31) and community settings (41). Testing initiatives targeted population groups such as migrants, drug users, prisoners, pregnant women and the general population. Testing targeted to populations at higher risk yielded high coverage rates in many settings. Implementation of novel testing approaches, including dried blood spot (DBS) testing, was associated with increased coverage in several settings including drug services, pharmacies and STI clinics. Community-based testing services were effective in reaching populations at higher risk for infection, vulnerable and hard-to-reach populations. In conclusion, our review identified several successful testing approaches implemented in healthcare and community settings, including testing approaches targeting groups at higher risk, community-based testing services and DBS testing. Combining a diverse set of testing opportunities within national testing strategies may lead to higher impact both in terms of testing coverage and in terms of reduction, on the undiagnosed fraction.
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Affiliation(s)
| | - Irene K. Veldhuijzen
- The Netherlands National Institute for Public Health and the EnvironmentBilthovenThe Netherlands
| | - Erika Duffell
- European Centre for Disease Prevention and ControlStockholmSweden
| | - Ayla van Ahee
- Pallas Health Research and Consultancy B.V.RotterdamThe Netherlands
| | - Eveline M. Bunge
- Pallas Health Research and Consultancy B.V.RotterdamThe Netherlands
| | | | - Lara Tavoschi
- European Centre for Disease Prevention and ControlStockholmSweden
- Present address:
University of PisaPisaItaly
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Surey J, Menezes D, Francis M, Gibbons J, Sultan B, Miah A, Abubakar I, Story A. From peer-based to peer-led: redefining the role of peers across the hepatitis C care pathway: HepCare Europe. J Antimicrob Chemother 2019; 74:v17-v23. [PMID: 31782500 PMCID: PMC6883389 DOI: 10.1093/jac/dkz452] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND HCV infection disproportionately affects underserved populations such as homeless individuals, people who inject drugs and prison populations. Peer advocacy can enable active engagement with healthcare services and increase the likelihood of favourable treatment outcomes. OBJECTIVES This observational study aims to assess the burden of disease in these underserved populations and describe the role of peer support in linking these individuals to specialist treatment services. METHODS Services were identified if they had a high proportion of individuals with risk factors for HCV, such as injecting drug use or homelessness. Individuals were screened for HCV using point-of-care tests and a portable FibroScan. All positive cases received peer support for linkage to specialist care. Information was gathered on risk factors, demographics and follow-up information regarding linkage to care and treatment outcomes. RESULTS A total of 461 individuals were screened, of which 197 (42.7%) were chronically infected with HCV. Referral was made to secondary care for 176 (89.3%) and all received peer support, with 104 (52.8%) individuals engaged with treatment centres. Of these, 89 (85.6%) started treatment and 76 (85.4%) had a favourable outcome. Factors associated with not being approved for treatment were recent homelessness, younger age and current crack cocaine injecting. CONCLUSIONS Highly trained peer support workers working as part of a specialist outreach clinical team help to identify a high proportion of individuals exposed to HCV, achieve high rates of engagement with treatment services and maintain high rates of treatment success amongst a population with complex needs.
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Affiliation(s)
- Julian Surey
- Institute of Global Health, University College London, London, UK
- Find and Treat, University College London Hospitals NHS Trust, London, UK
- Universidad Autónoma de Madrid, Madrid, Spain
| | - Dee Menezes
- Institute of Health Informatics, University College London, London, UK
| | - Marie Francis
- Institute of Global Health, University College London, London, UK
- Find and Treat, University College London Hospitals NHS Trust, London, UK
| | - John Gibbons
- Find and Treat, University College London Hospitals NHS Trust, London, UK
- Groundswell, London, UK
| | - Binta Sultan
- Institute of Global Health, University College London, London, UK
| | | | - Ibrahim Abubakar
- Institute of Global Health, University College London, London, UK
| | - Alistair Story
- Find and Treat, University College London Hospitals NHS Trust, London, UK
- Collaborative Centre for Inclusion Health, UCL, London, UK
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Crowley D, Cullen W, Lambert JS, Van Hout MC. Competing priorities and second chances - A qualitative exploration of prisoners' journeys through the Hepatitis C continuum of care. PLoS One 2019; 14:e0222186. [PMID: 31509571 PMCID: PMC6738615 DOI: 10.1371/journal.pone.0222186] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 08/25/2019] [Indexed: 12/13/2022] Open
Abstract
High levels of undiagnosed and untreated HCV infection exist in prison populations globally. Prisons are a key location to identify, treat and prevent HCV infection among people who inject drugs (PWID). Understanding prisoners’ lived experiences of the HCV continuum of care informs how HCV care can be effectively delivered to this marginalised and high-risk population. This study aimed to explore Irish prisoners’ experience of prison and community-based HCV care. We conducted one-to-one interviews with 25 male prisoners with chronic HCV infection. Data collection and analysis was informed by grounded theory. The mean age of participants and first incarceration was 39.5 and 18.3 years respectively. The mean number of incarcerations was eight. The following themes were identified: medical and social factors influencing engagement (fear of treatment and lack of knowledge, HCV relevance and competing priorities), adverse impact of HCV on health and wellness, positive experience of prison life and health care and the transformative clinical and non-clinical changes associated with HCV treatment and cure. Findings suggest that prison release was associated with multiple stressors including homelessness and drug dependence which quickly eroded the health benefits gained during incarceration. The study generated a substantive theory of the need to increase the importance of HCV care among the routine competing priorities associated with the lives of PWID. HCV infected prisoners often lead complex lives and understanding their journeys through the HCV continuum can inform the development of meaningful HCV care pathways. Many challenges exist to optimising HCV treatment uptake in this group and incarceration is an opportunity to successfully engage HCV infected prisoners who underutilise and are underserved by community-based medical services. Support and linkage to care on release is essential to optimising HCV management.
