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Clipman SJ, Mehta SH, Mohapatra S, Srikrishnan AK, Zook KJC, Kumar MS, Lucas GM, Latkin CA, Solomon SS. Network-based strategies to combat HCV: Examining social and spatial drivers of transmission among PWID in New Delhi. J Viral Hepat 2024. [PMID: 38837275 DOI: 10.1111/jvh.13960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 04/30/2024] [Accepted: 05/13/2024] [Indexed: 06/07/2024]
Abstract
People who inject drugs (PWID) account for some of the fastest-growing HCV epidemics globally. While individual risk factors for infection are understood, less is known about network and spatial factors critical for elimination strategies. Two thousand five hundred twelve PWID in New Delhi, India, were recruited (2017-19) through network referrals. Biometrics identified duplicates and cross-network linkages. Participants completed semi-annual surveys and blood tests for HCV antibodies and RNA. Poisson regression and network analyses identified predictors of incident HCV and compared network-based intervention approaches. Baseline HCV antibody prevalence was 65.1%, of whom 79.6% were HCV RNA-positive. We observed 92 HCV seroconversions over 382.25 person-years (incidence: 24.1 per 100 person-years). Of the 92 seroconverters, 67% (62) were directly connected to an RNA-positive participant, and all were within one degree of separation from an RNA-positive participant. Individual-level factors associated with seroconversion included age, sexual activity, and injection behaviours. After adjusting for individual-level factors, seroconversion was significantly associated with number of RNA-positive partners (adjusted incidence rate ratio [AIRR] = 1.30) and injecting at a particular venue (AIRR = 2.53). This association extended to indirect ties, with 17% reduced odds of seroconversion for each degree of separation from the venue (AIRR = 0.83). Network analyses comparing intervention strategies found that targeting venues identified more cases compared to a treat-a-friend approach. We observed a fast-growing HCV epidemic driven by viremia within individuals' immediate networks and indirect social and spatial ties, demonstrating the importance of achieving broad, sustained virologic response and rethinking network-based interventions to include venues.
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Affiliation(s)
- Steven J Clipman
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Shobha Mohapatra
- YR Gaitonde Centre for AIDS Research and Education (YRGCARE), Chennai, India
| | - Aylur K Srikrishnan
- YR Gaitonde Centre for AIDS Research and Education (YRGCARE), Chennai, India
| | - Katie J C Zook
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Gregory M Lucas
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Carl A Latkin
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sunil S Solomon
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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2
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Caroline A, Kate M, Roberts M, Ryan J, Murphy S, Richardson C, Coyte A, Taha Y, Stuart M. What is the impact of a Hepatitis C 'test, trace and treat' pilot using peer workers? J Viral Hepat 2023; 30:922-925. [PMID: 37723934 DOI: 10.1111/jvh.13888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/05/2023] [Accepted: 09/08/2023] [Indexed: 09/20/2023]
Abstract
Chronic Hepatitis C virus (HCV) infection is a major cause of morbidity and deaths worldwide. HCV treating teams are working toward the goal of eliminating HCV by 2030. People who inject drugs (PWIDs) are at high risk of HCV but contact tracing is not routine practice. Here, we present the outcomes of a HCV 'test, trace and treat' pilot using peer workers to test contacts of individuals with HCV. PWIDs with HCV were invited to participate when they presented for treatment. For those agreeing to participate, a peer approached them to invite potential contacts for HCV testing. Data were collected on uptake, HCV test results, treatment rates and reasons for declining. Overall, 295 individuals (162 recent HCV [<1 year], 69 reinfections, 64 known chronic HCV) were invited to participate, of whom 147 (50%) agreed and 30 (20% of those agreeing) brought forward 120 contacts for testing. Of these, 44 (37%) were HCV RNA positive, including 23 who were not known to services. 34 (77%) started antiviral treatment. HCV RNA positivity was highest in contacts of reinfections (45%) compared with recent HCV (33%) and known chronic HCV (25%). The most common reason for index individuals declining participation was that they reported no longer being in contact with individuals from their injecting network (65%). In conclusion, half of PWIDs with HCV agreed to participate in the pilot, but only 20% of these brought contacts forward. The frequency of active HCV was high in the contacts and the majority started antiviral treatment.
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Affiliation(s)
- Allsop Caroline
- Viral Hepatitis Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Mcque Kate
- Viral Hepatitis Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Jelley Ryan
- Viral Hepatitis Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | | | - Aishah Coyte
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Yusri Taha
- Viral Hepatitis Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - McPherson Stuart
- Viral Hepatitis Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Newcastle NIHR Biomedical Research Centre, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Translational & Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
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3
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Nagot N, Binh NT, Hong TT, Vinh VH, Quillet C, Vallo R, Huong DT, Hai Oanh KT, Thanh NTT, Rapoud D, Quynh BTN, Nguyen DQ, Feelemyer J, Michel L, Vickerman P, Fraser H, Weiss L, Lemoine M, Lacombe K, Des Jarlais D, Khue PM, Moles JP, Laureillard D. A community-based strategy to eliminate hepatitis C among people who inject drugs in Vietnam. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 37:100801. [PMID: 37693880 PMCID: PMC10485672 DOI: 10.1016/j.lanwpc.2023.100801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/27/2023] [Accepted: 05/10/2023] [Indexed: 09/12/2023]
Abstract
Background Towards hepatitis C elimination among people who inject drugs (PWID), we assessed the effectiveness of a strategy consisting of a community-based respondent-driven sampling (RDS) as wide screening, a simplified and integrated hospital-based care, and prevention of reinfection supported by community-based organisations (CBO), in Hai Phong, Vietnam. Methods Adults who injected heroin were enrolled in a RDS survey implemented in two CBO premises. Rapid HIV and HCV tests were done on site, and blood was taken for HCV RNA testing. Those with detectable HCV RNA were referred with CBO support to three public hospitals for 12-week sofosbuvir/daclatasvir, plus ribavirin for patients with cirrhosis. Participants were followed-up 12 weeks post-treatment (SVR12) and 48 weeks after enrolment. The primary endpoint was the rate of undetectable HCV RNA participants at 48 weeks. Findings Among the 1444 RDS survey participants, 875 had hepatitis C. Their median age was 41 years (IQR 36-47), 96% were males, 36% were HIV-coinfected. Overall, 686 (78.4%) started sofosbuvir/daclatasvirs, and 629 of the 647 (97.2%) patients tested at SVR12 were cured. At week 48 (581/608) 95.6% had undetectable HCV RNA, representing 66.4% of all PWID identified with hepatitis C. The reinfection rate after SVR12 was 4/100 person-years (95% CI: 2-7). Interpretation Our strategy, involving CBO and addressing all steps from wide HCV screening to prevention of reinfection, stands as a promising approach to eliminate HCV among PWID in low and middle-income countries. Funding France ANRS|MIE (#ANRS12380). The RDS survey was implemented with grants from the NIDA (#R01DA041978) and ANRS|MIE (#ANRS12353).
