1
|
Torre P, Festa M, Sarcina T, Masarone M, Persico M. Elimination of HCV Infection: Recent Epidemiological Findings, Barriers, and Strategies for the Coming Years. Viruses 2024; 16:1792. [PMID: 39599906 PMCID: PMC11598908 DOI: 10.3390/v16111792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2024] [Revised: 11/04/2024] [Accepted: 11/14/2024] [Indexed: 11/29/2024] Open
Abstract
Hepatitis C is a disease for which in approximately 30 years we have gone from the discovery of the causative agent in 1989, to the introduction of direct-acting antiviral (DAAs) therapies starting from 2011, and to a proposal for its elimination in 2016, with some countries being on track for this goal. Elimination efforts, in the absence of a vaccine, rely on prevention measures and antiviral therapies. However, treatment rates have declined in recent years and are not considered adequate to achieve this goal at a global level. This poses a great epidemiological challenge, as HCV in many countries still causes a significant burden and most infected people are not yet diagnosed. Consequently, efforts are needed at different levels with common purposes: to facilitate access to screening and diagnosis and to improve linkage to care pathways. In this review, we discuss the latest epidemiological findings on HCV infection, the obstacles to its elimination, and strategies that are believed to be useful to overcome these obstacles but are applied unevenly across the world.
Collapse
Affiliation(s)
| | | | | | | | - Marcello Persico
- Internal Medicine and Hepatology Unit, Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Largo Città d’Ippocrate, 84131 Salerno, Italy; (P.T.); (M.F.); (T.S.); (M.M.)
| |
Collapse
|
2
|
Chiu KW, Lin YC, Li WF, Huang KT, Hsu LW, Wang CC. The Pre-/Post-Transplant Hepatitis C Antibody Associated with the IL-28B RS8099917 TT Genotype and miRNA-122 Expression May Protect Acute Cellular Rejection After LDLT. Curr Issues Mol Biol 2024; 46:12772-12783. [PMID: 39590354 PMCID: PMC11592417 DOI: 10.3390/cimb46110760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2024] [Revised: 11/07/2024] [Accepted: 11/08/2024] [Indexed: 11/28/2024] Open
Abstract
This study aimed to investigate the relationship between the IL-28B SNP rs8099917 genotype, miRNA-122 expression, and the immune mechanism of ACR after LT using anti-HCV antibody calibration. A total of 45 patients with HCV received LT. IL-28B SNP rs8099917 genotyping was used to divide patients into TT and GT groups. The relative expression levels of miRNA-122 were calculated by quantitative PCR. Anti-HCV titers before and after LT were tracked to observe the relationship with ACR. The ACR rates were 27.6% for genotype TT and 62.5% for genotype GT, indicating a significantly higher rate in the GT group compared to the TT group (p = 0.024). In the rs8099917 genotype, TT was significantly associated with higher serum miRNA-122 levels than GT (p < 0.001). The TT group had significantly better outcomes than the GT group (p = 0.005). The Mann-Whitney U test showed significant differences in pre-LT and post-LT anti-HCV titers between the IL-28B genotypes (TT and GT) (p values of 0.006 and 0.027, respectively). These results suggested that the IL-28B rs8099917 genotype TT may play a significant role in modulating immune responses, both in terms of anti-HCV titers and the risk of ACR, possibly mediated through miRNA-122 levels.
Collapse
Affiliation(s)
- King-Wah Chiu
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan;
- Liver Transplantation Program, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan; (Y.-C.L.); (W.-F.L.)
- College of Medicine, Chang Gung University, Tao-Yuen 33302, Taiwan
| | - Yu-Cheng Lin
- Liver Transplantation Program, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan; (Y.-C.L.); (W.-F.L.)
- Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
| | - Wei-Feng Li
- Liver Transplantation Program, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan; (Y.-C.L.); (W.-F.L.)
- Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
| | - Kuang-Tzu Huang
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301,Taiwan; (K.-T.H.); (L.-W.H.)
| | - Li-Wen Hsu
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301,Taiwan; (K.-T.H.); (L.-W.H.)
| | - Chih-Chi Wang
- Liver Transplantation Program, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan; (Y.-C.L.); (W.-F.L.)
- College of Medicine, Chang Gung University, Tao-Yuen 33302, Taiwan
- Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
| |
Collapse
|
3
|
Friedman JR, Abramovitz D, Skaathun B, Rangel G, Harvey-Vera A, Vera CF, Artamonova I, Muñoz S, Martin NK, Eger WH, Bailey K, Go BS, Bourgois P, Strathdee SA. Illicit Fentanyl Use and Hepatitis C Virus Seroconversion Among People Who Inject Drugs in Tijuana and San Diego: Results From a Binational Cohort Study. Clin Infect Dis 2024; 79:1109-1116. [PMID: 39078273 PMCID: PMC11478577 DOI: 10.1093/cid/ciae372] [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: 03/21/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND Illicitly manufactured fentanyl (IMF) increases overdose mortality, but its role in infectious disease transmission is unknown. We examined whether IMF use predicts hepatitis C virus (HCV) and human immunodeficiency virus (HIV) incidence among a cohort of people who inject drugs (PWID) in San Diego, California and Tijuana, Mexico. METHODS PWID were recruited during 2020-2022, undergoing semi-annual interviewer-administered surveys and HIV and HCV serological rapid tests through 2024. Cox regression was conducted to examine predictors of seroconversion considering self-reported IMF use as a 6-month lagged, time-dependent covariate. RESULTS Of 398 PWID at baseline, 67% resided in San Diego, 70% were male, median age was 43 years, 42% reported receptive needle sharing, and 25% reported using IMF. HCV incidence was 14.26 per 100 person-years (95% confidence interval [CI]: 11.49-17.02), and HIV incidence was 1.29 (95% CI: .49-2.10). IMF was associated with HCV seroconversion, with a univariable hazard ratio (HR) of 1.64 (95% CI: 1.09-2.40), and multivariable HR of 1.57 (95% CI: 1.03-2.40). The direction of the relationship with HIV was similar, albeit not significant (HR 2.39; 95% CI: .66-8.64). CONCLUSIONS We document a novel association between IMF and HCV seroconversion among PWID in Tijuana-San Diego. Few HIV seroconversions (n = 10) precluded our ability to assess if a similar relationship held for HIV. IMF's short half-life may destabilize PWID-increasing the need for repeat dosing and sharing smoking materials and syringes. New preventive care approaches may reduce HCV transmission in the fentanyl era.
Collapse
Affiliation(s)
| | | | - Britt Skaathun
- Department of Medicine, University of California, San Diego
| | - Gudelia Rangel
- Department of Population Studies, Colegio de la Frontera Norte
- Sección mexicana, Comisión de Salud Fronteriza México–Estados Unidos
| | | | - Carlos F Vera
- Department of Medicine, University of California, San Diego
- Sección mexicana, Comisión de Salud Fronteriza México–Estados Unidos
| | | | - Sheryl Muñoz
- Sección mexicana, Comisión de Salud Fronteriza México–Estados Unidos
- Escuela de Medicina, Universidad Xochicalco, Campus Tijuana, Mexico
| | | | - William H Eger
- Department of Medicine, University of California, San Diego
- School of Social Work, San Diego State University, California
| | - Katie Bailey
- Department of Medicine, University of California, San Diego
| | - Bo-Shan Go
- School of Medicine, University of Amsterdam, The Netherlands
| | | | | |
Collapse
|
4
|
Buser GL, Marginean H, Dada M, Woodward S, Young A, Chen C, Tomlinson MW. Hepatitis C infection screening and connection to care among postpartum patients and exposed infants in two community hospitals, 3-year follow-up - Oregon, 2019-2024. J Perinatol 2024:10.1038/s41372-024-02138-4. [PMID: 39369084 DOI: 10.1038/s41372-024-02138-4] [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: 06/20/2024] [Revised: 09/25/2024] [Accepted: 09/27/2024] [Indexed: 10/07/2024]
Abstract
OBJECTIVE Determine prevalence of hepatitis C virus (HCV) positivity among postpartum patients to inform prenatal screening recommendations, postpartum connection to care, and infant HCV screening practices. STUDY DESIGN Convenience sample of postpartum patients at one urban and one suburban hospital to undergo rapid fingerstick testing for hepatitis C antibodies. RESULT Of 2060 postpartum participants successfully screened, 20 (0.97%) had evidence of past or current HCV infection. One co-infection with syphilis occurred. After a median follow-up of 3.75 years, 6 of 12 participants (50.0%) with chronic HCV infection completed treatment with cure, and 9 of 20 infants (45.0%) completed screening. One neonatal transmission event occurred (5.8%). CONCLUSION HCV infection was more common in our postpartum population than other viral infections routinely screened for during pregnancy. Efforts to decrease perinatal HCV transmission should focus on early postpartum connection to treatment team, early screening in infants aged 2-6 months, and pediatric test completion.
Collapse
Affiliation(s)
- Genevieve L Buser
- Pediatric Infectious Diseases, Providence St Vincent Medical Center, Portland, OR, USA.
| | | | - Mayen Dada
- Providence Brain and Spine Institute, Portland, OR, USA
| | | | - Alexis Young
- Providence Brain and Spine Institute, Portland, OR, USA
| | - Chiayi Chen
- Providence Brain and Spine Institute, Portland, OR, USA
| | - Mark W Tomlinson
- Obstetrics and Gynecology, Providence St Vincent Medical Center, Portland, OR, USA
| |
Collapse
|
5
|
Sallam M, Khalil R. Contemporary Insights into Hepatitis C Virus: A Comprehensive Review. Microorganisms 2024; 12:1035. [PMID: 38930417 PMCID: PMC11205832 DOI: 10.3390/microorganisms12061035] [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: 04/30/2024] [Revised: 05/15/2024] [Accepted: 05/20/2024] [Indexed: 06/28/2024] Open
Abstract
Hepatitis C virus (HCV) remains a significant global health challenge. Approximately 50 million people were living with chronic hepatitis C based on the World Health Organization as of 2024, contributing extensively to global morbidity and mortality. The advent and approval of several direct-acting antiviral (DAA) regimens significantly improved HCV treatment, offering potentially high rates of cure for chronic hepatitis C. However, the promising aim of eventual HCV eradication remains challenging. Key challenges include the variability in DAA access across different regions, slightly variable response rates to DAAs across diverse patient populations and HCV genotypes/subtypes, and the emergence of resistance-associated substitutions (RASs), potentially conferring resistance to DAAs. Therefore, periodic reassessment of current HCV knowledge is needed. An up-to-date review on HCV is also necessitated based on the observed shifts in HCV epidemiological trends, continuous development and approval of therapeutic strategies, and changes in public health policies. Thus, the current comprehensive review aimed to integrate the latest knowledge on the epidemiology, pathophysiology, diagnostic approaches, treatment options and preventive strategies for HCV, with a particular focus on the current challenges associated with RASs and ongoing efforts in vaccine development. This review sought to provide healthcare professionals, researchers, and policymakers with the necessary insights to address the HCV burden more effectively. We aimed to highlight the progress made in managing and preventing HCV infection and to highlight the persistent barriers challenging the prevention of HCV infection. The overarching goal was to align with global health objectives towards reducing the burden of chronic hepatitis, aiming for its eventual elimination as a public health threat by 2030.
Collapse
Affiliation(s)
- Malik Sallam
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
- Department of Clinical Laboratories and Forensic Medicine, Jordan University Hospital, Amman 11942, Jordan
| | - Roaa Khalil
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
| |
Collapse
|
6
|
Page K, Feinberg J. What Hepatitis C Virus (HCV) Diagnostic Tools Are Needed to Advance Diagnosis of Current HCV Infection in Outreach Settings and in a Nonclinical Setting? J Infect Dis 2024; 229:S328-S333. [PMID: 37739782 PMCID: PMC11078315 DOI: 10.1093/infdis/jiad269] [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: 03/01/2023] [Revised: 06/28/2023] [Accepted: 07/11/2023] [Indexed: 09/24/2023] Open
Abstract
Given the growing hepatitis C virus (HCV) epidemic in the United States, it is imperative to implement a coordinated, equitable public health approach to HCV testing that will facilitate immediate access to treatment, especially for individuals with limited healthcare access and those who inject drugs. Point-of-care RNA diagnostic tests have the greatest potential to address this need. Future regulatory approval has been facilitated by a recent change in the US Food and Drug Administration's approach to evaluating point-of-care diagnostic tests that have been developed and validated.
Collapse
Affiliation(s)
- Kimberly Page
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque
| | - Judith Feinberg
- Department of Behavioral Medicine and Psychiatry
- Division of Infectious Diseases, Department of Medicine, West Virginia University School of Medicine, Morgantown
| |
Collapse
|
7
|
Cooke GS, Flower B, Cunningham E, Marshall AD, Lazarus JV, Palayew A, Jia J, Aggarwal R, Al-Mahtab M, Tanaka Y, Jeong SH, Poovorawan K, Waked I, Hiebert L, Khue PM, Grebely J, Alcantara-Payawal D, Sanchez-Avila JF, Mbendi C, Muljono DH, Lesi O, Desalegn H, Hamid S, de Araujo A, Cheinquer H, Onyekwere CA, Malyuta R, Ivanchuk I, Thomas DL, Pimenov N, Chulanov V, Dirac MA, Han H, Ward JW. Progress towards elimination of viral hepatitis: a Lancet Gastroenterology & Hepatology Commission update. Lancet Gastroenterol Hepatol 2024; 9:346-365. [PMID: 38367629 DOI: 10.1016/s2468-1253(23)00321-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 09/11/2023] [Accepted: 09/14/2023] [Indexed: 02/19/2024]
Abstract
The top 20 highest burdened countries (in disability-adjusted life years) account for more than 75% of the global burden of viral hepatitis. An effective response in these 20 countries is crucial if global elimination targets are to be achieved. In this update of the Lancet Gastroenterology & Hepatology Commission on accelerating the elimination of viral hepatitis, we convene national experts from each of the top 20 highest burdened countries to provide an update on progress. Although the global burden of diseases is falling, progress towards elimination varies greatly by country. By use of a hepatitis elimination policy index conceived as part of the 2019 Commission, we measure countries' progress towards elimination. Progress in elimination policy has been made in 14 of 20 countries with the highest burden since 2018, with the most substantial gains observed in Bangladesh, India, Indonesia, Japan, and Russia. Most improvements are attributable to the publication of formalised national action plans for the elimination of viral hepatitis, provision of publicly funded screening programmes, and government subsidisation of antiviral treatments. Key themes that emerged from discussion between national commissioners from the highest burdened countries build on the original recommendations to accelerate the global elimination of viral hepatitis. These themes include the need for simplified models of care, improved access to appropriate diagnostics, financing initiatives, and rapid implementation of lessons from the COVID-19 pandemic.
