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Gray A, Surey J, Veitch M, Menezes D, Gibbons J, Leonard M, Sultan B, Esmail H, Story A. Diagnosis and management of tuberculosis infection in inclusion health populations in London. BMC Infect Dis 2024; 24:252. [PMID: 38395793 PMCID: PMC10893593 DOI: 10.1186/s12879-024-09132-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/13/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Tuberculosis in the UK is more prevalent in people with social risk factors- e.g. previous incarceration, homelessness - and in migrants from TB endemic countries. The management of TB infection is part of TB elimination strategies, but is challenging to provide to socially excluded groups and the evidence base for effective interventions is small. METHODS We evaluated a TB infection screening and treatment programme provided by a peer-led service (Find&Treat) working in inclusion health settings (e.g. homeless hostels) in London. IGRA (interferon-gamma release assay) testing and TB infection treatment were offered to eligible adults using a community-based model. The primary outcome was successful progression through the cascade of care. We also evaluated socio-demographic characteristics associated with a positive IGRA. RESULTS 42/312 (13.5%) participants had a positive IGRA and no one had evidence of active TB. 35/42 completed a medical evaluation; 22 started treatment, and 17 completed treatment. Having a positive IGRA was associated with previous incarceration and being born outside of the UK. DISCUSSION Provision of TB infection diagnosis and management to this socially excluded population has several challenges including maintaining people in care and drug-drug interactions. Peer-support workers provided this service safely and effectively with appropriate support. Further work to generate data to inform risks and benefits of treatment for TB infection in this group is needed to facilitate joint decision making.
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Affiliation(s)
- Adam Gray
- University College London Hospitals, London, UK
- Hospital for Tropical Diseases, University College London Hospitals, London, UK
- Institute for Global Health, University College London, London, UK
| | - Julian Surey
- University College London Hospitals, London, UK
- Institute for Global Health, University College London, London, UK
- Universidad Autonoma de Madrid, Madrid, Spain
| | | | - Dee Menezes
- Public Health Data Science, Institute of Health Informatics, University College London, London, UK
| | | | | | | | - Hanif Esmail
- Hospital for Tropical Diseases, University College London Hospitals, London, UK
- Institute for Global Health, University College London, London, UK
- TB Service, Whittington Hospital, London, UK
| | - Al Story
- University College London Hospitals, London, UK.
- Collaborative Centre for Inclusion Health, University College London, London, UK.
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Riccò M, Baldassarre A, Corrado S, Bottazzoli M, Marchesi F. Respiratory Syncytial Virus, Influenza and SARS-CoV-2 in Homeless People from Urban Shelters: A Systematic Review and Meta-Analysis (2023). EPIDEMIOLOGIA 2024; 5:41-79. [PMID: 38390917 PMCID: PMC10885116 DOI: 10.3390/epidemiologia5010004] [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: 11/24/2023] [Revised: 01/20/2024] [Accepted: 01/23/2024] [Indexed: 02/24/2024] Open
Abstract
Homeless people (HP) are disproportionally affected by respiratory disorders, including pneumococcal and mycobacterial infections. On the contrary, more limited evidence has been previously gathered on influenza and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and very little is known about the occurrence of human respiratory syncytial virus (RSV), a common cause of respiratory tract infections among children and the elderly. The present systematic review was designed to collect available evidence about RSV, influenza and SARS-CoV-2 infections in HP, focusing on those from urban homeless shelters. Three medical databases (PubMed, Embase and Scopus) and the preprint repository medRxiv.org were therefore searched for eligible observational studies published up to 30 December 2023, and the collected cases were pooled in a random-effects model. Heterogeneity was assessed using the I2 statistics. Reporting bias was assessed by funnel plots and a regression analysis. Overall, 31 studies were retrieved, and of them, 17 reported on the point prevalence of respiratory pathogens, with pooled estimates of 4.91 cases per 1000 HP (95%CI: 2.46 to 9.80) for RSV, 3.47 per 1000 HP for influenza and 40.21 cases per 1000 HP (95%CI: 14.66 to 105.55) for SARS-CoV-2. Incidence estimates were calculated from 12 studies, and SARS-CoV-2 was characterized by the highest occurrence (9.58 diagnoses per 1000 persons-months, 95%CI: 3.00 to 16.16), followed by influenza (6.07, 95%CI: 0.00 to 15.06) and RSV (1.71, 95%CI: 0.00 to 4.13). Only four studies reported on the outcome of viral infections in HP: the assessed pathogens were associated with a high likelihood of hospitalization, while high rates of recurrence and eventual deaths were reported in cases of RSV infections. In summary, RSV, influenza and SARS-CoV-2 infections were documented in HP from urban shelters, and their potential outcomes stress the importance of specifically tailored preventive strategies.
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Affiliation(s)
- Matteo Riccò
- AUSL-IRCCS di Reggio Emilia, Servizio di Prevenzione e Sicurezza Negli Ambienti di Lavoro (SPSAL), Local Health Unit of Reggio Emilia, 42122 Reggio Emilia, Italy
| | - Antonio Baldassarre
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
| | - Silvia Corrado
- ASST Rhodense, Dipartimento della Donna e Area Materno-Infantile, UOC Pediatria, 20024 Milan, Italy
| | - Marco Bottazzoli
- Department of Otorhinolaryngology, APSS Trento, 38122 Trento, Italy
| | - Federico Marchesi
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
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Crane M, Joly L, Daly BJ, Gage H, Manthorpe J, Cetrano G, Ford C, Williams P. Integration, effectiveness and costs of different models of primary health care provision for people who are homeless: an evaluation study. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2023; 11:1-217. [PMID: 37839804 DOI: 10.3310/wxuw5103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Background There is a high prevalence of health problems among single people who are homeless. Specialist primary health care services for this population have been developed in several locations across England; however, there have been very few evaluations of these services. Objectives This study evaluated the work of different models of primary health care provision in England to determine their effectiveness in engaging people who are homeless in health care and in providing continuity of care for long-term conditions. It concerned single people (not families or couples with dependent children) staying in hostels, other temporary accommodation or on the streets. The influence on outcomes of contextual factors and mechanisms (service delivery factors), including integration with other services, were examined. Data from medical records were collated on participants' use of health care and social care services over 12 months, and costs were calculated. Design and setting The evaluation involved four existing Health Service Models: (1) health centres primarily for people who are homeless (Dedicated Centres), (2) Mobile Teams providing health care in hostels and day centres, (3) Specialist GPs providing some services exclusively for patients who are homeless and (4) Usual Care GPs providing no special services for people who are homeless (as a comparison). Two Case Study Sites were recruited for each of the specialist models, and four for the Usual Care GP model. Participants People who had been homeless during the previous 12 months were recruited as 'case study participants'; they were interviewed at baseline and at 4 and 8 months, and information was collected about their circumstances and their health and service use in the preceding 4 months. Overall, 363 participants were recruited; medical records were obtained for 349 participants. Interviews were conducted with 65 Case Study Site staff and sessional workers, and 81 service providers and stakeholders. Results The primary outcome was the extent of health screening for body mass index, mental health, alcohol use, tuberculosis, smoking and hepatitis A among participants, and evidence of an intervention if a problem was identified. There were no overall differences in screening between the models apart from Mobile Teams, which scored considerably lower. Dedicated Centres and Specialist GPs were more successful in providing continuity of care for participants with depression and alcohol and drug problems. Service use and costs were significantly higher for Dedicated Centre participants and lower for Usual Care GP participants. Participants and staff welcomed flexible and tailored approaches to care, and related services being available in the same building. Across all models, dental needs were unaddressed and staff reported poor availability of mental health services. Limitations There were difficulties recruiting mainstream general practices for the Usual Care GP model. Medical records could not be accessed for 14 participants of this model. Conclusions Participant characteristics, contextual factors and mechanisms were influential in determining outcomes. Overall, outcomes for Dedicated Centres and for one of the Specialist GP sites were relatively favourable. They had dedicated staff for patients who were homeless, 'drop-in' services, on-site mental health and substance misuse services, and worked closely with hospitals and homelessness sector services. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (HSDR 13/156/03) and will be published in full in Health and Social Care Delivery Research; Vol. 11, No. 16. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Maureen Crane
