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Ho N, Vandyk A, Horvath C, Magboo Cahill T, O'Byrne P. The experiences of people who use injection drugs with accessing hepatitis c testing and diagnosis in western countries: A scoping review. Public Health Nurs 2024; 41:37-56. [PMID: 37712447 DOI: 10.1111/phn.13254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 07/28/2023] [Accepted: 08/29/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND The purpose of this scoping review was to summarize the literature that reported on the experiences of people who use injection drugs' access to hepatitis C testing and diagnosis in Western countries. METHODS The initial search was conducted in 2020 and an updated review was completed in 2022. Seven electronic databases were searched using a peer-reviewed search strategy and included: full-text, peer-reviewed studies with people who inject(ed) drugs, hepatitis C testing or diagnosis, conducted in Western countries. Excluded were studies published prior to 2014 and intervention studies. Two-step screening was conducted in duplicate. Conventional content analysis was used. RESULTS Six studies were found from the search. The studies were published between 2014 and 2021 in Australia, United Kingdom, and United States. A total of 19 participant characteristics were extracted to contextualize their experiences, demonstrating a lack of demographic data. Four themes were found: Awareness and Knowledge, Stigma, Healthcare Service, and Psychological Responses. There were 58 occurrences of client quotes where participants described their experiences, 29 occurrences of quotes describing client-identified barriers, and 14 occurrences of quotes describing client-identified facilitators. CONCLUSION A scoping review was conducted to present the experiences, barriers, and facilitators of people who use injection drugs to hepatitis C testing. The lack of demographic data and connection to client quotes further exacerbates the inequities among the population by overlooking their intragroup identities. Understanding their experiences of accessing hepatitis C testing and collecting demographic data will help advance health policies and interventions targeting people who use injection drugs.
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Affiliation(s)
- Nikki Ho
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Amanda Vandyk
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Cynthia Horvath
- Ottawa Public Health, Health Protection Service, Ottawa, Ontario, Canada
| | - Taliesin Magboo Cahill
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Patrick O'Byrne
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Public Health, Health Protection Service, Ottawa, Ontario, Canada
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Bitnun A, Sauvé L, Fanella S. Reducing perinatal infection risk in newborns of mothers who received inadequate prenatal care. Paediatr Child Health 2023; 28:307-323. [PMID: 37484040 PMCID: PMC10362956 DOI: 10.1093/pch/pxad014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 11/23/2022] [Indexed: 07/25/2023] Open
Abstract
Inadequate prenatal care increases risk for maternal infections going undetected and untreated, putting both the mother's health and that of her infant at risk. When pregnant women present late to care, routine testing that impacts infant management should include: hepatitis B surface antigen (HBsAg); serology for hepatitis C virus (HCV), human immunodeficiency virus (HIV), and syphilis; and testing for Chlamydia trachomatis and Neisseria gonorrhoeae. If the mother was not tested before or after delivery and is not available for testing, the infant should undergo testing for HIV, HBV, HCV, and syphilis. Testing for C. trachomatis and N. gonorrhoeae should be undertaken if the infant develops compatible clinical manifestations. Rapid turnaround of test results for HIV, HBV, and syphilis is optimal because preventive treatment decisions are time-sensitive. Early and effective preventive interventions are available for newborns at risk for HIV, HBV, syphilis, or gonorrhea. Close clinical follow-up and follow-up testing of infants born to mothers with inadequate prenatal care are warranted, as not all infections can be fully excluded perinatally.
