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Gahrton C, Navér G, Warnqvist A, Dalgard O, Aleman S, Kåberg M. Changes in hepatitis C virus prevalence and incidence among people who inject drugs in the direct acting antiviral era. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 128:104433. [PMID: 38703622 DOI: 10.1016/j.drugpo.2024.104433] [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: 02/05/2024] [Revised: 03/28/2024] [Accepted: 04/16/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND The World Health Organization (WHO) has set a goal to eliminate hepatitis C virus (HCV) infection by 2030, including a 90% reduction of HCV incidence. With the introduction of a needle syringe program (NSP) in Stockholm, Sweden, and unrestricted availability of direct acting antiviral (DAA) treatment, we investigate the change of prevalence and incidence of HCV infection among people who inject drugs (PWID) over time. METHODS All persons attending the Stockholm NSP 2013-2021 (n=4,138) were included. The prevalence of viremic HCV infection was investigated yearly. For incidence analysis, PWID at risk with at least one follow-up test were included. Participants were divided into naive defined as anti-HCV negative (n=791), and exposed, defined as anti-HCV positive with a negative HCV RNA (n=1,030). Risk factors for HCV infection were analyzed using parametric exponential proportional hazards regression models. RESULTS The prevalence of viremic HCV infection decreased from 62% to 30% year 2013-2021 while the prevalence of cured after treatment increased from 0 to 22%, corresponding to 42% cured after treatment out of eligible in 2021. The overall incidence rate in naive was 16.9 (95% CI 15.0-19.0) and in exposed 12.8 (95% CI 11.6-14.2) per 100 person years (PY) and was not significantly reduced years 2013-2015 to 2020-2021 in either group. Risk factors for incident HCV infection in multivariable analysis were sharing needles/syringes, younger age, custody/prison past year, and homelessness, whereas opioid agonist treatment was protective. CONCLUSION The prevalence of HCV was halved in PWID as unrestricted DAA treatment became available and NSP was established in Stockholm. However, overall incidence was not reduced. To meet the WHO incidence goal, targeting PWID with high injection risk behaviors for testing and treatment is essential, along with engagement in harm reduction services.
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Affiliation(s)
- Caroline Gahrton
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine Huddinge, Infectious Diseases, Karolinska Institutet, Stockholm, Sweden.
| | - Georg Navér
- Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Warnqvist
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Olav Dalgard
- Department of Gastroenterology, Oslo University Hospital, Norway; Department of Infectious Diseases, Akershus University Hospital, Norway
| | - Soo Aleman
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine Huddinge, Infectious Diseases, Karolinska Institutet, Stockholm, Sweden
| | - Martin Kåberg
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; Stockholm Needle Exchange, Stockholm Centre for Dependency Disorders, Stockholm, Sweden
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Lindqvist K, Thorin Z, Kåberg M. Real-world hepatitis C treatment outcomes and reinfections among people who inject drugs at a needle and syringe program in Stockholm, Sweden. Harm Reduct J 2023; 20:72. [PMID: 37308951 DOI: 10.1186/s12954-023-00801-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 06/03/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND People who inject drugs (PWID) represent a population with an increased prevalence of hepatitis C (HCV) infections. HCV treatment among PWID is essential to reach the WHO goal of eliminating HCV as a major public health threat by 2030. Despite better understanding of PWID subgroups and changes in risk behaviors over time, more knowledge about HCV treatment outcomes in different HCV prevalence populations and settings is warranted to enhance the continuum of care. METHODS All Stockholm Needle and Syringe Program (NSP) participants who initiated HCV treatment between October 2017 and June 2020 were HCV RNA tested at end of treatment and twelve weeks thereafter to confirm cure with a sustained virological response (SVR). All cured participants were prospectively followed from SVR to the last negative HCV RNA test or a subsequent reinfection, until October 31, 2021. RESULTS Overall, 409 NSP participants initiated HCV treatment, 162 at the NSP and 247 in another treatment setting. There were a total of 6.4% treatment dropouts (n = 26), 11.7% among participants treated at the NSP and 2.8% among those treated elsewhere (p < 0.001). Stimulant use (p < 0.05) and not being in an opioid agonist treatment program (p < 0.05) was associated with dropout. More participants treated outside the NSP were lost to follow-up between end of treatment and SVR (p < 0.05). During follow-up post-SVR, 43 reinfections occurred, corresponding to a reinfection rate of 9.3/100 PY (95% CI 7.0, 12.3). Factors associated with reinfection were younger age (p < 0.001), treatment while in prison (p < 0.01) and homelessness (p < 0.05). DISCUSSION In this high HCV prevalence NSP setting, with a majority of stimulant users, treatment success was high and the level of reinfections manageable. To reach HCV elimination, there is a need to target specific PWID subgroups for HCV treatment, in both harm reduction and adjacent healthcare settings frequented by PWID.
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Affiliation(s)
- K Lindqvist
- Stockholm Centre for Dependency Disorders, Stockholm Needle Syringe Program, Stockholm, Sweden
| | - Z Thorin
- Stockholm Centre for Dependency Disorders, Stockholm Needle Syringe Program, Stockholm, Sweden
| | - M Kåberg
- Stockholm Centre for Dependency Disorders, Stockholm Needle Syringe Program, Stockholm, Sweden.
- Department of Global Public Health, Karolinska Institutet, Sprututbytet, S:t Görans Sjukhus, Akutvägen 29, 112 81, Stockholm, Sweden.
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Artenie A, Stone J, Fraser H, Stewart D, Arum C, Lim AG, McNaughton AL, Trickey A, Ward Z, Abramovitz D, Alary M, Astemborski J, Bruneau J, Clipman SJ, Coffin CS, Croxford S, DeBeck K, Emanuel E, Hayashi K, Hermez JG, Low-Beer D, Luhmann N, Macphail G, Maher L, Palmateer NE, Patel EU, Sacks-Davis R, Van Den Boom W, van Santen DK, Walker JG, Hickman M, Vickerman P. Incidence of HIV and hepatitis C virus among people who inject drugs, and associations with age and sex or gender: a global systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2023; 8:533-552. [PMID: 36996853 PMCID: PMC10817215 DOI: 10.1016/s2468-1253(23)00018-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/26/2023] [Accepted: 01/27/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Measuring the incidence of HIV and hepatitis C virus (HCV) infection among people who inject drugs (PWID) is key to track progress towards elimination. We aimed to summarise global data on HIV and primary HCV incidence among PWID and associations with age and sex or gender. METHODS In this systematic review and meta-analysis, we updated an existing database of HIV and HCV incidence studies among PWID by searching MEDLINE, Embase, and PsycINFO, capturing studies published between Jan 1, 2000, and Dec 12, 2022, with no language or study design restrictions. We contacted authors of identified studies for unpublished or updated data. We included studies that estimated incidence by longitudinally re-testing people at risk of infection or by using assays for recent infection. We pooled incidence and relative risk (RR; young [generally defined as ≤25 years] vs older PWID; women vs men) estimates using random-effects meta-analysis and assessed risk of bias with a modified Newcastle-Ottawa scale. This study is registered with PROSPERO, CRD42020220884. FINDINGS Our updated search identified 9493 publications, of which 211 were eligible for full-text review. An additional 377 full-text records from our existing database and five records identified through cross-referencing were assessed. Including 28 unpublished records, 125 records met the inclusion criteria. We identified 64 estimates of HIV incidence (30 from high-income countries [HICs] and 34 from low-income or middle-income countries [LMICs]) and 66 estimates of HCV incidence (52 from HICs and 14 from LMICs). 41 (64%) of 64 HIV and 42 (64%) of 66 HCV estimates were from single cities rather than being multi-city or nationwide. Estimates were measured over 1987-2021 for HIV and 1992-2021 for HCV. Pooled HIV incidence was 1·7 per 100 person-years (95% CI 1·3-2·3; I2=98·4%) and pooled HCV incidence was 12·1 per 100 person-years (10·0-14·6; I2=97·2%). Young PWID had a greater risk of HIV (RR 1·5, 95% CI 1·2-1·8; I2=66·9%) and HCV (1·5, 1·3-1·8; I2=70·6%) acquisition than older PWID. Women had a greater risk of HIV (RR 1·4, 95% CI 1·1-1·6; I2=55·3%) and HCV (1·2, 1·1-1·3; I2=43·3%) acquisition than men. For both HIV and HCV, the median risk-of-bias score was 6 (IQR 6-7), indicating moderate risk. INTERPRETATION Although sparse, available HIV and HCV incidence estimates offer insights into global levels of HIV and HCV transmission among PWID. Intensified efforts are needed to keep track of the HIV and HCV epidemics among PWID and to expand access to age-appropriate and gender-appropriate prevention services that serve young PWID and women who inject drugs. FUNDING Canadian Institutes of Health Research, Fonds de recherche du Québec-Santé, Canadian Network on Hepatitis C, UK National Institute for Health and Care Research, and WHO.