- National Institute for Health and Care Research Health and Social Care Workforce Research Unit, King's College London, London, UK
| | - Louise Joly
- National Institute for Health and Care Research Health and Social Care Workforce Research Unit, King's College London, London, UK
| | - Blánaid Jm Daly
- Special Care Dentistry, Division of Population and Patient Health, King's College London, London, UK
| | - Heather Gage
- Surrey Health Economics Centre, Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - Jill Manthorpe
- National Institute for Health and Care Research Health and Social Care Workforce Research Unit, King's College London, London, UK
| | - Gaia Cetrano
- National Institute for Health and Care Research Health and Social Care Workforce Research Unit, King's College London, London, UK
| | | | - Peter Williams
- Department of Mathematics, University of Surrey, Guildford, UK
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Gray AT, Surey J, Esmail H, Story A, Harris M. "It's too hard" - the management of latent TB in under-served populations in the UK: a qualitative study. BMC Health Serv Res 2022; 22:1464. [PMID: 36457026 PMCID: PMC9715280 DOI: 10.1186/s12913-022-08855-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/18/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND UK national guidance recommends systematic screening for latent tuberculosis infection (LTBI) in under-served populations, including people experiencing homelessness and people who use drugs. This is not routinely implemented in the UK, and the reasons for this policy-practice mismatch remain underexplored. METHODS Semi-structured qualitative interviews were conducted with 19 healthcare professionals from across the UK. Participants were recruited using purposive sampling and snowballing, identifying individuals with excellent knowledge of their regions practice and policy of LTBI management. The interviews were conducted online, and were audio recorded, with transcripts thematically analysed using a two-stage inductive coding process to explore perceived barriers and enablers to LTBI screening. RESULTS Most participants had previous experience managing LTBI in under-served populations, but none were conducting systematic screening as per national guidance. We identified service provision challenges and low prioritisation of LTBI as the key explanatory themes driving this policy-practice mismatch. Lack of resource, and the complexity of clinical decision making were two key service level barriers. System and service inertia, and lack of cost effectiveness evidence led to LTBI being deprioritised. Service integration and promotion of WHO targets for TB elimination were highlighted as potential solutions. CONCLUSION Integrating LTBI testing and treatment with existing health services for under-served populations could improve feasibility and efficacy. Promotion of UK TB elimination goals and generation of regional evidence to support commissioning for LTBI care is vital. Without such a multi-pronged approach inertia is likely to persist and the zeitgeist will remain: "it's too hard".
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Affiliation(s)
- Adam Thorburn Gray
- Find and Treat, University College London Hospitals, London, UK.
- Hospital for Tropical Diseases, University College London Hospitals, London, UK.
- Institute for Global Health, University College London, London, UK.
| | - Julian Surey
- Find and Treat, University College London Hospitals, London, UK
- Institute for Global Health, University College London, London, UK
| | - Hanif Esmail
- Hospital for Tropical Diseases, University College London Hospitals, London, UK
- Institute for Global Health, University College London, London, UK
- MRC Clinical Trials Unit, University College London, London, UK
| | - Alistair Story
- Find and Treat, University College London Hospitals, London, UK
- Collaborative Centre for Inclusion Health, University College London, London, UK
| | - Magdalena Harris
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
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Guise A, Burridge S, Annand P, Burrows M, Platt L, Rathod SD, Hosseini P, Cornes M. Why were COVID-19 infections lower than expected amongst people who are homeless in London, UK in 2020? Exploring community perspectives and the multiple pathways of health inequalities in pandemics. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:100038. [PMID: 35036989 PMCID: PMC8744008 DOI: 10.1016/j.ssmqr.2021.100038] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 12/21/2021] [Accepted: 12/31/2021] [Indexed: 01/12/2023]
Abstract
High rates of COVID-19 infections and deaths amongst people who are homeless in London, UK were feared. Rates however stayed much lower than expected throughout 2020; an experience that compares to other settings globally. This study sought a community level perspective to explore this rate of infections, and through this explore relationships between COVID-19 and existing health inequalities. Analyses are reported from ongoing qualitative studies on COVID-19 and homeless health service evaluation in London, UK. Repeated in-depth telephone interviews were implemented with people experiencing homelessness in London (n=17; 32 interviews in total) as well as street outreach workers, nurses and hostel staff (n=10) from September 2020 to early 2021. Thematic analysis generated three themes to explore peoples' experiences of, and perspectives on, low infections: people experiencing homelessness following, creating and breaking social distancing and hygiene measures; social distancing in the form of social exclusion as a long-running feature of life; and a narrative of 'street immunity' resulting from harsh living conditions. Further study is needed to understand how these factors combine to prevent COVID-19 and how they relate to different experiences of homelessness. This community perspective can ensure that emerging narratives of COVID-19 prevention success don't ignore longer running causes of homelessness and reinforce stigmatising notions of people who are homeless as lacking agency. Our findings aid theorisation of how health inequalities shape pandemic progression: severe exclusion may substantially delay epidemics in some communities, although with considerable other non-COVID-19 impacts.
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Affiliation(s)
- Andy Guise
- King's College London, Guy's Campus, London, SE1 3UZ, UK,Corresponding author. King's College London, 5th Floor, Addison House, Guy's Campus, London, SE1 3UZ, UK
| | | | - P.J. Annand
- King's College London, Guy's Campus, London, SE1 3UZ, UK
| | - Martin Burrows
- Groundswell, St Matthews, Brixton Hill, London, SW2 1JF, UK
| | - Lucy Platt
- London School of Hygiene and Tropical Medicine, Tavistock Place, London, WC1X 9SH, UK
| | - Sujit D. Rathod
- London School of Hygiene and Tropical Medicine, Tavistock Place, London, WC1X 9SH, UK
| | - Paniz Hosseini
- London School of Hygiene and Tropical Medicine, Tavistock Place, London, WC1X 9SH, UK
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Al Mahrouqi S, Gadalla A, Al Azri S, Al-Hamidhi S, Al-Jardani A, Balkhair A, Al-fahdi A, Al Balushi L, Al Zadjali S, Al Marhoubi AMN, Babiker HA. Drug resistant Mycobacterium tuberculosis in Oman: resistance-conferring mutations and lineage diversity. PeerJ 2022; 10:e13645. [PMID: 35919400 PMCID: PMC9339217 DOI: 10.7717/peerj.13645] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 06/07/2022] [Indexed: 01/17/2023] Open
Abstract
Background The Sultanate of Oman is country a low TB-incidence, with less than seven cases per 105 population detected in 2020. Recent years have witnessed a persistence in TB cases, with sustained incidence rate among expatriates and limited reduction among Omanis. This pattern suggests transmission from the migrant population. The present study examined the genetic profile and drug resistance-conferring mutations in Mycobacterium tuberculosis collected from Omanis and expatriates to recognise possible causes of disease transmission. Methods We examined M. tuberculosis cultured positive samples, collected from Omanis (n = 1,344) and expatriates (n = 1,203) between 2009 and 2018. These isolates had a known in vitro susceptibility profile to first line anti-TB, Streptomycin (SM), Isoniazid (INH), Rifampicin (RIF), Ethambutol (EMB) and Pyrazinamide (PZA). The diversity of the isolates was assessed by spacer oligo-typing (spoligotyping). Drug resistance-conferring mutations resulted from full-length sequence of nine genes (katG, inhA, ahpc, rpoB, rpsL, rrs, embB, embC, pncA) and their phenotypic relationship were analysed. Results In total, 341/2192 (13.4%), M. tuberculosis strains showed resistance to any drug, comprising mono-resistance (MR) (242, 71%), poly-resistance (PR) (40, 11.7%) and multi-drug resistance (MDR) (59, 17.3%). The overall rate of resistance among Omanis and expatriates was similar; however, MDR and PZAR were significantly higher among Omanis, while INHR was greater among expatriates. Mutations rpsL K43R and rpoB S450L were linked to Streptomycin (SMR) and Rifampicin resistance (RIFR) respectively. Whereas, katG S315T and inhA -C15T/G-17T were associated with Isoniazid resistance (INHR). The resistance patterns (mono-resistant, poly-resistant and MDR) and drug resistance-conferring mutations were found in different spoligo-lineages. rpsL K43R, katG S315T and rpoB S450L mutations were significantly higher in Beijing strains. Conclusions Diverse drug resistant M. tuberculosis strains exist in Oman, with drug resistance-conferring mutations widespread in multiple spoligo-lineages, indicative of a large resistance reservoir. Beijing's M. tuberculosis lineage was associated with MDR, and multiple drug resistance-conferring mutations, favouring the hypothesis of migration as a possible source of resistant lineages in Oman.