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Affiliation(s)
- Nicolas Nagot
- Pathogenesis and Control of Chronic and Emerging Infections, Université de Montpellier, Inserm, Etablissement Français du Sang, Montpellier, France
| | - Nguyen Thanh Binh
- Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Tran Thi Hong
- Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Vu Hai Vinh
- Infectious and Tropical Diseases Department, Viet Tiep Hospital, Hai Phong, Vietnam
| | - Catherine Quillet
- Pathogenesis and Control of Chronic and Emerging Infections, Université de Montpellier, Inserm, Etablissement Français du Sang, Montpellier, France
| | - Roselyne Vallo
- Pathogenesis and Control of Chronic and Emerging Infections, Université de Montpellier, Inserm, Etablissement Français du Sang, Montpellier, France
| | - Duong Thi Huong
- Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | | | | | - Delphine Rapoud
- Pathogenesis and Control of Chronic and Emerging Infections, Université de Montpellier, Inserm, Etablissement Français du Sang, Montpellier, France
| | - Bach Thi Nhu Quynh
- Department of Molecular Biology, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Duc Quang Nguyen
- Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | | | - Laurent Michel
- CESP Inserm UMRS 1018, Paris Saclay University, Pierre Nicole Center, French Red Cross, Paris, France
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Hannah Fraser
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Laurence Weiss
- Université de Paris Cité, Department of Clinical Immunology, Hôpital Hôtel Dieu AP-HP, Paris, France
| | - Maud Lemoine
- Liver Unit, Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Karine Lacombe
- Sorbonne Université Inserm IPLESP, Hôpital St Antoine AP-HP, Paris, France
| | - Don Des Jarlais
- School of Global Public Health, New York University, New York, USA
| | - Pham Minh Khue
- Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Jean Pierre Moles
- Pathogenesis and Control of Chronic and Emerging Infections, Université de Montpellier, Inserm, Etablissement Français du Sang, Montpellier, France
| | - Didier Laureillard
- Pathogenesis and Control of Chronic and Emerging Infections, Université de Montpellier, Inserm, Etablissement Français du Sang, Montpellier, France
- Infectious and Tropical Diseases Department, Caremeau University Hospital, Nîmes, France
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4
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Siegele-Brown C, Siegele-Brown M, Cook C, Khakoo SI, Parkes J, Wright M, Buchanan RM. Testing to sustain hepatitis C elimination targets in people who inject drugs: A network-based model. J Viral Hepat 2023; 30:242-249. [PMID: 36529668 DOI: 10.1111/jvh.13786] [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] [Received: 10/26/2022] [Accepted: 12/03/2022] [Indexed: 01/14/2023]
Abstract
Little is known about the level of testing required to sustain elimination of hepatitis C (HCV), once achieved. In this study, we model the testing coverage required to maintain HCV elimination in an injecting network of people who inject drugs (PWID). We test the hypothesis that network-based strategies are a superior approach to deliver testing. We created a dynamic injecting network structure connecting 689 PWID based on empirical data. The primary outcome was the testing coverage required per month to maintain prevalence at the elimination threshold over 5 years. We compared four testing strategies. Without any testing or treatment provision, the prevalence of HCV increased from the elimination threshold (11.68%) to a mean of 25.4% (SD 2.96%) over the 5-year period. To maintain elimination with random testing, on average, 4.96% (SD 0.83%) of the injecting network needs to be tested per month. However, with a 'bring your friends' strategy, this was reduced to 3.79% (SD 0.64%) of the network (p < .001). The addition of contact tracing improved the efficiency of both strategies. In conclusion, we report that network-based approaches to testing such as 'bring a friend' initiatives and contact tracing lower the level of testing coverage required to maintain elimination.
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Affiliation(s)
- Chloë Siegele-Brown
- Faculty of Medicine, University of Southampton, Southampton, UK.,University Hospital Southampton, Southampton, UK
| | | | - Charlotte Cook
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Salim I Khakoo
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Julie Parkes
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Mark Wright
- University Hospital Southampton, Southampton, UK
| | - Ryan M Buchanan
- Faculty of Medicine, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, Southampton, UK
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5
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Kuwano A, Yada M, Kurosaka K, Tanaka K, Masumoto A, Motomura K. Risk factors for loss to follow-up after the start of direct-acting antiviral treatment for hepatitis C virus infection. JGH Open 2022; 7:98-104. [PMID: 36852151 PMCID: PMC9958342 DOI: 10.1002/jgh3.12855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/01/2022] [Accepted: 12/12/2022] [Indexed: 01/01/2023]
Abstract
Background and Aim Direct-acting antivirals (DAAs) have recently been developed to treat hepatitis C virus (HCV) infection. Additionally, interferon-free DAA treatment has improved liver function and reduced the risk of hepatocellular carcinoma (HCC) following HCV eradication. Previous studies on HCV have focused mainly on the treatment rate and the risk of developing HCC, and less attention has been given to loss to follow-up (LTFU) after DAA treatment. Therefore, the present study aimed to identify the definitive risk factors for LTFU after the start of DAA treatment. Methods Between September 2017 and March 2022, 296 patients receiving glecaprevir and pibrentasvir for HCV infection were enrolled in this study. The incidence of LTFU following DAA treatment and the risk factors contributing to LTFU were identified using the patients' clinical characteristics. Results In the present study, 75 patients (25.3%) interrupted their follow-up visits. Multivariate logistic analysis revealed a history of injection drug use (hazard ratio [HR], 1.81; P = 0.017), treatment duration (8 weeks) (HR, 3.51; P = 0.0033), and age <70 years (HR, 1.9; P = 0.0422) as independent factors associated with LTFU after the start of DAA treatment. Conclusion Young patients and those with injection drug use are likely to discontinue their follow-up visits after the start of DAA treatment for HCV infection. Therefore, these patients require strict supervision.