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Affiliation(s)
- Adelina Artenie
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK.
| | - Jack Stone
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Hannah Fraser
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Daniel Stewart
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; National Public Health Speciality Training Programme, South West, Bristol, UK
| | - Chiedozie Arum
- Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Aaron G Lim
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Anna L McNaughton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Adam Trickey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Zoe Ward
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | | | - Michel Alary
- Centre de recherche du CHU de Québec-Université Laval, Québec City, QC, Canada; Département de médecine sociale et préventive, Université Laval, Québec City, QC, Canada; Institut national de santé publique du Québec, Québec City, QC, Canada
| | - Jacquie Astemborski
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Julie Bruneau
- Département de Médecine Familiale et Médecine d'Urgence, Université de Montréal, Montréal, QC, Canada; Centre Hospitalier de l'Université de Montréal Research Center, Montréal, QC, Canada
| | - Steven J Clipman
- Department of Medicine, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Carla S Coffin
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sara Croxford
- Public Health and Clinical Directorate, UK Health Security Agency, London, UK
| | - Kora DeBeck
- School of Public Policy, Simon Fraser University, Vancouver, BC, Canada; BC Centre on Substance Use, Vancouver, BC, Canada
| | - Eva Emanuel
- Blood Safety, Hepatitis, STI and HIV Division, UK Health Security Agency, London, UK
| | - Kanna Hayashi
- BC Centre on Substance Use, Vancouver, BC, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Joumana G Hermez
- Department of Communicable Diseases, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Daniel Low-Beer
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Niklas Luhmann
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Gisela Macphail
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Infectious Diseases, CUPS Liver Clinic, Calgary, AB, Canada
| | - Lisa Maher
- Kirby Institute for Infection and Immunity, UNSW Sydney, Sydney, NSW, Australia
| | - Norah E Palmateer
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Public Health Scotland, Glasgow, UK
| | - Eshan U Patel
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Rachel Sacks-Davis
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | | | - Daniela K van Santen
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia; School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, Netherlands
| | - Josephine G Walker
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
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Malme KB, Ulstein K, Finbråten AK, Wüsthoff LEC, Kielland KB, Hauge J, Dalgard O, Midgard H. Hepatitis C treatment uptake among people who inject drugs in Oslo, Norway: A registry-based study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 116:104044. [PMID: 37149914 DOI: 10.1016/j.drugpo.2023.104044] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 04/18/2023] [Accepted: 04/23/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND Improving HCV treatment uptake among people who inject drugs (PWID) is crucial to achieving the WHO elimination targets. The aims were to evaluate HCV treatment uptake and HCV RNA prevalence in a large cohort of PWID in Norway. METHODS Registry-based observational study where all users of the City of Oslo's low-threshold social and health services for PWID between 2010-2016 (n = 5330) were linked to HCV notifications (1990-2019) and dispensions of HCV treatment, opioid agonist treatment (OAT) and benzodiazepines (2004-2019). Cases were weighted to account for spontaneous HCV clearance. Treatment rates were calculated using person-time of observation, and factors associated with treatment uptake were analysed using logistic regression. HCV RNA prevalence was estimated among individuals alive by the end of 2019. RESULTS Among 2436 participants with chronic HCV infection (mean age 46.8 years, 30.7% female, 73.3% OAT), 1118 (45.9%) had received HCV treatment between 2010-2019 (88.7% DAA-based). Treatment rates increased from 1.4/100 PY (95% CI 1.1-1.8) in the pre-DAA period (2010-2013) to 3.5/100 PY (95% CI 3.0-4.0) in the early DAA period (2014-2016; fibrosis restrictions) and 18.4/100 PY (95% CI 17.2-19.7) in the late DAA period (2017-2019; no restrictions). Treatment rates for 2018 and 2019 exceeded a previously modelled elimination threshold of 50/1000 PWID. Treatment uptake was less likely among women (aOR 0.74; 95% CI 0.62-0.89) and those aged 40-49 years (aOR 0.74; 95% CI 0.56-0.97), and more likely among participants with current OAT (aOR 1.21; 95% CI 1.01-1.45). The estimated HCV RNA prevalence by the end of 2019 was 23.6% (95% CI 22.3-24.9). CONCLUSION Although HCV treatment uptake among PWID increased, strategies to improve treatment among women and individuals not engaged in OAT should be addressed.
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Affiliation(s)
- Kristian Braathen Malme
- Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Norway.
| | - Kjersti Ulstein
- Agency for Social and Welfare Services, City of Oslo, Norway
| | | | - Linda Elise Couëssurel Wüsthoff
- Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, Norway; Unit for Clinical Research on Addictions, Oslo University Hospital Health Trust, Oslo, Norway
| | - Knut Boe Kielland
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumundal, Norway
| | - Joakim Hauge
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumundal, Norway
| | - Olav Dalgard
- Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Norway
| | - Håvard Midgard
- Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway; Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
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Ydreborg M, Lundström E, Kolleby R, Lexén S, Pizarro E, Lindgren J, Wejstål R, Larsson SB. Linkage to hepatitis C treatment in two opioid substitution treatment units in Gothenburg, Sweden: a retrospective cohort study. Subst Abuse Treat Prev Policy 2023; 18:17. [PMID: 36907872 PMCID: PMC10009929 DOI: 10.1186/s13011-023-00527-0] [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: 12/22/2022] [Accepted: 03/07/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Chronic infection with the hepatitis C virus (HCV) is common in people with former or current injection drug use. Among the patients in the opioid substitution treatment (OST) program in Gothenburg, Sweden, more than 50% had been infected with HCV. However, many patients did not have any follow-up for their infection and the linkage to treatment could be improved. METHODS A model of care for HCV was introduced at an OST unit in Gothenburg, Sweden, in 2017. The aim was to increase testing and linkage to HCV treatment. A nurse and a medical doctor, both specialized in infectious diseases, performed on-site testing at the OST unit with transient liver elastography (Fibroscan) to evaluate the fibrosis stage and initiated HCV treatment. This study retrospectively reviewed the patients' medical records to assess information regarding participation in the model of care, hepatitis C status, linkage to treatment and treatment outcome. RESULTS Among the 225 patients enrolled in OST at baseline, 181 were still in the OST program at the end of study (December 31st, 2018). In total, 29 patients, most of whom did not attend the Clinic of Infectious Diseases, were referred to the model of care. By the end of study, 17 patients (100% of those treated) reached sustained virologic response. In parallel, an additional 19 patients got treatment directly at the Clinic of Infectious Diseases. CONCLUSION Integrating HCV screening and examination in an OST unit successfully linked patients to treatment. However, not all patients received treatment. To reach the goal of eliminating HCV, different models of care are needed.
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Affiliation(s)
- Magdalena Ydreborg
- Department of Infectious Diseases, Sahlgrenska Academy, University of Gothenburg, Box 480, 405 30, Gothenburg, Sweden
- Clinic of Infectious Diseases, Sahlgrenska University Hospital, Region Västra Götaland, Journalvägen, 10 416 50, Gothenburg, Sweden
| | - Emil Lundström
- Department of Addiction and Dependency, Sahlgrenska University Hospital, Region Västra Götaland, Journalvägen, 5 416 85, Gothenburg, Sweden
| | - Rosanna Kolleby
- Clinic of Infectious Diseases, Sahlgrenska University Hospital, Region Västra Götaland, Journalvägen, 10 416 50, Gothenburg, Sweden
| | - Sofia Lexén
- Department of Addiction and Dependency, Sahlgrenska University Hospital, Region Västra Götaland, Journalvägen, 5 416 85, Gothenburg, Sweden
| | - Elena Pizarro
- Department of Addiction and Dependency, Sahlgrenska University Hospital, Region Västra Götaland, Journalvägen, 5 416 85, Gothenburg, Sweden
| | - Jessica Lindgren
- Department of Addiction and Dependency, Sahlgrenska University Hospital, Region Västra Götaland, Journalvägen, 5 416 85, Gothenburg, Sweden
| | - Rune Wejstål
- Department of Infectious Diseases, Sahlgrenska Academy, University of Gothenburg, Box 480, 405 30, Gothenburg, Sweden
- Clinic of Infectious Diseases, Sahlgrenska University Hospital, Region Västra Götaland, Journalvägen, 10 416 50, Gothenburg, Sweden
| | - Simon B Larsson
- Department of Infectious Diseases, Sahlgrenska Academy, University of Gothenburg, Box 480, 405 30, Gothenburg, Sweden.
- Department of Addiction and Dependency, Sahlgrenska University Hospital, Region Västra Götaland, Journalvägen, 5 416 85, Gothenburg, Sweden.
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Kåberg M, Larsson S, Bergström J, Hammarberg A. Quality-adjusted life years among people who inject drugs in a needle syringe program in Sweden. Qual Life Res 2023; 32:197-207. [PMID: 35996040 PMCID: PMC9829569 DOI: 10.1007/s11136-022-03209-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2022] [Indexed: 01/13/2023]
Abstract
PURPOSE Needle syringe programs (NSP) significantly reduce risk behavior and HIV and hepatitis transmission in people who inject drugs (PWID). However, PWID are underrepresented in studies on health-related quality of life (HRQoL), representing a barrier to evaluate effects of public health and preventive measures related to injecting drug use. In this study, we investigate how well the two questionnaires EQ-5D-3L and SF-6D measure health in PWID. We also estimate HRQoL in the PWID population. METHOD Data on demographics, injection drug use, HIV, hepatitis status, and self-reported HRQoL were collected from 550 PWID enrolled in the Stockholm NSP at enrollment and at 6-, 12-, and 24-month follow-up. Self-rated HRQoL was measured as QALY, using EQ-5D-3L and the SF-6D. Item response theory (IRT) was used to evaluate which of the two instruments that measure health most accurately in this population. Regression analysis was used to estimate population-specific QALYs. RESULTS The IRT analysis showed that SF-6D was better suited to measure health in PWID. More specifically, SF-6D to a larger extent discriminated between persons regardless of their health status, while EQ-5D was more suitable to detect persons with poorer health. Self-rated HRQoL showed that average QALY was lower among PWID compared to the general Swedish population. However, a general increase in self-reported health was noted over time among participants. CONCLUSION This study increase knowledge of what instruments are most suitable to measure health among PWID. This is of great importance when evaluating effects of public health and preventive measures in the PWID population.