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Affiliation(s)
- Sara Al Mahrouqi
- Biochemistry Department, College of Medicine and Health Sciences, Sultan Qaboos University, Oman, Muscat, Oman
| | - Amal Gadalla
- Division of Population Medicine, School of Medicine, College of Biomedical Sciences, Cardiff University, Cardiff, United Kingdom
| | - Saleh Al Azri
- Central Public Health Laboratories, MOH, Muscat, Oman
| | - Salama Al-Hamidhi
- Biochemistry Department, College of Medicine and Health Sciences, Sultan Qaboos University, Oman, Muscat, Oman
| | | | - Abdullah Balkhair
- Department of Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Oman, Muscat, Oman
| | - Amira Al-fahdi
- Biochemistry Department, College of Medicine and Health Sciences, Sultan Qaboos University, Oman, Muscat, Oman
| | | | | | | | - Hamza A. Babiker
- Biochemistry Department, College of Medicine and Health Sciences, Sultan Qaboos University, Oman, Muscat, Oman,Institute of Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom
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Scholze AR, Alves JD, Berra TZ, Ramos ACV, Pieri FM, Pillon SC, Martins JT, Galdino MJQ, Melo EC, Delpino FM, Tártaro AF, Fronteira I, Arcêncio RA. Tuberculosis among People Living on the Street and Using Alcohol, Tobacco, and Illegal Drugs: Analysis of Territories in Extreme Vulnerability and Trends in Southern Brazil. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137721. [PMID: 35805377 PMCID: PMC9265499 DOI: 10.3390/ijerph19137721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 06/15/2022] [Accepted: 06/21/2022] [Indexed: 11/30/2022]
Abstract
(1) Background: Tuberculosis presents an epidemiological trend toward inequality, especially among people in social exclusion and situations of vulnerability. This study aimed to analyze territories with a concentration of people diagnosed with tuberculosis in a street situation and who partake in chronic use of alcohol, tobacco, and illicit drugs. We also analyzed trends in this health condition in southern Brazil. (2) Methods: Ecological study, developed in the 399 municipalities of Paraná, southern Brazil, with all tuberculosis cases in the homeless population registered in the Information System of Notifiable Diseases between 2014 and 2018. For data analysis, we used descriptive statistics, the Prais–Winsten autoregression method for the time series, and the Getis-Ord Gi technique* for spatial analysis. (3) Results: in total, 560 cases were reported. We found a predominance of alcohol, smoking, and illicit drug users, with an increasing trend in the state and clusters of spatial risk in the East health macro-region. (4) Conclusions: We observed territories with critical levels of highly vulnerable people who use psychoactive substances and are in a street situation. The results highlight the importance of incorporating public policies of social protection for these individuals and resolutive health services that receive these cases and assist in eradicating TB.
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Affiliation(s)
- Alessandro Rolim Scholze
- Department of Maternal-Infant and Public Health Nursing, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto 14040-902, Brazil; (T.Z.B.); (A.C.V.R.); (F.M.D.); (A.F.T.); (R.A.A.)
- Correspondence: ; Tel.: +55-(43)-99602-8846
| | - Josilene Dália Alves
- Institute of Biological Sciences and Health, Federal University of Mato Grosso, Barra do Garças 78605-091, Brazil;
| | - Thaís Zamboni Berra
- Department of Maternal-Infant and Public Health Nursing, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto 14040-902, Brazil; (T.Z.B.); (A.C.V.R.); (F.M.D.); (A.F.T.); (R.A.A.)
| | - Antônio Carlos Vieira Ramos
- Department of Maternal-Infant and Public Health Nursing, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto 14040-902, Brazil; (T.Z.B.); (A.C.V.R.); (F.M.D.); (A.F.T.); (R.A.A.)
| | - Flávia Meneguetti Pieri
- Department of Nursing, State University of Londrina, Londrina 86057-970, Brazil; (F.M.P.); (J.T.M.)
| | - Sandra Cristina Pillon
- Department of Psychiatric Nursing and Human Sciences, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto 14040-902, Brazil;
| | - Júlia Trevisan Martins
- Department of Nursing, State University of Londrina, Londrina 86057-970, Brazil; (F.M.P.); (J.T.M.)
| | - Maria José Quina Galdino
- Department of Nursing, State University of Northern Paraná, Bandeirantes 86360-000, Brazil; (M.J.Q.G.); (E.C.M.)
| | - Emiliana Cristina Melo
- Department of Nursing, State University of Northern Paraná, Bandeirantes 86360-000, Brazil; (M.J.Q.G.); (E.C.M.)
| | - Felipe Mendes Delpino
- Department of Maternal-Infant and Public Health Nursing, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto 14040-902, Brazil; (T.Z.B.); (A.C.V.R.); (F.M.D.); (A.F.T.); (R.A.A.)
| | - Ariela Fehr Tártaro
- Department of Maternal-Infant and Public Health Nursing, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto 14040-902, Brazil; (T.Z.B.); (A.C.V.R.); (F.M.D.); (A.F.T.); (R.A.A.)
| | - Inês Fronteira
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, University Nova de Lisboa, 1349-008 Lisboa, Portugal;
| | - Ricardo Alexandre Arcêncio
- Department of Maternal-Infant and Public Health Nursing, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto 14040-902, Brazil; (T.Z.B.); (A.C.V.R.); (F.M.D.); (A.F.T.); (R.A.A.)
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Munteanu I, Cioran N, van Hest R, Abubakar I, Story A, Chiotan D, de Vries G, Mahler B. Tuberculosis Surveillance in Romania Among Vulnerable Risk Groups Between 2015 and 2017. Ther Clin Risk Manag 2022; 18:439-446. [PMID: 35478731 PMCID: PMC9035834 DOI: 10.2147/tcrm.s347748] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 04/10/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Ioana Munteanu
- Department of Pneumology, Marius Nasta Institute of Pneumology, Bucharest, Romania
| | - Nicoleta Cioran
- Department of Pneumology, Marius Nasta Institute of Pneumology, Bucharest, Romania
- 3 Department – Complementary Sciences, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Correspondence: Nicoleta Cioran, Department of Pneumology, Marius Nasta Institute of Pneumology, Soseaua Viilor nr.90, Sector 5, Bucharest, Romania, Tel +40 745 419 994, Fax +40 213 373 801, Email
| | - Rob van Hest
- Department of Tuberculosis Control, Regional Public Health Service Groningen, Groningen, The Netherlands
- Department of Lung Diseases and Tuberculosis, University Medical Centre Groningen (UMCG), Groningen, The Netherlands
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, London, UK
| | - Alistair Story
- Institute of Health Informatics, University College London, London, UK
- Find and Treat, University College Hospitals NHS Foundation Trust, London, UK
| | - Domnica Chiotan
- Department of Pneumology, Marius Nasta Institute of Pneumology, Bucharest, Romania
| | - Gerard de Vries
- KNCV Tuberculosis Foundation, The Hague, The Netherlands
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Beatrice Mahler
- Department of Pneumology, Marius Nasta Institute of Pneumology, Bucharest, Romania
- 4 Department – Cardio-Thoracic Pathology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
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Paisi M, Crombag N, Burns L, Bogaerts A, Withers L, Bates L, Crowley D, Witton R, Shawe J. Barriers and facilitators to hepatitis C screening and treatment for people with lived experience of homelessness: A mixed-methods systematic review. Health Expect 2022; 25:48-60. [PMID: 34862710 PMCID: PMC8849376 DOI: 10.1111/hex.13400] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 10/28/2021] [Accepted: 11/07/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND People experiencing homelessness have an increased risk of hepatitis C virus (HCV) infection, with rates higher than the general population. However, their access to HCV diagnosis is limited and treatment uptake is low. OBJECTIVES To identify and describe the barriers and facilitators for HCV screening and treatment for adults with lived experience of homelessness in highly developed countries. METHODS Bibliographic databases (Embase, MEDLINE, CINAHL and SocINDEX) and grey literature (Google, EThOS, the Health Foundation, Social Care Online, the World Health Organisation, Shelter, Crisis and Pathway) were searched. Two reviewers independently screened and appraised all studies. The Critical Appraisal Skills Programme tool and the Joanna Briggs Institute checklist were used. The analysis involved a three-stage process: coding, theme generation and theme mapping under Penchansky and Thomas's modified access model. RESULTS Twelve papers/reports were included in the review. Several interacting factors influence access of people with lived experience of homelessness to HCV testing and treatment. Some mirror those identified for the general population. The precarious conditions associated with the lived experience of homelessness along with the rigidity of hospital settings and lack of awareness emerged as dominant barriers. Flexibility, outreach, effective communication, tailoring and integration of services were found to be important facilitators. Evidence from Black, Asian and minority ethnic groups is limited. CONCLUSIONS People experiencing homelessness face multiple barriers in accessing and completing HCV treatment, relating to both their lived experience and characteristics of health systems. Although some barriers are readily amenable to change, others are more difficult to modify. The facilitators identified could inform future targeted measures to improve HCV diagnosis and treatment for people experiencing homelessness. Research is warranted into successful models to promote screening, diagnosis and treatment. PATIENT OR PUBLIC CONTRIBUTION Our team includes a peer advocate, a hepatology nurse and a community volunteer, all with significant experience in promoting and engaging in HCV care and outreach for people experiencing homelessness. They contributed to the protocol, interpretation and reporting of the review findings.