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6
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Bar N, Bensoussan N, Rabinowich L, Levi S, Houri I, Ben-Ami Shor D, Shibolet O, Mor O, Weitzman E, Turner D, Katchman H. Barriers and Facilitators of Hepatitis C Care in Persons Coinfected with Human Immunodeficiency Virus. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15237. [PMID: 36429957 PMCID: PMC9690547 DOI: 10.3390/ijerph192215237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/09/2022] [Accepted: 11/13/2022] [Indexed: 06/16/2023]
Abstract
Hepatitis C virus (HCV) and human immunodeficiency virus (HIV) are often co-transmitted. Viral coinfection results in worse outcomes. Persons who inject drugs (PWIDs) face barriers to medical treatment, but HCV treatment is indicated and effective even with ongoing active drug use. We aimed to assess access to HCV care and treatment results in patients coinfected with HIV-HCV. This is a real-world retrospective single-center study of patients followed in the HIV clinic between 2002 and 2018. Linkage to care was defined as achieving care cascade steps: (1) hepatology clinic visit, (2) receiving prescription of anti-HCV treatment, and (3) documentation of sustained virologic response (SVR). Of 1660 patients with HIV, 254 with HIV-HCV coinfection were included. Only 39% of them achieved SVR. The rate limiting step was the engagement into hepatology care. Being a PWID was associated with ~50% reduced odds of achieving study outcomes, active drug use was associated with ~90% reduced odds. Older age was found to facilitate treatment success. Once treated, the rate of SVR was high in all populations. HCV is undertreated in coinfected young PWIDs. Further efforts should be directed to improve access to care in this marginalized population.
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Affiliation(s)
- Nir Bar
- Gastroenterology and Hepatology Department, Tel Aviv Medical Center, Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6195001, Israel
| | - Noa Bensoussan
- Gastroenterology and Hepatology Department, Tel Aviv Medical Center, Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6195001, Israel
| | - Liane Rabinowich
- Gastroenterology and Hepatology Department, Tel Aviv Medical Center, Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6195001, Israel
| | - Sharon Levi
- Gastroenterology and Hepatology Department, Tel Aviv Medical Center, Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6195001, Israel
| | - Inbal Houri
- Gastroenterology and Hepatology Department, Tel Aviv Medical Center, Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6195001, Israel
| | - Dana Ben-Ami Shor
- Gastroenterology and Hepatology Department, Tel Aviv Medical Center, Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6195001, Israel
| | - Oren Shibolet
- Gastroenterology and Hepatology Department, Tel Aviv Medical Center, Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6195001, Israel
| | - Orna Mor
- Central Virology Laboratory, Ministry of Health, Chaim Sheba Medical Center, Ramat Gan 5262000, Israel
- Department of Epidemiology, School of public health, Faculty of Medicine, Tel Aviv University, Tel Aviv 6195001, Israel
| | - Ella Weitzman
- Center for Liver Disease, Rambam Healthcare Campus, Rappaport Faculty of Medicine, Technion, Haifa 3109601, Israel
| | - Dan Turner
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6195001, Israel
- Crusaid Kobler AIDS Center, Tel Aviv Medical Center, Tel Aviv 6423906, Israel
| | - Helena Katchman
- Gastroenterology and Hepatology Department, Tel Aviv Medical Center, Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6195001, Israel
- Department of Gastroenterology and Hepatology, Tel Aviv Medical Center, Tel Aviv 6423906, Israel
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7
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Ortiz-Paredes D, Amoako A, Ekmekjian T, Engler K, Lebouché B, Klein MB. Interventions to Improve Uptake of Direct-Acting Antivirals for Hepatitis C Virus in Priority Populations: A Systematic Review. Front Public Health 2022; 10:877585. [PMID: 35812487 PMCID: PMC9263261 DOI: 10.3389/fpubh.2022.877585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 06/06/2022] [Indexed: 11/16/2022] Open
Abstract
Background & Objective Access to Hepatitis C (HCV) care remains suboptimal. This systematic review sought to identify existing interventions designed to improve direct-acting antiviral (DAA) uptake among HCV infected women, people who inject drugs (PWID), men who have sex with men (MSM), and Indigenous peoples. Methods Studies published in high- and middle-income countries were retrieved from eight electronic databases and gray literature (e.g., articles, research reports, theses, abstracts) were screened by two independent reviewers. Identified interventions were summarized using textual narrative synthesis. Results After screening 3,139 records, 39 studies were included (11 controlled comparative studies; 36 from high-income countries). Three groups of interventions were identified: interventions involving patients; providers; or the healthcare system. Interventions directed to patients included care co-ordination, accelerated DAA initiation, and patient education. Interventions involving providers included provider education, telemedicine, multidisciplinary teams, and general practitioner-led care. System-based interventions comprised DAA universal access policies and offering HCV services in four settings (primary care, secondary care, tertiary care, and community settings). Most studies (30/39) described complex interventions, i.e., those with two or more strategies combined. Most interventions (37/39) were tailored to, or studied among, PWID. Only one study described an intervention that was aimed at women. Conclusions Combining multiple interventions is a common approach for supporting DAA initiation. Three main research gaps were identified, specifically, a lack of: (1) controlled trials estimating the individual or combined effects of interventions on DAA uptake; (2) studies in middle-income countries; and (3) interventions tailored to women, MSM, and Indigenous people.