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Affiliation(s)
- Martin Kåberg
- grid.4714.60000 0004 1937 0626Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden ,Stockholm Centre for Dependency Disorders, Stockholm Needle Exchange, Stockholm, Sweden
| | - Sofie Larsson
- grid.419734.c0000 0000 9580 3113Department of Public Health Analysis and Data Management, Public Health Agency of Sweden, Stockholm, Sweden
| | - Jakob Bergström
- grid.419734.c0000 0000 9580 3113Department of Public Health Analysis and Data Management, Public Health Agency of Sweden, Stockholm, Sweden
| | - Anders Hammarberg
- grid.4714.60000 0004 1937 0626Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden ,grid.467087.a0000 0004 0442 1056Stockholm Centre for Dependency Disorders, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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7
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Colombe S, Axelsson M, Aleman S, Duberg AS, Lundberg Ederth J, Dahl V. Monitoring the progress towards the elimination of hepatitis B and C in Sweden: estimation of core indicators for 2015 and 2018. BMC Infect Dis 2022; 22:885. [PMCID: PMC9700967 DOI: 10.1186/s12879-022-07886-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 11/18/2022] [Indexed: 11/27/2022] Open
Abstract
Introduction To monitor Sweden’s progress towards the WHO goal of eliminating viral hepatitis, we estimated the prevalence, notification rate, and liver-related morbidity and mortality for diagnosed hepatitis B virus (HBV) and hepatitis C virus (HCV) infections in 2015 and 2018. Methods We identified cases of hepatitis B and C within the National System for Notifiable Diseases and obtained data on treatment and whether the case was deceased or not. We calculated prevalence, notification rates per 100,000, and proportion of newly diagnosed cases of hepatitis with liver disease at the time of diagnosis, and proportion of all deceased cases who died from liver disease. We calculated Poisson 95% confidence intervals (CIs) around the notification rates and Wilson 95% CIs around prevalence and mortality estimates. Results In 2015 and 2018, the prevalence of diagnosed HBV infections was 0.20% [95% CI: 0.19–0.20] and 0.21% [0.20–0.21]. Notification rates per 100,000 for HBV infections were 13.02 [12.32–13.76] and 7.71 [7.18–8.27]. HBV liver-related morbidity was 2.65% [1.90–3.68] and 2.16% [1.35–3.43]. HBV liver-related mortality was 20.00% [14.81–26.44] and 17.95% [13.20–23.94]. In 2015 and 2018, the prevalence of diagnosed HCV-infections was 0.24% [0.24–0.25] and 0.18% [0.18–0.19]. Notification rates per 100,000 for HCV infections were 15.92 [15.14–16.73] and 13.05 [12.36–13.77]. HCV liver–related morbidity was 8.14% [6.89–9.60] and 3.90% [2.99–5.08]. HCV liver–related mortality was 27.08% [24.54–29.77] and 26.90% [24.12–29.88]. Conclusions All indicators decreased or remained stable between 2015 and 2018, indicating progress in the elimination of viral hepatitis, especially for HCV infection.
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Affiliation(s)
- Soledad Colombe
- grid.419734.c0000 0000 9580 3113Public Health Agency of Sweden, Solna, Sweden ,grid.418914.10000 0004 1791 8889European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Solna, Sweden ,grid.11505.300000 0001 2153 5088Outbreak Research Team, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Maria Axelsson
- grid.419734.c0000 0000 9580 3113Public Health Agency of Sweden, Solna, Sweden
| | - Soo Aleman
- grid.24381.3c0000 0000 9241 5705Department of Infectious Diseases, Karolinska University Hospital/Karolinska Institutet, Stockholm, Sweden
| | - Ann-Sofi Duberg
- grid.15895.300000 0001 0738 8966Department of Infectious Diseases, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | | | - Viktor Dahl
- grid.419734.c0000 0000 9580 3113Public Health Agency of Sweden, Solna, Sweden
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8
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Chen B, Gao LY, Ma ZH, Chang H, Pei LJ, Zhou Q, Xing WG. The signal-to-cutoff ratios to predict HCV infection among people who inject drugs. Virusdisease 2022; 33:363-370. [PMID: 36278030 PMCID: PMC9579682 DOI: 10.1007/s13337-022-00797-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 10/03/2022] [Indexed: 11/22/2022] Open
Abstract
People who inject drugs (PWIDs) are primarily the high-risk population for HCV infection. This study aims to determine the optimal cut-off values for predicting HCV infection status based on the Signal-to-Cutoff (S/CO) ratio. In this study, a total of 719 PWIDs’ samples were collected, and performed for screening test by ELISA assay, and followed by RIBA assay and NAT assay to detect HCV antibody and HCV RNA levels, respectively. The findings revealed that the prevalence of HCV infection among PWIDs was 54.66% (393/719), and the false-positive rate of HCV antibody detection by ELISA assay among PWIDs was only 3.85% (16/416). In addition, when the optimal cut-off value for S/CO ratio was 2.0, the sensitivity and specificity of HCV antibody were 100.00% and 93.55%, respectively. And when the optimal cut-off value for S/CO ratio was 21.36, the sensitivity and specificity of HCV RNA positive were 89.90% and 72.73%, respectively. In conclusion, the status of HCV infection can be predicted based on the S/CO ratios of the ELISA assay, which can improve diagnosis and facilitate timely treatment to effectively prevent the spread of HCV infection.
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9
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Midgard H, Bjørnestad R, Egeland M, Dahl E, Finbråten A, Kielland KB, Blindheim M, Dalgard O. Peer support in small towns: A decentralized mobile Hepatitis C virus clinic for people who inject drugs. Liver Int 2022; 42:1268-1277. [PMID: 35362660 PMCID: PMC9543121 DOI: 10.1111/liv.15266] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 03/20/2022] [Accepted: 03/29/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND & AIMS New models of HCV care are needed to reach people who inject drugs (PWID). The primary aim was to evaluate HCV treatment uptake among HCV RNA positive individuals identified by point-of-care (POC) testing and liver disease assessment in a peer-driven decentralized mobile clinic. METHODS This prospective study included consecutive patients assessed in a mobile clinic visiting 32 small towns in Southern Norway from November 2019 to November 2020. The clinic was staffed by a bus driver and a social educator offering POC HCV RNA testing (GeneXpert®), liver disease staging (FibroScan® 402) and peer support. Viremic individuals were offered prompt pan-genotypic treatment prescribed by local hospital-employed specialists following a brief telephone assessment. RESULTS Among 296 tested individuals, 102 (34%) were HCV RNA positive (median age 51 years, 77% male, 24% advanced liver fibrosis/cirrhosis). All participants had a history of injecting drug use, 71% reported past 3 months injecting, and 37% received opioid agonist treatment. Treatment uptake within 6 months following enrolment was achieved in 88%. Treatment uptake was negatively associated with recent injecting (aHR 0.60; 95% CI 0.36-0.98), harmful alcohol consumption (aHR 0.44; 95% CI 0.20-0.99), and advanced liver fibrosis/cirrhosis (aHR 0.44; 95% CI 0.25-0.80). HCV RNA prevalence increased with age (OR 1.81 per 10-year increase; 95% 1.41-2.32), ranging from 3% among those <30 years to 55% among those ≥60 years. CONCLUSIONS A peer-driven mobile HCV clinic is an effective and feasible model of care that should be considered for broader implementation to reach PWID outside the urban centres.
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Affiliation(s)
- Håvard Midgard
- Department of Infectious DiseasesAkershus University HospitalLørenskogNorway,Department of GastroenterologyOslo University HospitalOsloNorway
| | | | | | | | | | - Knut B. Kielland
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health DisordersInnlandet Hospital TrustBrumunddalNorway
| | | | - Olav Dalgard
- Department of Infectious DiseasesAkershus University HospitalLørenskogNorway,Institute of Clinical MedicineUniversity of OsloOsloNorway
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10
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Grebely J, Collins AB, Artenie AA, Sutherland R, Meyer JP, Barocas JA, Falade-Nwulia O, Cepeda JA, Cunningham EB, Hajarizadeh B, Lafferty L, Lazarus JV, Bonn M, Marshall AD, Treloar C. Progress and remaining challenges to address hepatitis C, other infectious diseases, and drug-related harms to improve the health of people who use drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 96:103469. [PMID: 34610884 DOI: 10.1016/j.drugpo.2021.103469] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/08/2021] [Accepted: 09/09/2021] [Indexed: 12/31/2022]
Affiliation(s)
- Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, Australia.
| | | | | | - Rachel Sutherland
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Jaimie P Meyer
- AIDS Program, Yale School of Medicine, New Haven, United States; Chronic Disease Epidemiology, Yale School of Public Health, New Haven, United States
| | - Joshua A Barocas
- Divisions of General Internal Medicine and Infectious Diseases, University of Colorado School of Medicine, Aurora, United States
| | - Oluwaseun Falade-Nwulia
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, United States
| | - Javier A Cepeda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health,Baltimore, United States
| | | | | | - Lise Lafferty
- The Kirby Institute, UNSW Sydney, Sydney, Australia; Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Matthew Bonn
- Canadian Association of People Who Use Drugs, Dartmouth, Canada
| | - Alison D Marshall
- The Kirby Institute, UNSW Sydney, Sydney, Australia; Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
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11
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Blach S, Blomé M, Duberg A, Jerkeman A, Kåberg M, Klasa P, Lagging M, Razavi‐Shearer D, Razavi H, Aleman S. Hepatitis C elimination in Sweden: Progress, challenges and opportunities for growth in the time of COVID-19. Liver Int 2021; 41:2024-2031. [PMID: 34051065 PMCID: PMC8242794 DOI: 10.1111/liv.14978] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/20/2021] [Accepted: 05/23/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND & AIMS In 2014, the burden of hepatitis C virus (HCV) in Sweden was evaluated, to establish a baseline and inform public health interventions. Considering the changing landscape of HCV treatment, prevention, and care, and in light of the COVID-19 pandemic, this analysis seeks to evaluate Sweden's progress towards the World Health Organization (WHO) elimination targets and identify remaining barriers. METHODS The data used for modelling HCV transmission and disease burden in Sweden were obtained through literature review, unpublished sources and expert input. A dynamic Markov model was employed to forecast population sizes and incidence of HCV through 2030. Two scenarios ('2019 Base' and 'WHO Targets') were developed to evaluate Sweden's progress towards HCV elimination. RESULTS At the beginning of 2019, there were 29 700 (95% uncertainty interval: 19 300-33 700) viremic infections in Sweden. Under the base scenario, Sweden would achieve and exceed the WHO targets for diagnosis, treatment and liver-related death. However, new infections would decrease by less than 10%, relative to 2015. Achieving all WHO targets by 2030 would require (i) expanding harm reduction programmes to reach more than 90% of people who inject drugs (PWID) and (ii) treating 90% of HCV + PWID engaged in harm reduction programmes and ≥7% of PWID not involved in harm reduction programmes, annually by 2025. CONCLUSIONS It is of utmost importance that Sweden, and all countries, find sustainability in HCV programmes by broadening the setting and base of providers to provide stability and continuity of care during turbulent times.