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Affiliation(s)
- Martha Paisi
- School of Nursing and MidwiferyUniversity of PlymouthPlymouthUK
- Peninsula Dental SchoolUniversity of PlymouthPlymouthUK
| | - Neeltje Crombag
- Department of Development and Regeneration, Urogenital, Abdominal and Plastic SurgeryKU LeuvenLeuvenBelgium
| | - Lorna Burns
- Peninsula Dental SchoolUniversity of PlymouthPlymouthUK
| | - Annick Bogaerts
- School of Nursing and MidwiferyUniversity of PlymouthPlymouthUK
- Department of Development and Regeneration, Unit Woman and ChildKU LeuvenLeuvenBelgium
- Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care (CRIC)University of AntwerpAntwerpBelgium
| | | | - Laura Bates
- Hepatology Nursing TeamUniversity Hospitals Plymouth NHS TrustPlymouthUK
| | | | - Robert Witton
- Peninsula Dental SchoolUniversity of PlymouthPlymouthUK
| | - Jill Shawe
- School of Nursing and MidwiferyUniversity of PlymouthPlymouthUK
- Royal Cornwall NHS TrustCornwallUK
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10
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Nyamathi A, Morisky D, Wall SA, Yadav K, Shin S, Hall E, Chang AH, White K, Arce N, Parsa T, Salem BE. Nurse-led intervention to decrease drug use among LTBI positive homeless adults. Public Health Nurs 2022; 39:778-787. [PMID: 35014087 DOI: 10.1111/phn.13044] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 12/09/2021] [Accepted: 12/11/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND People experiencing homelessness (PEH) are disproportionately diagnosed with active tuberculosis. While promoting latent tuberculosis infection (LTBI) treatment has been a call to action, PEH engaging in substance use often experience challenges in completing LTBI treatment. METHODS In this non-randomized single arm study, we tested an innovative, community-based, nurse-led community health worker (RN-CHW) model, on reducing drug use among 50 PEH, residing in homeless shelters or living on the streets in Los Angeles. Follow-up was at 3- and 6- months. RESULTS Findings revealed significant and ongoing decrease in any drug use (odds ratio [OR] = 0.30; 95% confidence interval [CI] = 0.14-0.68); p = .004), amphetamine use (OR = 0.14; 95% CI = 0.02-0.81; p = .029), cannabis use (OR = 0.26; 95% CI = 0.12-0.57; p = .001) and methamphetamine use (OR = 0.30; 95% CI = 0.10-0.90; p = .031) at 6-month follow-up. CONCLUSIONS To our knowledge, this pilot study is the first to evaluate the impact a RN-CHW delivered intervention on reduction in drug use among PEH enrolled in a LTBI intervention. LTBI interventions may serve as an entryway into reduction in drug use among this underserved population.
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Affiliation(s)
- Adeline Nyamathi
- Sue & Bill Gross School of Nursing, University of California, Irvine, California
| | - Donald Morisky
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
| | - Sarah Akure Wall
- School of Nursing, University of California, Los Angeles, California
| | - Kartik Yadav
- Sue & Bill Gross School of Nursing, University of California, Irvine, California
| | - Sangshuk Shin
- Sue & Bill Gross School of Nursing, University of California, Irvine, California
| | - Elizabeth Hall
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, California
| | - Alicia H Chang
- Los Angeles County Department of Public Health, Tuberculosis Control Program, Los Angeles, California
| | - Kathryn White
- Los Angeles Christian Health Centers, Los Angeles, California
| | - Nicholas Arce
- School of Social Ecology, University of California, Irvine, California
| | - Therese Parsa
- School of Nursing, University of California, Los Angeles, California
| | - Benissa E Salem
- School of Nursing, University of California, Los Angeles, California
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11
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Nyamathi A, Salem BE, Shin SS, Jones AA, Garfin DR, Yadav K, Chang AH, White K, Morisky D. Effect of a Nurse-Led Community Health Worker Intervention on Latent Tuberculosis Medication Completion Among Homeless Adults. Nurs Res 2021; 70:433-442. [PMID: 34380979 PMCID: PMC8563379 DOI: 10.1097/nnr.0000000000000545] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Tuberculosis (TB) disproportionately affects marginalized and impoverished homeless adults. Although active TB can be prevented by treating latent TB infection (LTBI), individual factors, such as high prevalence of depression and anxiety, drug and alcohol use, and unstable housing, lead to poor LTBI treatment adherence and completion among homeless adults. OBJECTIVES We hypothesized that the delivery of a tailored nurse-led, community health worker (RN/CHW) program across the LTBI continuum of care (e.g., screening, diagnosis, and treatment) that delivers 3HP treatment (3HP: rifapentine plus isoniazid) for homeless adults (e.g., sheltered and unsheltered) and is tailored to their health and social service needs will overcome existing treatment completion barriers. We also hypothesized that mental health symptoms (e.g., depression and anxiety), drug use score, and problematic alcohol use will decline over time among clients receiving this treatment. METHODS We assessed the effect of delivering a theoretically guided, RN/CHW-based, single-arm study among eligible LTBI-positive homeless adults (N = 50) on completion of a weekly, directly observed, 12-dose 3HP LTBI treatment in Central City East (Skid Row). Completing 3HP treatment was compared to the only known historical, clinic-based control that obtained 65% completion among homeless adults. Secondary outcomes included drug and alcohol use, depression, and anxiety. RESULTS The RN/CHW program achieved a 91.8% 3HP treatment completion rate among homeless adults. Younger homeless adults (<50 years old) were less likely to complete 3HP treatment compared to those who were older. Neither drug use, depression, nor anxiety was associated with 3HP treatment completion. Decrease in anxiety was observed at 3 months, but not at 6 months, compared to baseline. DISCUSSION To our knowledge, the pilot study is the first to evaluate an effective RN/CHW-delivered, community-based intervention, which can reduce the burden of active TB for homeless adults.