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Affiliation(s)
- David Ortiz-Paredes
- Center for Outcome Research and Evaluation, Research Institute of the McGill University Health Center, Montreal, QC, Canada
| | - Afia Amoako
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Taline Ekmekjian
- Medical Libraries, McGill University Health Center, Montreal, QC, Canada
| | - Kim Engler
- Center for Outcome Research and Evaluation, Research Institute of the McGill University Health Center, Montreal, QC, Canada
| | - Bertrand Lebouché
- Center for Outcome Research and Evaluation, Research Institute of the McGill University Health Center, Montreal, QC, Canada
- Department of Family Medicine, McGill University, Montreal, QC, Canada
- Division of Infectious Diseases/Chronic Viral Illness Service, Department of Medicine, Glen site, McGill University Health Center, Montreal, QC, Canada
| | - Marina B. Klein
- Division of Infectious Diseases/Chronic Viral Illness Service, Department of Medicine, Glen site, McGill University Health Center, Montreal, QC, Canada
- CIHR Canadian HIV Trials Network, Vancouver, BC, Canada
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Nagot N, D’Ottavi M, Quillet C, Debellefontaine A, Castellani J, Langendorfer N, Hanslik B, Guichard S, Baglioni R, Faucherre V, Tuaillon E, Pageaux GP, Laureillard D, Donnadieu-Rigole H. Reaching hardly reached people who use drugs: a community-based strategy for the elimination of hepatitis C. Open Forum Infect Dis 2022; 9:ofac181. [PMID: 35774932 PMCID: PMC9239554 DOI: 10.1093/ofid/ofac181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 04/11/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Elimination of HCV among people who use drugs (PWUD) remains a challenge even in countries in which HCV care is provided free of cost. We assessed whether an innovative community-based respondent-driven sampling (RDS) survey, coupled with HCV screening and immediate treatment, could be efficient to detect and cure active PWUD with chronic HCV in a large city of Southern France.
Methods
At a community site with peers, PWUD (cannabis not included) were enrolled after confirmation by a urine drug test. Participants were then screened for HBV/HCV/HIV and benefited from on-site HCV treatment evaluation and prescription. Peer support was provided during treatment, and a systematic visit was scheduled 12 weeks after the end of treatment. The cost of the intervention was estimated.
Results
554 participants were enrolled. Most were male (78.8%) with a median age of 39 years (IQR: 33-46). Cocaine (73.1%) and heroine (46.8%) were the main drugs consumed. Overall, 32.6% of PWUD (N = 181) were HCV seropositive, of which 49 (27.1%) had detectable HCV RNA and were thus eligible for treatment. Ten of these patients had severe fibrosis. HCV treatment was initiated for 37 (75.5%) patients among whom 30 (81.1%) completed their treatment and 27 (73.0%) achieved sustained viral response at week 12. The total cost was 161€ per screened patient and 1,816€ per patient needing treatment.
Conclusions
Community-based RDS survey approach, involving peers, proved efficient and cost-effective to reach and cure PWUD for HCV. This innovative strategy could be key for the final step of HCV elimination.
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Affiliation(s)
- Nicolas Nagot
- Pathogenesis and Control of Chronic & Emerging Infections, University of Montpellier, INSERM, Etablissement Français du Sang, University of Antilles-Guyane, Montpellier, France
| | - Morgana D’Ottavi
- Pathogenesis and Control of Chronic & Emerging Infections, University of Montpellier, INSERM, Etablissement Français du Sang, University of Antilles-Guyane, Montpellier, France
| | - Catherine Quillet
- Pathogenesis and Control of Chronic & Emerging Infections, University of Montpellier, INSERM, Etablissement Français du Sang, University of Antilles-Guyane, Montpellier, France
| | - Anne Debellefontaine
- Pathogenesis and Control of Chronic & Emerging Infections, University of Montpellier, INSERM, Etablissement Français du Sang, University of Antilles-Guyane, Montpellier, France
- Groupe SOS Solidarité, Montpellier, France
| | - Joëlle Castellani
- Pathogenesis and Control of Chronic & Emerging Infections, University of Montpellier, INSERM, Etablissement Français du Sang, University of Antilles-Guyane, Montpellier, France
| | - Nicolas Langendorfer
- Department of Addiction Medicine, Montpellier University Hospital, Montpellier, France
| | - Bertrand Hanslik
- Department of Addiction Medicine, Montpellier University Hospital, Montpellier, France
| | - Sylvain Guichard
- Association of Marginality and Drug Addiction (AMT), Montpellier, France
| | - René Baglioni
- Department of Addiction Medicine, Montpellier University Hospital, Montpellier, France
| | - Vincent Faucherre
- Department of Addiction Medicine, Montpellier University Hospital, Montpellier, France
| | - Edouard Tuaillon
- Pathogenesis and Control of Chronic & Emerging Infections, University of Montpellier, INSERM, Etablissement Français du Sang, University of Antilles-Guyane, Montpellier, France
| | - Georges-Philippe Pageaux
- Department of Hepatology and Gastroenterology, Montpellier University Hospital, Montpellier, France
| | - Didier Laureillard
- Pathogenesis and Control of Chronic & Emerging Infections, University of Montpellier, INSERM, Etablissement Français du Sang, University of Antilles-Guyane, Montpellier, France
- Department of Infectious Diseases, Caremeau University Hospital, Nimes, France
| | - Hélène Donnadieu-Rigole
- Pathogenesis and Control of Chronic & Emerging Infections, University of Montpellier, INSERM, Etablissement Français du Sang, University of Antilles-Guyane, Montpellier, France
- Department of Addiction Medicine, Montpellier University Hospital, Montpellier, France
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9
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Against All Odds? Addiction History Associated with Better Viral Hepatitis Care: A Dutch Nationwide Claims Data Study. J Clin Med 2022; 11:jcm11041146. [PMID: 35207419 PMCID: PMC8878485 DOI: 10.3390/jcm11041146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/15/2022] [Accepted: 02/18/2022] [Indexed: 02/01/2023] Open
Abstract
The elimination of viral hepatitis in target populations is crucial in reaching WHO viral hepatitis elimination goals. Several barriers for the treatment of viral hepatitis in people with addictive disorders have been identified, yet nationwide data on hepatitis healthcare utilization (HCU) in these patients are limited. We investigated whether a history of addictive disorder is associated with suboptimal hepatitis HCU, indicating failure to receive diagnostic care or treatment. We identified all newly referred viral hepatitis patients in the Netherlands between 2014 and 2019 by query of the Dutch national hospital claims database. Each patient’s first year of HBV or HCV care activities was collected and clustered in two categories, ‘optimal’ or ‘suboptimal’ hepatitis HCU. Optimal HCU includes antiviral therapy. We tested the association between addiction history and HCU, adjusted for sex, age, migrant status, and comorbidity. In secondary analyses, we explored additional factors affecting hepatitis HCU. We included 10,513 incident HBV and HCV patients, with 13% having an addiction history. Only 47% of all patients achieved optimal hepatitis HCU. Addiction history was associated with less suboptimal HCU (adjusted OR = 0.73, 95% CI = 0.64–0.82). Migration background was associated with suboptimal HCU (OR = 1.62, 95% CI = 1.50–1.76). This study shows that addiction history is associated with higher viral hepatitis HCU; thus, this population performs better compared to non-addicted patients. However, less than 50% of all patients received optimal hepatitis care. This study highlights the need to improve hepatitis HCU in all patients, with a focus on migrant populations. Linkage to care in the addicted patients is not studied here and may be a remaining obstacle to be studied and improved to reach WHO viral hepatitis elimination goals.