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Affiliation(s)
- Sarah Blach
- Department of EpidemiologyCenter for Disease Analysis FoundationLafayetteCOUSA
| | - Marianne Blomé
- Faculty of MedicineDepartment of Translational MedicineClinical Infection MedicineLund UniversityMalmöSweden
| | - Ann‐Sofi Duberg
- Faculty of Medicine and HealthDepartment of Infectious DiseasesÖrebro UniversityÖrebroSweden
| | - Anna Jerkeman
- Faculty of MedicineDepartment of Translational MedicineClinical Infection MedicineLund UniversityMalmöSweden
| | - Martin Kåberg
- Stockholm Needle ExchangeStockholm Centre for Dependency DisordersStockholmSweden,Division of Infection and DermatologyDepartment of Medicine HuddingeKarolinska InstituteKarolinska University Hospital HuddingeStockholmSweden
| | | | - Martin Lagging
- Department of Infectious Diseases/VirologyInstitute of BiomedicineSahlgrenska AcademyUniversity of GothenburgGothenburgSweden,Department of Clinical MicrobiologyRegion Västra GötalandSahlgrenska University HospitalGothenburgSweden
| | | | - Homie Razavi
- Department of EpidemiologyCenter for Disease Analysis FoundationLafayetteCOUSA
| | - Soo Aleman
- Department of Medicine HuddingeKarolinska InstituteStockholmSweden,Department of Infectious DiseasesKarolinska University HospitalStockholmSweden
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12
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Waldenström J, Kåberg M, Alanko Blomé M, Widell A, Björkman P, Nilsson S, Hammarberg A, Weiland O, Nyström K, Lagging M. Absence of interferon-λ 4 enhances spontaneous clearance of acute hepatitis C virus genotypes 1-3 infection. Scand J Gastroenterol 2021; 56:855-861. [PMID: 34034600 DOI: 10.1080/00365521.2021.1925956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Absence of a functional interferon-λ 4 (IFN-λ4) gene (IFNL4) predicts spontaneous resolution of acute hepatitis C virus (HCV) infections in regions with a predominance of genotype 1, whereas variants of the inosine triphosphate pyrophosphatase (ITPase) gene (ITPA) entailing reduced activity associate with increased sustained virologic response rates following some therapeutic regimens. This study aimed at investigating the impact of IFNL4 on acute HCV genotype 2 or 3 infections, and whether ITPase activity influenced outcome. MATERIALS AND METHODS Two hundred and seven people who injected drugs (PWID) with documented anti-HCV seroconversion, and 57 PWID with reinfection with HCV were analyzed regarding IFNL4 (rs368234815 and rs12979860) and ITPA (rs1127354 and rs7270101), and longitudinally followed regarding HCV RNA. RESULTS The spontaneous clearance of HCV infection in anti-HCV seronegative PWID was enhanced when IFN-λ4 was absent (44% vs. 20% for IFNL4 TT/TTrs1368234815 and ΔGrs1368234815 respectively, p < .001; OR 3.2) across genotypes 1-3. The proportion lacking IFN-λ4 was further increased following resolution of repeated re-exposure to HCV (74% among re-infected participants who had cleared at least two documented HCV infections). ITPA genetic variants did not independently impact on the outcome, but among males lacking IFN-λ4, reduced ITPase activity markedly augmented the likelihood of resolution (65% vs. 29% for <100% and 100% ITPase activity, p = .006). CONCLUSIONS Absence of IFN-λ4 entails an enhanced likelihood of spontaneous resolution both following primary acute infection and repeated re-exposure to HCV across genotypes 1-3. Among men lacking IFN-λ4, reduced ITPase activity improved outcome.
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Affiliation(s)
- Jesper Waldenström
- Department of Infectious Diseases/Virology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Infectious Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Martin Kåberg
- Department of Medicine, Huddinge Division of Infection and Dermatology, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden
| | | | - Anders Widell
- Department of Clinical Virology, Department of Translational Medicine, Lund University, Lund, Sweden
| | - Per Björkman
- Department of Clinical Infection Medicine, Lund University, Lund, Sweden
| | - Staffan Nilsson
- Department of Mathematical Sciences, Chalmers University of Technology, Sweden.,Department of Pathology and Genetics, Institute of Biomedicine, University of Gothenburg, Göteborg, Sweden
| | - Anders Hammarberg
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden.,Stockholm Centre for Dependency Disorders, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Ola Weiland
- Department of Medicine, Huddinge Division of Infection and Dermatology, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden
| | - Kristina Nyström
- Department of Infectious Diseases/Virology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Clinical Microbiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Martin Lagging
- Department of Infectious Diseases/Virology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Clinical Microbiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
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13
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Lindqvist K, Wallmofeldt C, Holmén E, Hammarberg A, Kåberg M. Health literacy and changes in pattern of drug use among participants at the Stockholm Needle Exchange Program during the COVID-19 pandemic. Harm Reduct J 2021; 18:52. [PMID: 33971892 PMCID: PMC8107802 DOI: 10.1186/s12954-021-00499-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 04/29/2021] [Indexed: 02/06/2023] Open
Abstract
Background and aims People who inject drugs may be particularly vulnerable to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) due to underlying health problems, stigma and social vulnerabilities. Harm reduction services, including needle exchange programs (NEP), have been subjected to varying degrees of disruption in the world, especially in the beginning of the coronavirus disease 2019 (COVID-19) pandemic. Compared to responses in other countries, Sweden’s initial strategy toward limiting the spread and impact of COVID-19 was less restrictive to its citizens with no imposed general societal lockdown. In this study, we investigate changes in drug use patterns, utilization of NEP associated health services, COVID-19 health literacy and the prevalence of SARS-CoV-2 antibodies among NEP clients in Stockholm during the COVID-19 pandemic.
Methods NEP visits and services provided (needles/syringes, HIV and hepatitis C tests and treatment, naloxone distributed) and overall mortality among NEP clients between January 1 and October 31, 2020, were used for trend analyses in comparison with corresponding 2019 data. Between July 27 and October 2, 2020, NEP clients (n = 232) responded to a 27 item COVID-19 Health Literacy Questionnaire. SARS CoV-2 IgG antibody tests (n = 779) were performed between June 15 and October 31, 2020. Results During the COVID-19 pandemic number of clients, client visits, naloxone distribution and HCV tests remained stable compared to 2019, while distribution of needles/syringes increased (p < 0.0001); number of HIV tests and HCV treatments decreased (p < 0.05); and mortality decreased (< 0.01). Overall, the level of health literacy concerning transmission routes and protective measures was high. SARS-CoV-2 antibody prevalence was 5.4% (95% CI 4.0–7.2). Conclusions The Stockholm NEP managed to maintain a high level of clients and services during the pandemic. In general, COVID-19 health literacy was adequate and the overall SARS-CoV-2 antibody prevalence was low compared to the general population, which highlights a need for prioritized and targeted COVID-19 vaccination among PWID.
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Affiliation(s)
- K Lindqvist
- Stockholm Needle Exchange, Stockholm Centre for Dependency Disorders, Stockholm, Sweden
| | - C Wallmofeldt
- Norra Stockholms Psykiatri (Psychiatry of Northern Stockholm), S:t Görans Hospital, Stockholm, Sweden
| | - E Holmén
- Stockholm Needle Exchange, Stockholm Centre for Dependency Disorders, Stockholm, Sweden.,Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - A Hammarberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Stockholm Centre for Dependency Disorders, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - M Kåberg
- Stockholm Needle Exchange, Stockholm Centre for Dependency Disorders, Stockholm, Sweden. .,Department of Medicine Huddinge, Division of Infection and Dermatology, Karolinska Institutet, Karolinska University Hospital Huddinge, Sprututbytet, S:t Görans sjukhus, Akutvägen 29, 112 81, Stockholm, Sweden.
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14
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Arum C, Fraser H, Artenie AA, Bivegete S, Trickey A, Alary M, Astemborski J, Iversen J, Lim AG, MacGregor L, Morris M, Ong JJ, Platt L, Sack-Davis R, van Santen DK, Solomon SS, Sypsa V, Valencia J, Van Den Boom W, Walker JG, Ward Z, Stone J, Vickerman P. Homelessness, unstable housing, and risk of HIV and hepatitis C virus acquisition among people who inject drugs: a systematic review and meta-analysis. Lancet Public Health 2021; 6:e309-e323. [PMID: 33780656 PMCID: PMC8097637 DOI: 10.1016/s2468-2667(21)00013-x] [Citation(s) in RCA: 92] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 01/12/2021] [Accepted: 01/14/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND People who inject drugs (PWID) are at increased risk for HIV and hepatitis C virus (HCV) infection and also have high levels of homelessness and unstable housing. We assessed whether homelessness or unstable housing is associated with an increased risk of HIV or HCV acquisition among PWID compared with PWID who are not homeless or are stably housed. METHODS In this systematic review and meta-analysis, we updated an existing database of HIV and HCV incidence studies published between Jan 1, 2000, and June 13, 2017. Using the same strategy as for this existing database, we searched MEDLINE, Embase, and PsycINFO for studies, including conference abstracts, published between June 13, 2017, and Sept 14, 2020, that estimated HIV or HCV incidence, or both, among community-recruited PWID. We only included studies reporting original results without restrictions to study design or language. We contacted authors of studies that reported HIV or HCV incidence, or both, but did not report on an association with homelessness or unstable housing, to request crude data and, where possible, adjusted effect estimates. We extracted effect estimates and pooled data using random-effects meta-analyses to quantify the associations between recent (current or within the past year) homelessness or unstable housing compared with not recent homelessness or unstable housing, and risk of HIV or HCV acquisition. We assessed risk of bias using the Newcastle-Ottawa Scale and between-study heterogeneity using the I2 statistic and p value for heterogeneity. FINDINGS We identified 14 351 references in our database search, of which 392 were subjected to full-text review alongside 277 studies from our existing database. Of these studies, 55 studies met inclusion criteria. We contacted the authors of 227 studies that reported HIV or HCV incidence in PWID but did not report association with the exposure of interest and obtained 48 unpublished estimates from 21 studies. After removal of duplicate data, we included 37 studies with 70 estimates (26 for HIV; 44 for HCV). Studies originated from 16 countries including in North America, Europe, Australia, east Africa, and Asia. Pooling unadjusted estimates, recent homelessness or unstable housing was associated with an increased risk of acquiring HIV (crude relative risk [cRR] 1·55 [95% CI 1·23-1·95; p=0·0002]; I2= 62·7%; n=17) and HCV (1·65 [1·44-1·90; p<0·0001]; I2= 44·8%; n=28]) among PWID compared with those who were not homeless or were stably housed. Associations for both HIV and HCV persisted when pooling adjusted estimates (adjusted relative risk for HIV: 1·39 [95% CI 1·06-1·84; p=0·019]; I2= 65·5%; n=9; and for HCV: 1·64 [1·43-1·89; p<0·0001]; I2= 9·6%; n=14). For risk of HIV acquisition, the association for unstable housing (cRR 1·82 [1·13-2·95; p=0·014]; n=5) was higher than for homelessness (1·44 [1·13-1·83; p=0·0036]; n=12), whereas no difference was seen between these outcomes for risk of HCV acquisition (1·72 [1·48-1·99; p<0·0001] for unstable housing, 1·66 [1·37-2·00; p<0·0001] for homelessness). INTERPRETATION Homelessness and unstable housing are associated with increased risk of HIV and HCV acquisition among PWID. Our findings support the development of interventions that simultaneously address homelessness and unstable housing and HIV and HCV transmission in this population. FUNDING National Institute for Health Research, National Institute on Drug Abuse, National Institute of Allergy and Infectious Diseases, and Commonwealth Scholarship Commission.