Collapse
Affiliation(s)
- Graham S Cooke
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK; Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA.
| | - Barnaby Flower
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | | | | | - Jeffrey V Lazarus
- CUNY Graduate School of Public Health and Health Policy, New York, NY, USA; Barcelona Institute for Global Health, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Adam Palayew
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Jidong Jia
- Liver Research Centre, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Rakesh Aggarwal
- Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Mamum Al-Mahtab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Yashuito Tanaka
- Department of Gastroenterology and Hepatology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Sook-Hyang Jeong
- Department of Internal Medicine, Seoul National University Bundang Hospital, College of Medicine, Seoul National University, Seongnam, South Korea
| | - Kittiyod Poovorawan
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Mahidol Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, Thailand
| | - Imam Waked
- Hepatology Department, National Liver Institute, Shibin El Kom, Egypt
| | - Lindsey Hiebert
- Coalition for Global Hepatitis Elimination, Task Force for Global Health, Decatur, GA, USA
| | - Pham M Khue
- Faculty of Public Health, Haiphong University of Medicine and Pharmacy, Haiphong, Viet Nam
| | - Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Diana Alcantara-Payawal
- Department of Internal Medicine, Fatima University Medical Center, Valenzuela, Philippines; Committee on Hepatology, Section of Gastroenterology, Cardinal Santos Medical Center, San Juan, Philippines
| | - Juan F Sanchez-Avila
- Global Health and Emerging Diseases Investigation Group, Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey Monterrey, Mexico
| | - Charles Mbendi
- Service of Gastroenterology, Internal Medicine, University Clinic of Kinshasa, Faculty of Medicine, University of Kinshasa, Kinshasha, DR Congo
| | - David H Muljono
- Ministry of Health, Jakarta, Indonesia; Faculty of Medicine, Universitas Hasanuddin, Makassar, Indonesia; Indonesian Academy of Sciences, Jakarta, Indonesia
| | - Olufunmilayo Lesi
- Gastroenterology and Hepatology Unit, College of Medicine, University of Lagos and Lagos University Teaching Hospital, Lagos, Nigeria
| | - Hailemichael Desalegn
- Department of Internal Medicine, St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Saeed Hamid
- Clinical Trials Unit, Aga Khan University, Karachi, Pakistan
| | - Alexandre de Araujo
- Universidade Federal do Rio Grande do Sul, Gastroenterology and Hepatology Unit of Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Hugo Cheinquer
- Universidade Federal do Rio Grande do Sul, Gastroenterology and Hepatology Unit of Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Charles A Onyekwere
- Deparment Of Medicine, Lagos State University College of Medicine, Lagos, Nigeria
| | | | - Iryna Ivanchuk
- Department of Viral Hepatitis Control at National Institute of Public Health, Kyiv, Ukraine
| | - David L Thomas
- Divison of Infectious Diseases, John Hopkins School of Medicine, Baltimore, MD, USA
| | - Nikolay Pimenov
- National Medical Research Center of Tuberculosis and Infectious Diseases, Moscow, Russia
| | | | - Mae Ashworth Dirac
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA; Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - Hannah Han
- Department of Epidemiology, University of Washington, Seattle, WA, USA; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - John W Ward
- Coalition for Global Hepatitis Elimination, Task Force for Global Health, Decatur, GA, USA; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| |
Collapse
|
8
|
Wissel K, Vernazza P, Kuster S, Hensel-Koch K, Bregenzer A. Hepatitis C prevalence and cascade of care among patients in the decentralised opioid agonist therapy programme of the canton of St Gallen, Switzerland: a cross-sectional study. Swiss Med Wkly 2024; 154:3352. [PMID: 38579293 DOI: 10.57187/s.3352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND To eliminate chronic hepatitis C virus (HCV) infection by 2030, 90% of those infected must be diagnosed and 80% treated. In Switzerland, >40% of the estimated 32,000 infected people are still undiagnosed. In the canton of St Gallen, HCV prevalence and cascade of care have only been studied in the centralised opioid agonist therapy (OAT) setting (institutions), although about 80% of OAT patients are treated decentrally (general practitioner [GP] or pharmacy). AIM To describe HCV prevalence and cascade of care among patients in the decentralised OAT programme of the canton of St Gallen, Switzerland, and compare it to contemporaneous data from the centralised setting. METHODS For each patient receiving his/her OAT from a GP or pharmacy on 1 April 2021, the cantonal medical office sent a questionnaire to the prescribing GP. Patient characteristics, HCV antibody (Ab)/RNA screening uptake, HCV Ab/RNA prevalence and HCV treatment uptake were obtained and compared to those of patients of the Medizinisch-soziale Hilfsstelle 1 in St Gallen (centralised setting). RESULTS Of the 563 OAT patients under the care of 127 GPs, 107 patients from 41 GPs could be analysed (median age: 48 years [IQR: 40-56]; ongoing intravenous drug use: 25%; OAT provider: 66% GP, 34% pharmacy). HCV Ab screening uptake was 68% (73/107) with an HCV Ab prevalence of 68% (50/73) among those tested. Of the HCV Ab-positive patients, 84% (42/50) were HCV RNA-tested, among whom 57% (24/42) were viraemic. HCV treatment uptake was 83% (20/24), with 95% (19/20) achieving a sustained virological response. Non-uptake of HCV screening and treatment tended to be higher among patients receiving OAT at the pharmacy vs at the GP's office: 37% vs 26% (p = 0.245) for screening and 30% vs 7% (p = 0.139) for treatment. The proportion never HCV Ab-tested and the proportion of HCV Ab-positives never HCV RNA-tested was significantly higher in the decentralised compared to the centralised setting: 32% vs 3% (p <0.001) never Ab-tested and 16% vs 0% (p = 0.002) never RNA-tested. In contrast, HCV treatment uptake (83% vs 78%), sustained virological response rate (95% vs 100%) and residual HCV RNA prevalence among the HCV Ab-positive (12% vs 14%) were comparable for both settings. CONCLUSION In the decentralised OAT setting of the canton of St Gallen, HCV Ab prevalence is high. Since HCV Ab and RNA screening uptake are markedly lower than in the centralised setting, potentially >40% of patients with chronic HCV are not diagnosed yet. HCV screening in the decentralised setting needs improvement, e.g. by increasing awareness and simplifying testing. High HCV treatment uptake and cure rates are possible in centralised and decentralised settings.
Collapse
Affiliation(s)
| | - Pietro Vernazza
- Division of Infectious Diseases, Infection Prevention and Travel Medicine, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Stefan Kuster
- Division of Infectious Diseases, Infection Prevention and Travel Medicine, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | | | - Andrea Bregenzer
- Division of Infectious Diseases, Infection Prevention and Travel Medicine, Cantonal Hospital St Gallen, St Gallen, Switzerland
- Department of Infectious Diseases and Infection Prevention, Cantonal Hospital Aarau, Aarau, Switzerland
| |
Collapse
|
9
|
Lin SH, Wu KT, Wang CC, Huang KT, Hsu LW, Eng HL, Chiu KW. Immune Responses to Anti-Hepatitis C Virus Antibodies during Pre-Liver Transplantation Direct-Acting Antiviral Therapy in Hepatitis C Virus-Infected Recipients Associated with Post-Liver Transplantation Allograft Injury. Antibodies (Basel) 2024; 13:7. [PMID: 38247571 PMCID: PMC10801541 DOI: 10.3390/antib13010007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/29/2023] [Accepted: 01/10/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND AND AIMS The impact of antibody responses following direct-acting antiviral (DAA) therapy in hepatitis C virus (HCV)-infected recipients before and after liver transplantation (LT) is still undetermined. METHODS In this observational cohort study, we aimed to explore the association between changes in anti-HCV antibody titers following pre-LT DAA therapy and allograft injury, including biliary complications (BCs) and acute cellular rejection (ACR). RESULTS A total of 153 cases were enrolled from January 2015 to February 2021. Serum anti-HCV antibody titers were assessed before and after (day 30) LT. Among all recipients, 31/153 (20.3%) had pre-LT DAA therapy (the DAA group) and 122/153 (79.7%) did not undergo pre-LT DAA therapy (the DAA-naïve group). A higher incidence of post-LT BCs was observed in the DAA group (p = 0.028). Compared with the DAA-naïve group, the DAA group had a significantly higher mean level of anti-HCV titer upregulation (p = 0.0024); furthermore, among the recipients with BCs (n = 28) and ACR (n = 41), those in the DAA group exhibited significantly higher mean levels of anti-HCV antibody titer upregulation (p < 0.005). CONCLUSIONS In conclusion, we speculate that the upregulation of anti-HCV antibody titers, which might have been induced via the restoration of HCV-specific immune responses through pre-LT DAA therapy, was associated with post-LT allograft injury.
Collapse
Affiliation(s)
- Shu-Hsien Lin
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan;
- Liver Transplantation Center, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan; (C.-C.W.); (K.-T.H.); (L.-W.H.); (H.-L.E.)
| | - Kun-Ta Wu
- E-Da Healthcare Group, E-Da Hospital, College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan;
| | - Chih-Chi Wang
- Liver Transplantation Center, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan; (C.-C.W.); (K.-T.H.); (L.-W.H.); (H.-L.E.)
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
| | - Kuang-Tzu Huang
- Liver Transplantation Center, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan; (C.-C.W.); (K.-T.H.); (L.-W.H.); (H.-L.E.)
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
| | - Li-Wen Hsu
- Liver Transplantation Center, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan; (C.-C.W.); (K.-T.H.); (L.-W.H.); (H.-L.E.)
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
| | - Hock-Liew Eng
- Liver Transplantation Center, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan; (C.-C.W.); (K.-T.H.); (L.-W.H.); (H.-L.E.)
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Department of Pathology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
| | - King-Wah Chiu
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan;
- Liver Transplantation Center, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan; (C.-C.W.); (K.-T.H.); (L.-W.H.); (H.-L.E.)
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| |
Collapse
|
10
|
Pauly MD, Ganova-Raeva L. Point-of-Care Testing for Hepatitis Viruses: A Growing Need. Life (Basel) 2023; 13:2271. [PMID: 38137872 PMCID: PMC10744957 DOI: 10.3390/life13122271] [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: 09/19/2023] [Revised: 11/23/2023] [Accepted: 11/23/2023] [Indexed: 12/24/2023] Open
Abstract
Viral hepatitis, caused by hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis D virus (HDV), or hepatitis E virus (HEV), is a major global public health problem. These viruses cause millions of infections each year, and chronic infections with HBV, HCV, or HDV can lead to severe liver complications; however, they are underdiagnosed. Achieving the World Health Organization's viral hepatitis elimination goals by 2030 will require access to simpler, faster, and less expensive diagnostics. The development and implementation of point-of-care (POC) testing methods that can be performed outside of a laboratory for the diagnosis of viral hepatitis infections is a promising approach to facilitate and expedite WHO's elimination targets. While a few markers of viral hepatitis are already available in POC formats, tests for additional markers or using novel technologies need to be developed and validated for clinical use. Potential methods and uses for the POC testing of antibodies, antigens, and nucleic acids that relate to the diagnosis, monitoring, or surveillance of viral hepatitis infections are discussed here. Unmet needs and areas where additional research is needed are also described.
Collapse
Affiliation(s)
| | - Lilia Ganova-Raeva
- Division of Viral Hepatitis, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd., NE, Atlanta, GA 30329, USA;
| |
Collapse
|
11
|
Martinello M, Solomon SS, Terrault NA, Dore GJ. Hepatitis C. Lancet 2023; 402:1085-1096. [PMID: 37741678 DOI: 10.1016/s0140-6736(23)01320-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 05/30/2023] [Accepted: 06/22/2023] [Indexed: 09/25/2023]
Abstract
Hepatitis C virus (HCV) is a hepatotropic RNA virus that can cause acute and chronic hepatitis, with progressive liver damage resulting in cirrhosis, decompensated liver disease, and hepatocellular carcinoma. In 2016, WHO called for the elimination of HCV infection as a public health threat by 2030. Despite some progress, an estimated 57 million people were living with HCV infection in 2020, and 300 000 HCV-related deaths occur per year. The development of direct-acting antiviral therapy has revolutionised clinical care and generated impetus for elimination, but simplified and broadened HCV screening, enhanced linkage to care, and higher coverage of treatment and primary prevention strategies are urgently required.
Collapse
Affiliation(s)
- Marianne Martinello
- Viral Hepatitis Clinical Research Program, Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; Department of Infectious Diseases, Prince of Wales Hospital, Sydney, NSW, Australia.
| | - Sunil S Solomon
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Norah A Terrault
- Division of Gastrointestinal and Liver Diseases, University of Southern California, Los Angeles, CA, USA
| | - Gregory J Dore
- Viral Hepatitis Clinical Research Program, Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; Department of Infectious Diseases, St Vincent's Hospital, Sydney, NSW, Australia
| |
Collapse
|
12
|
Sosa-Jurado F, Palencia-Lara R, Xicoténcatl-Grijalva C, Bernal-Soto M, Montiel-Jarquin Á, Ibarra-Pichardo Y, Rosas-Murrieta NH, Lira R, Cortes-Hernandez P, Santos-López G. Donated Blood Screening for HIV, HCV and HBV by ID-NAT and the Residual Risk of Iatrogenic Transmission in a Tertiary Care Hospital Blood Bank in Puebla, Mexico. Viruses 2023; 15:1331. [PMID: 37376630 DOI: 10.3390/v15061331] [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: 05/11/2023] [Revised: 06/01/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
Hepatitis C virus (HCV), human immunodeficiency virus (HIV) and hepatitis B virus (HBV) can be transmitted by blood transfusion. Most transmission occurs during the acute viremic phase (AVP), before antibody development. To reduce transmission risk, individual donor nucleic acid testing (ID-NAT) is used. In Puebla, Mexico, serological tests and ID-NAT have been applied to screen blood donors and detect individuals in AVP. In the present study, 106,125 blood donors' data in two periods (2012-2015 and 2017-2019) were analyzed. The residual risk (RR) values were calculated considering ID-NAT results. The RR for HIV was 14 in 1 million donations or 1 in 71,428, the RR for HVC was 6.8 in 1 million donations or 1 in 147,058 and, for HBV, it was 156 in 1 million donations, or 1 in 6410. Previously, it was predicted that the transmission RR of these viruses would be reduced in Mexico through better screening with NAT. The use of ID-NAT has, indeed, increased the safety of blood reserves for HIV and HCV. However, more research is needed to determine why the residual risk of HBV did not decrease as much over the study period. ID-NAT is an important complementary tool for blood donor screening that should be implemented.
Collapse
Affiliation(s)
- Francisca Sosa-Jurado
- Laboratorio de Biología Molecular y Virología, Centro de Investigación Biomédica de Oriente, Instituto Mexicano del Seguro Social, Metepec, Atlixco, Puebla 74360, CP, Mexico
| | - Roxana Palencia-Lara
- Banco de Sangre, Hospital Especialidades, Unidad Médica de Alta Especialidad, Centro Médico Nacional General de División Manuel Ávila Camacho, Instituto Mexicano del Seguro Social, Puebla, Puebla 72000, CP, Mexico
| | - Cinthia Xicoténcatl-Grijalva
- Laboratorio de Biología Molecular y Virología, Centro de Investigación Biomédica de Oriente, Instituto Mexicano del Seguro Social, Metepec, Atlixco, Puebla 74360, CP, Mexico
| | - Maribel Bernal-Soto
- Banco de Sangre, Hospital Especialidades, Unidad Médica de Alta Especialidad, Centro Médico Nacional General de División Manuel Ávila Camacho, Instituto Mexicano del Seguro Social, Puebla, Puebla 72000, CP, Mexico
| | - Álvaro Montiel-Jarquin
- Coordinación Clínica de Investigación y Enseñanza en Salud, Hospital Especialidades, Unidad Médica de Alta Especialidad, Centro Médico Nacional General de División Manuel Ávila Camacho, Instituto Mexicano del Seguro Social, Puebla, Puebla 72000, CP, Mexico
| | - Yolanda Ibarra-Pichardo
- Banco de Sangre, Hospital Especialidades, Unidad Médica de Alta Especialidad, Centro Médico Nacional General de División Manuel Ávila Camacho, Instituto Mexicano del Seguro Social, Puebla, Puebla 72000, CP, Mexico
| | - Nora Hilda Rosas-Murrieta
- Centro de Química, Instituto de Ciencias, Benemérita Universidad Autónoma de Puebla, Puebla, Puebla 72570, CP, Mexico
| | - Rosalia Lira
- Unidad de Investigación Médica en Enfermedades Infecciosas y Parasitarias, UMAE Hospital de Pediatría, CMN Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City 06720, MX, Mexico
| | - Paulina Cortes-Hernandez
- Laboratorio de Metadinámica y Salud de Poblaciones, Centro de Investigación Biomédica de Oriente, Instituto Mexicano del Seguro Social (IMSS), Metepec 74360, MX, Mexico
| | - Gerardo Santos-López
- Laboratorio de Biología Molecular y Virología, Centro de Investigación Biomédica de Oriente, Instituto Mexicano del Seguro Social, Metepec, Atlixco, Puebla 74360, CP, Mexico
| |
Collapse
|
13
|
Muñoz-Chimeno M, Valencia J, Rodriguez-Recio A, Cuevas G, Garcia-Lugo A, Manzano S, Rodriguez-Paredes V, Fernandez B, Morago L, Casado C, Avellón A, Ryan P. HCV, HIV AND HBV rapid test diagnosis in non-clinical outreach settings can be as accurate as conventional laboratory tests. Sci Rep 2023; 13:7554. [PMID: 37160925 PMCID: PMC10170094 DOI: 10.1038/s41598-023-33925-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 04/20/2023] [Indexed: 05/11/2023] Open
Abstract
Point of care rapid diagnostic tests (POC-RDT) for Hepatitis C virus (HCV), Human Immunodeficiency virus (HIV) and Hepatitis B virus (HBV), are ideal for screening in non-clinical outreach settings as they can provide immediate results and facilitate diagnosis, allowing high risk population screening. The aim of this study was to compare POC-RDT with laboratory conventional tests. A total of 301 vulnerable evaluable subjects (drug users, migrants and homeless population) were recruited at a mobile screening unit in outreach settings in Madrid. Fingerprick whole blood capillary samples were tested using the SD BIOLINE HCV POC-RDT, Determine HIV Early Detect and Determine HBsAg 2, and the results were assessed against the LIAISON XL HCV, HIV and Murex-HBsAg-Quant, reference assays, respectively. The feasibility and user satisfaction of the POC-RDT were evaluated through a questionnaire. The resolved sensitivity and resolved specificity and their 95% confidence intervals (95% CI) were as follows, respectively: SD-BIOLINE-HCV: 98.8% (95% CI 93.4, 100.0) and 100.0% (95% CI 98.3, 100.0); Determine HIV Early Detect: 100% (95% CI 85.2, 100.0) and 100% (95% CI 98.7, 100); and Determine HBsAg 2: 66.7% (95% CI 9.4, 99.2) and 100.0% (95% CI 98.7, 100.0). As expected, the number of subjects with a confirmed positive result for HBsAg was very low (n = 4). Therefore, the analytical sensitivity has been evaluated in addition: The Determine HBsAg 2 test demonstrated 100% sensitivity for standard concentrations ≥ 0.125 IU/mL. The subject questionnaire yielded positive feedback for most subjects. The POC-RDT fingerprick blood collection method was well received, and the tests demonstrated a comparable clinical performance with conventional tests in outreach settings and vulnerable high-risk populations.