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Affiliation(s)
- Desmond Crowley
- Irish College of General Practitioners, Lincoln Place, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
- * E-mail:
| | - Walter Cullen
- School of Medicine, University College Dublin, Dublin, Ireland
| | - John S. Lambert
- School of Medicine, University College Dublin, Dublin, Ireland
- Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin, Ireland
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Crowley D, Murtagh R, Cullen W, Keevans M, Laird E, McHugh T, McKiernan S, Miggin SJ, O'Connor E, O'Reilly D, Betts-Symonds G, Tobin C, Van Hout MC, Lambert JS. Evaluating peer-supported screening as a hepatitis C case-finding model in prisoners. Harm Reduct J 2019; 16:42. [PMID: 31277665 PMCID: PMC6612120 DOI: 10.1186/s12954-019-0313-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 06/04/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Hepatitis C Virus (HCV) infection is endemic in prison populations, and HCV management in prisons is suboptimal. Incarceration is a public health opportunity to target this cohort. Community peer support increases HCV screening and treatment uptake. Prison peer workers have the potential to support the engagement of prisoners with health services and reduce stigma. This study's primary aim is to evaluate peer-supported screening as a model of active HCV case finding with a secondary aim to describe the HCV cascade among those infected including linkage to care and treatment outcomes. METHODS An observational study was conducted in a medium-security Irish male prison housing 538 inmates, using a risk-based questionnaire, medical records, peer-supported screening, laboratory-based HCV serology tests and mobile elastography. RESULTS A prison peer-supported screening initiative engaged large numbers of prisoners in HCV screening (n = 419). The mean age of participants was 32.8 years, 92% were Irish and 33% had a history of injecting drug use. Multiple risk factors for HCV acquisition were identified including needle sharing (16%). On serological testing, 87 (21%) were HCV Ab +ve and 50 (12%) were HCV RNA +ve of whom 80% were fibroscaned (25% showing evidence of liver disease). Eighty-six percent of those with active infection were linked with HCV care, with 33% undergoing or completing treatment. There was a high concordance with HCV disclosure at committal and serological testing (96% for HCV Ab +ve and 89% for HCV Ab -ve). CONCLUSION Peer-supported screening is an effective active HCV case-finding model to find and link prisoners with untreated active HCV infection to HCV care.
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Affiliation(s)
- Desmond Crowley
- Irish College of General Practitioners, Lincoln Place, Dublin 2, Ireland. .,School of Medicine, University College Dublin, Dublin, Ireland.
| | - Ross Murtagh
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Walter Cullen
- School of Medicine, University College Dublin, Dublin, Ireland
| | | | | | - Tina McHugh
- Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin, Ireland
| | | | | | - Eileen O'Connor
- School of Medicine, University College Dublin, Dublin, Ireland.,Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin, Ireland
| | | | | | | | | | - John S Lambert
- School of Medicine, University College Dublin, Dublin, Ireland.,Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin, Ireland
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20
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Bundle N, Balasegaram S, Parry S, Ullah S, Harris RJ, Ahmad K, Foster GR, Tong CYW, Orkin C. Seroprevalence and demographic factors associated with hepatitis B, hepatitis C and HIV infection from a hospital emergency department testing programme, London, United Kingdom, 2015 to 2016. Euro Surveill 2019; 24:1800377. [PMID: 31290390 PMCID: PMC6628754 DOI: 10.2807/1560-7917.es.2019.24.27.1800377] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BackgroundProgress towards HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV) elimination requires local prevalence estimates and linkage to care (LTC) of undiagnosed or disengaged cases.AimWe aimed to estimate seroprevalence, factors associated with positive blood-borne virus (BBV) serology and numbers needed to screen (NNS) to detect a new BBV diagnosis and achieve full LTC from emergency department (ED) BBV testing.MethodsDuring a 9-month programme in an ED in east London, England, testing was offered to adult attendees having a full blood count (FBC). We estimated factors associated with positive BBV serology using logistic regression and NNS as the inverse of seroprevalence. Estimates were weighted to the age, sex and ethnicity of the FBC population.ResultsOf 6,211 FBC patients tested, 217 (3.5%) were positive for at least one BBV. Weighted BBV seroprevalence was 4.2% (95% confidence interval (CI): 3.6-4.9). Adjusted odds ratios (aOR) of positive BBV serology were elevated among patients that were: male (aOR: 2.7; 95% CI: 1.9-3.9), 40-59 years old (aOR: 1.9; 95% CI: 1.4-2.7), of Black British/Black other ethnicity (aOR: 1.8; 95% CI: 1.2-2.8) or had no fixed address (aOR: 2.9; 95% CI: 1.5-5.5). NNS to detect a new BBV diagnosis was 154 (95% CI: 103-233) and 135 (95% CI: 93-200) to achieve LTC.ConclusionsThe low NNS suggests routine BBV screening in EDs may be worthwhile. Those considering similar programmes should use our findings to inform their assessments of anticipated public health benefits.