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Ortiz-Paredes D, Amoako A, Lessard D, Engler K, Lebouché B, Klein MB. Potential interventions to support HCV treatment uptake among HIV co-infected people in Canada: Perceptions of patients and health care providers. CANADIAN LIVER JOURNAL 2022; 5:14-30. [DOI: 10.3138/canlivj-2021-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 08/28/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND: Increasing direct-acting antiviral (DAA) treatment uptake is key to eliminating HCV infection as a public health threat in Canada. People living with human immunodeficiency virus (HIV) and hepatitis C (HCV) co-infection face barriers to HCV treatment initiation. We sought to identify interventions that could support HCV treatment initiation based on patient and HCV care provider perspectives. METHODS: Eleven people living with HIV with a history of HCV infection and 12 HCV care providers were recruited for this qualitative descriptive study. Participants created ranked-ordered lists of potential interventions during nominal groups ( n = 4) and individual interviews ( n = 6). Following the nominal group technique, transcripts and intervention lists underwent thematic analysis and ranking scores were merged to create consolidated and prioritized lists from patient and provider perspectives. RESULTS: Patient participants identified a total of eight interventions. The highest-ranked interventions were multidisciplinary clinics, HCV awareness campaigns and patient education, nurse- or pharmacist-led care, peer involvement, and more and better-prepared health professionals. Provider participants identified 11 interventions. The highest-ranked were mobile outreach, DAA initiation at pharmacies, a simplified process of DAA prescription, integration of primary and specialist care, and patient-centred approaches. CONCLUSION: Participants proposed alternatives to hospital-based specialist HCV care, which require increasing capacity for nurses, pharmacists, primary care providers, and peers to have more direct roles in HCV treatment provision. They also identified the need for structural changes and educational initiatives. In addition to optimizing HCV care, these interventions might result in broader benefits for the health of HIV–HCV co-infected people.
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Affiliation(s)
- David Ortiz-Paredes
- Centre for Outcome Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Afia Amoako
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - David Lessard
- Centre for Outcome Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Kim Engler
- Centre for Outcome Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Bertrand Lebouché
- Centre for Outcome Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
- Department of Medicine, Division of Infectious Diseases/Chronic Viral Illness Service, Glen site, McGill University Health Centre, Montreal, Quebec, Canada
| | - Marina B Klein
- Department of Medicine, Division of Infectious Diseases/Chronic Viral Illness Service, Glen site, McGill University Health Centre, Montreal, Quebec, Canada
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11
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Falade-Nwulia O, Momoh O, Felsher M, Nwulia E, Tofighi B, Ward K, McCormick S, Sulkowski M, Latkin C. Validation of a tool to assess effectiveness of peer-recruitment for hepatitis C testing and linkage to care among people who inject drugs. Drug Alcohol Depend 2022; 230:109177. [PMID: 34808487 DOI: 10.1016/j.drugalcdep.2021.109177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 10/17/2021] [Accepted: 10/29/2021] [Indexed: 12/09/2022]
Abstract
OBJECTIVE People who inject drugs (PWID) have high hepatitis C virus (HCV) infection prevalence but low rates of HCV treatment uptake. To better harness the potential of peer-led social network-based interventions to increase HCV treatment uptake among PWID, simple tools that can help identify individuals with the potential to function effectively as peer-mentors who support network members to get HCV tested and linked to care are needed. METHODS Data from a survey administered to index PWID enrolled in a social network-based intervention, in which they were invited to recruit drug use network members for HCV testing and linkage to care, was analyzed. Constructs derived from exploratory factor analysis were validated through confirmatory factor analysis (CFA). We used logistic regression analysis to assess the association between scores in identified constructs and subsequent effectiveness in the peer mentor role, defined as recruiting at least one network member for HCV testing and linkage to care in the 12 weeks following survey completion. RESULTS Among 100 PWID with median age 53 years, 74% male, and 71% Black, CFA resulted in a multidimensional three-factor survey with 4 questions related to opinion leadership, 3 questions related to perceived HCV-related stigma, and 3 questions related to HCV communication comfort and care support willingness. Only self-designated opinion leadership was associated with effectiveness in the peer mentor role (adjusted odds ratio 3.76 (95% Confidence interval CI 1.01, 14.0)). CONCLUSION We developed and validated a simple tool with potential to ease and improve the efficiency of peer-led social network interventions.