Collapse
Affiliation(s)
- Milagros Muñoz-Chimeno
- Hepatitis Unit, National Center of Microbiology, Carlos III Institute of Health, Madrid, Spain
| | | | - Alvaro Rodriguez-Recio
- Hepatitis Unit, National Center of Microbiology, Carlos III Institute of Health, Madrid, Spain
| | | | - Alejandra Garcia-Lugo
- Hepatitis Unit, National Center of Microbiology, Carlos III Institute of Health, Madrid, Spain
| | | | | | | | - Lucía Morago
- Hepatitis Unit, National Center of Microbiology, Carlos III Institute of Health, Madrid, Spain
| | - Concepción Casado
- Molecular Virology Unit, National Center of Microbiology, Carlos III Institute of Health, Madrid, Spain
| | - Ana Avellón
- Hepatitis Unit, National Center of Microbiology, Carlos III Institute of Health, Madrid, Spain.
- CIBERESP Epidemiology and Public Health, Madrid, Spain.
| | - Pablo Ryan
- Infanta Leonor Hospital, Madrid, Spain.
- CIBER Infectious Diseases (CB 21/13/00044), Madrid, Spain.
- Complutense University of Madrid, Madrid, Spain.
| |
Collapse
|
14
|
Walker JG, Ivanova E, Jamil MS, Ong JJ, Easterbrook P, Fajardo E, Johnson CC, Luhmann N, Terris-Prestholt F, Vickerman P, Shilton S. Cost-effectiveness of Hepatitis C virus self-testing in four settings. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001667. [PMID: 37018166 PMCID: PMC10075433 DOI: 10.1371/journal.pgph.0001667] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 02/20/2023] [Indexed: 04/06/2023]
Abstract
Globally, there are approximately 58 million people with chronic hepatitis C virus infection (HCV) but only 20% have been diagnosed. HCV self-testing (HCVST) could reach those who have never been tested and increase uptake of HCV testing services. We compared cost per HCV viraemic diagnosis or cure for HCVST versus facility-based HCV testing services. We used a decision analysis model with a one-year time horizon to examine the key drivers of economic cost per diagnosis or cure following the introduction of HCVST in China (men who have sex with men), Georgia (men 40-49 years), Viet Nam (people who inject drugs, PWID), and Kenya (PWID). HCV antibody (HCVAb) prevalence ranged from 1%-60% across settings. Model parameters in each setting were informed by HCV testing and treatment programmes, HIV self-testing programmes, and expert opinion. In the base case, we assume a reactive HCVST is followed by a facility-based rapid diagnostic test (RDT) and then nucleic acid testing (NAT). We assumed oral-fluid HCVST costs of $5.63/unit ($0.87-$21.43 for facility-based RDT), 62% increase in testing following HCVST introduction, 65% linkage following HCVST, and 10% replacement of facility-based testing with HCVST based on HIV studies. Parameters were varied in sensitivity analysis. Cost per HCV viraemic diagnosis without HCVST ranged from $35 2019 US dollars (Viet Nam) to $361 (Kenya). With HCVST, diagnosis increased resulting in incremental cost per diagnosis of $104 in Viet Nam, $163 in Georgia, $587 in Kenya, and $2,647 in China. Differences were driven by HCVAb prevalence. Switching to blood-based HCVST ($2.25/test), increasing uptake of HCVST and linkage to facility-based care and NAT testing, or proceeding directly to NAT testing following HCVST, reduced the cost per diagnosis. The baseline incremental cost per cure was lowest in Georgia ($1,418), similar in Viet Nam ($2,033), and Kenya ($2,566), and highest in China ($4,956). HCVST increased the number of people tested, diagnosed, and cured, but at higher cost. Introducing HCVST is more cost-effective in populations with high prevalence.
Collapse
Affiliation(s)
- Josephine G. Walker
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Elena Ivanova
- FIND, The Global Alliance for Diagnostics, Geneva, Switzerland
| | - Muhammad S. Jamil
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Jason J. Ong
- London School of Hygiene & Tropical Medicine, London, United Kingdom
- Central Clinical School, Monash University, Melbourne, Australia
| | - Philippa Easterbrook
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Emmanuel Fajardo
- FIND, The Global Alliance for Diagnostics, Geneva, Switzerland
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Cheryl Case Johnson
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Niklas Luhmann
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | | | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | | |
Collapse
|
15
|
Epstein RL, Pramanick T, Baptiste D, Buzzee B, Reese PP, Linas BP, Sawinski D. A Microsimulation Study of the Cost-Effectiveness of Hepatitis C Virus Screening Frequencies in Hemodialysis Centers. J Am Soc Nephrol 2023; 34:205-219. [PMID: 36735375 PMCID: PMC10103100 DOI: 10.1681/asn.2022030245] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 10/14/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND National guidelines recommend twice-yearly hepatitis C virus (HCV) screening for patients receiving in-center hemodialysis. However, studies examining the cost-effectiveness of HCV screening methods or frequencies are lacking. METHODS We populated an HCV screening, treatment, and disease microsimulation model with a cohort representative of the US in-center hemodialysis population. Clinical outcomes, costs, and cost-effectiveness of the Kidney Disease Improving Global Outcomes (KDIGO) 2018 guidelines-endorsed HCV screening frequency (every 6 months) were compared with less frequent periodic screening (yearly, every 2 years), screening only at hemodialysis initiation, and no screening. We estimated expected quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) between each screening strategy and the next less expensive alternative strategy, from a health care sector perspective, in 2019 US dollars. For each strategy, we modeled an HCV outbreak occurring in 1% of centers. In sensitivity analyses, we varied mortality, linkage to HCV cure, screening method (ribonucleic acid versus antibody testing), test sensitivity, HCV infection rates, and outbreak frequencies. RESULTS Screening only at hemodialysis initiation yielded HCV cure rates of 79%, with an ICER of $82,739 per QALY saved compared with no testing. Compared with screening at hemodialysis entry only, screening every 2 years increased cure rates to 88% and decreased liver-related deaths by 52%, with an ICER of $140,193. Screening every 6 months had an ICER of $934,757; in sensitivity analyses using a willingness-to-pay threshold of $150,000 per QALY gained, screening every 6 months was never cost-effective. CONCLUSIONS The KDIGO-recommended HCV screening interval (every 6 months) does not seem to be a cost-effective use of health care resources, suggesting that re-evaluation of less-frequent screening strategies should be considered.
Collapse
Affiliation(s)
- Rachel L. Epstein
- Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts
- Department of Pediatrics, Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts
| | | | - Dimitri Baptiste
- Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts
| | - Benjamin Buzzee
- Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts
| | - Peter P. Reese
- Department of Medicine, Renal-Electrolyte Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Benjamin P. Linas
- Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Deirdre Sawinski
- Department of Nephrology and Transplantation, Weill Cornell College of Medicine, New York, New York
| |
Collapse
|
16
|
Jiang X, Diaby V, Vouri SM, Lo-Ciganic W, Parker RL, Wang W, Chang SH, Wilson DL, Henry L, Park H. Economic Impact of Universal Hepatitis C Virus Testing for Middle-Aged Adults Who Inject Drugs. Am J Prev Med 2023; 64:96-104. [PMID: 36257884 PMCID: PMC10074824 DOI: 10.1016/j.amepre.2022.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 08/02/2022] [Accepted: 08/24/2022] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The objective of this study was to estimate the economic impact of providing universal hepatitis C virus testing in commercially insured middle-aged persons who inject drugs in the U.S. METHODS This study developed a dynamic 10-year economic model to project the clinical and economic outcomes associated with hepatitis C virus testing among middle-aged adult persons who inject drugs, from a payer's perspective. Costs related to hepatitis C virus testing, direct-acting antiviral, and liver-related outcomes between the (1) current hepatitis C virus testing rate (i.e., 8%) and (2) universal hepatitis C virus testing rate (i.e., 100%) were compared. Among patients testing positive, 21% of those without cirrhosis and 48% of those with cirrhosis were assumed to initiate direct-acting antivirals. Sensitivity analyses were performed to identify variables (e.g., direct-acting antiviral drug costs, hepatitis C virus testing costs, direct-acting antiviral treatment rate) influencing this study's conclusion. RESULTS The model predicts that during the 10-year period, universal hepatitis C virus testing will cost an additional $242 per person who injects drugs to the payers' healthcare budgets compared with the current scenario. Sensitivity analyses showed values ranging from $1,656 additional costs to $1,085 cost savings across all varied parameters and scenarios. A total of 80% of the current direct-acting antiviral costs indicated that cost savings will be $383 per person who injects drugs. CONCLUSIONS Universal hepatitis C virus testing among persons who inject drugs would not achieve cost savings within 10 years, with the cost of direct-acting antivirals contributing the most to the spending. To promote universal hepatitis C virus testing among persons who inject drugs, decreasing direct-acting antiviral costs and sustainable funding streams for hepatitis C virus testing should be considered.
Collapse
Affiliation(s)
- Xinyi Jiang
- Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, Florida
| | - Vakaramoko Diaby
- Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, Florida; Center for Drug Evaluation and Safety (CoDES), University of Florida College of Pharmacy, Gainesville, Florida
| | - Scott Martin Vouri
- Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, Florida; Center for Drug Evaluation and Safety (CoDES), University of Florida College of Pharmacy, Gainesville, Florida
| | - Weihsuan Lo-Ciganic
- Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, Florida; Center for Drug Evaluation and Safety (CoDES), University of Florida College of Pharmacy, Gainesville, Florida
| | - Robert L Parker
- Department of Biostatistics, University of Florida College of Public Health and Health Professions & College of Medicine, Gainesville, Florida
| | - Wei Wang
- Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, Florida
| | - Shao-Hsuan Chang
- Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, Florida
| | - Debbie L Wilson
- Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, Florida
| | - Linda Henry
- Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, Florida
| | - Haesuk Park
- Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, Florida; Center for Drug Evaluation and Safety (CoDES), University of Florida College of Pharmacy, Gainesville, Florida.
| |
Collapse
|
17
|
Lucey O, Acana S, Olupot‐Olupot P, Muhindo R, Ayikobua R, Uyoga S, Kyeyune‐Byabazaire D, Cooke G, Maitland K. High false discovery rate of the Architect anti-HCV screening test in blood donors in Uganda and evaluation of an algorithm for confirmatory testing. Vox Sang 2022; 117:1360-1367. [PMID: 36218235 PMCID: PMC10092297 DOI: 10.1111/vox.13364] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 09/13/2022] [Accepted: 09/16/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVES Adequate supplies of donor blood remain a major challenge in sub-Saharan Africa. This is exacerbated by a lack of confirmatory testing for transfusion-transmitted infections by blood transfusion services (BTS), leading to significant blood disposal owing to putatively high seroprevalence rates amongst Ugandan blood donors. We aimed to ascertain the false discovery rate of the Architect anti-hepatitis C virus (HCV) screening assay and categorize screen-reactive samples into three groups: presumed false positive, active and past infection, and develop an algorithm for confirmatory testing. MATERIALS AND METHODS A total of 470 screen-reactive HCV blood donations were retested using the Architect anti-HCV assay, an alternative antibody test (SD Biosensor) and a core antigen (cAg) test. signal-to cut-off (S/CO) ratios and pre-analytical factors (centrifugation speed, haemolysis check, time between collection and testing) were recorded. Based on the S/CO ratio evaluation, we propose a testing algorithm to guide supplemental tests. RESULTS The false discovery rate of the Architect anti-HCV assay was 0.84 as 395/470 (84%) screen-reactive samples had no evidence of HCV infection (SD Biosensor and cAg negative) (presumed false positive), 38/470 (8.1%) were antigenaemic, and 32/470 (6.8%) had evidence of past infection. The median S/CO ratios of the presumed false-positive and active infection samples were 1.8 and 17.3, respectively. The positive predictive value of HCV positivity in samples with ratios above 12 was 91.8%. On retesting, 104/470 (22.1%) samples became negative. CONCLUSION The Architect anti-HCV assay has a very high false discovery rate in Ugandan BTSs, leading to excessive blood disposal. Pre-analytical factors likely contribute to this. An introduction of confirmatory testing using an algorithm based on S/CO ratio evaluation could limit unnecessary blood wastage and donor deferral.
Collapse
Affiliation(s)
- Olivia Lucey
- Department of Infectious Disease, Division of MedicineImperial CollegeLondonUK
- Kilifi County Hospital and Kenya Medical Research Institute (KEMRI)‐Wellcome Trust Research ProgrammeKilifiKenya
| | - Susan Acana
- Ugandan Blood Transfusion ServiceKampalaUganda
| | - Peter Olupot‐Olupot
- Busitema University Faculty of Health SciencesMbale Campus and Mbale Regional Referral HospitalMbaleUganda
- Department of PaediatricsMbale Clinical Research InstituteMbaleUganda
| | - Rita Muhindo
- Busitema University Faculty of Health SciencesMbale Campus and Mbale Regional Referral HospitalMbaleUganda
- Department of PaediatricsMbale Clinical Research InstituteMbaleUganda
| | | | - Sophie Uyoga
- Kilifi County Hospital and Kenya Medical Research Institute (KEMRI)‐Wellcome Trust Research ProgrammeKilifiKenya
- Busitema University Faculty of Health SciencesMbale Campus and Mbale Regional Referral HospitalMbaleUganda
| | | | - Graham Cooke
- Department of Infectious Disease, Division of MedicineImperial CollegeLondonUK
| | - Kathryn Maitland
- Department of Infectious Disease, Division of MedicineImperial CollegeLondonUK
- Kilifi County Hospital and Kenya Medical Research Institute (KEMRI)‐Wellcome Trust Research ProgrammeKilifiKenya
- Institute of Global Health and Innovation, Division of MedicineImperial CollegeLondonUK
| |
Collapse
|
18
|
Comparing RT-qPCR and Hepatitis C Virus Antigen Detection Assay for Detecting Active Infection in Blood Donors in Fars Province, Iran. HEPATITIS MONTHLY 2022. [DOI: 10.5812/hepatmon-123438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
Background: Immunoassay is still used to detect hepatitis C virus (HCV) antibodies in donated blood in many developing countries. However, an immunoblotting confirmation test is needed to confirm positive results. Objectives: We compared the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of nucleic acid testing and HCV core antigen (HCVcAg) detection in the serum samples of blood donors with HCV antibodies to determine active infection. Methods: Overall, 90 serum samples from blood donors referred to Fars Blood Transfusion Organization, Iran during March 2017-March 2019 and initially tested for HCV antibodies were included in the study. Enzyme immunoassays were used to detect the HCV antigen and anti-HCV antibody. A commercial reverse transcription-polymerase chain reaction (RT-PCR) kit was used to quantify HCV RNA. The HCV genotypes were also determined by DNA sequencing. In order to compare the HCVcAg detection method with the RT-qPCR reference method, sensitivity, specificity, performance, PPV, and NPV were calculated. Results: Out of 90 serum samples, 73 were positive for anti-HCV antibody, and 17 sera were negative. The HCV RNA was detected in 60 (82%) of anti-HCV antibody-positive samples, whereas the HCVcAg test detected HCV antigen in 54 (74%) of the samples, indicating a significant correlation between the two assays (r = 0.86). The overall sensitivity and specificity for HCVcAg detection method were 93.85% [95% confidence interval (CI): 84.99 - 98.3%] and 100% (95% CI: 94.64 - 100%), respectively. Based on the statistical analysis, the accuracy of the antigen detection test was 94.83% (95% CI: 87.26 - 98.58%). Moreover, the agreement between HCV RNA detection using RT-qPCR and HCVcAg detection was 97.78% (kappa value: 0.94). Conclusions: The sensitivity and specificity of HCVcAg detection in blood donors were ideal compared to the RT-qPCR reference method. However, the method should be tested on more HCV antibody-positive and -negative samples. Furthermore, our study revealed a significant association between the number of RT-qPCR-positive cases and the cases diagnosed by the HCVcAg detection method for screening and detecting active HCV infection in blood donors.