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Affiliation(s)
- Chiedozie Arum
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Hannah Fraser
- Population Health Sciences, University of Bristol, Bristol, UK
| | | | - Sandra Bivegete
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Adam Trickey
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Michel Alary
- Centre de recherche du CHU de Québec, Université Laval, Quebec City, QC, Canada; Département de médecine sociale et préventive, Université Laval, Quebec City, QC, Canada; Institut national de santé publique du Québec, Québec, QC, Canada
| | - Jacquie Astemborski
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jennifer Iversen
- Kirby Institute for Infection and Immunity, UNSW Sydney, NSW, Australia
| | - Aaron G Lim
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Louis MacGregor
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Meghan Morris
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Jason J Ong
- Population Health Sciences, University of Bristol, Bristol, UK; Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Lucy Platt
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Rachel Sack-Davis
- Burnet Institute, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Daniela K van Santen
- Burnet Institute, Melbourne, VIC, Australia; Department of Infectious Disease Research and Prevention, Public Health Service of Amsterdam, Amsterdam, Netherlands
| | - Sunil S Solomon
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Jorge Valencia
- Harm Reduction Unit "SMASD", Department of Addictions and Mental Health, Madrid, Spain
| | | | | | - Zoe Ward
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Jack Stone
- Population Health Sciences, University of Bristol, Bristol, UK.
| | - Peter Vickerman
- Population Health Sciences, University of Bristol, Bristol, UK
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15
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Marquez LK, Cepeda JA, Bórquez A, Strathdee SA, Gonzalez-Zúñiga PE, Fleiz C, Rafful C, Garfein RS, Kiene SM, Brodine S, Martin NK. Is hepatitis C virus (HCV) elimination achievable among people who inject drugs in Tijuana, Mexico? A modeling analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 88:102710. [PMID: 32165050 PMCID: PMC8133359 DOI: 10.1016/j.drugpo.2020.102710] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 02/08/2020] [Accepted: 02/16/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND In 2019, Mexico became the first Latin American country committed to hepatitis C virus (HCV) elimination, but the amount of intervention scale-up required is unclear. In Tijuana, HCV among people who inject drugs (PWID) is high; yet there is minimal and intermittent harm reduction, and involuntary exposure to compulsory abstinence programs (CAP) occurs which is associated with increased HCV risk. We determined what combination intervention scale-up can achieve HCV elimination among current and former PWID in Tijuana. METHODS We constructed a dynamic, deterministic model of HCV transmission, disease progression, and harm reduction among current and former PWID parameterized to Tijuana (~10,000 current PWID, 90% HCV seropositive, minimal opiate agonist therapy [OAT] or high coverage needle/syringe programs [HCNSP]). We evaluated the number of direct-acting antiviral (DAA) treatments needed from 2019 to achieve elimination targets (80% incidence reduction, 65% mortality reduction by 2030) with: (a) DAAs alone, (b) DAAs plus scale-up of OAT+HCNSP (up to 50% coverage of OAT and HCNSP separately, producing 25% of PWID receiving both), (c) DAAs plus CAP scale-up to 50%. Scenarios examined the number of DAAs required if prioritized to current PWID or provided regardless of current injection status, and impact of harm reduction interruptions. RESULTS Modeling suggests among ~30,000 current and former PWID in Tijuana, 16,160 (95%CI: 12,770-21,610) have chronic HCV. DAA scale-up can achieve the incidence target, requiring 770 treatments/year (95%CI: 640-970) if prioritized to current PWID. 40% fewer DAAs are required with OAT+HCNSP scale-up to 50% among PWID, whereas more are required with involuntary CAP scale-up. Both targets can only be achieved through treating both current and former PWID (1,710 treatments/year), and impact is reduced with harm reduction interruptions. CONCLUSIONS Elimination targets are achievable in Tijuana through scale-up of harm reduction and DAA therapy, whereas involuntary CAP and harm reduction interruptions hamper elimination.
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Affiliation(s)
- Lara K Marquez
- Department of Family Medicine & Public Health, University of California San Diego, La Jolla, California, United States; School of Public Health, San Diego State University, San Diego, California, United States.
| | - Javier A Cepeda
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, California, United States
| | - Annick Bórquez
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, California, United States
| | - Steffanie A Strathdee
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, California, United States
| | - Patricia E Gonzalez-Zúñiga
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, California, United States
| | - Clara Fleiz
- National Institute of Psychiatry Ramon de la Fuente Muniz, Huipulco, Tlalpan, Mexico City, United States
| | - Claudia Rafful
- Faculty of Psychology, Universidad Nacional Autónoma de México, Mexico City, United States; Center on Global Mental Health Research, National Institute of Psychiatry, Mexico City, United States; Centre on Drug Policy Evaluation, St. Michael's Hospital, Toronto, OH, Canada
| | - Richard S Garfein
- Department of Family Medicine & Public Health, University of California San Diego, La Jolla, California, United States
| | - Susan M Kiene
- School of Public Health, San Diego State University, San Diego, California, United States
| | - Stephanie Brodine
- School of Public Health, San Diego State University, San Diego, California, United States
| | - Natasha K Martin
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, California, United States; Population Health Sciences, University of Bristol, Bristol, United Kingdom
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16
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Schulte B, Schmidt CS, Strada L, Rosenkranz M, Schäfer I, Verthein U, Reimer J. Hepatitis C Virus Prevalence and Incidence in a Large Nationwide Sample of Patients in Opioid Substitution Treatment in Germany: A Prospective Cohort Study. Clin Infect Dis 2021; 70:2199-2205. [PMID: 31631215 DOI: 10.1093/cid/ciz661] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 07/31/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) infection is highly prevalent among people who inject drugs (PWID). Accurate data on HCV prevalence and incidence rates among patients receiving opioid substitution treatment (OST) are needed to estimate the current and future burden of HCV infections in this high-risk population. METHODS Baseline data from routine care were collected between October 2014 and June 2016 from randomly selected OST facilities in Germany. The primary outcome measure was the HCV status (antibody and RNA prevalence). Patients who were HCV antibody-negative at baseline were followed up after 12 months to calculate the HCV incidence rate. RESULTS Sixty-three facilities from 14 German Federal States provided clinical data for a total of 2466 OST patients. HCV antibody and HCV RNA prevalence were 58.8% (95% confidence interval [CI], 56.8%-60.8%) and 27.3% (95% CI, 25.5%-29.2%), respectively. At baseline, a total of 528 patients (21.4%) had previously undergone antiviral treatment. Moreover, lower HCV RNA prevalence was associated with female gender, employment, younger age, and shorter duration of OST and opioid dependence. The HCV incidence rate was 2.5 cases per 100 person-years. CONCLUSIONS The low HCV RNA prevalence and HCV incidence rates confirm that OST in Germany is an effective setting both for treating chronic HCV infections and for preventing new infections among PWID. Scaling up the provision of OST, HCV testing, and HCV treatment among OST patients are important public health strategies for reducing HCV infections in this high-risk population.