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Affiliation(s)
| | | | - Marisa Felsher
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Babak Tofighi
- New York University School of Medicine, Department of Population Health, USA; Center for Drug Use and HIV Research, NYU College of Global Public Health, US
| | - Kathleen Ward
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sean McCormick
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mark Sulkowski
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carl Latkin
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, US
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12
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Felsher M, Tobin KE, Sulkowski M, Latkin C, Falade-Nwulia O. HCV communication within ego-centric networks of men and women who inject drugs. Drug Alcohol Depend 2021; 229:109157. [PMID: 34740020 PMCID: PMC8665146 DOI: 10.1016/j.drugalcdep.2021.109157] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 09/27/2021] [Accepted: 10/14/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Leveraging interpersonal communication among social networks of people who inject drugs (PWID) may be an innovative strategy to increase awareness and access to hepatitis C (HCV) care. However, little is known about HCV communication patterns among PWID and if these patterns vary by gender. METHODS Egocentric network data collected at baseline from HCV-infected PWID enrolled in a randomized HCV treatment intervention trial in Baltimore, Maryland were analyzed. Logistic generalized estimating models were conducted to identify predictors of HCV communication. RESULTS Among 227 PWID, the mean age was 43.8 (SD=10.3), 28.2% (n = 64) were women and 71.8% (n = 163) were men. Female participants reported 516 dyadic relationships and male participants 1139 dyadic relationships. While there were significant gender differences based on socio-demographics, risk behavior and network composition, there were few differences in HCV communication patterns. Both men and women had increased odds of HCV communication with alters who are currently enrolled in drug treatment (AOR 1.7, 95% CI: 1.3-2.4), alters with whom participants share drug preparation equipment (AOR 3.0, 95% CI: 1.9-4.6), alters who are sex partners compared to kin (AOR 3.0; 95% CI: 1.9-4.9) and alters with whom respondents have increased trust (AOR 1.1; 95% CI: 1.11.2) and daily/weekly interactions (AOR 1.7; 95% CI 1.3-2.1). CONCLUSION PWID engaged with trusted alters about HCV disclosure and information, highlighting the important role network interventions could play in this vulnerable population.
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Affiliation(s)
- Marisa Felsher
- Johns Hopkins University School of Medicine, Division of Infectious Diseases, 5200 Eastern Avenue, MFL Center Tower, Suite 381, Baltimore, MD 21224, USA.
| | - Karin E Tobin
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Mark Sulkowski
- Johns Hopkins University School of Medicine, Division of Infectious Diseases, 5200 Eastern Avenue, MFL Center Tower, Suite 381, Baltimore, MD 21224, USA
| | - Carl Latkin
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Oluwaseun Falade-Nwulia
- Johns Hopkins University School of Medicine, Division of Infectious Diseases, 5200 Eastern Avenue, MFL Center Tower, Suite 381, Baltimore, MD 21224, USA
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13
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Levander XA, Vega TA, Seaman A, Korthuis PT, Englander H. Utilising an access to care integrated framework to explore the perceptions of hepatitis C treatment of hospital-based interventions among people who use drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 96:103356. [PMID: 34226111 PMCID: PMC8568624 DOI: 10.1016/j.drugpo.2021.103356] [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: 02/13/2021] [Revised: 06/15/2021] [Accepted: 06/16/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Gaps remain in the hepatitis C virus (HCV) care cascade for people who use drugs (PWUD). Acute medical or surgical illnesses requiring hospitalisation are an opportunity to address addiction, but how inpatient strategies could affect HCV care accessibility for PWUD remains unknown. We explored patient perspectives of hospital-based interventions using an integrated framework of access to HCV care. METHODS We conducted a qualitative study of hospitalised adults (n=27) with HCV and addiction admitted to an urban academic medical centre in the United States between June and November 2019. Individual interviews were audio-recorded, transcribed, and dual-coded. We analysed data with coding specific for hospital-based interventions including screening, conducting HCV-related laboratory work-up, starting treatment, connecting with peers, and coordinating outpatient care. We analysed coded data at the semantic level for emergent themes using a framework approach based off an integrated framework of access to HCV care. RESULTS The majority of participants primarily used opioids (78%), were white (85%) and men (67%). Participants frequently reported HCV screening during previous hospitalisation with rare inpatient connection to HCV-related services. Participants expressed willingness to discuss HCV treatment candidacy during hospitalisation; however, lack of inpatient conversations led to perception that "nothing could be done" during admission. Participants expressed interest in completing inpatient HCV work-up to "get the ball rollin'" - consolidating care would enhance outpatient service permeability by reducing barriers. Others resisted HCV care coordination, preferring to focus on "immediate" issues including health conditions and addiction treatment. Participants also expressed openness to engaging with peers about HCV, noting shared drug use experience as critical to a peer relationship when discussing HCV. CONCLUSION Hospitalised PWUD have varied priorities, necessitating adaptable interventions for addressing HCV. Hospitalisation can be an opportunity to address HCV access to care including identification of treatment eligibility, consolidation of care, and facilitation of HCV-related referrals.
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Affiliation(s)
- Ximena A Levander
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Section of Addiction Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR, 97239 United States.