Collapse
|
19
|
Adee M, Zhong H, Reipold EI, Zhuo Y, Shilton S, Chhatwal J. Cost-Effectiveness of a Core Antigen-Based Rapid Diagnostic Test for Hepatitis C. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:1107-1115. [PMID: 35272954 DOI: 10.1016/j.jval.2022.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 11/29/2021] [Accepted: 01/02/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Hepatitis C virus (HCV) affects 58 million worldwide and > 79% of people remain undiagnosed. Rapid diagnostic tests (RDTs) for HCV can help improve diagnosis and treatment rates. Nevertheless, the high price and infrastructure needed to use current molecular HCV RDT options present a barrier to widespread use-particularly in low- and middle-income countries. We evaluated the performance and cost-effectiveness of a theoretical core antigen (cAg) RDT for HCV viremia confirmation, which requires fewer resources. METHODS We adapted a previously validated microsimulation model to simulate HCV disease progression and outcomes under different HCV testing algorithms in Georgia and Malaysia. We compared standard of care testing with laboratory-based ribonucleic acid HCV to a cAg-based RDT for HCV confirmation. We simulated a cohort of 10 000 adults in each country, with an HCV-ribonucleic acid prevalence of 5.40% in Georgia and 1.54% in Malaysia. We projected the cumulative healthcare costs, quality-adjusted life-years, and diagnosis coverage rates over a lifetime horizon. RESULTS Compared with the standard of care testing, the cAg-based RDT would increase quality-adjusted life-years by 270 in Georgia and 259 in Malaysia per 10 000 people. The high diagnosis rate and treatment rate of the cAg-based RDT result in substantial cost savings because of averted HCV sequelae management costs. Cost savings are $281 000 for Georgia and $781 000 for Malaysia. CONCLUSIONS We found that a cAg-based RDT for HCV could improve the diagnosis rate and result in cost savings. Such a test could have a substantial impact on the feasibility and cost of HCV elimination.
Collapse
Affiliation(s)
| | - Huaiyang Zhong
- Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | - Yueran Zhuo
- Mississippi State University College of Business, Mississippi State, MS, USA
| | | | - Jagpreet Chhatwal
- Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
20
|
Prevalence of Transfusion-Transmitted Infections (HCV, HIV, Syphilis and Malaria) in Blood Donors: A Large-Scale Cross-Sectional Study. Pathogens 2022; 11:pathogens11070726. [PMID: 35889972 PMCID: PMC9321235 DOI: 10.3390/pathogens11070726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 06/04/2022] [Accepted: 06/24/2022] [Indexed: 11/27/2022] Open
Abstract
Blood plays a major role in transmitting infectious diseases such as hepatitis C virus (HCV), human immunodeficiency virus (HIV), hepatitis B virus (HBV), syphilis, malaria, and many others. Thus, this study sought to evaluate the distribution of HCV, HIV, syphilis, and malaria among blood donors in Yemen. This is a cross-sectional study, conducted on blood donors at the national center in Yemen. Blood donors’ specimens were serologically tested for the presence of anti-HCV and anti-HIV antibodies, as well as anti-Treponema pallidum, anti-Plasmodium falciparum, and anti-Plasmodium vivax. A total of 16,367 donors were included in this study. Based on the donor’s occupation, the study showed that the relative seroprevalence of anti-HCV Ab among the donors was statistically significant, and relatively high prevalence was found among military donors (2.8%). Positive HIV antibody tests were only reported in 33 male donors (0.2%), who were mostly manual workers. A remarkably high prevalence of anti-Treponema pallidum was observed among manual workers (3.1%). There was a statistically significant difference in the distribution of anti-malaria Ab based on residency and age groups. This study revealed that the prevalence of HCV, HIV, syphilis, and malaria among donors was 2.0%, 0.2%, 2.4%, and 0.7%, respectively. Further genotyping studies are necessary to provide a complete picture of the prevalence of transfusion-transmitted infections (TTIs).
Collapse
|
21
|
Becker SCDC, Medina-Pestana JO, Canziani MEF, Souza ALS, Amaral AC, Vieira GA, Ferraz ML. Performance of rapid test for antibodies to hepatitis C virus (anti-HCV) in hemodialysis patients and kidney transplant recipients. Int J Artif Organs 2022; 45:680-684. [PMID: 35751365 DOI: 10.1177/03913988221104834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Rapid tests (RT) have been widely used for screening of hepatitis C virus (HCV) in general population, but its performance in hemodialysis (HD) patients and mainly in kidney-transplant recipients (RTx) is less known. The aim of this study was to evaluate the accuracy of RT for detection of anti-HCV in HD and RTx patients. Patients were prospectively included subdivided in four groups according to the positivity for anti-HCV detected by conventional serology: (1) HD patients anti-HCV +, (2) HD patients anti-HCV -, (3) RTx patients anti-HCV +, and (4) RTx patients anti-HCV -. All patients were retested for HCV using the commercial kit Alere HCV® Bioeasy Rapid Test (Bioeasy Diagnóstica LTDA-Minas Gerais, Brazil) in capillary whole blood samples. During the period of study were included 46 HD patients anti-HCV+, 62 HD patients anti-HCV -, 53 RTx patients anti-HCV + and 56 RTx patients anti-HCV -. In patients on HD, the RT showed sensitivity (S), specificity (SP), positive predictive value (PPV), negative predictive value (NPV), and accuracy of 100%. In RTx patients, S of 96%, SP of 100%, PPV of 100% and NPV of 97% were found (accuracy of 98%). In conclusion, in patients on HD there was 100% agreement between RT and the conventional immunoassay. In the RTx group, although the agreement was not 100%, the RT performed very well when compared to conventional serology. This study demonstrates that the RT can be an alternative to conventional serology in HCV screening of patients on HD and RTx.
Collapse
Affiliation(s)
| | | | | | | | - Ana Cristina Amaral
- Division of Gastroenterology, Federal University of São Paulo, Sao Paulo, Brazil
| | | | - Maria Lucia Ferraz
- Division of Gastroenterology, Federal University of São Paulo, Sao Paulo, Brazil
| |
Collapse
|
22
|
Thompson LA, Fenton J, Charlton CL. HCV reflex testing: A single-sample, low-contamination method that improves the diagnostic efficiency of HCV testing among patients in Alberta, Canada. JOURNAL OF THE ASSOCIATION OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASE CANADA = JOURNAL OFFICIEL DE L'ASSOCIATION POUR LA MICROBIOLOGIE MEDICALE ET L'INFECTIOLOGIE CANADA 2022; 7:97-107. [PMID: 36337352 PMCID: PMC9608109 DOI: 10.3138/jammi-2021-0028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 06/16/2023]
Abstract
BACKGROUND Hepatitis C virus (HCV) can be cured with antiviral treatments. Diagnosis normally requires two blood samples, one for serology screening and one for molecular confirmation. This multi-step process creates barriers in patient care and decreases testing for hard-to-reach populations. We used the cobas® 6800 to detect HCV RNA after antibody testing to investigate whether a single-sample reflex testing method is effective and efficient for diagnosing HCV-positive patients. METHODS HCV RNA-positive clinical samples (n = 152) were interchangeably loaded on the ARCHITECT i2000SR with negative samples (n = 152) in a checkerboard fashion, tested for HCV antibodies using fixed probes, and directly transferred to the cobas 6800 for molecular testing. Contamination rates, sensitivity, and specificity were determined by comparing Abbott m2000 and cobas 6800 viral loads. After implementing reflex testing, clinical data over a 6-month period were analyzed for diagnostic efficiency. RESULTS Contamination was present in 5 of 152 pairs (3.29%) after reflex testing. Sensitivity and specificity were 99.3% (95% CI 95.1% to 99.9%) and 100% (95% CI 97.5% to 100%), respectively, using the cobas 6800 assay after serotesting. Approximately 97% of clinical patients received a conclusive test result with the reflex-testing algorithm. For HCV-positive patients, mean diagnostic turnaround times were significantly lower using reflex testing versus the two-sample method (4 versus 39 days; p < 0.0001). CONCLUSIONS HCV reflex testing demonstrated low levels of contamination without compromising the integrity of the molecular assay. Implementation in clinical laboratories would increase the efficiency of diagnosis and decrease steps in the continuum of care for patients.
Collapse
Affiliation(s)
- L Alexa Thompson
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Jayne Fenton
- Alberta Precision Laboratories (ProvLab), University of Alberta Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Carmen L Charlton
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
- Alberta Precision Laboratories (ProvLab), University of Alberta Hospital, University of Alberta, Edmonton, Alberta, Canada
- Li Ka Shing Institute of Virology, Edmonton, Alberta, Canada
| |
Collapse
|
23
|
Fajardo E, Watson V, Kumwenda M, Usharidze D, Gogochashvili S, Kakhaberi D, Giguashvili A, Johnson CC, Jamil MS, Dacombe R, Stvilia K, Easterbrook P, Ivanova Reipold E. Usability and acceptability of oral-based HCV self-testing among key populations: a mixed-methods evaluation in Tbilisi, Georgia. BMC Infect Dis 2022; 22:510. [PMID: 35641908 PMCID: PMC9154030 DOI: 10.1186/s12879-022-07484-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 05/18/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Hepatitis C virus self-testing (HCVST) is an additional approach that may expand access to HCV testing. We conducted a mixed-methods cross-sectional observational study to assess the usability and acceptability of HCVST among people who inject drugs (PWID), men who have sex with men (MSM) and transgender (TG) people in Tbilisi, Georgia. METHODS The study was conducted from December 2019 to June 2020 among PWID at one harm reduction site and among MSM/TG at one community-based organization. We used a convergent parallel mixed-methods design. Usability was assessed by observing errors made and difficulties faced by participants. Acceptability was assessed using an interviewer-administered semi-structured questionnaire. A subset of participants participated in cognitive and in-depth interviews. RESULTS A total of 90 PWID, 84 MSM and 6 TG were observed performing HCVST. PWID were older (median age 35 vs 24) and had a lower level of education compared to MSM/TG (27% vs 59%). The proportion of participants who completed all steps successfully without assistance was 60% among PWID and 80% among MSM/TG. The most common error was in sample collection and this was observed more often among PWID than MSM/TG (21% vs 6%; p = 0.002). More PWID requested assistance during HCVST compared to MSM/TG (22% vs 8%; p = 0.011). Acceptability was high in both groups (98% vs 96%; p = 0.407). Inter-reader agreement was 97% among PWID and 99% among MSM/TG. Qualitative data from cognitive (n = 20) and in-depth interviews (n = 20) was consistent with the quantitative data confirming a high usability and acceptability. CONCLUSIONS HCVST was highly acceptable among key populations in Georgia of relatively high educational level, and most participants performed HCVST correctly. A significant difference in usability was observed among PWID compared to MSM/TG, indicating that PWID may benefit from improved messaging and education as well as options to receive direct assistance when self-testing for HCV.
Collapse
Affiliation(s)
- Emmanuel Fajardo
- grid.452485.a0000 0001 1507 3147The Foundation for Innovative New Diagnostics (FIND), Campus Biotech, Chemin des Mines 9, 1202 Geneva, Switzerland
| | - Victoria Watson
- grid.48004.380000 0004 1936 9764Liverpool School of Tropical Medicine (LSTM), Liverpool, UK
| | - Moses Kumwenda
- grid.419393.50000 0004 8340 2442Malawi Liverpool Wellcome Trust Clinical Research Programme (MLW), Blantyre, Malawi ,grid.10595.380000 0001 2113 2211College of Medicine, University of Malawi (CoM), Blantyre, Malawi
| | | | | | - David Kakhaberi
- Community-Based Organization Equality Movement, Tbilisi, Georgia
| | - Ana Giguashvili
- National Centre for Disease Control and Public Health of Georgia, Tbilisi, Georgia
| | - Cheryl C. Johnson
- grid.3575.40000000121633745Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Muhammad S. Jamil
- grid.3575.40000000121633745Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Russell Dacombe
- grid.48004.380000 0004 1936 9764Liverpool School of Tropical Medicine (LSTM), Liverpool, UK
| | - Ketevan Stvilia
- National Centre for Disease Control and Public Health of Georgia, Tbilisi, Georgia
| | - Philippa Easterbrook
- grid.3575.40000000121633745Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Elena Ivanova Reipold
- grid.452485.a0000 0001 1507 3147The Foundation for Innovative New Diagnostics (FIND), Campus Biotech, Chemin des Mines 9, 1202 Geneva, Switzerland
| |
Collapse
|
24
|
Carty PG, Fawsitt CG, Gillespie P, Harrington P, O'Neill M, Smith SM, Teljeur C, Ryan M. Population-Based Testing for Undiagnosed Hepatitis C: A Systematic Review of Economic Evaluations. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2022; 20:171-183. [PMID: 34870793 DOI: 10.1007/s40258-021-00694-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/19/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND OBJECTIVES Recognising the significant public health threat posed by hepatitis C, international targets have been established by the World Health Organization with the aim of eradicating the hepatitis C virus (HCV) by 2030. With the availability of safe and effective therapies, the greatest challenge to achieving elimination is the identification and treatment of those currently undiagnosed. This systematic review aimed to identify and appraise the international literature on the cost-effectiveness of birth cohort, universal, and age-based general population testing for identifying people with undiagnosed chronic HCV infection. METHODS A comprehensive literature search was undertaken in Medline, Embase and grey literature sources to identify studies published between 1 January 2000 and 17 July 2020. Retrieved citations were independently reviewed by two reviewers according to pre-defined eligibility criteria. Data extraction and critical appraisal were completed in duplicate. Study quality, relevance and credibility were assessed using the Consensus for Health Economic Criteria and the ISPOR questionnaires. All costs were reported in 2019 Irish Euro following adjustment for inflation and purchasing power parity. Willingness-to-pay (WTP) thresholds of €20,000 and €45,000 were adopted as reference points for interpreting cost-effectiveness in the narrative synthesis. The systematic review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. RESULTS Overall, 4622 citations were retrieved in the literature search. Of these, 27 studies met the inclusion criteria. Six (22%) of the 27 studies were rated as low quality, 17 (63%) were moderate quality and four (15%) were high quality. Compared with no testing or risk-based testing: 14 of 16 (88%) cost-utility analyses found that birth cohort testing was cost effective, eight of nine (89%) analyses found that universal testing was cost effective, and eight of eight (100%) analyses found that age-based general population testing was cost effective. Cost effectiveness was influenced by disease prevalence and progression, testing and treatment uptake, treatment eligibility of those identified by testing, the cost of treatment and the proportion of those treated that achieve sustained virological response. CONCLUSION Overall, the international evidence supports the potential cost effectiveness of birth cohort, universal, and age-based general population testing, but is caveated by study generalisability, specifically the transferability of findings from one jurisdiction to another, and institutional variations in healthcare delivery systems and budgetary constraints. The cost effectiveness of each approach will vary according to population- and health system-specific characteristics such as epidemiological context, testing coverage, linkage to care and capacity to treat. Given issues regarding the transferability of economic evaluations (for example, model inputs and assumptions) and the significant resources required to implement these interventions, jurisdiction-specific economic evaluations and budget impact analyses will likely be required to inform investment and implementation decisions. REGISTRATION PROSPERO, CRD42019127159. Registered 29 April 2019.