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Affiliation(s)
- Nick Bundle
- United Kingdom Field Epidemiology Training Programme, Public Health England, London, United Kingdom,Field Epidemiology Services, National Infection Service, Public Health England, London, United Kingdom
| | - Sooria Balasegaram
- Field Epidemiology Services, National Infection Service, Public Health England, London, United Kingdom
| | - Sarah Parry
- Queen Mary University of London, London, United Kingdom
| | - Sadna Ullah
- Queen Mary University of London, London, United Kingdom
| | - Ross J Harris
- Statistics, Modelling and Economics Department, National Infection Service, Public Health England, London, United Kingdom
| | - Karim Ahmad
- Barts Health NHS Trust, Emergency Department, Royal London Hospital, London, United Kingdom
| | - Graham R Foster
- Blizard Institute, Queen Mary University, London, United Kingdom
| | - Cheuk YW Tong
- Barts Health NHS Trust, Virology department, Royal London Hospital, London, United Kingdom
| | - Chloe Orkin
- Queen Mary University of London, London, United Kingdom
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21
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Cullen L, Grenfell P, Rodger A, Orkin C, Mandal S, Rhodes T. 'Just another vial…': a qualitative study to explore the acceptability and feasibility of routine blood-borne virus testing in an emergency department setting in the UK. BMJ Open 2019; 9:e024085. [PMID: 31048425 PMCID: PMC6501954 DOI: 10.1136/bmjopen-2018-024085] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Increased test uptake for HIV and viral hepatitis is fast becoming a health priority at both national and global levels. Late diagnosis of these infections remains a critical public health concern in the UK. Recommendations have been issued to expand blood-borne virus (BBV) testing in alternative settings. Emergency departments (EDs) offer a potentially important point of testing. This paper presents findings from a qualitative study which aimed to explore the acceptability and feasibility of a routine opt-out combined BBV testing intervention implemented at an inner London ED. METHODS We conducted 22 semistructured interviews with patients and service providers in the ED over a 4-month period during the intervention pilot. A grounded analytical approach was employed to conduct thematic analysis of qualitative study data. RESULTS Core interrelating thematic areas, identified and analytically developed in relation to test intervention implementation and experience, included the following: the remaking of routine test procedure; notions of responsibility in relation to status knowledge and test engagement; the opportunity and constraints of the ED as a site for testing; and the renegotiation of testing cultures within and beyond the clinic space. CONCLUSION Study findings demonstrate how relational and spatial dynamics specific to the ED setting shape test meaning and engagement. We found acceptability of the test practice was articulated through narratives of situated responsibility, with the value of the test offset by perceptions of health need and justification of the test expense. Participant accounts indicate that the nontargeted approach of the test affords a productive disruption to 'at-risk' identities, yet they also reveal limits to the test intervention's 'normalising' effect. Evaluation of the intervention must attend to the situated dynamics of the test practice if opportunities of an opt-out BBV test procedure are to be fully realised. Findings also highlight the critical need to further evaluate post-test intervention practices and experiences.