| | - Taylor A Vega
- School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, United States
| | - Andrew Seaman
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Section of Addiction Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR, 97239 United States; Central City Concern, 232 NW 6th Ave., Portland, OR, 97209, United States
| | - P Todd Korthuis
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Section of Addiction Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR, 97239 United States
| | - Honora Englander
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Section of Addiction Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR, 97239 United States; Department of Medicine, Division of Hospital Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR, 97239 United States
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14
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Brown C, Siegele M, Wright M, Cook C, Parkes J, I Khakoo S, Sacks-Davis R, Buchanan RM. Injecting network structure determines the most efficient strategy to achieve Hepatitis C elimination in people who inject drugs. J Viral Hepat 2021; 28:1274-1283. [PMID: 34048117 DOI: 10.1111/jvh.13554] [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] [Received: 02/26/2021] [Revised: 04/05/2021] [Accepted: 05/16/2021] [Indexed: 12/09/2022]
Abstract
Transmission of Hepatitis C (HCV) continues via sharing of injection equipment between people who inject drugs (PWID). Network-based modelling studies have produced conflicting results about whether random treatment is preferable to targeting treatment at PWID with multiple partners. We hypothesise that differences in the modelled injecting network structure produce this heterogeneity. The study aimed to test how changing network structure affects HCV transmission and treatment effects. We created three dynamic injecting network structures connecting 689 PWID (UK-net, AUS-net and USA-net) based on published empirical data. We modelled HCV in the networks and at 5 years compared prevalence of HCV 1) with no treatment, 2) with randomly targeted treatment and 3) with treatment targeted at PWID with the most injecting partnerships (degree-based treatment). HCV prevalence at 5 years without treatment differed significantly between the three networks (UK-net (42.8%) vs. AUS-net (38.2%), p < 0.0001 and vs. USA-net (54.0%), p < 0.0001). In the treatment scenarios UK-net and AUS-net showed a benefit of degree-based treatment with a 5-year prevalence of 1.0% vs. 9.6% p < 0.0001 and 0.15% vs. 0.44%, p < 0.0001. USA-net showed no significant difference (29.3% vs. 29.2%, p = 0.0681). Degree-based treatment was optimised with low prevalence, moderate treatment coverage conditions whereas random treatment was optimised in low treatment coverage, high prevalence conditions. In conclusion, injecting network structure determines the transmission rate of HCV and the most efficient treatment strategy. In real-world injecting network structures, the benefit of targeting HCV treatment at individuals with multiple injecting partnerships may have been underestimated.
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Affiliation(s)
- Chloe Brown
- Faculty of Medicine, University of Southampton, Southampton, UK
| | | | - Mark Wright
- University Hospital Southampton, Southampton, UK
| | - Charlotte Cook
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Julie Parkes
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Salim I Khakoo
- Faculty of Medicine, University of Southampton, Southampton, UK
| | | | - Ryan M Buchanan
- Faculty of Medicine, University of Southampton, Southampton, UK
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Goodyear T, Brown H, Browne AJ, Hoong P, Ti L, Knight R. "I want to get better, but…": identifying the perceptions and experiences of people who inject drugs with respect to evolving hepatitis C virus treatments. Int J Equity Health 2021; 20:81. [PMID: 33740984 PMCID: PMC7977167 DOI: 10.1186/s12939-021-01420-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 03/04/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The advent of highly tolerable and efficacious direct-acting antiviral (DAA) medications has transformed the hepatitis C virus (HCV) treatment landscape. Yet, people who inject drugs (PWID) - a population with inequitably high rates of HCV and who face significant socio-structural barriers to healthcare access - continue to have disproportionately low rates of DAA uptake. The objective of this study is to explore how PWID with lived experience of HCV perceive and experience DAA treatment, in a setting with universal coverage of these medications since 2018. METHODS Informed by a critical interpretive framework, we thematically analyze data from in-depth, semi-structured interviews conducted between January and June 2018 in Vancouver, Canada, with a purposive sample (n = 56) of PWID at various stages (e.g., pre, peri, post) of DAA treatment. RESULTS The analysis yielded three key themes: (i) life with HCV, (ii) experiences with and perceptions of evolving HCV treatments, and (iii) substance use and the uptake of DAA treatments. First, participants described how health and healthcare conditions, such as the deprioritizing of HCV (e.g., due to: being asymptomatic, healthcare provider inaction, gatekeeping) and catalysts to care (e.g., symptom onset, treatment for co-morbidities) shaped DAA treatment motivation and access. Second, participants described how individual and community-level accounts of evolving HCV treatments, including skepticism following negative experiences with Interferon-based treatment and uncertainty regarding treatment eligibility, negatively influenced willingness and opportunities to access DAAs. Concurrently, participants described how peer and community endorsement of DAAs was positively associated with treatment uptake. Third, participants favoured HCV care that was grounded in harm reduction, which included the integration of DAAs with other substance use-related services (e.g., opioid agonist therapy, HIV care), and which was often contrasted against abstinence-focused care wherein substance use is framed as a contraindication to HCV treatment access. CONCLUSIONS These findings underscore several equity-oriented healthcare service delivery and clinician adaptations that are required to scale up DAAs among PWID living with HCV, including the provision of harm reduction-focused, non-stigmatizing, integrated, and peer-led care that responds to power differentials.
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Affiliation(s)
- Trevor Goodyear
- School of Nursing, University of British Columbia, Vancouver, Canada
- British Columbia Centre on Substance Use, 400-1045 Howe St, V6Z 2A9, Vancouver, BC, Canada
| | - Helen Brown
- School of Nursing, University of British Columbia, Vancouver, Canada
| | - Annette J Browne
- School of Nursing, University of British Columbia, Vancouver, Canada
| | - Peter Hoong
- British Columbia Centre on Substance Use, 400-1045 Howe St, V6Z 2A9, Vancouver, BC, Canada
| | - Lianping Ti
- British Columbia Centre on Substance Use, 400-1045 Howe St, V6Z 2A9, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Rod Knight
- British Columbia Centre on Substance Use, 400-1045 Howe St, V6Z 2A9, Vancouver, BC, Canada.
- Department of Medicine, University of British Columbia, Vancouver, Canada.