Collapse
Affiliation(s)
- Paul G Carty
- RCSI University of Medicine and Health Sciences, Dublin, Ireland.
- Health Information and Quality Authority, Dublin, Ireland.
| | | | - Paddy Gillespie
- Health Economics and Policy Analysis Centre, CÚRAM, the SFI Research Centre for Medical Devices (12/RC/2073_2), National University of Ireland Galway, Galway, Ireland
| | | | | | - Susan M Smith
- Health Research Board Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin, Ireland
| | - Conor Teljeur
- Health Information and Quality Authority, Dublin, Ireland
| | - Mairin Ryan
- Health Information and Quality Authority, Dublin, Ireland
- Department of Pharmacology and Therapeutics, Trinity College Dublin, Trinity Health Sciences, St James's Hospital, Dublin 8, Ireland
| |
Collapse
|
25
|
Niquini RP, Corrêa da Mota J, Bastos LS, da Costa Moreira Barbosa D, Falcão JDS, Palmieri P, Martins P, Melo Villar L, Bastos FI. Persistently high hepatitis C rates in haemodialysis patients in Brazil [a systematic review and meta-analysis]. Sci Rep 2022; 12:330. [PMID: 35013390 PMCID: PMC8748660 DOI: 10.1038/s41598-021-03961-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 12/13/2021] [Indexed: 02/07/2023] Open
Abstract
We conducted a systematic review and meta-analysis of studies assessing HCV infection rates in haemodialysis patients in Brazil (Prospero CRD #42021275068). We included studies on patients under haemodialysis, comprising both convenience samples and exhaustive information from selected services. Patients underwent HCV serological testing with or without confirmation by HCV RNA PCR. Exclusion criteria were the following: absence of primary empirical information and studies without information on their respective settings, study year, accurate infection rates, or full specification of diagnostic tests. Studies with samples ≤ 30 and serial assessments with repeated information were also excluded. Reference databases included PubMed, LILACS, Scopus, and Web of Science for the period 1989–2019. A systematic review was carried out, followed by two independent meta-analyses: (i) studies with data on HCV prevalence and (ii) studies with a confirmatory PCR (i.e., active infection), respectively. A comprehensive set of different methods and procedures were used: forest plots and respective statistics, polynomial regression, meta-regression, subgroup influence, quality assessment, and trim-and-fill analysis. 29 studies and 11,290 individuals were assessed. The average time patients were in haemodialysis varied from 23.5 to 56.3 months. Prevalence of HCV infection was highly heterogeneous, with a pronounced decrease from 1992 to 2001, followed by a plateau and a slight decrease in recent years. The summary measure for HCV prevalence was 34% (95% CI 26–43%) for studies implemented before 2001. For studies implemented after 2001, the corresponding summary measure was 11% (95% CI 8–15%). Estimates for prevalence of active HCV infection were also highly heterogeneous. There was a marked decline from 1996 to 2001, followed by a plateau and a slight increase after 2010. The summary measure for active HCV infection was 19% (95% CI 15–25%) in studies carried out before 2001. For studies implemented after 2001, the corresponding summary measure was 9% (95% CI 6–13%). Heterogeneity was pervasive, but different analyses helped to identify its underlying sources. Besides the year each study was conducted, the findings differed markedly between geographic regions and were heavily influenced by the size of the studies and publication biases. Our systematic review and meta-analysis documented a substantial decline in HCV prevalence among Brazilian haemodialysis patients from 1992 to 2015. CKD should be targeted with specific interventions to prevent HCV infection, and if prevention fails, prompt diagnosis and treatment. Although the goal of HCV elimination by 2030 in Brazil remains elusive, it is necessary to adopt measures to achieve micro-elimination and to launch initiatives towards targeted interventions to curb the spread of HCV in people with CKD, among other high-risk groups. This is of particular concern in the context of a protracted COVID-19 pandemic and a major economic and political crisis.
Collapse
Affiliation(s)
- Roberta Pereira Niquini
- Federal Institute of Education, Science, and Technology of Rio de Janeiro (IFRJ), Rio de Janeiro, Brazil
| | - Jurema Corrêa da Mota
- Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation (ICICT-FIOCRUZ), Biblioteca de Manguinhos suite 229, Av. Brasil 4365, Rio de Janeiro, 21045-900, Brazil
| | - Leonardo Soares Bastos
- Program for Scientific Computing, Oswaldo Cruz Foundation (PROCC-FIOCRUZ), Rio de Janeiro, Brazil
| | | | - Juliane da Silva Falcão
- Federal Institute of Education, Science, and Technology of Rio de Janeiro (IFRJ), Rio de Janeiro, Brazil
| | - Paloma Palmieri
- Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation (ICICT-FIOCRUZ), Biblioteca de Manguinhos suite 229, Av. Brasil 4365, Rio de Janeiro, 21045-900, Brazil
| | - Patrícia Martins
- Laboratory of Viral Hepatitis, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (IOC-FIOCRUZ), Rio de Janeiro, Brazil
| | - Livia Melo Villar
- Laboratory of Viral Hepatitis, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (IOC-FIOCRUZ), Rio de Janeiro, Brazil
| | - Francisco I Bastos
- Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation (ICICT-FIOCRUZ), Biblioteca de Manguinhos suite 229, Av. Brasil 4365, Rio de Janeiro, 21045-900, Brazil.
| |
Collapse
|
26
|
Marcellusi A, Mennini FS, Ruf M, Galli C, Aghemo A, Brunetto MR, Babudieri S, Craxi A, Andreoni M, Kondili LA. Optimizing diagnostic algorithms to advance Hepatitis C elimination in Italy: A cost effectiveness evaluation. Liver Int 2022; 42:26-37. [PMID: 34582627 PMCID: PMC9292516 DOI: 10.1111/liv.15070] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 09/22/2021] [Accepted: 09/24/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Optimized diagnostic algorithms to detect active infections are crucial to achieving HCV elimination. We evaluated the cost effectiveness and sustainability of different algorithms for HCV active infection diagnosis, in a context of a high endemic country for HCV infection. METHODS A Markov disease progression model, simulating six diagnostic algorithms in the birth cohort 1969-1989 over a 10-year horizon from a healthcare perspective was used. Conventionally diagnosis of active HCV infection is through detection of antibodies (HCV-Ab) detection followed by HCV-RNA or HCV core antigen (HCV-Ag) confirmatory testing either on a second sample or by same sample reflex testing. The undiagnosed and unconfirmed rates were evaluated by assays false negative estimates and each algorithm patients' drop-off. Age, liver disease stages distribution, liver disease stage costs, treatment effectiveness and costs were used to evaluate the quality-adjusted life-years (QALYs) and the incremental cost-effectiveness ratios (ICER). RESULTS The reference option was Rapid HCV-Ab followed by second sample HCV-Ag testing which produced the lowest QALYs (866,835 QALYs). The highest gains in health (QALYs=974,458) was obtained by HCV-RNA reflex testing which produced a high cost-effective ICER (€891/QALY). Reflex testing (same sample-single visit) vs two patients' visits algorithms, yielded the highest QALYs and high cost-effective ICERs (€566 and €635/QALY for HCV-Ag and HCV-RNA, respectively), confirmed in 99.9% of the 5,000 probabilistic simulations. CONCLUSIONS Our data confirm, by a cost effectiveness point of view, the EASL and WHO clinical practice guidelines recommending HCV reflex testing as most cost effective diagnostic option vs other diagnostic pathways.
Collapse
Affiliation(s)
- Andrea Marcellusi
- Economic Evaluation and HTA (EEHTA)CEISFaculty of EconomicsUniversity of Rome “Tor Vergata”RomeItaly
- Institute of Leadership and Management in HealthKingston Business SchoolKingston UniversityLondonUK
| | - Francesco Saverio Mennini
- Economic Evaluation and HTA (EEHTA)CEISFaculty of EconomicsUniversity of Rome “Tor Vergata”RomeItaly
- Institute of Leadership and Management in HealthKingston Business SchoolKingston UniversityLondonUK
| | - Murad Ruf
- Public Health, Medical AffairsGilead ScienceLondonUK
| | - Claudio Galli
- Global Medical and Scientific AffairsCore Laboratory, AbbottRomeItaly
| | - Alessio Aghemo
- Department of Biomedical SciencesHumanitas UniversityPieve EmanueleItaly
- Division of Internal Medicine and HepatologyHumanitas Research Hospital IRCCSRozzanoItaly
| | - Maurizia R. Brunetto
- Internal MedicineDepartment of Clinical and Experimental MedicineUniversity of PisaPisaItaly
- Hepatology Unit and Laboratory of Molecular Genetics and Pathology of Hepatitis VirusesUniversity Hospital of PisaPisaItaly
| | - Sergio Babudieri
- Infectious and Tropical Disease UnitDepartment of MedicalSurgical and Experimental SciencesUniversity of SassariSassariItaly
| | - Antonio Craxi
- Gastroenterology and Hepatology UnitDepartment of Internal Medicine and Medical Specialties “PROMISE”University of PalermoPalermoItaly
| | - Massimo Andreoni
- Department of Systems MedicineUniversity of Rome “Tor Vergata”RomeItaly
- Infectious Diseases ClinicUniversity Hospital “Tor Vergata”RomeItaly
| | | |
Collapse
|
27
|
Adee M, Zhuo Y, Zhong H, Zhan T, Aggarwal R, Shilton S, Chhatwal J. Assessing cost-effectiveness of hepatitis C testing pathways in Georgia using the Hep C Testing Calculator. Sci Rep 2021; 11:21382. [PMID: 34725356 PMCID: PMC8560949 DOI: 10.1038/s41598-021-00362-y] [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: 11/13/2020] [Accepted: 10/06/2021] [Indexed: 12/03/2022] Open
Abstract
The cost of testing can be a substantial contributor to hepatitis C virus (HCV) elimination program costs in many low- and middle-income countries such as Georgia, resulting in the need for innovative and cost-effective strategies for testing. Our objective was to investigate the most cost-effective testing pathways for scaling-up HCV testing in Georgia. We developed a Markov-based model with a lifetime horizon that simulates the natural history of HCV, and the cost of detection and treatment of HCV. We then created an interactive online tool that uses results from the Markov-based model to evaluate the cost-effectiveness of different HCV testing pathways. We compared the current standard-of-care (SoC) testing pathway and four innovative testing pathways for Georgia. The SoC testing was cost-saving compared to no testing, but all four new HCV testing pathways further increased QALYs and decreased costs. The pathway with the highest patient follow-up, due to on-site testing, resulted in the highest discounted QALYs (124 QALY more than the SoC) and lowest costs ($127,052 less than the SoC) per 10,000 persons screened. The current testing algorithm in Georgia can be replaced with a new pathway that is more effective while being cost-saving.
Collapse
Affiliation(s)
| | - Yueran Zhuo
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,College of Business, Mississippi State University, Mississippi State, MS, USA
| | - Huaiyang Zhong
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | | | - Rakesh Aggarwal
- Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | | | - Jagpreet Chhatwal
- Massachusetts General Hospital, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
28
|
Malaisamy M, Nagarajan K, Kirti T, Malkeet S, Venkatesan P, Senthilkumar S, Sananthya K, Rajendran K, Kavitha R, Vivekanandan S, Selvavinayagam TS. Economic Evaluation of Implementing a Rapid Point-of-Care Screening Test for the Identification of Hepatitis C Virus under National Viral Hepatitis Control Programme in Tamil Nadu, South India. J Glob Infect Dis 2021; 13:126-132. [PMID: 34703152 PMCID: PMC8491813 DOI: 10.4103/jgid.jgid_394_20] [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: 11/02/2020] [Revised: 11/27/2020] [Accepted: 01/30/2021] [Indexed: 12/05/2022] Open
Abstract
Introduction: Viral hepatitis is a crucial public health problem in India. Hepatitis C virus (HCV) elimination is a national priority and a key strategy has been adopted to strengthen the HCV diagnostics services to ensure early and accurate diagnosis. Methods: To conduct an economic evaluation of implementing a rapid point-of-care screening test for the identification of HCV among the selected key population under the National Viral Hepatitis Control Programme in Tamil Nadu, South India. Economic evaluation of a point-of-care screening test for HCV diagnosis among the key population attending the primary health care centers. A combination of decision tree and Markov model was developed to estimate cost-effectiveness of point-of-care screening test for HCV diagnosis at the primary health care centers. Total costs, quality-adjusted life years (QALYs) of the intervention and comparator, and incremental cost-effectiveness ratio (ICER) were calculated. The model parameter uncertainties which would influence the cost-effectiveness outcome has been evaluated by one-way sensitivity analysis and probabilistic sensitivity analysis. Results: When compared to the tertiary level diagnostic strategy for HCV, the point-of-care screening for selected key population at primary health care level results in a gain of 57 undiscounted QALYs and 38 discounted QALYs, four undiscounted life years and two discounted life years. The negative ICER of the new strategy indicates that it is less expensive and more effective compared with the current HCV diagnosis strategy. Conclusions: The proposed strategy for HCV diagnosis in the selected key population in Tamil Nadu is dominant and cost-saving compared to the current strategy.
Collapse
Affiliation(s)
- Muniyandi Malaisamy
- Department of Health Economics, ICMR-National Institute for Research in Tuberculosis, New Delhi, India
| | - Karikalan Nagarajan
- Department of Health Economics, ICMR-National Institute for Research in Tuberculosis, New Delhi, India
| | - Tyagi Kirti
- Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India
| | - Singh Malkeet
- Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India
| | - Prakash Venkatesan
- Department of Public Health and Preventive Medicine, Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, Tamil Nadu, India
| | - S Senthilkumar
- Department of Health Economics, ICMR-National Institute for Research in Tuberculosis, New Delhi, India
| | - Karthikeyan Sananthya
- Department of Health Economics, ICMR-National Institute for Research in Tuberculosis, New Delhi, India
| | - Krishnan Rajendran
- Department of Statistics, ICMR-National Institute for Research in Tuberculosis, New Delhi, India
| | - Rajsekar Kavitha
- Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India
| | | | - T S Selvavinayagam
- Department of Public Health and Preventive Medicine, Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, Tamil Nadu, India
| |
Collapse
|
29
|
Atalay MA, Sağıroğlu P, Oskay M, Emir B. Comparison of samples found positive by anti-HCV screening test with line immunoassay and determination of threshold value. Rev Assoc Med Bras (1992) 2021; 67:1480-1484. [DOI: 10.1590/1806-9282.20210668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 11/22/2022] Open
|
30
|
Abstract
Efforts to control transmissible infectious diseases rely on the ability to screen large populations, ideally in community settings. These efforts can be limited by the requirement for invasive or logistically difficult collection of patient samples, such as blood, urine, stool, sputum, and nasopharyngeal swabs. Oral sampling is an appealing, noninvasive alternative that could greatly facilitate high-throughput sampling in community settings. Oral sampling has been described for the detection of dozens of human pathogens, including pathogens whose primary sites of infection are outside of the oral cavity, such as the respiratory pathogens Mycobacterium tuberculosis and SARS-CoV-2. Oral sampling can demonstrate active infections as well as resolving or previous infections, the latter through the detection of antibodies. Its potential applications are diverse, including improved diagnosis in special populations (e.g., children), population surveillance, and infectious disease screening. In this minireview, we address the use of oral samples for the detection of diseases that primarily manifest outside the oral cavity. Focusing on well-supported examples, we describe applications for such methods and highlight their potential advantages and limitations in medicine, public health, and research.