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Affiliation(s)
- Ari Bitnun
- Canadian Paediatric Society, Infectious Diseases and Immunization Committee, Ottawa, Ontario, Canada
| | - Laura Sauvé
- Canadian Paediatric Society, Infectious Diseases and Immunization Committee, Ottawa, Ontario, Canada
| | - Sergio Fanella
- Canadian Paediatric Society, Infectious Diseases and Immunization Committee, Ottawa, Ontario, Canada
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Bitnun A, Sauvé L, Fanella S. La réduction du risque d'infection périnatale chez les nouveau-nés de mères dont les soins prénatals étaient inappropriés. Paediatr Child Health 2023; 28:307-323. [PMID: 37484035 PMCID: PMC10362960 DOI: 10.1093/pch/pxad015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 11/23/2022] [Indexed: 07/25/2023] Open
Abstract
Le risque que des infections maternelles ne soient ni décelées ni traitées augmente lorsque les soins prénatals sont inappropriés, ce qui met la santé de la mère et de son nouveau-né à risque. Lorsqu'une femme enceinte se présente tardivement pour recevoir des soins, les tests systématiques qui influent sur la prise en charge du nouveau-né devraient inclure l'antigène de surface de l'hépatite B (AgHBs), la sérologie du virus de l'hépatite C (VHC), du virus de l'immunodéficience humaine (VIH) et de la syphilis, de même que le dépistage de la Chlamydia trachomatis et de la Neisseria gonorrhoeae. Si la mère ne s'est pas soumise aux dépistages avant ou après l'accouchement et qu'elle n'est pas disponible pour s'y soumettre, il faudrait procéder au dépistage du VIH, du virus de l'hépatite B (VHB), du VHC et de la syphilis chez le nouveau-né. Le dépistage de la C. trachomatis et de la N. gonorrhoeae est toutefois réservé aux cas où le nouveau-né démontre des manifestations cliniques compatibles avec ces infections. Il est optimal d'obtenir rapidement les résultats du dépistage du VIH, du VHB et de la syphilis, car l'utilisation des traitements préventifs est circonscrite dans le temps. Il existe des interventions préventives précoces et efficaces pour les nouveau-nés à risque de VIH, de VHB, de syphilis ou de gonorrhée. Un suivi clinique étroit et des tests de suivi s'imposent auprès des nouveau-nés de mères dont les soins prénatals étaient inappropriés, car il est impossible d'exclure pleinement toutes les infections pendant la période périnatale.
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Affiliation(s)
- Ari Bitnun
- Société canadienne de pédiatrie, comité des maladies infectieuses et d'immunisation, Ottawa (Ontario)Canada
| | - Laura Sauvé
- Société canadienne de pédiatrie, comité des maladies infectieuses et d'immunisation, Ottawa (Ontario)Canada
| | - Sergio Fanella
- Société canadienne de pédiatrie, comité des maladies infectieuses et d'immunisation, Ottawa (Ontario)Canada
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Brahmania M, Biondi MJ, Joshi S, Lee E, Jung HM, Kehar M. Priority actions for elevating liver health in Canada: A call to action. CANADIAN LIVER JOURNAL 2023; 6:283-290. [PMID: 37503516 PMCID: PMC10370728 DOI: 10.3138/canlivj-2022-0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 11/20/2022] [Indexed: 07/29/2023]
Abstract
Chronic liver disease (CLD) has become a silent epidemic in our country and has resulted in significant physical, psychosocial, and financial burden. Although other international liver associations have published frameworks for the principal actions required to improve liver health across health systems, Canada does not have a strategy to address the growing concerns of CLD. Thus, a multidisciplinary group of care providers involved in CLD management in Canada gathered to review the current burden of disease, gaps in management, and key opportunities for improving the identification and management of people at risk of developing progressive CLD.
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Affiliation(s)
- Mayur Brahmania
- Foothills Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Mia J Biondi
- School of Nursing, York University, Toronto, Ontario, Canada
- Viral Hepatitis Care Network (VIRCAN) Study Group, Toronto Centre for Liver Disease, Toronto, Ontario, Canada
| | - Supriya Joshi
- Credit Valley Hospital, Trillium Health Partners, Toronto, Ontario, Canada
| | - Elizabeth Lee
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | | | - Mohit Kehar
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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Lettner B, Mason K, Greenwald ZR, Broad J, Mandel E, Feld JJ, Powis J. Rapid hepatitis C virus point-of-care RNA testing and treatment at an integrated supervised consumption service in Toronto, Canada: a prospective, observational cohort study. LANCET REGIONAL HEALTH. AMERICAS 2023; 22:100490. [PMID: 37388709 PMCID: PMC10300568 DOI: 10.1016/j.lana.2023.100490] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 07/01/2023]
Abstract