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Affiliation(s)
- Bernd Schulte
- Centre for Interdisciplinary Addiction Research, University Medical Centre Hamburg-Eppendorf
| | | | - Lisa Strada
- Centre for Interdisciplinary Addiction Research, University Medical Centre Hamburg-Eppendorf
| | - Moritz Rosenkranz
- Centre for Interdisciplinary Addiction Research, University Medical Centre Hamburg-Eppendorf
| | - Ingo Schäfer
- Centre for Interdisciplinary Addiction Research, University Medical Centre Hamburg-Eppendorf
| | - Uwe Verthein
- Centre for Interdisciplinary Addiction Research, University Medical Centre Hamburg-Eppendorf
| | - Jens Reimer
- Centre for Interdisciplinary Addiction Research, University Medical Centre Hamburg-Eppendorf.,Gesundheit Nord, Bremen, Germany
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Karlsson N, Kåberg M, Berglund T, Hammarberg A, Widman L, Ekström AM. A prospective cohort study of risk behaviours, retention and loss to follow-up over 5 years among women and men in a needle exchange program in Stockholm, Sweden. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 90:103059. [PMID: 33360734 DOI: 10.1016/j.drugpo.2020.103059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 11/09/2020] [Accepted: 11/18/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Needle exchange programs (NEP) are important in reducing risk behaviours among people who inject drugs (PWID), also exposed to HIV and hepatitis C (HCV) through injecting drug use (IDU). Women (WWID) compared to men who inject drugs (MWID), are particularly vulnerable with complex needs, however less is known about their risk determinants and NEP outcomes. METHODS In an open prospective NEP cohort, 697 WWID and 2122 MWID were followed, 2013-2018. Self-reported socio/drug-related determinants for receptive injection (needle/syringe and paraphernalia) and sexual risk behaviours at enrolment, lost to follow-up (LTFU) and probability of retention, were assessed for both groups. Multivariable logistic regression (adjusted odds ratios, aOR) for enrolment and Poisson regression (adjusted incidence rate ratios, aIRR) for LTFU, were used. Cumulative NEP-retention probability was analysed using a six- and 12-month scenario. RESULTS At NEP enrolment, injection risk behaviours among WWID were associated with: younger age; homelessness; amphetamine-IDU; non-participation in opioid substitution therapy (OST); history of custody and among MWID: lower education level; cohabitation; homelessness, being a tenant; amphetamine-IDU; non-participation in OST; history of being sectioned, HIV-negative and HCV-positive. Condomless sex among WWID was associated with: younger age; lower education-level; cohabitation; having a partner; amphetamine-IDU; non-participation in OST; being HIV-negative and HCV-positive and among MWID: younger age; married; cohabitation; having a partner; amphetamine-IDU; non-participation in OST; history of custody, prison and being HIV-negative. WWID had higher NEP-retention levels compared to MWID over time. Being LTFU among WWID was associated with being HIV-negative and reporting injection risk behaviours and among MWID, younger age, non-participation in OST, being HIV-negative and having protected sex. CONCLUSIONS Despite better NEP compliance among WWID, high injection and sexual risk behaviours in both gender-subgroups, especially in intimate relationships, suggests ongoing HCV and HIV-infection risks. Subgroup-variation in the NEP continuum of care warrants more gender-disaggregated research and tailoring gender-sensitive services may improve prevention, health and retention outcomes.
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Affiliation(s)
- Niklas Karlsson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; Department of Public Health Analysis and Development, Public Health Agency of Sweden (Folkhälsomyndigheten), Solna, Sweden.
| | - Martin Kåberg
- Department of Medicine Huddinge, Division of Infection and Dermatology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden; Stockholm Needle Exchange, Stockholm Centre for Dependency Disorders, Stockholm, Sweden
| | - Torsten Berglund
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; Department of Public Health Analysis and Development, Public Health Agency of Sweden (Folkhälsomyndigheten), Solna, Sweden
| | - Anders Hammarberg
- Stockholm Needle Exchange, Stockholm Centre for Dependency Disorders, Stockholm, Sweden; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Centre for Dependency Disorders, Stockholm Health Care Services, Stockholm County Council, Sweden
| | - Linnea Widman
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anna Mia Ekström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Karlsson N, Berglund T, Ekström AM, Hammarberg A, Tammi T. Could 30 years of political controversy on needle exchange programmes in Sweden contribute to scaling-up harm reduction services in the world? NORDIC STUDIES ON ALCOHOL AND DRUGS 2020; 38:66-88. [PMID: 35309093 PMCID: PMC8899060 DOI: 10.1177/1455072520965013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 09/17/2020] [Indexed: 11/17/2022] Open
Abstract
Aims: To end the hepatitis and AIDS epidemics in the world by 2030, countries are encouraged to scale-up harm reduction services and target people who inject drugs (PWID). Blood-borne viruses (BBV) among PWID spread via unsterile injection equipment sharing and to combat this, many countries have introduced needle and syringe exchange programmes (NEP), though not without controversy. Sweden’s long, complicated harm reduction policy transition has been deviant compared to the Nordic countries. After launch in 1986, no NEP were started in Sweden for 23 years, the reasons for which are analysed in this study. Methods: Policy documents, grey literature and research mainly published in 2000–2017 were collected and analysed using a hierarchical framework, to understand how continuous build-up of evidence, decisions and key events, over time influenced NEP development. Results: Sweden’s first NEP opened in a repressive-control drug policy era with a drug-free society goal. Despite high prevalence of BBV among PWID with recurring outbreaks, growing research and key-actor support including a NEP law, no NEP were launched. Political disagreements, fluctuating actor-coalitions, questioning of research, and a municipality veto against NEP, played critical roles. With an individual-centred perspective being brought into the drug policy domain, the manifestation of a dual drug and health policy track, a revised NEP law in 2017 and removal of the veto, Sweden would see fast expansion of new NEP. Conclusions: Lessons from the Swedish case could provide valuable insight for countries about to scale-up harm reduction services including how to circumvent costly time- and resource-intensive obstacles and processes involving ideological and individual moral dimensions.
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Affiliation(s)
- Niklas Karlsson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; and Department of Public Health Analysis and Development, Public Health Agency of Sweden, Solna, Sweden
| | - Torsten Berglund
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; and Department of Public Health Analysis and Development, Public Health Agency of Sweden, Solna, Sweden
| | - Anna Mia Ekström
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; and Department of Medicine Huddinge, Division of Infectious Diseases, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Anders Hammarberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; and Stockholm Centre for Dependency Disorders, Stockholm Health Care Services, Stockholm County Council, Sweden
| | - Tuukka Tammi
- Finnish Institute for Health and Welfare, Finland
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Värmå Falk M, Strömdahl S, Ekström AM, Kåberg M, Karlsson N, Dahlborn H, Hammarberg A. A qualitative study of facilitators and barriers to participate in a needle exchange program for women who inject drugs. Harm Reduct J 2020; 17:84. [PMID: 33092595 PMCID: PMC7579804 DOI: 10.1186/s12954-020-00425-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/08/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Women who inject drugs (WWID) show higher levels of injecting risk behaviour compared to men, putting them at risk of contracting HIV and hepatitis C (HCV). Compared to men, WWID are also less present in harm reduction programs such as needle exchange programs (NEP). The aim of this study is to investigate reasons for, and barriers to, participation in NEP among WWID in Sweden, and to identify measures that could be taken to strengthen the program and increase participation among WWID. METHOD In-depth interviews (IDIs) were conducted with 20 WWID who had participated in the Stockholm NEP for at least six months and was over 18 years old. IDIs were audio recorded and transcribed et verbatim. Qualitative content analysis was used to identify themes. RESULTS The need for sterile injection equipment was identified as the main driver to join and remain in the NEP program. Continuous participation in the NEP was further driven by easy access to a multitude of health-related services. The most valued service was the sexual and reproductive health services (SRHR), allowing participants to access contraceptives, cervical cancer screening and sexually transmitted infections testing (STI-testing). NEP staffs' respectful treatment of participants further contributed to program participation. However, participants also expressed a number of concerns around NEP participation, which created barriers to joining. These included losing custody or visitation rights to children, male partner jealousy and violence, unwillingness to spend time in the waiting area and fear of receiving positive HIV/HCV test results. Practical barriers included limited opening hours and travel distance to the NEP. To strengthen the program, most participants requested additional SRHR services. Most participants also proposed some form of "women only" access to the NEP, to strengthen the feeling of the NEP as a safe space. CONCLUSION This study identified factors that may increase uptake of NEP among WWID. Additional SRHR services and "women only" access are recommended to be implemented and evaluated as part of NEP. These findings may inform and improve the current scale-up of NEPs in Sweden to ensure equal access to services.
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Affiliation(s)
- Malin Värmå Falk
- Stockholm Needle Exchange, Stockholm Centre for Dependency Disorders, Stockholm, Sweden.
| | - Susanne Strömdahl
- Department of Medical Sciences, Section of Infectious Diseases, Uppsala University, Uppsala, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Anna Mia Ekström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Martin Kåberg
- Stockholm Needle Exchange, Stockholm Centre for Dependency Disorders, Stockholm, Sweden
- Division of Infection and Dermatology, Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Niklas Karlsson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Monitoring and Evaluation, Public Health Agency of Sweden, Stockholm, Sweden
| | - Helena Dahlborn
- Stockholm Needle Exchange, Stockholm Centre for Dependency Disorders, Stockholm, Sweden
| | - Anders Hammarberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Centre for Dependency Disorders, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
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Hepatitis C Reinfection in People Who Inject Drugs in Resource-Limited Countries: A Systematic Review and Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17144951. [PMID: 32659974 PMCID: PMC7400365 DOI: 10.3390/ijerph17144951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/01/2020] [Accepted: 07/07/2020] [Indexed: 12/12/2022]
Abstract
Hepatitis C (HCV) is a global pandemic. The World Health Organization has developed a strategic plan for HCV elimination that focuses on low- and middle-income countries (LMICs) and high-risk populations, including people who inject drugs (PWID). While direct-acting antiviral (DAA) therapies are highly effective at eliminating HCV infections and have few side effects, medical professionals and policymakers remain concerned about the risk of reinfection among PWID. This study is a systematic review of research measuring the rate of HCV reinfection among PWID in LMICs and identifies additional areas for further research. A systematic search strategy was used to identify studies documenting HCV reinfection after sustained virologic response in PWID in LMICs. We refined results to include studies where at least 50% of participants had DAA treatment for primary HCV infection. Pooled reinfection rate was calculated across all studies. Seven studies met eligibility criteria. Most studies were conducted in six upper middle-income countries (Mexico, Romania, Russia, Taiwan, Georgi, and Brazil) and one lower middle-income country (Bangladesh) with a total of 7665 participants. No study included information from PWID in low-income countries. Sample sizes ranged from 200 to 3004 individuals, with demographic data missing for most participants. Four studies used deep gene sequencing, and reflex genotyping procedures to differentiate reinfection (infection by a different HCV genotype/subtype) from virologic relapse (infection by the same strain). The follow-up time of people cured from primary chronic HCV infection ranged from 12 weeks to 6.6 years. The pooled reinfection rate of all seven studies was 2.8 (range: 0.02 to 10.5) cases per 100 person-years (PY). In the five studies that differentiated relapse from reinfection, the incidence of reinfection was 1.0 per 100 PY. To date, research on reinfection rates among PWID in LMICs remains limited. Research focused on PWID in low-income countries is particularly needed to inform clinical decision making and evidence-based programs. While rates of reinfection among PWID who complete DAA treatment in upper and lower middle-income countries were similar or lower than rates observed in PWID in high-income countries, the rates were highly variable and factors may influence the accuracy of these measurements. This systematic review identifies several areas for continued research. Policies concerning access to HCV testing and treatment should be comprehensive and not place restrictions on PWID in these settings.