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Affiliation(s)
- Lucy Cullen
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- National Institute for Health Research (NIHR), Health Protection Research Unit (HPRU) in Blood Borne and SexuallyTransmitted Infections, London, UK
| | - Pippa Grenfell
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- National Institute for Health Research (NIHR), Health Protection Research Unit (HPRU) in Blood Borne and SexuallyTransmitted Infections, London, UK
| | - Alison Rodger
- National Institute for Health Research (NIHR), Health Protection Research Unit (HPRU) in Blood Borne and SexuallyTransmitted Infections, London, UK
- Infection & Population Health, Institute for Global Health, University College London, London, UK
| | - Chloe Orkin
- HIV Medicine, Barts Health NHS Trust, London, UK
| | - Sema Mandal
- National Institute for Health Research (NIHR), Health Protection Research Unit (HPRU) in Blood Borne and SexuallyTransmitted Infections, London, UK
- Immunisation, Hepatitis, Blood Safety and Countermeasures Response, Public Health England, London, UK
| | - Tim Rhodes
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- National Institute for Health Research (NIHR), Health Protection Research Unit (HPRU) in Blood Borne and SexuallyTransmitted Infections, London, UK
- National Centre for Social Research on Health, University of New South Wales, Sydney, Australia
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22
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El diagnóstico de la infección por el virus de la hepatitis C en España: una oportunidad para mejorar. Enferm Infecc Microbiol Clin 2019; 37:231-238. [DOI: 10.1016/j.eimc.2018.05.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 05/09/2018] [Accepted: 05/12/2018] [Indexed: 12/17/2022]
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23
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Caldwell H. Preventing, identifying and treating hepatitis C. Nurs Stand 2019; 34:e11321. [PMID: 31468895 DOI: 10.7748/ns.2018.e11321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2018] [Indexed: 06/10/2023]
Abstract
Hepatitis C is a blood-borne virus that, if left untreated, can result in significant liver damage and cancer. Most individuals are unaware that they have been infected with the hepatitis C virus and remain asymptomatic, which makes early diagnosis challenging. While the virus will spontaneously clear in some individuals, the majority will develop chronic hepatitis C. This article provides nurses with an overview of hepatitis C and how it is transmitted. It details the available treatments, and examines the challenges involved in early identification and access to treatment, as well as outlining the barriers to treatment and how these can be overcome. This article also discusses the role of the nurse in the management of people with hepatitis C and in addressing their complex needs.
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Affiliation(s)
- Helen Caldwell
- Nurse consultant in hepatology, Royal Liverpool University Hospital NHS Trust, Liverpool, England
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24
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Harris M, Rhodes T. Caring and curing: Considering the effects of hepatitis C pharmaceuticalisation in relation to non-clinical treatment outcomes. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 60:24-32. [PMID: 30092546 DOI: 10.1016/j.drugpo.2018.07.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 07/18/2018] [Accepted: 07/20/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND The development of simplified and effective hepatitis C (HCV) pharmaceuticals enables treatment scale up among the most marginalised. This potentiates a promise of viral elimination at the population level but also individual level clinical and non-clinical benefits. Reports of transformative non-clinical outcomes, such as changes in self-worth and substance use, are primarily associated with arduous interferon-based treatments that necessitate intensive care relationships. We consider the implications of simplified treatment provision in the era of direct acting antivirals (DAAs) for the realisation of non-clinical benefits. METHODS We draw on qualitative data from ethnographic observations and longitudinal interviews with people receiving (n = 22) and providing (n = 10) HCV treatment in London during a transition in HCV biomedicine. First generation DAAs in conjunction with interferon were standard of care for most of this time, with the promise of simplified treatment provision on the horizon. FINDINGS Patient accounts of care accentuate the transformative value of interferon-based HCV treatment derived through non-clinical benefits linked to identity and lifestyle change. Such care is constituted as extending beyond the virus and its biomedical effects, with nurse specialists positioned as vital to this care being realised. Provider accounts emphasise the increased pharmaceuticalisation of HCV treatment; whereby care shifts from the facilitation of therapeutic relationships to pharmaceutical access. CONCLUSION HCV care in the interferon-era affords identity transformations for those receiving and providing treatment. Biomedical promise linked to the increasing pharmaceuticalisation of HCV treatment has disruptive potential, shifting how care is practised and potentially the realisation of non-clinical treatment outcomes.
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Affiliation(s)
- Magdalena Harris
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH, United Kingdom.
| | - Tim Rhodes
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH, United Kingdom
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25
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Evans H, Balasegaram S, Douthwaite S, Hunter L, Kulasegaram R, Wong T, Querol-Rubiera A, Nebbia G. An innovative approach to increase viral hepatitis diagnoses and linkage to care using opt-out testing and an integrated care pathway in a London Emergency Department. PLoS One 2018; 13:e0198520. [PMID: 30044779 PMCID: PMC6059401 DOI: 10.1371/journal.pone.0198520] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 05/21/2018] [Indexed: 01/23/2023] Open
Abstract
Therapies that halt progression of chronic hepatitis B virus (HBV) and achieve a cure for chronic hepatitis C virus (HCV) have encouraged development of innovative strategies to diagnose and link patients to care. We describe the prevalence and risk factors for HBV and HCV infections and use of an opt-out hepatitis testing and integrated linkage to care pathway in a London Emergency Department (ED). ED patients aged ≥16 years having routine blood tests from 15 February-28 March 2016 were tested for hepatitis, unless opted out. Hepatitis B surface antigen (HBsAg) and hepatitis C antibody tests (HCV-Ab, including a confirmatory hepatitis C antigen test (HCV-Ag)) were pre-selected on electronic blood test requests. Linkage to care (attending one clinic appointment) was offered to HBsAg and HCV-Ag patients (new or known-disengaged with care diagnoses). Weighted prevalence estimates and risk factors for seropositivity adjusted by demographics and survey weights were calculated using logistic regression. Hepatitis testing uptake was 56% (3,290/5,865). Overall, 26 HBsAg (10 new diagnoses) and 63 HCV-Ab patients were identified of which 32 were HCV-Ag positive (10 new diagnoses). Weighted seroprevalence of HBsAg was 0.50% (95% CI 0.3-0.8%); HCV-Ab 2.0% (95% CI 1.5-2.7%) and HCV-Ag 1.2% (95% CI 0.8-1.7%). Risk factors for infection were being male (HBsAg: aOR 4.1, 95% CI 1.5-11.3), of non-White British ethnicity (HBsAg: aOR>11) or being homeless (HCV-Ag: aOR 18.9, 95% CI 6.9-51.4). We achieved a high linkage to care uptake for HBsAg (93%) and HCV-Ag (78%) among patients who were contacted and required linkage. A pre-selected hepatitis testing ordering system facilitated a high testing uptake. New and disengaged with care diagnoses and a high HCV prevalence were identified demonstrating the potential to identify and link patients to care in this setting. Strategies connecting clinical care with community outreach services are key for improving patient linkage to care.