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12
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Mahler B, de Vries G, van Hest R, Gainaru D, Menezes D, Popescu G, Story A, Abubakar I. Use of targeted mobile X-ray screening and computer-aided detection software to identify tuberculosis among high-risk groups in Romania: descriptive results of the E-DETECT TB active case-finding project. BMJ Open 2021; 11:e045289. [PMID: 34429305 PMCID: PMC8386204 DOI: 10.1136/bmjopen-2020-045289] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 08/07/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To implement and assess the mobile X-ray unit (MXU) equipped with digital radiography, computer-aided detection (CAD) software and molecular point of care tests to improve early tuberculosis (TB) diagnosis in vulnerable populations in a TB outreach screening programme in Romania. DESIGN Descriptive study. SETTINGS Prisons in Bucharest and other cities in the southern part of Romania, homeless shelters and services for problem drug users in Bucharest, and Roma populations in Bucharest and Craiova. PARTICIPANTS 5510 individuals attended the MXU service; 5003 persons were radiologically screened, 61% prisoners, 15% prison staff, 11% Roma population, 10% homeless persons and/or problem drug users and 3% other. INTERVENTIONS Radiological digital chest X-ray (CXR) screening of people at risk for TB, followed by CAD and human reading of the CXRs, and further TB diagnostics when the pulmonologist classified the CXR as suggestive for TB. PRIMARY AND SECONDARY OUTCOME MEASURES Ten bacteriologically confirmed TB cases were identified translating into an overall yield of 200 per 100 000 persons screened (95% CIs of 109 to 368 per 100 000). Prevalence rates among homeless persons and/or problem drug users (826/100 000; 95% CI 326 to 2105/100 000) and the Roma population (345/100 000; 95% CI 95 to 1251/100 000) were particularly high. RESULTS The human reader classified 6.4% (n=317) of the CXRs as suspect for TB (of which 32 were highly suggestive for TB); 16.3% of all CXRs had a CAD4TB version 6 score >50. All 10 diagnosed TB patients had a CAD4TB score >50; 9 had a CAD4TB score >60. CONCLUSIONS Given the high TB prevalence rates found among homeless persons and problem drug users and in the Roma population, targeted active case finding has the potential to deliver a major contribution to TB control in Romania.
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Affiliation(s)
- Beatrice Mahler
- Department of Pulmonoloy, Institute for Lung Diseases Marius Nasta, Bucuresti, Romania
| | - Gerard de Vries
- Team The Netherlands & Elimination, KNCV Tuberculosis Foundation, Den Haag, Zuid-Holland, The Netherlands
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Rob van Hest
- Department of Lung Diseases and Tuberculosis, University Medical Centre Groningen, Groningen, The Netherlands
- Department of Tuberculosis Control, Public Health Service, Groningen, The Netherlands
| | - Dan Gainaru
- Department of Pulmonoloy, Institute for Lung Diseases Marius Nasta, Bucuresti, Romania
| | - Dee Menezes
- Public Health Data Science, UCL Institute of Health Informatics, London, UK
| | - Gilda Popescu
- Department of Pulmonoloy, Institute for Lung Diseases Marius Nasta, Bucuresti, Romania
| | - Alistair Story
- Find&Treat, University College London Hospitals NHS Foundation Trust, London, UK
- Institute of Health Informatics, University College of London, London, UK
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, London, UK
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13
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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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14
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Nyamathi AM, Salem BE. The impact of unstable housing on health. LANCET PUBLIC HEALTH 2021; 6:e265-e266. [PMID: 33780657 DOI: 10.1016/s2468-2667(21)00035-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 02/12/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Adeline M Nyamathi
- Sue & Bill Gross School of Nursing, University of California, Irvine, CA 92697, USA.
| | - Benissa E Salem
- School of Nursing, University of California, Los Angeles, CA, USA
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15
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Wilkinson R, Mandal S, Phipps E. Evaluation of Hepatitis C Test and Treat Interventions Targeted at Homeless Populations (Outside London) in England During the COVID-19 Pandemic. Clin Liver Dis (Hoboken) 2021; 17:90-94. [PMID: 33680443 PMCID: PMC7916438 DOI: 10.1002/cld.1098] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 02/04/2023] Open
Affiliation(s)
- Rebecca Wilkinson
- Public Health RegistrarSchool of Primary Care, Population Sciences and Medical EducationUniversity of SouthamptonSouthamptonUnited Kingdom
| | - Sema Mandal
- Blood Safety, Hepatitis, STI and HIV DivisionNational Infection ServicePublic Health EnglandLondonUnited Kingdom
| | - Emily Phipps
- Blood Safety, Hepatitis, STI and HIV DivisionNational Infection ServicePublic Health EnglandLondonUnited Kingdom
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16
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Heyd A, Heffernan C, Storey K, Wild TC, Long R. Treating latent tuberculosis infection (LTBI) with isoniazid and rifapentine (3HP) in an inner-city population with psychosocial barriers to treatment adherence: A qualitative descriptive study. PLOS GLOBAL PUBLIC HEALTH 2021; 1:e0000017. [PMID: 36962068 PMCID: PMC10021900 DOI: 10.1371/journal.pgph.0000017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 11/15/2021] [Indexed: 11/18/2022]
Abstract
In Canada, preventive therapy for latent tuberculosis infection (LTBI) has required multiple doses of medication over an extended period of time. Such regimens are associated with poor adherence and completion rates. A shortened treatment regimen of once weekly isoniazid plus rifapentine for 3 months (3HP), is now available, and holds promise in populations facing challenges to treatment adherence. Although many factors impact treatment adherence, a knowledge gap exists in describing these factors in the context of this regimen. We present findings from a qualitative descriptive study, involving semi-structured interviews with unstably housed or homeless individuals in Edmonton and Fort McMurray, Alberta, Canada who were offered directly-observed preventive therapy (DOPT) with 3HP, and their health care providers. Latent content analysis revealed incomplete understandings of LTBI and about the need for preventive therapy. Clients' motivation to be healthy, alongside education, health care outreach, relationships developed in the context of DOPT, ease of treatment regimen, incentives, and collaboration were all described as supporting treatment completion. Competing priorities, difficulty in reaching clients, undesirable aspects of the regimen and difficulties obtaining and initiating 3HP were identified as barriers. Perceptions of stigma related to LTBI and TB were described by clients in addition to feelings of shame related to their diagnosis. Our study provides insight into LTBI and indicates that multiple interacting psychosocial factors influence preventive therapy access, uptake, and adherence. Findings from this study of both client and provider perspectives can be used to inform and address inequities among individuals experiencing homelessness, and ultimately contribute to a diminished reservoir of LTBI.
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Affiliation(s)
- Amber Heyd
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Courtney Heffernan
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Kate Storey
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - T Cameron Wild
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Richard Long
- School of Public Health, University of Alberta, Edmonton, AB, Canada
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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17
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Story A, Garber E, Aldridge RW, Smith CM, Hall J, Ferenando G, Possas L, Hemming S, Wurie F, Luchenski S, Abubakar I, McHugh TD, White PJ, Watson JM, Lipman M, Garfein R, Hayward AC. Management and control of tuberculosis control in socially complex groups: a research programme including three RCTs. PROGRAMME GRANTS FOR APPLIED RESEARCH 2020. [DOI: 10.3310/pgfar08090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background
Socially complex groups, including people experiencing homelessness, prisoners and drug users, have very high levels of tuberculosis, often complicated by late diagnosis and difficulty in adhering to treatment.
Objective
To assess a series of interventions to improve tuberculosis control in socially complex groups.
Design
A series of observational surveys, evaluations and trials of interventions.
Setting
The pan-London Find&Treat service, which supports tuberculosis screening and case management in socially complex groups across London.
Participants
Socially complex groups with tuberculosis or at risk of tuberculosis, including people experiencing homelessness, prisoners, drug users and those at high risk of poor adherence to tuberculosis treatment.
Interventions and main outcome measures
We screened 491 people in homeless hostels and 511 people in prison for latent tuberculosis infection, human immunodeficiency virus, hepatitis B and hepatitis C. We evaluated an NHS-led prison radiographic screening programme. We conducted a cluster randomised controlled trial (2348 eligible people experiencing homelessness in 46 hostels) of the effectiveness of peer educators (22 hostels) compared with NHS staff (24 hostels) at encouraging the uptake of mobile radiographic screening. We initiated a trial of the use of point-of-care polymerase chain reaction diagnostics to rapidly confirm tuberculosis alongside mobile radiographic screening. We undertook a randomised controlled trial to improve treatment adherence, comparing face-to-face, directly observed treatment with video-observed treatment using a smartphone application. The primary outcome was completion of ≥ 80% of scheduled treatment observations over the first 2 months following enrolment. We assessed the cost-effectiveness of latent tuberculosis screening alongside radiographic screening of people experiencing homelessness. The costs of video-observed treatment and directly observed treatment were compared.