Background Despite high burden of Hepatitis C (HCV) among people who inject drugs, significant barriers to care persist. The aim of this study was to evaluate the provision of rapid, low-barrier point-of-care (POC) HCV RNA testing and linkage to care among clients of a supervised consumption service (SCS) located within a community health centre in Toronto, Canada. Secondary aims included measuring HCV RNA prevalence at baseline, HCV incidence during follow-up and exploring factors associated with HCV RNA positivity and treatment uptake. Methods Participants were enrolled in a prospective, observational cohort from August 13, 2018 to September 30, 2021. Those with positive HCV RNA tests were offered immediate referral to onsite treatment. Those with negative results were offered repeat testing every three months for up to four visits. HCV incidence was estimated as the number of incident HCV infections per 100 person-years at risk, among those HCV RNA negative at baseline who returned for ≥1 follow-up visit. Missing data were reported when present. Findings 128 participants were enrolled with four later removed due to ineligibility. At baseline, 54 of 124 eligible participants (43.5%) tested HCV RNA positive. HCV incidence was 35.1 cases per 100 person-years (95% CI: 18.9-65.3) with a cumulative incidence of 38.3% at 15 months of follow-up. Among participants HCV RNA positive at baseline or follow-up (n = 64), 67.2% (n = 43) were linked to HCV care and treatment was initiated among 67.4% (n = 29/43). Interpretation High HCV RNA prevalence and incidence demonstrate that the SCS serves a high-risk population for HCV. Testing acceptance was high, as was treatment engagement. POC HCV RNA testing positions SCSs as an important point of HCV care access. Funding HCV Micro-Elimination Grant, Gilead Sciences Canada; in-kind support from Cepheid.
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Affiliation(s)
- Bernadette Lettner
- South Riverdale Community Health Centre, 955 Queen St E, Toronto, ON, M4M 3P3, Canada
| | - Kate Mason
- South Riverdale Community Health Centre, 955 Queen St E, Toronto, ON, M4M 3P3, Canada
| | - Zoë R. Greenwald
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON M5T 3M7, Canada
- Centre on Drug Policy Evaluation, MAP Centre for Urban Health Solutions, St. Michael's Hospital, 30 Bond Street, Toronto, ON M5B 1X1, Canada
| | - Jennifer Broad
- South Riverdale Community Health Centre, 955 Queen St E, Toronto, ON, M4M 3P3, Canada
| | - Erin Mandel
- Toronto Centre for Liver Disease, Toronto General Hospital, 200 Elizabeth St, Toronto, ON, M5G 2C4, Canada
| | - Jordan J. Feld
- Toronto Centre for Liver Disease, Toronto General Hospital, 200 Elizabeth St, Toronto, ON, M5G 2C4, Canada
| | - Jeff Powis
- Michael Garron Hospital, 825 Coxwell Ave, Toronto, ON, M4C 3E7, Canada
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6
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Enns B, Krebs E, Whitehurst DGT, Jutras-Aswad D, Le Foll B, Socias ME, Nosyk B. Cost-effectiveness of flexible take-home buprenorphine-naloxone versus methadone for treatment of prescription-type opioid use disorder. Drug Alcohol Depend 2023; 247:109893. [PMID: 37120920 DOI: 10.1016/j.drugalcdep.2023.109893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 03/21/2023] [Accepted: 04/19/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND Our objective was to examine the cost-effectiveness of flexible take-home buprenorphine-naloxone (BNX) versus methadone alongside the OPTIMA trial in Canada. METHODS The OPTIMA study was a pragmatic, open-label, noninferiority, two-arm randomized controlled trial, to assess the comparative effectiveness of flexible take-home BNX vs. methadone in routine clinical care for individuals with prescription-type opioid use disorder. We evaluated cost-effectiveness using a semi-Markov cohort model. Probabilities of overdose were calibrated, accounting for fentanyl prevalence and other overdose risk factors such as naloxone availability. We considered health sector and societal cost perspectives, including costs (2020 CAD) for treatment, health resource use, criminal activity, and health state-specific preference weights as outcomes to calculate incremental cost-effectiveness ratios. Six-month and lifetime (3% annual discount rate) time-horizons were explored. RESULTS Over a lifetime time horizon, individuals accumulated -0.144 [CI: -0.302, -0.025] incremental quality-adjusted life years (QALYs) in BNX compared with methadone. Incremental costs were -$2047 [CI: -$39,197, $24,250] from a societal perspective, and -$4549 [CI: -$6332, -$3001] from a health sector perspective. Over a six-month time-horizon, individuals accumulated 0.002 [credible interval (CI): -0.011, 0.016] incremental QALYs in BNX compared with methadone. Incremental costs were -$307 [CI: -$10,385, $8466] from a societal perspective and -$1111 [CI: -$1517, -$631] from a health sector perspective. BNX was dominated (costlier, less effective) in 49.7% of simulations when adopting a societal perspective over a lifetime time horizon. CONCLUSIONS Flexible take-home BNX was not cost-effective versus methadone over a lifetime time horizon, resulting from better treatment retention in methadone compared to BNX.