Collapse
Affiliation(s)
- Ethan D. Valinetz
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Gerard A. Cangelosi
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington, USA
| |
Collapse
|
31
|
Sadeghimehr M, Bertisch B, Negro F, Butsashvili M, Shilton S, Tskhomelidze I, Tsereteli M, Keiser O, Estill J. Hepatitis C core antigen test as an alternative for diagnosing HCV infection: mathematical model and cost-effectiveness analysis. PeerJ 2021; 9:e11895. [PMID: 34595063 PMCID: PMC8436958 DOI: 10.7717/peerj.11895] [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: 12/23/2020] [Accepted: 07/12/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The cost and complexity of the polymerase chain reaction (PCR) test are barriers to diagnosis and treatment of hepatitis C virus (HCV) infection. We investigated the cost-effectiveness of testing strategies using antigen instead of PCR testing. METHODS We developed a mathematical model for HCV to estimate the number of diagnoses and cases of liver disease. We compared the following testing strategies: antibody test followed by PCR in case of positive antibody (baseline strategy); antibody test followed by HCV-antigen test (antibody-antigen); antigen test alone; PCR test alone. We conducted cost-effectiveness analyses considering either the costs of HCV testing of infected and uninfected individuals alone (A1), HCV testing and liver-related complications (A2), or all costs including HCV treatment (A3). The model was parameterized for the country of Georgia. We conducted several sensitivity analyses. RESULTS The baseline scenario could detect 89% of infected individuals. Antibody-antigen detected 86% and antigen alone 88% of infected individuals. PCR testing alone detected 91% of the infected individuals: the remaining 9% either died or spontaneously recovered before testing. In analysis A1, the baseline strategy was not essentially more expensive than antibody-antigen. In analysis A2, strategies using PCR became cheaper than antigen-based strategies. In analysis A3, antibody-antigen was again the cheapest strategy, followed by the baseline strategy, and PCR testing alone. CONCLUSIONS Antigen testing, either following a positive antibody test or alone, performed almost as well as the current practice of HCV testing. The cost-effectiveness of these strategies depends on the inclusion of treatment costs.
Collapse
Affiliation(s)
| | - Barbara Bertisch
- Institute of Global Health, University of Geneva, Geneva, Switzerland
- Checkin Helvetiaplatz, Zürich, Switzerland
| | - Francesco Negro
- Divisions of Gastroenterology and Hepatology and of Clinical Pathology, Geneva University Hospitals, Geneva, Switzerland
| | | | | | - Irina Tskhomelidze
- TEPHINET for Georgia Hepatitis C Elimination Program, I. Javakhishvili Tbilisi State University, Tbilisi, Georgia
| | - Maia Tsereteli
- Department of HIV/AIDS, Hepatitis, STI and TB, National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Olivia Keiser
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Janne Estill
- Institute of Global Health, University of Geneva, Geneva, Switzerland
- Institute of Mathematical Statistics and Actuarial Science, University of Bern, Bern, Switzerland
| |
Collapse
|
32
|
Busschots D, Bielen R, Koc ÖM, Heyens L, Dercon E, Verrando R, Janssens F, Van den Bergh L, Van Lint P, Bruckers L, Nevens F, Robaeys G. On-site testing and case management to improve hepatitis C care in drug users: a prospective, longitudinal, multicenter study in the DAA era. BMC Public Health 2021; 21:1574. [PMID: 34416867 PMCID: PMC8379886 DOI: 10.1186/s12889-021-11608-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 08/08/2021] [Indexed: 01/15/2023] Open
Abstract
Background Screening and treatment of hepatitis C virus (HCV) infection in people who use drugs (PWUD) remains insufficient. Reducing the burden of HCV infection in PWUD requires interventions focusing on the different steps of the HCV care cascade. Methods We performed a prospective, multicenter study, evaluating the impact of an HCV care model on the HCV care cascade among PWUD attending an addiction care center in Belgium between 2015 and 2018. Interventions within the care model consisted of pre-test counseling, on-site HCV screening and case management services. A multiple logistic regression model was performed to identify the independent factors influencing the outcomes. Results During the study period, 441 PWUD were registered at the addiction care center, 90% (395/441) were contacted, 88% (349/395) were screened for HCV infection. PWUD were more likely to be screened if they had ever injected drugs (p < .001; AOR 6.411 95% CI 3.464–11.864). In 45% (157/349), the HCV antibody (Ab) test was positive, and in 27% (94/349) HCV RNA was positive. Within the Belgian reimbursement criteria (fibrosis stage ≥ F2), 44% (41/94) were treated. Specialist evaluation at the hospital was lower for PWUD receiving decentralized opioid agonist therapy (p = .005; AOR 0.430 95% CI 0.005–0.380), PWUD with unstable housing in the past 6 months before inclusion (p = .015; AOR 0.035 95% CI 0.002–0.517) or if they were recently incarcerated (p = .001; AOR 0.010 95% CI 0.001–0.164). Conclusions This HCV care model demonstrated high screening, linkage to care, and treatment initiation among PWUD in Belgium. Using the cascade of care to guide interventions is easy and necessary to monitor results. This population needs guidance, not only for screening and treatment initiation but also for the long-term follow-up since one in six had cirrhosis and could develop hepatocellular carcinoma. Further interventions are necessary to increase linkage to care and treatment initiation. Universal access to direct-acting antiviral therapy from 2019 will contribute to achieving HCV elimination in the PWUD population. Trial registration Clinical trial registration details: www.clinicaltrials.gov (NCT03106194). Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11608-9.
Collapse
Affiliation(s)
- Dana Busschots
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Diepenbeek, Belgium. .,Department of Gastroenterology and Hepatology, Ziekenhuis-Oost Limburg, Genk, Belgium.
| | - Rob Bielen
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Diepenbeek, Belgium.,Department of Gastroenterology and Hepatology, Ziekenhuis-Oost Limburg, Genk, Belgium
| | - Özgür M Koc
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Diepenbeek, Belgium.,Department of Gastroenterology and Hepatology, Ziekenhuis-Oost Limburg, Genk, Belgium.,Medical Microbiology, School of NUTRIM, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Leen Heyens
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Diepenbeek, Belgium.,Department of Gastroenterology and Hepatology, Ziekenhuis-Oost Limburg, Genk, Belgium.,Medical Microbiology, School of NUTRIM, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | | | - Filip Janssens
- Department of Gastroenterology, Jessa Hospital, Hasselt, Belgium
| | - Luc Van den Bergh
- Department of Gastroenterology, Sint-Trudo Hospital, Sint-Truiden, Belgium
| | - Peter Van Lint
- Department of Gastroenterology, AZ Vesalius, Tongeren, Belgium
| | - Liesbeth Bruckers
- Faculty of Science, Center for statistics, Interuniversity Institute for Biostatistics and statistical Bioinformatics, Hasselt University, Diepenbeek, Belgium
| | - Frederik Nevens
- Department of Gastroenterology and Hepatology, University Hospitals KU Leuven, Leuven, Belgium
| | - Geert Robaeys
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Diepenbeek, Belgium.,Department of Gastroenterology and Hepatology, Ziekenhuis-Oost Limburg, Genk, Belgium.,Department of Gastroenterology and Hepatology, University Hospitals KU Leuven, Leuven, Belgium
| |
Collapse
|
33
|
Ryan P, Valencia J, Cuevas G, Troya J, Torres-Macho J, Muñoz-Gómez MJ, Muñoz-Rivas N, Canorea I, Vázquez-Morón S, Resino S. HIV screening and retention in care in people who use drugs in Madrid, Spain: a prospective study. Infect Dis Poverty 2021; 10:111. [PMID: 34412695 PMCID: PMC8375145 DOI: 10.1186/s40249-021-00894-5] [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: 06/10/2021] [Accepted: 08/08/2021] [Indexed: 11/17/2022] Open
Abstract
Background The burden of human immunodeficiency virus (HIV) infection in people who use drugs (PWUD) is significant. We aimed to screen HIV infection among PWUD and describe their retention in HIV care. Besides, we also screen for hepatitis C virus (HCV) infection among HIV-seropositive PWUD and describe their linkage to care. Methods We conducted a prospective study in 529 PWUD who visited the “Cañada Real Galiana” (Madrid, Spain). The study period was from June 1, 2017, to May 31, 2018. HIV diagnosis was performed with a rapid antibody screening test at the point-of-care (POC) and HCV diagnosis with immunoassay and PCR tests on dried blood spot (DBS) in a central laboratory. Positive PWUD were referred to the hospital. We used the Chi-square or Fisher’s exact tests, as appropriate, to compare rates between groups. Results Thirty-five (6.6%) participants were positive HIV antibodies, but 34 reported previous HIV diagnoses, and 27 (76%) had prior antiretroviral therapy. Among patients with a positive HIV antibody test, we also found a higher prevalence of homeless (P < 0.001) and injection drug use (PWID) (P < 0.001), and more decades of drug use (P = 0.002). All participants received HIV test results at the POC. Of the 35 HIV positives, 28 (80%) were retained in HIV medical care at the end of the HIV screening study (2018), and only 22 (62.9%) at the end of 2020. Moreover, 12/35 (34.3%) were positive for the HCV RNA test. Of the latter, 10/12 (83.3%) were contacted to deliver the HCV results test (delivery time of 19 days), 5/12 (41.7%) had an appointment and were attended at the hospital and started HCV therapy, and only 4/12 (33.3%) cleared HCV. Conclusions We found almost no new HIV-infected PWUD, but their cascade of HIV care was low and remains a challenge in this population at risk. The high frequency of active hepatitis C in HIV-infected PWUD reflects the need for HCV screening and reinforcing the link to care. ![]()
Collapse
Affiliation(s)
- Pablo Ryan
- Hospital Universitario Infanta Leonor, Madrid, Spain.,Universidad Complutense de Madrid (UCM), Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Jorge Valencia
- Hospital Universitario Infanta Leonor, Madrid, Spain.,Unidad de Reducción de Daños "SMASD", Madrid, Spain
| | | | - Jesús Troya
- Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | - María José Muñoz-Gómez
- Unidad de Infección Viral e Inmunidad, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Carretera Majadahonda- Pozuelo, Km 2.2, 28220, Majadahonda, Madrid, Spain
| | | | - Isabel Canorea
- Unidad de Infección Viral e Inmunidad, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Carretera Majadahonda- Pozuelo, Km 2.2, 28220, Majadahonda, Madrid, Spain
| | - Sonia Vázquez-Morón
- Unidad de Infección Viral e Inmunidad, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Carretera Majadahonda- Pozuelo, Km 2.2, 28220, Majadahonda, Madrid, Spain
| | - Salvador Resino
- Unidad de Infección Viral e Inmunidad, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Carretera Majadahonda- Pozuelo, Km 2.2, 28220, Majadahonda, Madrid, Spain.
| |
Collapse
|
34
|
Chevaliez S, Roudot-Thoraval F, Hézode C, Pawlotsky JM, Njouom R. Performance of rapid diagnostic tests for HCV infection in serum or plasma. Future Microbiol 2021; 16:713-719. [PMID: 34227402 DOI: 10.2217/fmb-2020-0295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: HCV diagnosis will become the bottleneck in eliminating hepatitis C. Simple, accurate and cost-effective testing strategies are urgently needed to improve hepatitis C screening and diagnosis. Materials & methods: Performance of seven rapid diagnostic tests (RDT) have been assessed in a large series (n = 498) of serum or plasma specimens collected in France and in Cameroon. Results: Specificity varied from 96.1 to 100%. The clinical sensitivity, compared with immunoassays as the reference, was high for all seven RDT (97.2-100%). The Multisure HCV antibody assay and OraQuick HCV rapid antibody test reached sensitivity ≥99%. Conclusion: A number of RDT may be suitable for WHO prequalification and may be implemented in the framework of large-scale low-cost treatment programs to achieve the WHO viral hepatitis objectives by 2030.
Collapse
Affiliation(s)
- Stéphane Chevaliez
- Department of Virology, National Reference Center for Viral Hepatitis B, C & Delta, Hôpital Henri Mondor, Université Paris-Est, Créteil, France.,INSERM U955, Créteil, France
| | - Françoise Roudot-Thoraval
- INSERM U955, Créteil, France.,Department of Hepatology, Hôpital Henri Mondor, Université Paris-Est, Créteil, France
| | - Christophe Hézode
- INSERM U955, Créteil, France.,Department of Hepatology, Hôpital Henri Mondor, Université Paris-Est, Créteil, France
| | - Jean-Michel Pawlotsky
- Department of Virology, National Reference Center for Viral Hepatitis B, C & Delta, Hôpital Henri Mondor, Université Paris-Est, Créteil, France.,INSERM U955, Créteil, France
| | - Richard Njouom
- Department of Virology, Centre Pasteur du Cameroun, Yaounde, Cameroon
| |
Collapse
|
35
|
Smookler D, Vanderhoff A, Biondi MJ, Valencia J, Ryan P, Karkada J, Hong R, Sattar I, Mandel E, Gjevori M, Casey J, Fletcher D, Shah H, Hansen BE, Capraru C, Janssen HLA, Lazarus JV, Feld JJ. Reducing Read Time of Point-of-Care Test Does Not Affect Detection of Hepatitis C Virus and Reduces Need for Reflex RNA. Clin Gastroenterol Hepatol 2021; 19:1451-1458.e4. [PMID: 32763480 DOI: 10.1016/j.cgh.2020.07.058] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/28/2020] [Accepted: 07/29/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Global elimination of hepatitis C virus (HCV) will require increases in diagnosis. Point of care (POC) tests that detect antibodies against HCV can be useful for testing large and difficult to reach populations. The most accurate POC test requires a 20 min read time to identify antibody-positive samples. We investigated whether viremic patients could be identified using a shorter read time, to increase efficiency and reduce the need for reflex tests (a follow-up test for HCV RNA on the same specimen to confirm viremia). METHODS Patients with past or current HCV infections provided samples at 2 clinics in Canada for evaluation by the OraQuick HCV Rapid antibody POC test. A community HCV-screening program in Madrid, Spain (real-world cohort) invited people to be tested for HCV with the same OraQuick test. Patients provided samples of whole blood, via finger prick. Fingerprick samples were tested immediately after collection. In the clinic cohort, photographs of the developing test were taken at 15 second intervals, and blinded readers recorded the time to positivity. In the real-world cohort, readers recorded the OraQuick result at 5 minutes, and each minute after, up to 10 minutes, and then again at 20 minutes; viremia was then evaluated using a POC HCV RNA test (GeneXpert HCV Viral Load Assay). Sera from viremic and non-viremic clinic patients were used to quantify antibody titers to investigate the relationship between the time of band appearance and antibody concentration. Fisher's exact test and exact logistic regression were used to determine factors associated with a positive result at 5 minutes. RESULTS Blood from all viremic patients produced a positive result in the antibody POC test by 5 min. Median time to a positive result for 171 viremic patients was 2.6 min (range, 1.8-4.6 min), vs 4.1 min (range, 2.3-14.4 min) for 108 patients with resolved infection (P < .001). The 5-min threshold identified all viremic cases among 176 HCV antibody-positive patients in the real-world cohort, confirmed by testing for HCV RNA. In the pooled cohorts, antibody positivity at 5 min identified viremic patients with 100% sensitivity (95% CI, 98.4%-100%); the negative predictive value was 100% (95% CI, 94.9%-100%). The positive predictive value at 5 min was 62.0% (95% CI, 56.7%-67.0%) and therefore insufficient alone to detect viremia; an HCV RNA test would still be necessary to confirm active infection. CONCLUSIONS The wait time for the OraQuick HCV Rapid antibody POC blood test can be reduced from 20 min to 5 min and continue to reliably identify patients with HCV infection. Shortening the test time could increase high-throughput screening, reduce loss to follow up, and reduce the need for reflex HCV RNA testing.