Results
In the homeless hostels, 16.5% of people experiencing homelessness had latent tuberculosis infection, 1.4% had current hepatitis B infection, 10.4% had hepatitis C infection and 1.0% had human immunodeficiency virus infection. When a quality-adjusted life-year is valued at £30,000, the latent tuberculosis screening of people experiencing homelessness was cost-effective provided treatment uptake was ≥ 25% (for a £20,000 quality-adjusted life-year threshold, treatment uptake would need to be > 50%). In prison, 12.6% of prisoners had latent tuberculosis infection, 1.9% had current hepatitis B infection, 4.2% had hepatitis C infection and 0.0% had human immunodeficiency virus infection. In both settings, levels of latent tuberculosis infection and blood-borne viruses were higher among injecting drug users. A total of 1484 prisoners were screened using chest radiography over a total of 112 screening days (new prisoner screening coverage was 43%). Twenty-nine radiographs were reported as potentially indicating tuberculosis. One prisoner began, and completed, antituberculosis treatment in prison. In the cluster randomised controlled trial of peer educators to increase screening uptake, the median uptake was 45% in the control arm and 40% in the intervention arm (adjusted risk ratio 0.98, 95% confidence interval 0.80 to 1.20). A rapid diagnostic service was established on the mobile radiographic unit but the trial of rapid diagnostics was abandoned because of recruitment and follow-up difficulties. We randomly assigned 112 patients to video-observed treatment and 114 patients to directly observed treatment. Fifty-eight per cent of those recruited had a history of homelessness, addiction, imprisonment or severe mental health problems. Seventy-eight (70%) of 112 patients on video-observed treatment achieved the primary outcome, compared with 35 (31%) of 114 patients on directly observed treatment (adjusted odds ratio 5.48, 95% confidence interval 3.10 to 9.68; p < 0.0001). Video-observed treatment was superior to directly observed treatment in all demographic and social risk factor subgroups. The cost for 6 months of treatment observation was £1645 for daily video-observed treatment, £3420 for directly observed treatment three times per week and £5700 for directly observed treatment five times per week.
Limitations
Recruitment was lower than anticipated for most of the studies. The peer advocate study may have been contaminated by the fact that the service was already using peer educators to support its work.
Conclusions
There are very high levels of latent tuberculosis infection among prisoners, people experiencing homelessness and drug users. Screening for latent infection in people experiencing homelessness alongside mobile radiographic screening would be cost-effective, providing the uptake of treatment was 25–50%. Despite ring-fenced funding, the NHS was unable to establish static radiographic screening programmes. Although we found no evidence that peer educators were more effective than health-care workers in encouraging the uptake of mobile radiographic screening, there may be wider benefits of including peer educators as part of the Find&Treat team. Utilising polymerase chain reaction-based rapid diagnostic testing on a mobile radiographic unit is feasible. Smartphone-enabled video-observed treatment is more effective and cheaper than directly observed treatment for ensuring that treatment is observed.
Future work
Trials of video-observed treatment in high-incidence settings are needed.
Trial registration
Current Controlled Trials ISRCTN17270334 and ISRCTN26184967.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 8, No. 9. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Alistair Story
- Institute of Health Informatics, University College London, London, UK
- Find&Treat, University College Hospitals NHS Foundation Trust, London, UK
| | - Elizabeth Garber
- Institute of Health Informatics, University College London, London, UK
- Royal Free London NHS Foundation Trust, London, UK
| | - Robert W Aldridge
- Institute of Health Informatics, University College London, London, UK
| | - Catherine M Smith
- Institute of Health Informatics, University College London, London, UK
| | - Joe Hall
- Institute of Health Informatics, University College London, London, UK
- Royal Free London NHS Foundation Trust, London, UK
| | - Gloria Ferenando
- Institute of Health Informatics, University College London, London, UK
- Royal Free London NHS Foundation Trust, London, UK
| | - Lucia Possas
- Institute of Health Informatics, University College London, London, UK
- Royal Free London NHS Foundation Trust, London, UK
| | - Sara Hemming
- Institute of Health Informatics, University College London, London, UK
- Royal Free London NHS Foundation Trust, London, UK
| | - Fatima Wurie
- Institute of Health Informatics, University College London, London, UK
| | - Serena Luchenski
- Institute of Health Informatics, University College London, London, UK
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, London, UK
| | - Timothy D McHugh
- Centre for Clinical Microbiology, University College London, London, UK
| | - Peter J White
- Medical Research Council Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
- National Institute for Health Research Health Protection Research Unit in Modelling Methodology, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
- Modelling and Economics Unit, National Infection Service, Public Health England, London, UK
| | - John M Watson
- Research Department of Infection and Population Health, University College London, London, UK
| | - Marc Lipman
- Royal Free London NHS Foundation Trust, London, UK
- Respiratory Medicine, Division of Medicine, University College London, London, UK
| | - Richard Garfein
- Division of Global Public Health, School of Medicine, University of California, San Diego, CA, USA
| | - Andrew C Hayward
- Institute of Epidemiology and Health Care, University College London, London, UK
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18
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Abstract
SUMMARY In this paper we build on work investigating the feasibility of human immunodeficiency virus (HIV) testing in emergency departments (EDs), estimating the prevalence of hepatitis B, C and HIV infections among persons attending two inner-London EDs, identifying factors associated with testing positive in an ED. We also undertook molecular characterisation to look at the diversity of the viruses circulating in these individuals, and the presence of clinically significant mutations which impact on treatment and control.Blood-borne virus (BBV) testing in non-traditional settings is feasible, with emergency departments (ED) potentially effective at reaching vulnerable and underserved populations. We investigated the feasibility of BBV testing within two inner-London EDs. Residual samples from biochemistry for adults (⩾18 years) attending The Royal Free London Hospital (RFLH) or the University College London Hospital (UCLH) ED between January and June 2015 were tested for human immunodeficiency virus (HIV)Ag/Ab, anti-hepatitis C (HCV) and HBsAg. PCR and sequence analysis were conducted on reactive samples. Sero-prevalence among persons attending RFH and UCLH with residual samples (1287 and 1546), respectively, were 1.1% and 1.0% for HBsAg, 1.6% and 2.3% for anti-HCV, 0.9% and 1.6% for HCV RNA, and 1.3% and 2.2% for HIV. For RFH, HBsAg positivity was more likely among persons of black vs. white ethnicity (odds ratio 9.08; 95% confidence interval 2.72-30), with anti-HCV positivity less likely among females (0.15, 95% CI 0.04-0.50). For UCLH, HBsAg positivity was more likely among non-white ethnicity (13.34, 95% CI 2.20-80.86 (Asian); 8.03, 95% CI 1.12-57.61 (black); and 8.11, 95% CI 1.13-58.18 (other/mixed)). Anti-HCV positivity was more likely among 36-55 year olds vs. ⩾56 years (7.69, 95% CI 2.24-26.41), and less likely among females (0.24, 95% CI 0.09-0.65). Persons positive for HIV-markers were more likely to be of black vs. white ethnicity (4.51, 95% CI 1.63-12.45), and less likely to have one ED attendance (0.39, 95% CI 0.17-0.88), or female (0.12, 95% CI 0.04-0.42). These results indicate that BBV-testing in EDs is feasible, providing a basis for further studies to explore provider and patient acceptability, referral into care and cost-effectiveness.