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Hajarizadeh B, Cunningham EB, Valerio H, Martinello M, Law M, Janjua NZ, Midgard H, Dalgard O, Dillon J, Hickman M, Bruneau J, Dore GJ, Grebely J. Hepatitis C reinfection after successful antiviral treatment among people who inject drugs: A meta-analysis. J Hepatol 2020; 72:643-657. [PMID: 31785345 DOI: 10.1016/j.jhep.2019.11.012] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 10/30/2019] [Accepted: 11/05/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS HCV reinfection following successful treatment can compromise treatment outcomes. This systematic review assessed the rate of HCV reinfection following treatment among people with recent drug use and those receiving opioid agonist therapy (OAT). METHODS We searched bibliographic databases and conference abstracts for studies assessing post-treatment HCV reinfection rates among people with recent drug use (injecting or non-injecting) or those receiving OAT. Meta-analysis was used to cumulate reinfection rates and meta-regression was used to explore heterogeneity across studies. RESULTS Thirty-six studies were included (6,311 person-years of follow-up). The overall rate of HCV reinfection was 5.9/100 person-years (95% CI 4.1-8.5) among people with recent drug use (injecting or non-injecting), 6.2/100 person-years (95% CI 4.3-9.0) among people recently injecting drugs, and 3.8/100 person-years (95% CI 2.5-5.8) among those receiving OAT. Reinfection rates were comparable following interferon-based (5.4/100 person-years; 95% CI 3.1-9.5) and direct-acting antiviral (3.9/100 person-years; 95% CI 2.5-5.9) therapy. In stratified analysis, reinfection rates were 1.4/100 person-years (95% CI 0.8-2.6) among people receiving OAT with no recent drug use, 5.9/100 person-years (95% CI 4.0-8.6) among people receiving OAT with recent drug use, and 6.6/100 person-years (95% CI 3.4-12.7) among people with recent drug use not receiving OAT. In meta-regression analysis, longer follow-up was associated with lower reinfection rate (adjusted rate ratio [aRR] per year increase in mean/median follow-up 0.77; 95% CI 0.69-0.86). Compared with people receiving OAT with no recent drug use, those with recent drug use receiving OAT (aRR 3.50; 95% CI 1.62-7.53), and those with recent drug use not receiving OAT (aRR 3.96; 95% CI 1.82-8.59) had higher reinfection rates. CONCLUSION HCV reinfection risk following treatment was higher among people with recent drug use and lower among those receiving OAT. The lower rates of reinfection observed in studies with longer follow-up suggested higher reinfection risk early post-treatment. LAY SUMMARY Our findings demonstrate that although reinfection by hepatitis C virus occurs following successful treatment in people with recent drug use, the rate of hepatitis C reinfection is lower than the rates of primary infection reported in the literature for this population - reinfection should not be used as a reason to withhold therapy from people with ongoing injecting drug use. The rate of hepatitis C reinfection was lowest among people receiving opioid agonist therapy with no recent drug use. These data illustrate that harm reduction services are required to reduce the reinfection risk, while regular post-treatment hepatitis C assessment is required for early detection and retreatment.
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Affiliation(s)
| | | | | | | | - Matthew Law
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Naveed Z Janjua
- British Columbia Centre for Disease Control, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Håvard Midgard
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
| | | | - John Dillon
- Ninewells Hospital and Medical School, University of Dundee, Dundee, The United Kingdom
| | - Matthew Hickman
- Population Health Sciences, University of Bristol, Bristol, The United Kingdom
| | - Julie Bruneau
- Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Gregory J Dore
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
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Kåberg M, Karlsson N, Discacciati A, Widgren K, Weiland O, Ekström AM, Hammarberg A. Significant decrease in injection risk behaviours among participants in a needle exchange programme. Infect Dis (Lond) 2020; 52:336-346. [PMID: 32072841 DOI: 10.1080/23744235.2020.1727002] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background and aims: Sharing of unsterile injection equipment contributes to transmission of hepatitis C virus (HCV), HIV and hepatitis B virus (HBV) among people who inject drugs (PWID) but is largely preventable through needle exchange programmes (NEP). Sweden has been one of the last countries in Europe to scale up access to NEP for PWID, who consequently have high prevalence rates of HCV and HIV. The aim of the study was to investigate demographic and drug-related determinants of injection risk behaviours, sharing of needle/syringe and paraphernalia, and patterns of change over time in subgroups of PWID participating in the Stockholm NEP.Methods: The Stockholm NEP started in 2013 as the first formal NEP in the region. A total of 2860 PWID were included in this prospective open cohort study. The association between demographic and drug-related determinants and injection risk behaviours were analysed at baseline and followed up at 6, 12, 24, 36 and 48 months post-enrolment.Results: The following factors were associated with high levels of injection risk behaviours at inclusion: female gender, homelessness, low education level, younger age, amphetamine use, not in opioid substitution therapy (OST), being HIV negative and being HCV positive. We found an overall significant decrease in injection risk behaviours over time among participants. Not previously investigated in depth, we found that subgroups of participants varied in degrees of injection risk behaviour reduction over time and that women decreased injection risk behaviours faster than men. Enrolment in OST, HIV positive and age <25 years at inclusion were not associated with a decrease in injection risk behaviours over time.Conclusions: In this prospective cohort study over 4 years, we found that NEP participation was associated with a significant decrease in injection risk behaviours.
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Affiliation(s)
- Martin Kåberg
- Department of Medicine Huddinge, Division of Infection and Dermatology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden.,Stockholm Needle Exchange, Stockholm Centre for Dependency Disorders, Stockholm, Sweden
| | - Niklas Karlsson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Department of Monitoring and Evaluation, Public Health Agency of Sweden, Stockholm, Sweden
| | - Andrea Discacciati
- Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Katarina Widgren
- Department of Medicine Huddinge, Division of Infection and Dermatology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden.,Department of Monitoring and Evaluation, Public Health Agency of Sweden, Stockholm, Sweden
| | - Ola Weiland
- Department of Medicine Huddinge, Division of Infection and Dermatology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Anna Mia Ekström
- Department of Medicine Huddinge, Division of Infection and Dermatology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden.,Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Anders Hammarberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Stockholm Centre for Dependency Disorders, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
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Elimination of hepatitis C virus infection among people who use drugs: Ensuring equitable access to prevention, treatment, and care for all. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 72:1-10. [PMID: 31345644 DOI: 10.1016/j.drugpo.2019.07.016] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 07/05/2019] [Accepted: 07/06/2019] [Indexed: 12/12/2022]
Abstract
There have been major strides towards the World Health Organization goal to eliminate hepatitis C virus (HCV) infection as a global public health threat. The availability of simple, well-tolerated direct-acting antiviral therapies for HCV infection that can achieve a cure in >95% of people has provided an important tool to help achieve the global elimination targets. Encouragingly, therapy is highly effective among people receiving opioid agonist therapy and people who have recently injected drugs. Moving forward, major challenges include ensuring that new infections are prevented from occurring and that people who are living with HCV are tested, linked to care, treated, receive appropriate follow-up, and have equitable access to care. This editorial highlights key themes and articles in a special issue focusing on the elimination of HCV among people who inject drugs. An overarching consideration flowing from this work is how to ensure equitable access to HCV treatment and care for all. This special issue maps the field in relation to: HCV prevention; the cascade of HCV care; strategies to enhance testing, linkage to care, and treatment uptake; and HCV treatment and reinfection. In addition, papers draw attention to the 'risk environments' and socio-ecological determinants of HCV acquisition, barriers to HCV care, the importance of messaging around the side-effects of new direct-acting antiviral therapies, the positive transformative potential of treatment and cure, and the key role of community-based drug user organizations in the HCV response. While this special issue highlights some successful efforts towards HCV elimination among people who inject drugs, it also highlights the relative lack of attention to settings in which resources enabling elimination are scarce, and where elimination hopes and potentials are less clear, such as in many low and middle income countries. Strengthening capacity in areas of the world where resources are more limited will be a critical step towards ensuring equity for all so that global HCV elimination among PWID can be achieved.
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Söderholm J, Yilmaz A, Svenningsson A, Büsch K, Wejstål R, Brolund A, Kövamees J, Sällberg M, Lagging M, Gisslén M. Lower risk of multiple sclerosis in patients with chronic hepatitis C: a nationwide population-based registry study. J Neurol 2019; 266:2208-2215. [PMID: 31152298 PMCID: PMC6687702 DOI: 10.1007/s00415-019-09397-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 05/13/2019] [Accepted: 05/22/2019] [Indexed: 12/15/2022]
Abstract
Background Multiple sclerosis (MS) is an immune-mediated neurological disease that causes demyelination. The etiology is unknown, but patients with a previous viral infection, such as Epstein–Barr virus, have been shown to be at a higher risk of developing MS. In contrast, people living with HIV have a lower risk of developing MS. Hepatitis C virus (HCV) mainly infects the liver, but patients with HCV can experience several extrahepatic manifestations and studies have shown an association with several autoimmune conditions such as neuropathy and myelitis. The present study aimed to investigate the risk of MS in patients with chronic HCV infection compared with matched comparators. Methods Patients were identified using the nationwide Swedish inpatient (2001–2013) and outpatient care registers (2001–2013) for HCV (B18.2) and MS (G35) according to the International Classification of Diseases-10. Up to five comparators (matched on age/sex/place of residency) were drawn from the general population for each HCV patient. Follow-up started at the first HCV visit from 2001 and the patients’ accrued person-time until death, emigration or 31 December 2013. Risk of MS diagnosis was calculated as standardized incidence ratio (SIR) with 95% confidence intervals (CIs). Results HCV patients were at lower risk of MS diagnosis (SIR 0.37; 95% CI 0.26–0.50). The incidence of MS during the study in the HCV cohort was 0.087% compared with 0.27% in the matched comparator cohort. Conclusion Surprisingly, these data suggest HCV patients to have a lower risk of MS diagnosis. Electronic supplementary material The online version of this article (10.1007/s00415-019-09397-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jonas Söderholm
- AbbVie AB, Hemvärnsgatan 9, Solna, Box 1523, 171 29, Stockholm, Sweden. .,Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska University Hospital Huddinge, Karolinska Institutet, Stockholm, Sweden.