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Affiliation(s)
- Hannah Evans
- United Kingdom Field Epidemiology Training Programme, Public Health England, United Kingdom
- Field Epidemiology Service, National Infection Service, Public Health England, London, United Kingdom
| | - Sooria Balasegaram
- United Kingdom Field Epidemiology Training Programme, Public Health England, United Kingdom
- Field Epidemiology Service, National Infection Service, Public Health England, London, United Kingdom
| | - Sam Douthwaite
- Department of Infection, Guy’s and St Thomas’ NHS Trust, London, United Kingdom
| | - Laura Hunter
- Emergency Department, Guy’s and St Thomas’ NHS Trust, London, United Kingdom
| | - Ranjababu Kulasegaram
- Department of HIV/GU Medicine, Guy’s and St Thomas’ NHS Trust, London, United Kingdom
| | - Terry Wong
- Gastroenterology and Hepatology Department, Guy’s and St Thomas’ NHS Trust, London, United Kingdom
| | | | - Gaia Nebbia
- Department of Infection, Guy’s and St Thomas’ NHS Trust, London, United Kingdom
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26
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Harris M, Bonnington O, Harrison G, Hickman M, Irving W. Understanding hepatitis C intervention success-Qualitative findings from the HepCATT study. J Viral Hepat 2018; 25:762-770. [PMID: 29369467 DOI: 10.1111/jvh.12869] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 12/14/2017] [Indexed: 12/11/2022]
Abstract
The United Kingdom has committed to eliminating viral hepatitis as a public health threat. Innovative interventions for marginalized populations are required to realize this goal. In 2016, the HepCATT study team implemented a complex hepatitis C (HCV) intervention in three English drug treatment services, with five controls. We report qualitative study findings from two intervention sites to explore intervention success and transferability potential. The intervention comprised multiple components, including a nurse facilitator, peer support and education initiatives. Qualitative data were generated at baseline (2014) and post-intervention (2016) at two sites through in-depth interviews, focus groups and observations. The 96 participants comprised drug service and intervention providers and clients with an injecting history. Data were triangulated and thematically analysed. Client engagement with a HCV treatment service rose from 16 at baseline to 147 in 2016. There was no comparable increase at the five control sites. Baseline testing and treatment barriers included the following: limited HCV knowledge; fear of diagnosis and treatment; precarious living circumstances and service-specific obstacles. Treatment engagement was aided by intervention timeliness; improved communication structures; personalized care; streamlined testing and treatment pathways; peer support. Multiple interrelated components influenced the increased levels of treatment engagement documented in HepCATT. The nurse facilitator, involved in implementation and innovation, was key to intervention success. Baseline barriers correspond with international literature-indicating transferability potential. Control data indicate that biomedical innovation alone is not sufficient to increase engagement among the most marginalized. Sustainable resourcing of community services is crucial to effect change.