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19
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Surey J, Menezes D, Francis M, Gibbons J, Sultan B, Miah A, Abubakar I, Story A. From peer-based to peer-led: redefining the role of peers across the hepatitis C care pathway: HepCare Europe. J Antimicrob Chemother 2019; 74:v17-v23. [PMID: 31782500 PMCID: PMC6883389 DOI: 10.1093/jac/dkz452] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND HCV infection disproportionately affects underserved populations such as homeless individuals, people who inject drugs and prison populations. Peer advocacy can enable active engagement with healthcare services and increase the likelihood of favourable treatment outcomes. OBJECTIVES This observational study aims to assess the burden of disease in these underserved populations and describe the role of peer support in linking these individuals to specialist treatment services. METHODS Services were identified if they had a high proportion of individuals with risk factors for HCV, such as injecting drug use or homelessness. Individuals were screened for HCV using point-of-care tests and a portable FibroScan. All positive cases received peer support for linkage to specialist care. Information was gathered on risk factors, demographics and follow-up information regarding linkage to care and treatment outcomes. RESULTS A total of 461 individuals were screened, of which 197 (42.7%) were chronically infected with HCV. Referral was made to secondary care for 176 (89.3%) and all received peer support, with 104 (52.8%) individuals engaged with treatment centres. Of these, 89 (85.6%) started treatment and 76 (85.4%) had a favourable outcome. Factors associated with not being approved for treatment were recent homelessness, younger age and current crack cocaine injecting. CONCLUSIONS Highly trained peer support workers working as part of a specialist outreach clinical team help to identify a high proportion of individuals exposed to HCV, achieve high rates of engagement with treatment services and maintain high rates of treatment success amongst a population with complex needs.
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Affiliation(s)
- Julian Surey
- Institute of Global Health, University College London, London, UK
- Find and Treat, University College London Hospitals NHS Trust, London, UK
- Universidad Autónoma de Madrid, Madrid, Spain
| | - Dee Menezes
- Institute of Health Informatics, University College London, London, UK
| | - Marie Francis
- Institute of Global Health, University College London, London, UK
- Find and Treat, University College London Hospitals NHS Trust, London, UK
| | - John Gibbons
- Find and Treat, University College London Hospitals NHS Trust, London, UK
- Groundswell, London, UK
| | - Binta Sultan
- Institute of Global Health, University College London, London, UK
| | | | - Ibrahim Abubakar
- Institute of Global Health, University College London, London, UK
| | - Alistair Story
- Find and Treat, University College London Hospitals NHS Trust, London, UK
- Collaborative Centre for Inclusion Health, UCL, London, UK
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20
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Bradshaw D, Mbisa JL, Geretti AM, Healy BJ, Cooke GS, Foster GR, Thomson EC, McLauchlan J, Agarwal K, Sabin C, Mutimer D, Moss P, Irving WL, Barnes E. Consensus recommendations for resistance testing in the management of chronic hepatitis C virus infection: Public Health England HCV Resistance Group. J Infect 2019; 79:503-512. [PMID: 31629015 DOI: 10.1016/j.jinf.2019.10.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 10/10/2019] [Accepted: 10/13/2019] [Indexed: 12/12/2022]
Abstract
The treatment of hepatitis C virus (HCV) infection has been revolutionised by the advent of oral, well-tolerated, direct acting antiviral therapies (DAA), with high cure rates. However, in some scenarios, HCV resistance to antiviral therapies may have an impact on treatment success. Public Health England's HCV Resistance Group was established to support clinicians treating people with HCV, where the issue of resistance may be a factor in clinical decision-making, and this review includes the Group's current recommendations on the use of HCV resistance testing. The authors describe the principles behind and approach to HCV resistance testing and consider evidence from in vitro studies, clinical trials and real world cohorts on the impact of HCV resistance on treatment outcomes for particular DAA regimens. Five scenarios are identified in the UK and similar settings, where, in the Group's opinion, resistance testing should be performed.
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Affiliation(s)
- Daniel Bradshaw
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK.
| | - Jean L Mbisa
- National Infection Service, Public Health England, London, UK
| | | | | | | | | | - Emma C Thomson
- MRC-University of Glasgow Centre for Virus Research, Glasgow, Scotland, UK
| | - John McLauchlan
- MRC-University of Glasgow Centre for Virus Research, Glasgow, Scotland, UK
| | - Kosh Agarwal
- Institute of Liver Studies, King's College Hospital, London, UK
| | | | | | - Peter Moss
- Hull University Teaching Hospitals NHS Trust, UK
| | - William L Irving
- Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
| | - Ellie Barnes
- Peter Medawar Building for Pathogen Research, University of Oxford, Oxford, UK
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21
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Collins JM, Onwubiko U, Holland DP. QuantiFERON-TB Gold Versus Tuberculin Screening and Care Retention Among Persons Experiencing Homelessness: Georgia, 2015-2017. Am J Public Health 2019; 109:1028-1033. [PMID: 31095412 DOI: 10.2105/ajph.2019.305069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To characterize the cascade of care for latent tuberculosis infection (LTBI) in persons experiencing homelessness (PEH) and evaluate the effect of screening by QuantiFERON-TB Gold (QFT) versus tuberculin skin test (TST). Methods. We performed a retrospective cohort study of all PEH screened for LTBI by QFT and TST from May 2015 to April 2017 in Fulton County, Georgia. Results. There were 3504 PEH screened by QFT and 5509 by TST, with 2925 TSTs administered on site at community shelters and 2584 at the health department. More valid test results were obtained in those screened by QFT (99.0% vs 69.0%; P < .001) because of low return rates for reading in both TST arms. For tests administered on site, testing by QFT versus TST improved retention in care with significantly more estimated LTBI cases following up for a medical examination (67.8% vs 51.0%; P < .001) and starting LTBI treatment (58.4% vs 39.8%; P < .001). Conclusions. A QFT-based screening strategy in PEH improved diagnosis and retention in care for new LTBI cases compared with TST and may be an effective strategy to limit progression to active tuberculosis.
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Affiliation(s)
- Jeffrey M Collins
- Jeffrey M. Collins and David P. Holland are with the School of Medicine, Emory University, Atlanta, GA. Udodirim Onwubiko and David P. Holland are with the Fulton County Board of Health, Atlanta
| | - Udodirim Onwubiko
- Jeffrey M. Collins and David P. Holland are with the School of Medicine, Emory University, Atlanta, GA. Udodirim Onwubiko and David P. Holland are with the Fulton County Board of Health, Atlanta
| | - David P Holland
- Jeffrey M. Collins and David P. Holland are with the School of Medicine, Emory University, Atlanta, GA. Udodirim Onwubiko and David P. Holland are with the Fulton County Board of Health, Atlanta
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22
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Taylor JEB, Surey J, MacLellan J, Francis M, Abubakar I, Stagg HR. Hepatitis B vaccination uptake in hard-to-reach populations in London: a cross-sectional study. BMC Infect Dis 2019; 19:372. [PMID: 31046683 PMCID: PMC6498651 DOI: 10.1186/s12879-019-3926-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 03/20/2019] [Indexed: 11/29/2022] Open
Abstract
Background In the UK, hepatitis B virus (HBV) incidence is associated with migrants from particular high-burden countries and population groups deemed ‘hard-to-reach’ by standard healthcare services: the homeless, people who inject drugs and ex-prisoners. Currently, there is a national targeted HBV vaccine policy for such at-risk groups, but there is limited recent evidence about 1) the levels of vaccine uptake, 2) the factors associated with incomplete vaccination, and 3) reasons for incomplete vaccination. Methods A questionnaire capturing social and medical history, demographic factors and information about HBV vaccination status was completed by individuals deemed hard-to-reach due to socio-structural factors that criminalise, isolate and stigmatise who consented to participate in a randomised controlled trial of a peer intervention to promote engagement with hepatitis C services. The questionnaire also captured the reasons for incomplete vaccination. Descriptive, univariable and multivariable regression analyses were undertaken. Results Three hundred fourty six participants completed the questionnaire. 1) 52.3% (n = 181) reported full HBV vaccination. 2) Within a multivariable model adjusting for sociodemographic variables, the presence of one or two or more socio-structural factors that are included in the national targeted vaccination policy was associated with protection against incomplete HBV vaccination (51.7% vaccine coverage in those with one factor, odds ratio 0.43 [95% confidence interval 0.20–0.92]); 70.1% coverage with two or more factors, 0.19 [0.09–0.39]; overall p-value < 0.001). Being female was also associated with lower vaccine uptake (2.37 [1.24–4.57], 0.01). Examining the socio-structural factors individually, intravenous drug use was associated with protection against incomplete HBV vaccination. 3) The most common reasons declared for incomplete vaccination were never being offered the vaccine or not returning for further doses. Conclusion Within this study of HBV vaccination uptake among hard-to-reach population groups in London, UK, we document 52.3% coverage of the full vaccine course. Critically, although participants recommended for immunisation within national guidelines had an increased likelihood of receiving a complete vaccine course, we note surprisingly low coverage in the presence of the risk factors that are national indicators for vaccination. Public health bodies should make additional efforts to improve coverage in the hard-to-reach through improved vaccine delivery systems. Trial registration ISRCTN24707359, Registered 19th October 2012. Electronic supplementary material The online version of this article (10.1186/s12879-019-3926-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Josephine E B Taylor
- Institute for Global Health, University College London, 4th floor, Mortimer Market Centre, off Capper Street, London, WC1E 6JB, UK
| | - Julian Surey
- Institute for Global Health, University College London, 4th floor, Mortimer Market Centre, off Capper Street, London, WC1E 6JB, UK
| | - Jennifer MacLellan
- Institute for Global Health, University College London, 4th floor, Mortimer Market Centre, off Capper Street, London, WC1E 6JB, UK
| | - Marie Francis
- Institute for Global Health, University College London, 4th floor, Mortimer Market Centre, off Capper Street, London, WC1E 6JB, UK
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, 4th floor, Mortimer Market Centre, off Capper Street, London, WC1E 6JB, UK.