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Perceptions of network based recruitment for hepatitis C testing and treatment among persons who inject drugs: a qualitative exploration. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 88:103019. [PMID: 33160152 DOI: 10.1016/j.drugpo.2020.103019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/30/2020] [Accepted: 10/20/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Social network interventions that take advantage of existing individual and group relationships may help overcome the significant patient, provider, and system level barriers that contribute to low hepatitis C Virus (HCV) treatment uptake among people who inject drugs (PWID). METHODS We conducted semi-structured interviews with 20 HCV antibody positive PWID (15 male, 5 female) in Baltimore, Maryland, USA. We utilized thematic analysis and employed both inductive and deductive coding techniques to assess perceptions of barriers and facilitators of social network interventions for HCV testing, linkage to care, and treatment among PWID. RESULTS PWID perceived a high prevalence of HCV within their social networks, especially within injection drug use networks. Overwhelmingly, participants reported a willingness to discuss HCV and provide informational, instrumental, and emotional support to their network members. Support included sharing knowledge, such as where and how to access HCV care, as well as sharing lived experiences about HCV treatment that could help peers build trust within networks. Participants who were already linked into HCV care had an increased understanding of using social network interventions to provide peer navigation, by accompanying network members to HCV related appointments. Across interviews, drug use related stigma and feeling undeserving of HCV treatment due to previous negative experiences accessing the health care system emerged as a major barrier to linkage to HCV treatment and cure. Undeservingness was often internalized and projected onto network members. To overcome this, participants supported access to low-barrier HCV treatment in alternative locations such as community-based or mobile clinics and drug treatment centers. CONCLUSION Social network based interventions have potential to increase HCV treatment uptake among PWID. To be successful, these interventions will need to train peers to share accurate information and personal experiences with HCV testing and treatment and enhance their ability to provide support to network members who face significant stigma related to both HCV and drug use.
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Falade-Nwulia O, Gicquelais RE, Astemborski J, McCormick SD, Kirk G, Sulkowski M, Thomas DL, Mehta SH. Hepatitis C treatment uptake among people who inject drugs in the oral direct-acting antiviral era. Liver Int 2020; 40:2407-2416. [PMID: 32770638 PMCID: PMC7706292 DOI: 10.1111/liv.14634] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 06/22/2020] [Accepted: 07/20/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Increased uptake of hepatitis C virus (HCV) treatment among people who inject drugs (PWID) will be critical to achieve HCV elimination goals. There are limited data on HCV treatment uptake among PWID recruited from community-based settings in the HCV direct-acting antiviral (DAA) era. METHODS We analysed data from PWID with HCV newly recruited into the Baltimore, Maryland-based AIDS Linked to the IntraVenous Experience (ALIVE) cohort between 2015 and 2018. We characterized the HCV care continuum and evaluated factors associated with HCV treatment uptake. RESULTS Of the 418 PWID with HCV, the median age was 49 years and most (88%) reported recent injection drug use (IDU). Overall, 23% had ever been evaluated by a provider for HCV treatment, 17% ever initiated DAA treatment and 13% were cured of HCV infection. Treatment uptake approximately doubled between 2015 and 2018 (13% to 26%, P = .01). In multivariable analyses, HIV infection (adjusted Odds Ratio [aOR] 2.5 [95% Confidence Interval (CI) 1.3, 4.8]), current employment (aOR 4.1 [CI 1.2, 14.4]), having a primary care provider (aOR 4.3 [CI 1.2, 14.9) and longer duration of IDU (aOR 1.3 [CI 1.1, 1.6]) were positively associated with HCV treatment. PWID with a lower annual income (≤$5000) were less likely to have initiated HCV treatment (aOR 0.5 [CI 0.3, 0.98]). CONCLUSIONS Although HCV treatment uptake among PWID in this community-based setting in the DAA era remains suboptimal, it is encouraging that treatment uptake has increased in recent years. Innovative strategies are needed to reach all PWID infected with HCV.
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Affiliation(s)
| | - Rachel E. Gicquelais
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jacquie Astemborski
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sean D. McCormick
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Greg Kirk
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Mark Sulkowski
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - David L. Thomas
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Shruti H. Mehta
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Falade-Nwulia O, Sacamano P, McCormick SD, Yang C, Kirk G, Thomas D, Sulkowski M, Latkin C, Mehta SH. Individual and network factors associated with HCV treatment uptake among people who inject drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 78:102714. [PMID: 32135398 DOI: 10.1016/j.drugpo.2020.102714] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/15/2020] [Accepted: 02/23/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Hepatitis C virus (HCV) treatment uptake among people who inject drugs (PWID), a population with disproportionately high rates of HCV, remains low. Peers have been shown to positively impact a broad range of health outcomes for PWID. There is, however, limited data on the impact of PWID social network members on HCV treatment. METHODS HCV-infected PWID enrolled in an ongoing community-based cohort were recruited as "indexes" to complete an egocentric social network survey. The survey elicited from the index PWID a list of their network members and the index's perception of network member characteristics. Logistic regression analyses were conducted to compare individual and network factors associated with HCV treatment in the index PWID. RESULTS Among 540 HCV-infected PWID, the mean age was 55.7 years and the majority were black (87.2%) and male (69.8%). PWID reported a mean of 4.4 (standard deviation [SD] 3.2) network members, most of whom were relatives (mean 2.2 [SD 1.5]). In multivariable analysis, increasing index age and HIV infection were positively associated with HCV treatment, while drug use and homelessness in the preceding 6 months were negatively associated with HCV treatment. From a network perspective, having at least one network member who regularly talked with the index about seeing their doctor for HIV care was associated with HCV treatment (Adjusted Odds Ratio [AOR] 2.7; 95% Confidence Interval (CI) [1.3, 5.6]). Conversely, PWID who had at least one network member who helped them understand their HCV care were less likely to have been HCV treated (AOR 0.2; CI [0.1, 0.6). CONCLUSION HCV treatment uptake in this group of PWID appeared to be positively influenced by discussions with network members living with HIV who were in care and negatively influenced by HCV information sharing within PWID networks. These findings underscore the influence of peers on health seeking behaviors of their network members and emphasizes the importance of well-informed peers.
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Affiliation(s)
- Oluwaseun Falade-Nwulia
- Johns Hopkins University School of Medicine, 725 N. Wolfe Street, Suite 215, Baltimore, MD 21205, USA.
| | - Paul Sacamano
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sean D McCormick
- Johns Hopkins University School of Medicine, 725 N. Wolfe Street, Suite 215, Baltimore, MD 21205, USA
| | - Cui Yang
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Greg Kirk
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - David Thomas
- Johns Hopkins University School of Medicine, 725 N. Wolfe Street, Suite 215, Baltimore, MD 21205, USA
| | - Mark Sulkowski
- Johns Hopkins University School of Medicine, 725 N. Wolfe Street, Suite 215, Baltimore, MD 21205, USA
| | - Carl Latkin
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shruti H Mehta
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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