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Affiliation(s)
- M Harris
- Department of Social and Environmental Health Research, London School of Hygiene, & Tropical Medicine, London, UK
| | - O Bonnington
- Department of Social and Environmental Health Research, London School of Hygiene, & Tropical Medicine, London, UK
| | - G Harrison
- Gastrointestinal and Liver Disorders Theme, NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - M Hickman
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - W Irving
- Gastrointestinal and Liver Disorders Theme, NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
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27
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Guise A, Witzel TC, Mandal S, Sabin C, Rhodes T, Nardone A, Harris M. A qualitative assessment of the acceptability of hepatitis C remote self-testing and self-sampling amongst people who use drugs in London, UK. BMC Infect Dis 2018; 18:281. [PMID: 29914381 PMCID: PMC6006927 DOI: 10.1186/s12879-018-3185-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 06/06/2018] [Indexed: 12/22/2022] Open
Abstract
Background Hepatitis C (HCV) diagnosis and care is a major challenge for people who use illicit drugs, and is characterised by low rates of testing and treatment engagement globally. New approaches to fostering engagement are needed. We explored the acceptability of remote forms of HCV testing including self-testing and self-sampling among people who use drugs in London, UK. Methods A qualitative rapid assessment was undertaken with people who use drugs and stakeholders in London, UK. Focus groups were held with men who have sex with men engaged in drug use, people who currently inject drugs and people who formerly injected drugs (22 participants across the 3 focus groups). Stakeholders participated in semi-structured interviews (n = 5). We used a thematic analysis to report significant themes in participants’ responses. Results We report an overarching theme of ‘tension’ in how participants responded to the acceptability of remote testing. This tension is evident across four separate sub-themes we explore. First, choice and control, with some valuing the autonomy and privacy remote testing could support. Second, the ease of use of self testing linked to its immediate result and saliva sample was preferred over the delayed result from a self administered blood sample tested in a laboratory. Third, many respondents described the need to embed remote testing within a supportive care pathway. Fourth, were concerns over managing a positive result, and its different meanings, in isolation. Conclusions The concept of remote HCV testing is acceptable to some people who use drugs in London, although tensions with lived experience of drug use and health system access limit its relevance. Future development of remote testing must respond to concerns raised in order for acceptable implementation to take place.
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Affiliation(s)
- Andy Guise
- London School of Hygiene and Tropical Medicine, London, UK. .,School of Population Health and Environmental Sciences, Guy's campus, King's College London, Addison House, London, UK.
| | - T Charles Witzel
- SIGMA Research, London School of Hygiene and Tropical Medicine, Tavistock Place, London, UK
| | - Sema Mandal
- Public Health England, Wellington House, Waterloo Road, London, UK.,National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in collaboration with Public Health England, London, UK
| | - Caroline Sabin
- National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in collaboration with Public Health England, London, UK. .,Institute for Global Health, UCL, London, UK.
| | - Tim Rhodes
- London School of Hygiene and Tropical Medicine, London, UK.,National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in collaboration with Public Health England, London, UK
| | - Anthony Nardone
- Public Health England, Wellington House, Waterloo Road, London, UK.,National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in collaboration with Public Health England, London, UK
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28
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Northrop JM. A dirty little secret: stigma, shame and hepatitis C in the health setting. MEDICAL HUMANITIES 2017; 43:218-224. [PMID: 28363990 DOI: 10.1136/medhum-2016-011099] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/02/2017] [Indexed: 05/23/2023]
Abstract
While recent medical innovation shows great promise in treating hepatitis C (HCV), it remains a condition associated with profound stigma. HCV is a bloodborne virus (BBV) most commonly transmitted in high-income countries by injecting drug use, and it is the stigmatising association between the two which is deeply problematic for those with HCV. A qualitative study undertaken in 2002 found that disclosure in health settings places those with HCV in positions of pronounced vulnerability. Disclosure is a primal scene, an interface, where the stigma of HCV, replete with connotations of disease and deviance, potentially transforms those affected into shamed subjects. Standard precautions protect health workers and minimise the transmission of contagion, measures which, in theory, also mitigate the requirement of those with BBVs to unnecessarily disclose their blood status. However, questions on pre-employment health checks, concerns that health treatments might adversely affect the liver and an ethical need to pre-emptively inform healthcare professionals undertaking exposure prone procedures are occasions when those with HCV confront the decision to disclose their blood status. This paper employs Goffman's model of actual and virtual social identities, along with Douglas' notion of dirt and pollution, to examine the dilemmas around disclosure those with HCV negotiate within the health setting. Discriminatory responses by healthcare professionals elucidate the stigmatising potential HCV carries. The subsequent reticence by those with HCV to disclose their blood status risks less than optimum healthcare. Recent studies indicate that stigma occurring in health settings remains a perennial concern for those with HCV.