| | - Helen R Stagg
- Institute for Global Health, University College London, 4th floor, Mortimer Market Centre, off Capper Street, London, WC1E 6JB, UK.,Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, 30 West Richmond Street, Edinburgh, EH8 9DX, UK
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23
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Aisyah DN, Shallcross L, Hayward A, Aldridge RW, Hemming S, Yates S, Ferenando G, Possas L, Garber E, Watson JM, Geretti AM, McHugh TD, Lipman M, Story A. Hepatitis C among vulnerable populations: A seroprevalence study of homeless, people who inject drugs and prisoners in London. J Viral Hepat 2018; 25:1260-1269. [PMID: 29851232 DOI: 10.1111/jvh.12936] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 05/17/2018] [Indexed: 01/17/2023]
Abstract
Injecting drugs substantially increases the risk of hepatitis C virus (HCV) infection and is common in the homeless and prisoners. Capturing accurate data on disease prevalence within these groups is challenging but is essential to inform strategies to reduce HCV transmission. The aim of this study was to estimate the prevalence of HCV in these populations. We conducted a cross-sectional study between May 2011 and June 2013 in London and, using convenience sampling, recruited participants from hostels for the homeless, drug treatment services and a prison. A questionnaire was administered and blood samples were tested for hepatitis C. We recruited 491 individuals who were homeless (40.7%), 205 drug users (17%) and 511 prisoners (42.3%). Eight per cent of patients (98/1207, 95% CI: 6.7%-9.8%) had active HCV infection and 3% (38/1207, 95% CI: 2.3%-4.3%) past HCV infection. Overall, one quarter (51/205) of people recruited in drug treatment services, 13% (65/491) of people from homeless residential sites and 4% (20/511) prisoners in this study were anti-HCV positive. Seventy-seven of the 136 (56.6%, 95% CI: 47.9%-65%) of HCV infected participants identified had a history of all three risk factors (homelessness, imprisonment and drug use), 27.3% (95% CI: 20.1%-35.6%) had 2 overlapping risk factors, and 15.4% (95% CI: 10.6%-23.7%) one risk factor. Drug treatment services, prisons and homelessness services provide good opportunities for identifying hepatitis C-infected individuals. Effective models need to be developed to ensure case identification in these settings that can lead to an effective treatment and an efficient HCV prevention.
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Affiliation(s)
- D N Aisyah
- UCL Infectious Disease Informatics, Farr Institute of Health Informatics, London, UK.,Faculty of Public Health Universitas Indonesia, Depok, Indonesia
| | - L Shallcross
- UCL Infectious Disease Informatics, Farr Institute of Health Informatics, London, UK
| | - A Hayward
- UCL Infectious Disease Informatics, Farr Institute of Health Informatics, London, UK.,Institute of Epidemiology and Health Care, University College London, London, UK
| | - R W Aldridge
- UCL Infectious Disease Informatics, Farr Institute of Health Informatics, London, UK.,Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
| | - S Hemming
- UCL Infectious Disease Informatics, Farr Institute of Health Informatics, London, UK.,Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK.,Royal Free London NHS Foundation Trust, London, UK
| | - S Yates
- UCL Infectious Disease Informatics, Farr Institute of Health Informatics, London, UK.,Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK.,Royal Free London NHS Foundation Trust, London, UK
| | - G Ferenando
- UCL Infectious Disease Informatics, Farr Institute of Health Informatics, London, UK.,Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK.,Royal Free London NHS Foundation Trust, London, UK
| | - L Possas
- UCL Infectious Disease Informatics, Farr Institute of Health Informatics, London, UK.,Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK.,Royal Free London NHS Foundation Trust, London, UK
| | - E Garber
- UCL Infectious Disease Informatics, Farr Institute of Health Informatics, London, UK.,Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK.,Royal Free London NHS Foundation Trust, London, UK
| | - J M Watson
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
| | - A M Geretti
- Institute of Infection & Global Health, University of Liverpool, Liverpool, UK
| | - T D McHugh
- Centre for Clinical Microbiology, Division of Infection and Immunity, University College London, London, UK
| | - M Lipman
- Royal Free London NHS Foundation Trust, London, UK.,UCL Respiratory, Division of Medicine, University College London, London, UK
| | - A Story
- University College London Hospitals, London, UK
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24
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Geretti AM, Austin H, Villa G, Hungerford D, Smith C, Davies P, Williams J, Beloukas A, Sawicki W, Hopkins M. Point-of-Care Screening for a Current Hepatitis C Virus Infection: Influence on Uptake of a Concomitant Offer of HIV Screening. Sci Rep 2018; 8:15297. [PMID: 30333568 PMCID: PMC6193009 DOI: 10.1038/s41598-018-33172-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 09/19/2018] [Indexed: 12/17/2022] Open
Abstract
Eliminating hepatitis C as a public health threat requires an improved understanding of how to increase testing uptake. We piloted point-of-care testing (POCT) for a current HCV infection in an inner-city Emergency Department (ED) and assessed the influence on uptake of offering concomitant screening for HIV. Over four months, all adults attending ED with minor injuries were first invited to complete an anonymous questionnaire then invited to test in alternating cycles offering HCV POCT or HCV+HIV POCT. Viral RNA was detected in finger-prick blood by GeneXpert. 814/859 (94.8%) questionnaires were returned and 324/814 (39.8%) tests were accepted, comprising 211 HCV tests and 113 HCV+HIV tests. Offering concomitant HIV screening reduced uptake after adjusting for age and previous HCV testing (odds ratio 0.51; 95% confidence interval [CI] 0.38–0.68; p < 0.001). HCV prevalence was 1/324 (0.31%; 95% CI 0.05–1.73); no participant tested positive for HIV. 167/297 (56.2%) POCT participants lived in the most deprived neighbourhoods in England. HCV RNA testing using finger-prick blood was technically feasible. Uptake was moderate and the offer of concomitant HIV screening showed a detrimental impact on acceptability in this low prevalence population. The findings should be confirmed in a variety of other community settings.
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Affiliation(s)
- Anna Maria Geretti
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom.
| | - Harrison Austin
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
| | - Giovanni Villa
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
| | - Dan Hungerford
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
| | - Colette Smith
- Department of Infection and Population Health, University College London, London, United Kingdom
| | - Paula Davies
- Royal Liverpool University Hospital, Liverpool, United Kingdom
| | | | - Apostolos Beloukas
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
| | | | - Mark Hopkins
- Royal Liverpool University Hospital, Liverpool, United Kingdom.,Barts Health NHS Trust, London, United Kingdom
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25
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Randers MB, Marschall J, Nielsen TT, Møller A, Zebis MK, Krustrup P. Heart rate and movement pattern in street soccer for homeless women. GERMAN JOURNAL OF EXERCISE AND SPORT RESEARCH 2018. [DOI: 10.1007/s12662-018-0503-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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