| | - Aylin Yilmaz
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anders Svenningsson
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Katharina Büsch
- AbbVie AB, Hemvärnsgatan 9, Solna, Box 1523, 171 29, Stockholm, Sweden.,Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska University Hospital Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Rune Wejstål
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Alma Brolund
- AbbVie AB, Hemvärnsgatan 9, Solna, Box 1523, 171 29, Stockholm, Sweden
| | - Jan Kövamees
- AbbVie AB, Hemvärnsgatan 9, Solna, Box 1523, 171 29, Stockholm, Sweden
| | - Matti Sällberg
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska University Hospital Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Martin Lagging
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Magnus Gisslén
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Fedorchenko SV, Klimenko A, Martynovich T, Liashok O, Yanchenko V. IL-28B genetic variation, gender, age, jaundice, hepatitis C virus genotype, and hepatitis B virus and HIV co-infection in spontaneous clearance of hepatitis C virus. THE TURKISH JOURNAL OF GASTROENTEROLOGY : THE OFFICIAL JOURNAL OF TURKISH SOCIETY OF GASTROENTEROLOGY 2019; 30:436-444. [PMID: 31060998 PMCID: PMC6505656 DOI: 10.5152/tjg.2019.18328] [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: 05/22/2018] [Accepted: 09/08/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND/AIMS Spontaneous viral clearance observed in some patients is one of the variants of the hepatitis C virus (HCV) infection natural history. We aimed to look at the complexity of factors affecting the spontaneous clearance of HCV (SC HCV). MATERIALS AND METHODS A total of 357 anti-HCV positive patients (309 with chronic hepatitis C and 48 patients with SC HCV) were included into the study. We studied the effects of the interleukin-28B (IL-28B) gene polymorphism, gender, age, the routes of virus transmission, past hepatitis C with jaundice, HCV genotype, and hepatitis B virus (HBV) and HIV co-infection on the outcome of HCV infection. RESULTS Based on the study results, the SC HCV was found in 48 individuals (13.4%). The most significant positive factors affecting the SC HCV included IL-28B single nucleotide polymorphism (SNP) rs12979860 (CC) and SNP rs8099917 (TT) (OR 4.03, p<0.001) and (OR 3.14, p<0.002), female gender (OR 2.72, p<0.001), young age (OR 2.30, p<0.008), and past history of jaundice (OR 5.12, p<0.001). The markers of a past HBV infection were found significantly more often in SC. CONCLUSION Positive predictors of the SC HCV include favorable IL-28B genotype, female gender, young age, a history of jaundice, markers of a past HBV infection, the absence of HIV infection, but not the viral genotype.
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Affiliation(s)
- Sergii V Fedorchenko
- Department of Viral Hepatitis and AIDS, The L.V. Gromashevskyi Institute of Epidemiology and Infectious Disease, Kiev, Ukraine
| | - Anna Klimenko
- Department of Viral Hepatitis and AIDS, The L.V. Gromashevskyi Institute of Epidemiology and Infectious Disease, Kiev, Ukraine
| | - Tetyana Martynovich
- Department of Viral Hepatitis and AIDS, The L.V. Gromashevskyi Institute of Epidemiology and Infectious Disease, Kiev, Ukraine
| | - Olga Liashok
- Department of Viral Hepatitis and AIDS, The L.V. Gromashevskyi Institute of Epidemiology and Infectious Disease, Kiev, Ukraine
| | - Vitaliy Yanchenko
- Department of Viral Hepatitis and AIDS, The L.V. Gromashevskyi Institute of Epidemiology and Infectious Disease, Kiev, Ukraine
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Yi S, Mun P, Chhoun P, Chann N, Tuot S, Mburu G. Prevalence of and risk factors for hepatitis C virus antibody among people who inject drugs in Cambodia: a national biological and behavioral survey. Harm Reduct J 2019; 16:29. [PMID: 31036011 PMCID: PMC6489344 DOI: 10.1186/s12954-019-0299-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 04/09/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) is a significant global health concern. Despite evidence of the relationship between injecting drug use and HCV, studies on HCV among people who inject drugs in developing countries remain scarce. To address this need, we conducted this study to explore the prevalence of and factors associated with HCV antibody positivity among people who inject drugs in Cambodia. METHODS Data used for this study were collected as part of the National Integrated Biological and Behavioral Survey among people who use and inject drugs conducted in 2017. We used the respondent-driven sampling method to recruit participants in 12 provinces for face-to-face interviews and HIV and HCV antibody testing. Weighted multivariable logistic regression analysis was conducted to identify risk factors associated with HCV antibody positivity. RESULTS This study included 286 people who inject drugs with a mean age of 31.6 (SD = 7.5) years. The prevalence of HCV antibody among participants in this study was 30.4%, of whom 31.0% were co-infected with HIV. After adjustment for other covariates, the odds of HCV antibody positivity was significantly higher among participants who were in the older age group of 25 to 34 (AOR = 1.85, 95% CI = 1.06-7.92) and ≥ 35 (AOR = 2.67, 95% CI = 1.24-5.71), were in Vietnamese ethnic group (AOR = 5.44, 95% CI = 2.25-13.14), were living on the streets (AOR = 3.01, 95% CI = 1.29-704), had been sent to a drug rehabilitation center in the past 12 months (AOR = 2.67, 95% CI = 1.21-5.90), had received methadone maintenance therapy in the past 12 months (AOR = 3.02, 95% CI = 1.32-6.92), and were tested positive for HIV (AOR = 3.80, 95% CI = 1.58-9.12) compared to their respective reference group. CONCLUSION The prevalence of HCV antibody among people who inject drugs in Cambodia is high, particularly in older and more vulnerable subgroups. Tailor-made interventions are required to increase access to culturally sensitive harm reduction interventions to prevent primary HCV infection and reinfection. In addition, there is an opportunity to expand screening, diagnosis, and treatment with new directly acting antiviral agents.
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Affiliation(s)
- Siyan Yi
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore. .,KHANA Center for Population Health Research, Phnom Penh, Cambodia. .,Center for Global Health Research, Touro University California, Vallejo, USA.
| | - Phalkun Mun
- National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia
| | - Pheak Chhoun
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Navy Chann
- National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia
| | - Sovannary Tuot
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Gitau Mburu
- Division of Health Research, Lancaster University, Lancaster, United Kingdom
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Kåberg M, Edgren E, Hammarberg A, Weiland O. Hepatitis C virus (HCV) related liver fibrosis in people who inject drugs (PWID) at the Stockholm Needle Exchange - evaluated with liver elasticity. Scand J Gastroenterol 2019; 54:319-327. [PMID: 30907178 DOI: 10.1080/00365521.2019.1580764] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background and aims: Sharing of unsterile injection equipment among people who inject drugs (PWID) is the major transmission-route for hepatitis C (HCV). HCV is highly prevalent in PWID in the Stockholm needle exchange programme (NEP). The frequency of advanced liver fibrosis among the participants is, however, unknown. Methods: From December 2016 to April 2018, all participants with chronic hepatitis C infection (CHC) were offered liver fibrosis evaluation at the Stockholm NEP, including liver stiffness measurement (LSM), a medical history and expanded blood tests to evaluate APRI and FIB-4 scores. Results: A total of 2037 individuals were enrolled of whom 964 (47.3%) had CHC. LSM was performed in 203 (21.1%) of eligible participants of whom 85% had mild fibrosis (LSM ≤9.4 kPa) and 15% advanced fibrosis (LSM ≥9.5 kPa). APRI >1 and FIB-4 > 3.25 only identified 30% of participants with advanced fibrosis. However, all 31(100%) participants with advanced fibrosis were detected when APRI >1 was combined with an age of ≥40 years and an injection drug use (IDU) duration of ≥15 years. Conclusions: We found that the diagnostic work-up for advanced fibrosis can be simplified with this combination of easily available factors. This allows identification of PWID in need of immediate HCV treatment to prevent further disease progression. Furthermore, LSM can be avoided among PWID with mild fibrosis, identified by age <40 years combined with IDU duration of <15 years and APRI score <1. This strategy enhances the HCV care cascade where LSM is not easily available, and will thus facilitate HCV treatment initiation.
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Affiliation(s)
- Martin Kåberg
- a Department of Medicine Huddinge, Division of Infectious Diseases , Karolinska Institutet, Karolinska University Hospital Huddinge , Stockholm , Sweden.,b Stockholm Centre for Dependency Disorders , Stockholm Needle Exchange , Stockholm , Sweden
| | - Erika Edgren
- b Stockholm Centre for Dependency Disorders , Stockholm Needle Exchange , Stockholm , Sweden
| | - Anders Hammarberg
- c Centre for Psychiatry Research, Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden.,d Stockholm Centre for Dependency Disorders, Stockholm Health Care Services , Stockholm , Sweden
| | - Ola Weiland
- a Department of Medicine Huddinge, Division of Infectious Diseases , Karolinska Institutet, Karolinska University Hospital Huddinge , Stockholm , Sweden
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Goldberg DS, Wolfe CR. Maximizing utilization of the donor pool by appropriate classification of hepatitis C antibody-positive donors. Am J Transplant 2018; 18:2380-2381. [PMID: 30125461 DOI: 10.1111/ajt.15077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 08/08/2018] [Accepted: 08/09/2018] [Indexed: 01/25/2023]
Affiliation(s)
- David S Goldberg
- Division of Gastroenterology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Cameron R Wolfe
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
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