Collapse
Affiliation(s)
- David Smookler
- Viral Hepatitis Care Network (VIRCAN), Toronto, Ontario, Canada; Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Aaron Vanderhoff
- Viral Hepatitis Care Network (VIRCAN), Toronto, Ontario, Canada; Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Mia J Biondi
- Viral Hepatitis Care Network (VIRCAN), Toronto, Ontario, Canada; Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Jorge Valencia
- Harm Reduction Unit (SMASD), Subdireccion General de Adicciones, Madrid, Spain
| | - Pablo Ryan
- Internal Medicine/HIV Unit, Infanta Leonor Hospital, Madrid, Spain
| | - Joel Karkada
- Viral Hepatitis Care Network (VIRCAN), Toronto, Ontario, Canada; Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Rachel Hong
- Viral Hepatitis Care Network (VIRCAN), Toronto, Ontario, Canada; Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Izza Sattar
- Viral Hepatitis Care Network (VIRCAN), Toronto, Ontario, Canada; Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Erin Mandel
- Viral Hepatitis Care Network (VIRCAN), Toronto, Ontario, Canada; Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Martina Gjevori
- Viral Hepatitis Care Network (VIRCAN), Toronto, Ontario, Canada; Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Julia Casey
- Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | - Hemant Shah
- Viral Hepatitis Care Network (VIRCAN), Toronto, Ontario, Canada; Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Bettina E Hansen
- Viral Hepatitis Care Network (VIRCAN), Toronto, Ontario, Canada; Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Ontario, Canada; Institute of Health, Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Camelia Capraru
- Viral Hepatitis Care Network (VIRCAN), Toronto, Ontario, Canada; Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Harry L A Janssen
- Viral Hepatitis Care Network (VIRCAN), Toronto, Ontario, Canada; Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | - Jordan J Feld
- Viral Hepatitis Care Network (VIRCAN), Toronto, Ontario, Canada; Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
36
|
Mari PC, Gulati R, Fragassi P. Adolescent Hepatitis C: Prevalence, Impact, and Management Challenges. ADOLESCENT HEALTH MEDICINE AND THERAPEUTICS 2021; 12:45-53. [PMID: 33994820 PMCID: PMC8112853 DOI: 10.2147/ahmt.s263864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 04/21/2021] [Indexed: 12/09/2022]
Abstract
The prevalence of Hepatitis C virus infection (HCV), a leading cause of chronic liver disease worldwide, is rising in the United States (US) and other high-income countries, especially among youth and young adults. This surge in cases is closely associated with the opioid crisis and intravenous drug use (IVDU). However, its prevalence and impact on the adolescent population have not been thoroughly studied and therefore is poorly understood. The pediatric population tends to have milder liver disease and progression when compared to adults; however, there is a risk of developing liver cirrhosis, in addition to facing decreased quality of life and stigmatization from the disease. The recent approval of direct-acting antiviral (DAA) regimens for all HCV genotypes and age greater than 3 years has revolutionized its management. Therapy has shifted from the prolonged interferon-based regimens, to shorter duration, once daily oral pills that are highly effective, curative and with fewer side effects. Therapy is now indicated for all adolescents with hepatitis C virus infection, regardless of stage of liver disease, recent IVDU, or coinfection with HIV, therefore eliminating a lifetime risk of chronic liver disease, cirrhosis and hepatocarcinoma. Nonetheless, adolescents are rarely tested or treated for hepatitis C infection, and very few adolescents complete therapy. Implementation of point of care (POC) testing of high-risk youth at drug treatment centers or other juvenile facilities may be a good strategy to increase testing, diagnosis and therapy. This review article aims to educate pediatricians and other primary care providers to help decrease the existing knowledge gap on the subject.
Collapse
Affiliation(s)
- Paula Chaves Mari
- Department of Pediatrics, MetroHealth Medical Center, Cleveland, OH, USA
| | - Reema Gulati
- Department of Pediatrics, MetroHealth Medical Center, Cleveland, OH, USA
| | - Philip Fragassi
- Department of Pediatrics, MetroHealth Medical Center, Cleveland, OH, USA
| |
Collapse
|
37
|
Uusküla A, Talu A, Rannap J, Barnes DM, Jarlais DD. Rapid point-of-care (POC) testing for Hepatitis C antibodies in a very high prevalence setting: persons injecting drugs in Tallinn, Estonia. Harm Reduct J 2021; 18:39. [PMID: 33794927 PMCID: PMC8015736 DOI: 10.1186/s12954-021-00485-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 03/22/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Between December 2018 and January of 2019, we evaluated the accuracy of the point-of-care Hepatitis C (HCV) antibody test (POC; OraQuick HCV) used at a community-based needle and syringe exchange program serving persons who inject drugs in Tallinn, Estonia. METHODS We compared the results of screening for HCV antibodies by OraQuick (oral swab) and enzyme immunoassay (EIA; blood draw) and assessed test results implications in a high prevalence setting. Findings Of the 100 participants, 88 (88%) had reactive POC test results, and 93 were HCV antibody positive on EIA testing. Sensitivity, specificity and negative predictive value (NPV) for the POC assay with EIA as the relevant reference test were as follows: 94.6% (95% CI 90.0-99.2%), 100% and 58.3% (95% CI 30.4-86.2%). Of the 12 testing, HCV-negative with the POC only 7 (58.3%) were true negatives. CONCLUSIONS Oral swab rapid testing HCV screening in this nonclinical setting was sensitive and specific but had unacceptably low NPV. In high prevalence settings, POC tests with high sensitivity and that directly measure HCV RNA may be warranted.
Collapse
Affiliation(s)
- Anneli Uusküla
- Department of Family Medicine and Public Health, University of Tartu, Ravila 19, 50411, Tartu, Estonia.
| | - Ave Talu
- Department of Family Medicine and Public Health, University of Tartu, Ravila 19, 50411, Tartu, Estonia
| | - Jürgen Rannap
- Department of Family Medicine and Public Health, University of Tartu, Ravila 19, 50411, Tartu, Estonia
| | - David M Barnes
- School of Global Public Health, New York University, 665 Broadway, New York, NY, 10012, USA
| | - Don Des Jarlais
- School of Global Public Health, New York University, 665 Broadway, New York, NY, 10012, USA
| |
Collapse
|
38
|
Chen B, Ma ZH, Xu B, Chang H, He XX, Pei LJ, Ren YN, Xing WG. Evaluation of seven rapid diagnostic tests for detection of hepatitis C virus antibodies in China. J Viral Hepat 2021; 28:657-663. [PMID: 33421262 DOI: 10.1111/jvh.13466] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 12/30/2020] [Indexed: 12/25/2022]
Abstract
Rapid diagnostic tests as an attractive alternative to enzyme immunoassay could identify hepatitis C virus (HCV) infected persons more expeditiously. The availability of high performing and quality-assured rapid diagnostic tests are essential to scale-up HCV screening. The study was undertaken to evaluate the performance of seven domestic HCV rapid diagnostic tests kits. The kits were evaluated by using HCV serum panels, including HCV basic panel, analytical specificity panel, mixed titre performance panel, characteristic panel, seroconversion panel, and genotype qualification panel. The results showed that clinical sensitivity, clinical specificity and analytical specificity of seven rapid diagnostic tests kits ranged from 94% (95% CI: 83.2-98.6) to 100% (95% CI: 91.5-100). Furthermore, specimens with HCV genotypes 1b, 2a, 3a, 4a, 5a, 6 could be detected by HCV rapid diagnostic tests kits, whereas specimens with genotypes 1a and 2b could not be detected. Additionally, most HCV rapid diagnostic tests kits had great performance in diagnosing different titres and/or different bands samples, but some low S/CO value specimens may not be fully detected by few rapid diagnostic test kits. In conclusion, seven HCV rapid diagnostic tests reagents presented high sensitivity, specificity, good anti-interference and detection ability of early infection, which could meet the requirements of clinical HCV antibody screening.
Collapse
Affiliation(s)
- Bing Chen
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.,Medical College, University of Chinese Academy of Sciences, Beijing, China
| | - Zhong-Hui Ma
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.,Fangshan District Center for Disease Control and Prevention in Beijing, China
| | - Bing Xu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Hao Chang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiao-Xia He
- Beijing Engineering Research Center of Food Safety Analysis, Beijing Engineering Technology Research Centre of Gene Sequencing and Gene Function Analysis, Beijing Center for Physical & Chemical Analysis, Beijing, China
| | - Li-Jian Pei
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ya-Nan Ren
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Wen-Ge Xing
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| |
Collapse
|
39
|
Abstract
Antibody responses in hepatitis C virus (HCV) have been a rather mysterious research topic for many investigators working in the field. Chronic HCV infection is often associated with dysregulation of immune functions particularly in B cells, leading to abnormal lymphoproliferation or the production of autoantibodies that exacerbate inflammation and extrahepatic diseases. When considering the antiviral function of antibody, it was difficult to endorse its role in HCV protection, whereas T-cell response has been shown unequivocally critical for natural recovery. Recent breakthroughs in the study of HCV and antigen-specific antibody responses provide important insights into viral vulnerability to antibodies and the immunogenetic and structural properties of the neutralizing antibodies. The new knowledge reinvigorates HCV vaccine research by illuminating a new path for the rational design of vaccine antigens to elicit broadly neutralizing antibodies for protection.
Collapse
Affiliation(s)
- Mansun Law
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, California 92109, USA
| |
Collapse
|
40
|
Acceptability and Usability of HCV Self-Testing in High Risk Populations in Vietnam. Diagnostics (Basel) 2021; 11:diagnostics11020377. [PMID: 33672241 PMCID: PMC7926709 DOI: 10.3390/diagnostics11020377] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 02/17/2021] [Accepted: 02/19/2021] [Indexed: 02/08/2023] Open
Abstract
HIV self-testing has emerged as a safe and effective approach to increase the access to and uptake of HIV testing and treatment, especially for key populations. Applying self-testing to hepatitis C virus (HCV) may also offer an additional way to address low coverage of HCV testing and to accelerate elimination efforts. To understand the potential for HCV self-testing (HCVST), an observational study was conducted to assess the acceptability and usability of the OraQuick® HCV Self-Test (prototype) among people who inject drugs (PWID) and men who have sex with men (MSM) in Thai Nguyen, a province in northern Vietnam. A total of 105 PWID and 104 MSM were eligible and agreed to participate in the study. Acceptability, defined as the proportion of participants among eligible subjects who agreed to participate in the study, was 92.9% in PWID and 98.6% in MSM. Compared to MSM, PWID were older (median age: 45 vs. 22 years; p < 0.0001) and had a lower education level (high school and college: 38.1% vs. 100%; p < 0.0001). HCVST usability was high among MSM with fewer observed mistakes, difficulties, or participants requiring assistance (33.7%, 28.8%, and 17.3%, respectively) compared to PWID (62.9%, 53.3%, and 66.7%, respectively; all p < 0.0001)). Inter-reader and inter-operator agreement were good in both groups (Kappa coefficient range: 0.61–0.99). However, the concordance between HCVST and study staff -read or performed HCV testing was lower among PWID than MSM (inter-reader concordance 88.6% vs. 99.0% and inter-operator concordance 81.9% vs. 99%). Overall, HCVST was highly acceptable with moderate to high usability among PWID and MSM in Thai Nguyen. Efforts to provide support and assistance may be needed to optimize performance, particularly for PWID populations and for those who are older and with lower literacy or education levels.
Collapse
|
41
|
Chugh Y, Premkumar M, Grover GS, Dhiman RK, Teerawattananon Y, Prinja S. Cost-effectiveness and budget impact analysis of facility-based screening and treatment of hepatitis C in Punjab state of India. BMJ Open 2021; 11:e042280. [PMID: 33589457 PMCID: PMC7887370 DOI: 10.1136/bmjopen-2020-042280] [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] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Despite treatment availability, chronic hepatitis C virus (HCV) public health burden is rising in India due to lack of timely diagnosis. Therefore, we aim to assess incremental cost per quality-adjusted life year (QALY) for one-time universal screening followed by treatment of people infected with HCV as compared with a no screening policy in Punjab, India. STUDY DESIGN Decision tree integrated with Markov model was developed to simulate disease progression. A societal perspective and a 3% annual discount rate were considered to assess incremental cost per QALY gained. In addition, budgetary impact was also assessed with a payer's perspective and time horizon of 5 years. STUDY SETTING Screening services were assumed to be delivered as a facility-based intervention where active screening for HCV cases would be performed at 22 district hospitals in the state of Punjab, which will act as integrated testing as well as treatment sites for HCV. INTERVENTION Two intervention scenarios were compared with no universal screening and treatment (routine care). Scenario I-screening with ELISA followed by confirmatory HCV-RNA quantification and treatment. Scenario II-screening with rapid diagnostic test (RDT) kit followed by confirmatory HCV-RNA quantification and treatment. PRIMARY AND SECONDARY OUTCOME MEASURES Lifetime costs; life years and QALY gained; and incremental cost-effectiveness ratio for each of the above-mentioned intervention scenario as compared with the routine care. RESULTS Screening with ELISA and RDT, respectively, results in a gain of 0.028 (0.008 to 0.06) and 0.027 (0.008 to 0.061) QALY per person with costs decreased by -1810 Indian rupees (-3376 to -867) and -1812 Indian rupees (-3468 to -850) when compared with no screening. One-time universal screening of all those ≥18 years at a base coverage of 30%, with ELISA and RDT, would cost 8.5 and 8.3 times more, respectively, when compared with screening the age group of the cohort 40-45 years old. CONCLUSION One-time universal screening followed by HCV treatment is a dominant strategy as compared with no screening. However, budget impact of screening of all ≥18-year-old people seems unsustainable. Thus, in view of findings from both cost-effectiveness and budget impact, we recommend beginning with screening the age cohort with RDT around mean age of disease presentation, that is, 40-45 years, instead of all ≥18-year-old people.
Collapse
Affiliation(s)
- Yashika Chugh
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research School of Public Health, Chandigarh, Punjab, India
| | - Madhumita Premkumar
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Gagandeep Singh Grover
- Department of Health and Family Welfare, National Viral Hepatitis Control Program, Government of Punjab, Chandigarh, India
| | - Radha K Dhiman
- Director, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Mueang Nonthaburi, Nonthaburi, Thailand
- Saw Swee Hock School of Public Health (SSHSPH), National University of Singapore, Singapore
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
42
|
Farnsworth CW, Lloyd M, Jean S. Opioid Use Disorder and Associated Infectious Disease: The Role of the Laboratory in Addressing Health Disparities. J Appl Lab Med 2020; 6:180-193. [PMID: 33438735 DOI: 10.1093/jalm/jfaa150] [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: 06/16/2020] [Accepted: 08/07/2020] [Indexed: 11/12/2022]
Abstract
BACKGROUND Opioid use disorder, defined as a pattern of problematic opioid use leading to clinically significant impairment, has resulted in considerable morbidity and mortality throughout the world. This is due, at least in part, to the marginalized status of patients with opioid use disorder, limiting their access to appropriate laboratory testing, diagnosis, and treatment. Infections have long been associated with illicit drug use and contribute considerably to morbidity and mortality. However, barriers to testing and negative stigmas associated with opioid use disorder present unique challenges to infectious disease testing in this patient population. CONTENT This review addresses the associations between opioid use disorder and infectious organisms, highlighting the health disparities encountered by patients with opioid use disorder, and the important role of laboratory testing for diagnosing and managing these patients. SUMMARY Infections are among the most frequent and adverse complications among patients with opioid use disorder. As a result of health disparities and systemic biases, patients that misuse opioids are less likely to receive laboratory testing and treatment. However, laboratories play a crucial in identifying patients that use drugs illicitly and infections associated with illicit drug use.
Collapse
Affiliation(s)
- Christopher W Farnsworth
- Division of Laboratory and Genomic Medicine, Department of Pathology and Immunology, Washington University, St. Louis, MO
| | - Matthew Lloyd
- Division of Laboratory and Genomic Medicine, Department of Pathology and Immunology, Washington University, St. Louis, MO
| | - Sophonie Jean
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH
| |
Collapse
|
43
|
Pawlotsky JM, Negro F, Aghemo A, Berenguer M, Dalgard O, Dusheiko G, Marra F, Puoti M, Wedemeyer H. EASL recommendations on treatment of hepatitis C: Final update of the series ☆. J Hepatol 2020; 73:1170-1218. [PMID: 32956768 DOI: 10.1016/j.jhep.2020.08.018] [Citation(s) in RCA: 669] [Impact Index Per Article: 167.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 08/18/2020] [Indexed: 02/08/2023]
Abstract
Hepatitis C virus (HCV) infection is a major cause of chronic liver disease, with approximately 71 million chronically infected individuals worldwide. Clinical care for patients with HCV-related liver disease has advanced considerably thanks to an enhanced understanding of the pathophysiology of the disease, as well as developments in diagnostic procedures and improvements in therapy and prevention. These therapies make it possible to eliminate hepatitis C as a major public health threat, as per the World Health Organization target, although the timeline and feasibility vary from region to region. These European Association for the Study of the Liver recommendations on treatment of hepatitis C describe the optimal management of patients with recently acquired and chronic HCV infections in 2020 and onwards.