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29
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McLeod A, Cullen BL, Hutchinson SJ, Roy KM, Dillon JF, Stewart EA, Goldberg DJ. Limited impact of awareness-raising campaigns on hepatitis C testing practices among general practitioners. J Viral Hepat 2017; 24:944-954. [PMID: 28502088 DOI: 10.1111/jvh.12724] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 04/20/2017] [Indexed: 12/21/2022]
Abstract
The global hepatitis strategy calls for increased effort to diagnose those infected, with a target of 90% diagnosed by 2030. Scotland's Action Plan on Hepatitis C included awareness-raising campaigns, undertaken during 2008-2011, to promote testing by general practitioners. We examined hepatitis C virus (HCV) testing practice among general practitioners before and following these campaigns. Scottish general practitioners were surveyed, using Dillman's method, in 2007 and 2013; response rates were 69% and 60%, respectively. Most respondents offer testing when presented with a risk history (86% in 2007, 88% in 2013) but only one-fifth actively sought out risk factors (19% in 2007, 21% in 2013). Testing was reportedly always/almost always/usually offered to people who inject drugs (84% in 2007, 87% in 2013). Significant improvements in the offer of testing were reported in patients with abnormal LFTs (41% in 2007, 65% in 2013, P<.001) and who had received medical/dental treatment in high prevalence countries (14% in 2007, 24% in 2013, P=.001). In 2013, 25% of respondents had undertaken HCV-related continued professional development. This group was significantly more likely to actively seek out risk factors (P=.009) but only significantly more likely to offer a test to patients who had received medical/dental treatment in high prevalence countries (P=.001). Our findings suggest that government-led awareness raising campaigns have limited impact on general practitioners' testing practices. If the majority of the HCV-infected population are to be diagnosed, practitioner-based or physician-centred interventions should be considered alongside educational initiatives targeted at professionals.
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Affiliation(s)
- A McLeod
- Health Protection Scotland, Glasgow, UK
| | | | - S J Hutchinson
- Health Protection Scotland, Glasgow, UK.,School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - K M Roy
- Health Protection Scotland, Glasgow, UK
| | - J F Dillon
- NHS Tayside and Medical Research Institute, University of Dundee, Dundee, UK
| | - E A Stewart
- Department of Public Health, NHS Lothian and Bonnyrigg Health Centre, Edinburgh, UK
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30
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Whiteley D, Whittaker A, Elliott L, Cunningham-Burley S. Hepatitis C in a new therapeutic era: Recontextualising the lived experience. J Clin Nurs 2017; 27:2729-2739. [PMID: 28960567 DOI: 10.1111/jocn.14083] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2017] [Indexed: 01/28/2023]
Abstract
AIMS AND OBJECTIVES To explore the experience of adults living with hepatitis C in a new era of interferon-free treatment. BACKGROUND Hepatitis C is a leading cause of morbidity and mortality worldwide, posing a significant challenge to global public health. Historically, the treatment of hepatitis C was poorly efficacious and highly demanding; however, more effective and tolerable therapies have become available in high-income nations in recent years. This is the first study to explore how these significant developments in the treatment of hepatitis C may have influenced the experience of those living with the virus, and their understanding of the disease. DESIGN A qualitative study underpinned by social phenomenological theory. METHODS Data were generated through semi-structured interviews with a purposive sample of 20 hepatitis C positive adults living in a large city in Scotland. RESULTS Thematic analysis identified three overriding themes. "Positioning hepatitis C" illustrated how the disease was understood within wider sociocultural, medical and politico-economic contexts. "Beyond a physical burden" emphasised the emotional aspect of infection, and "a new uncertainty" revealed participants' cautious response to the advances in hepatitis C therapy. CONCLUSIONS Interthematic discourse portrayed the new era of hepatitis C treatment as holding little sway over constructions of the illness, as narratives resonated with previous studies. Such unmoving "lay" understandings of hepatitis C may pose potential barriers to the new therapeutic era from reaching its full potential. RELEVANCE TO CLINICAL PRACTICE How people living with the virus perceive and understand hepatitis C can have an adverse impact on their engagement with care and treatment. Whilst global medical discourse eulogises the arrival of a new era of therapy, there remain significant challenges for nurses engaging those with hepatitis C in therapeutic pathways.
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Affiliation(s)
- David Whiteley
- Regional Infectious Diseases Unit, Western General Hospital, Edinburgh, UK.,School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK.,Substance Misuse Directorate, NHS Lothian, Astley Ainslie Hospital, Edinburgh, UK
| | - Anne Whittaker
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK.,Substance Misuse Directorate, NHS Lothian, Astley Ainslie Hospital, Edinburgh, UK
| | - Lawrie Elliott
- Department of Nursing and Community Health, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Sarah Cunningham-Burley
- School of Molecular, Genetic and Population Health Sciences, University of Edinburgh, Edinburgh, UK
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Turner BJ, Craig K, Makanji VS, Flores BE, Hernandez L. Improving support and education of low-income baby boomers diagnosed with chronic hepatitis C virus infection through universal screening. J Clin Nurs 2017; 26:4605-4612. [PMID: 28295785 DOI: 10.1111/jocn.13806] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2017] [Indexed: 02/07/2023]
Abstract
AIMS AND OBJECTIVES To identify support needs of low-income baby boomers recently diagnosed with chronic hepatitis C virus infection. BACKGROUND The U.S. Preventive Services Task Force has endorsed one-time screening of all baby boomers (born 1945-1965) for hepatitis C because 75% of the estimated 2-3 million persons with chronic infection are in this age range. We hypothesised that persons diagnosed by routine screening would have significant psycho-emotional, cognitive and healthcare challenges that need to be met by collaborative care and services from nurses and other healthcare personnel. DESIGN Qualitative descriptive study of data from three focus groups with predominantly minority participants (N = 16). Data were analysed using qualitative content analysis, and transcribed data were categorised by three domains in a previously developed model and a new domain identified in this study. Frequencies of unique participants' comments about each theme were calculated. RESULTS Elucidated domains were as follows: (i) psycho-emotional effects due to social stigma, shame, fear and dealing with risky behaviours; (ii) social effects due to concerns about infecting others; and (iii) cognitive deficits because of poor understanding about hepatitis C virus infection and its care. A new domain related to health care emerged reflecting the following themes: poor access to care, barriers to costly treatment, and navigating complex care for comorbidities. Despite these challenges, participants strongly endorsed universal baby boomer hepatitis C virus screening. CONCLUSIONS This study describes psycho-emotional and social challenges of people dealing with a hepatitis C diagnosis which are compounded by poor knowledge and barriers to supportive care. RELEVANCE TO CLINICAL PRACTICE Nursing and other allied health personnel require structured support programmes to assist older persons diagnosed with hepatitis C with addressing these common challenges with the ultimate goal of achieving a cure.