Collapse
|
44
|
Pawlotsky JM, Ramers CB, Dillon JF, Feld JJ, Lazarus JV. Simplification of Care for Chronic Hepatitis C Virus Infection. Semin Liver Dis 2020; 40:392-402. [PMID: 32725611 DOI: 10.1055/s-0040-1713657] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
In 2016, the World Health Organization (WHO) set a target for eliminating viral hepatitis as a major public health threat by 2030. However, while today's highly effective and well-tolerated pangenotypic direct-acting antiviral regimens have maximized simplification of hepatitis C virus (HCV) treatment, there remain a plethora of barriers to HCV screening, diagnosis, and linkage to care. As of 2017, only 19% of the estimated 71 million individuals living with chronic HCV worldwide were diagnosed and in 2015 to 2016, only 21% of diagnosed individuals had accessed treatment. Simplification and decentralization of the HCV care cascade would bolster patient engagement and support the considerable scale-up needed to achieve WHO targets. Recent developments in HCV screening and diagnosis, together with reduced pretreatment assessment and on-treatment monitoring requirements, can further streamline the care continuum, ensuring patients are linked to care quickly and earlier in the disease course, and minimize clinic visits.
Collapse
Affiliation(s)
- Jean-Michel Pawlotsky
- Department of Virology, National Reference Center for Viral Hepatitis B, C and D, Henri Mondor Hospital, University of Paris-Est-INSERM U955, Créteil, France
| | - Christian B Ramers
- Division of Infectious Diseases, Department of Medicine, UC San Diego School of Medicine, La Jolla, California
| | - John F Dillon
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Jordan J Feld
- Toronto Centre for Liver Disease, University Health Network, Sandra Rotman Centre for Global Health, Toronto, ON, Canada
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| |
Collapse
|
45
|
[Rapid diagnosis of sexually transmitted infections : Joint statement of DSTIG, RKI, and PEI, as well as the reference centers for HIV, HBV, and HCV and consulting laboratories for Chlamydia, gonococci, and Treponema pallidum]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020; 63:1271-1286. [PMID: 32930821 DOI: 10.1007/s00103-020-03218-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In February 2019, the fourth expert meeting on rapid diagnostic tests (RDTs) for sexually transmitted infections (STI) was held at the Robert Koch Institute (RKI) in Berlin. Novel technical developments and new aspects of RDT applications were discussed by representatives from the German STI Society (DSTIG); RKI; the Paul Ehrlich Institute; national reference centers for HIV, HBV, and HCV; and reference laboratories for Chlamydia, gonococci, and Treponema pallidum.As a result of this meeting, we present a revision of the joint statement on STI diagnostics with RDTs from 2017. The Regulation (EU) 2017/746 of the European Parliament and of the Council on in vitro diagnostic medical devices became effective in May 2017 and includes more stringent regulatory requirements for RDTs, mainly concerning conformity of manufacturing processes and performance characteristics of class D in vitro diagnostics (detection of HIV, HBV, HCV, and T. pallidum). Some RDTs for HIV, HCV, and T. pallidum have been evaluated in clinical studies and/or were WHO prequalified and may be used in low-threshold services. Among them are some HIV RDTs available and approved for self-testing. In addition, some HBV RDTs based on detection of HBs antigen (HBsAg) received WHO prequalification. However, false negative results may occur in samples with low HBsAg levels, as for instance in HIV-coinfected patients receiving antiretroviral therapy. For Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG), antigen-based RDTs still do not allow reliable detection of infection. Only PCR-based CT/NG RDTs possess sufficient diagnostic accuracy to be used as point-of-care tests. Rapid PCR tests for NG, however, do not provide any information about antimicrobial resistance.
Collapse
|
46
|
Kabamba AT, Mwamba CM, Dessilly G, Dufrasne F, Kabamba BM, Longanga AO. Evaluation of the analytical performance of six rapid diagnostic tests for the detection of viral hepatitis B and C in Lubumbashi, Democratic Republic of Congo. J Virol Methods 2020; 285:113961. [PMID: 32860797 DOI: 10.1016/j.jviromet.2020.113961] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/11/2020] [Accepted: 08/23/2020] [Indexed: 02/08/2023]
Abstract
Rapid diagnostic tests (RDTs) are widely used in Lubumbashi for the diagnosis of viral hepatitis B and C. To date, there are no works that have been carried out in Lubumbashi to independently assess the performance of such tests. This study aimed at assessing the effectiveness of RDTs for the detection of HBsAg and anti-HCV antibodies in order to identify infected blood donors in Lubumbashi. A total of 300 serum samples (100 HBsAg positive samples; 100 anti-HCV positive samples and 100 HBsAg and anti-HCV negative samples) were tested simultaneously using the 6 locally used RDTs and as gold standard the chemiluminescent assays for HBsAg and the RT-TMA for HCV detection. The six evaluated RDTs demonstrated a sensitivity and a negative predictive value (NPV) of 100 % whereas the specificity and positive predictive value (PPV) varied from 46 % to 98.1 %. SB BioLine HBsAg test performed best in this study with 100 % of sensitivity, 97.1 % of specificity, 100 % of NPV and 96.9 % of PPV. Furthermore, sensitivity, specificity, NPV and PPV for SB BioLine HCV test were as follows: 100 %, 98.1 %, 100 % and 93.9 %. Therefore, SD BioLine tests (HBsAg, HCV) would be selected as the first line RDTs for the detection and the diagnostic of hepatitis B and C. They can prevent blood-borne transmission of HBV and HCV in areas with limited incomes as Lubumbashi.
Collapse
Affiliation(s)
- Arsène T Kabamba
- Laboratoire de Biologie Clinique, Faculté des Sciences Pharmaceutiques, Université de Lubumbashi, Commune de Kampemba, Lubumbashi, DR, Congo; Institut de Recherche Expérimentale et Clinique, Pôle de Microbiologie, Université Catholique de Louvain, Brussels, Belgium.
| | - Claude M Mwamba
- Faculté de Médecine, Université de Lubumbashi, Commune de Lubumbashi, Lubumbashi, DR, Congo
| | - Géraldine Dessilly
- Institut de Recherche Expérimentale et Clinique, Pôle de Microbiologie, Université Catholique de Louvain, Brussels, Belgium
| | - François Dufrasne
- Institut de Recherche Expérimentale et Clinique, Pôle de Microbiologie, Université Catholique de Louvain, Brussels, Belgium
| | - Benoit M Kabamba
- Institut de Recherche Expérimentale et Clinique, Pôle de Microbiologie, Université Catholique de Louvain, Brussels, Belgium
| | - Albert O Longanga
- Laboratoire de Biologie Clinique, Faculté des Sciences Pharmaceutiques, Université de Lubumbashi, Commune de Kampemba, Lubumbashi, DR, Congo
| |
Collapse
|
47
|
Birjandi MM, Oroei M. The prevalence of positive rapid diagnostic test of hepatitis C virus infection in Ghana. Pan Afr Med J 2020; 36:322. [PMID: 33193976 PMCID: PMC7603834 DOI: 10.11604/pamj.2020.36.322.22490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 07/21/2020] [Indexed: 12/20/2022] Open
Abstract
Introduction hepatitis C virus (HCV) infection is one of the most common viral hepatitis in Africa. Rapid diagnostic test (RDT) is a useful tool to identify antibody anti-HCV in point of care. In this study, we decided to determine prevalence of cases with positive rapid diagnostic test of HCV infection. Methods this cross-sectional study was conducted in a polyclinic, Accra, Ghana. Using convenience sampling, 728 participants were screened with blood-based RDT and interviewed about personal risk behaviors for transmission of HCV. Data was entered in SPSS version 18 and analyzed. Results there was 1.6% positive RDT in our participants. The mean age of them was 29.58 ± 12.31 years old that were younger than the participants with negative RDT (p: 0.027). The rate of positive test was 66.67% in women and 33.33% in men. There was a negative association between age and RDT positive (aOR: 0.91, 95%CI 0.85-0.96). The odds of positive RDT in married participants was 6.32 fold others after adjusting model (p: 0.014). There were no important risk behavior for HCV, except one person with history of contacting blood or needles. Conclusion the risk of positive RDT has a reverse relationship with aging and also it has an increase in married individuals. Therefore preventive education and screening for HCV should be a priority in young and middle-aged adults because of more sexual activity.
Collapse
Affiliation(s)
| | - Mahbobeh Oroei
- Hearing Disorders Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
48
|
Vetter BN, Reipold EI, Ongarello S, Audu R, Ige FA, Alkhazashvili M, Chitadze N, Vanroye F, De Weggheleire A, An S, Fransen K. Sensitivity and Specificity of Rapid Diagnostic Tests for Hepatitis C Virus With or Without HIV Coinfection: A Multicentre Laboratory Evaluation Study. J Infect Dis 2020; 226:420-430. [PMID: 32614451 PMCID: PMC9417120 DOI: 10.1093/infdis/jiaa389] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 06/25/2020] [Indexed: 02/07/2023] Open
Abstract
Background Hepatitis C virus (HCV) screening is critical to HCV elimination efforts. Simplified diagnostics are required for low-resource settings and difficult-to-reach populations. This retrospective study assessed performance of rapid diagnostic tests (RDTs) for detection of HCV antibodies. Methods Two lots of 13 RDTs were evaluated at 3 laboratories using archived plasma samples from 4 countries (Nigeria, Georgia, Cambodia, and Belgium). HCV status was determined using 3 reference tests according to a composite algorithm. Sensitivity and specificity were evaluated in HIV-infected and HIV-uninfected populations. Operational characteristics were also assessed. Results In total, 1710 samples met inclusion criteria. In HIV-uninfected samples (n = 384), the majority of RDTs had sensitivity ≥98% in 1 or both lots and most RDTs had specificity ≥99%. In HIV-infected samples (n = 264), specificity remained high but sensitivity was markedly lower than in HIV-uninfected samples; only 1 RDT reached >95%. The majority of HIV-infected samples for which sensitivity was low did not have detectable HCV viral load/core antigen. Interreader variability, lot-to-lot variability, and rate of invalid runs were low for all RDTs (<2%). Conclusions HCV RDTs should be evaluated in the intended target population, as sensitivity can be impacted by population factors such as HIV status. Clinical Trials Registration NCT04033887
Collapse
Affiliation(s)
| | | | | | - Rosemary Audu
- Nigerian Institute of Medical Research, Lagos, Nigeria
| | | | - Maia Alkhazashvili
- National Center for Disease Control and Public Health/R. Lugar Center for Public Health Research, Tbilisi, Georgia
| | - Nazibrola Chitadze
- National Center for Disease Control and Public Health/R. Lugar Center for Public Health Research, Tbilisi, Georgia
| | - Fien Vanroye
- Institute of Tropical Medicine HIV/STD Reference Laboratory, Antwerp, Belgium
| | - Anja De Weggheleire
- Institute of Tropical Medicine HIV/STD Reference Laboratory, Antwerp, Belgium
| | - Sokkab An
- Sihanouk Hospital Center of Hope, Phnom Penh, Cambodia
| | - Katrien Fransen
- Institute of Tropical Medicine HIV/STD Reference Laboratory, Antwerp, Belgium
| |
Collapse
|
49
|
Bielen R, Koc ÖM, Busschots D, Verrando R, Nevens F, Robaeys G. Validation of hepatitis C virus RNA detection using capillary blood by finger prick (GenXpert system)-Hepatitis C fingerprick study. J Viral Hepat 2020; 27:709-714. [PMID: 32106345 DOI: 10.1111/jvh.13284] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 01/23/2020] [Accepted: 02/06/2020] [Indexed: 01/10/2023]
Abstract
To achieve the ambitious goals of the WHO to eliminate hepatitis C virus (HCV) infection as a public health threat by 2030, innovative approaches are needed to improve the uptake for screening and treatment in people who inject drugs (PWID). Important barriers to care are difficult venous access and the two-step approach in current point-of-care tests, using an HCV antibody screening test followed by a confirmatory HCV RNA test. In this study, we aimed to validate the new GenXpert instrument to diagnose HCV RNA by finger prick. This prospective study was conducted in a cohort of PWID in 6 alcohol/drug clinic sites and 1 outreach project in Belgium between January 2018 and March 2019. Plasma and capillary whole-blood samples were collected by venepuncture and finger prick, respectively. Sensitivity and specificity of the GenXpert system were compared to the gold standard Artus HCV RNA kit. Of 153 participants enrolled, 147 (96.1%) had results of both the GenXpert system and Artus HCV RNA kit available. HCV RNA was detected in 35 of 147 (23.8%) by the Artus HCV RNA kit and in 36 of 147 (24.8%) by the GenXpert. Median quantitative HCV RNA viral load on finger prick was 28 700 IU/mL (IQR 4070-65 875) vs 1 900 000IU/mL (IQR 416,466-2,265,510) on plasma. The GenXpert instrument had a sensitivity of 100% (95% CI 90%-100%) and a specificity of 99.1% (95.1%-99.9%). The overall diagnostic accuracy was 99.3% (96.3%-99.9%). This study validates the excellent performance of the GenXpert instrument to assess HCV RNA in capillary whole blood by finger prick in a PWID cohort.
Collapse
Affiliation(s)
- Rob Bielen
- Faculty of medicine and life sciences, Hasselt University, Hasselt, Belgium.,Department of gastroenterology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Özgür M Koc
- Faculty of medicine and life sciences, Hasselt University, Hasselt, Belgium.,Department of gastroenterology, Ziekenhuis Oost-Limburg, Genk, Belgium.,Medical Microbiology, School of NUTRIM, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Dana Busschots
- Faculty of medicine and life sciences, Hasselt University, Hasselt, Belgium.,Department of gastroenterology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Rita Verrando
- Centre for Alcohol and other Drugs (CAD) Limburg, Hasselt, Belgium
| | - Frederik Nevens
- Department of gastroenterology and hepatology, University Hospitals KULeuven, Leuven, Belgium
| | - Geert Robaeys
- Faculty of medicine and life sciences, Hasselt University, Hasselt, Belgium.,Department of gastroenterology, Ziekenhuis Oost-Limburg, Genk, Belgium.,Department of gastroenterology and hepatology, University Hospitals KULeuven, Leuven, Belgium
| |
Collapse
|
50
|
Bundling Rapid Human Immunodeficiency Virus and Hepatitis C Virus Testing to Increase Receipt of Test Results: A Randomized Trial. Med Care 2020; 58:445-452. [PMID: 32040038 DOI: 10.1097/mlr.0000000000001311] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND The overlapping human immunodeficiency virus (HIV) and hepatitis C virus (HCV) epidemics disproportionately affect people with substance use disorders. However, many people who use substances remain unaware of their infection(s). OBJECTIVE The objective of this study was to examine the efficacy of an on-site bundled rapid HIV and HCV testing strategy in increasing receipt of both HIV and HCV test results. RESEARCH DESIGN Two-armed randomized controlled trial in substance use disorder treatment programs (SUDTP) in New York City. Participants in the treatment arm were offered bundled rapid HIV and HCV tests with immediate results on-site. Participants in the control arm were offered the standard of care, that is, referrals to on-site or off-site laboratory-based HIV and HCV testing with delayed results. PARTICIPANTS A total of 162 clients with unknown or negative HIV and HCV status. MEASURES The primary outcome was the percentage of participants with self-reported receipt of HIV and HCV test results at 1-month postrandomization. RESULTS Over half of participants were Hispanic (51.2%), with 25.3% being non-Hispanic black and 17.9% non-Hispanic white. Two thirds were male, and 54.9% reported injection as method of drug use. One hundred thirty-four participants (82.7%) completed the 1-month assessment. Participants in the treatment arm were more likely to report having received both test results than those in the control arm (69% vs. 19%, P<0.001). Seven participants in the treatment arm received a preliminary new HCV diagnosis, versus 1 in the control arm (P=0.029). CONCLUSION Offering bundled rapid HIV and HCV testing with immediate results on-site in SUDTPs may increase awareness of HIV and HCV infection among people with substance use disorders.
Collapse
|