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Affiliation(s)
- Barbara J Turner
- Department of Medicine, University of Texas Health San Antonio (UT Health San Antonio), San Antonio, TX, USA.,Center for Research to Advance Community Health (ReACH), UT Health San Antonio, San Antonio, TX, USA
| | - Kathryn Craig
- School of Medicine, UT Health San Antonio, San Antonio, TX, USA
| | - Vidhi S Makanji
- School of Medicine, UT Health San Antonio, San Antonio, TX, USA
| | - Bertha E Flores
- Center for Research to Advance Community Health (ReACH), UT Health San Antonio, San Antonio, TX, USA.,School of Nursing, UT Health San Antonio, San Antonio, TX, USA
| | - Ludivina Hernandez
- Center for Research to Advance Community Health (ReACH), UT Health San Antonio, San Antonio, TX, USA
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Cardoso AR, Cabral-Miranda G, Reyes-Sandoval A, Bachmann MF, Sales MGF. Detecting circulating antibodies by controlled surface modification with specific target proteins: Application to malaria. Biosens Bioelectron 2017; 91:833-841. [DOI: 10.1016/j.bios.2017.01.031] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 01/13/2017] [Indexed: 01/10/2023]
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Younossi ZM, Tanaka A, Eguchi Y, Lim YS, Yu ML, Kawada N, Dan YY, Brooks-Rooney C, Negro F, Mondelli MU. The impact of hepatitis C virus outside the liver: Evidence from Asia. Liver Int 2017; 37:159-172. [PMID: 27748564 DOI: 10.1111/liv.13272] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 09/30/2016] [Indexed: 12/11/2022]
Abstract
Between 80 and 115 million people worldwide are chronically infected with hepatitis C virus, with 60%-90% of these being undiagnosed. Untreated chronic hepatitis C (CHC) is associated with progressive liver disease, cirrhosis, hepatocellular carcinoma and liver-related mortality. A number of extrahepatic manifestations are also reported in CHC patients, further adding to the burden of the disease. CHC also impacts patients in terms of lower health-related quality of life, higher levels of fatigue and reduced productivity. Furthermore, the later stages of disease are costly for both healthcare systems and society. Pegylated-interferon (PEG-IFN)+ribavirin (RBV), for many years the mainstay of treatment, leads to sustained virological response (SVR) in 40%-70% of patients. However, a substantial number of patients are ineligible for treatment, and many patients fail to achieve SVR with this regimen. Furthermore, PEG-IFN+RBV leads to impairment of patient-reported outcomes during treatment, and most patients suffer from adverse events, associated with poor adherence, treatment discontinuation and treatment failure. The approval of second-generation direct-acting antivirals (DAAs) has revolutionized the treatment of CHC patients. All-oral, PEG-IFN and RBV-free regimens have higher efficacy rates, shorter treatment durations, fewer adverse events, higher adherence rates and improvement in PROs from as early as Week 4, compared to PEG-IFN+RBV regimens. The aim of this article is to review the evidence for HCV infection as a systemic disease, summarizing the impact of hepatitis C and its treatments on clinical, patient and economic outcomes, with a focus on data from Asia and Japan specifically.
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Affiliation(s)
- Zobair M Younossi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA.,Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA
| | - Atsushi Tanaka
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Yuichiro Eguchi
- Liver Center, Saga University Hospital, Saga University, Saga, Japan
| | - Young-Suk Lim
- Department of Gastroenterology, Liver Center, Asan Medical Center, Seoul, Korea
| | - Ming-Lung Yu
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Norifumi Kawada
- Department of Hepatology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Yock Young Dan
- Department of Medicine, National University of Singapore, Singapore
| | | | - Francesco Negro
- Division of Gastroenterology and Hepatology and Division of Clinical Pathology, University Hospital, Geneva, Switzerland
| | - Mario U Mondelli
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
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