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Affiliation(s)
- Benjamin Enns
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
| | - Emanuel Krebs
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - David G T Whitehurst
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Didier Jutras-Aswad
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montréal, QuébecH2X 0A9, Canada; Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, 2900 boul. Edouard-Montpetit, Montréal, QuébecH3T1J4, Canada
| | - Bernard Le Foll
- Department of Pharmacology and Toxicology, Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, OntarioM5S 1A8, Canada; Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, 250 College Street, 8th floor, Toronto, OntarioM5T 1R8, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, OntarioM5T 3M7, Canada; Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, OntarioM5S 2S1, Canada; Acute Care Program, CAMH, 33 Ursula Franklin Street, Toronto, OntarioM5S 2S1, Canada
| | - M Eugenia Socias
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British ColumbiaV6Z 2A9, Canada; Department of Medicine, Faculty of Medicine, University of British Columbia, 1045 Howe Street, Vancouver, British ColumbiaV6Z 2A9, Canada
| | - Bohdan Nosyk
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.
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Saeed YA, Mason K, Mitsakakis N, Feld JJ, Bremner KE, Phoon A, Fried A, Wong JF, Powis J, Krahn MD, Wong WW. Disparities in health utilities among hepatitis C patients receiving care in different settings. CANADIAN LIVER JOURNAL 2023; 6:24-38. [PMID: 36908577 PMCID: PMC9997513 DOI: 10.3138/canlivj-2022-0009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/03/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND: Although chronic hepatitis C (CHC) disproportionately affects marginalized individuals, most health utility studies are conducted in hospital settings which are difficult for marginalized patients to access. We compared health utilities in CHC patients receiving care at hospital-based clinics and socio-economically marginalized CHC patients receiving care through a community-based program. METHODS: We recruited CHC patients from hospital-based clinics at the University Health Network and community-based sites of the Toronto Community Hep C Program, which provides treatment, support, and education to patients who have difficulty accessing mainstream health care. We elicited utilities using six standardized instruments (EuroQol-5D-3L [EQ-5D], Health Utilities Index Mark 2/Mark 3 [HUI2/HUI3], Short Form-6D [SF-6D], time trade-off [TTO], and Visual Analogue Scale [VAS]). Multivariable regression analysis was performed to examine factors associated with differences in health utility. RESULTS: Compared with patients recruited from the hospital setting (n = 190), patients recruited from the community setting (n = 101) had higher unemployment (87% versus 67%), history of injection drug use (88% versus 42%), and history of mental health issue(s) (79% versus 46%). Unadjusted health utilities were lower in community than hospital patients (e.g., EQ-5D: 0.722 [SD 0.209] versus 0.806 [SD 0.195]). Unemployment and a history of mental health issue(s) were significant predictors of low health utility. CONCLUSIONS: Socio-economically marginalized CHC patients have lower health utilities than patients typically represented in the CHC utility literature. Their utilities should be incorporated into future cost-utility analyses to better represent the population living with CHC in health policy decisions.
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Affiliation(s)
- Yasmin A Saeed
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.,Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
| | - Kate Mason
- Toronto Community Hep C Program (TCHCP), Toronto, Ontario, Canada
| | - Nicholas Mitsakakis
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Jordan J Feld
- Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada
| | - Karen E Bremner
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
| | - Arcturus Phoon
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
| | - Alice Fried
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
| | - Josephine F Wong
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
| | - Jeff Powis
- Toronto Community Hep C Program (TCHCP), Toronto, Ontario, Canada.,Michael Garron Hospital, Toronto, Ontario, Canada
| | - Murray D Krahn
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.,Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada.,Deceased 01 07 22
| | - William Wl Wong
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.,Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada.,School of Pharmacy, University of Waterloo, Kitchener, Ontario, Canada
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Landy R, Atkinson D, Ogilvie K, St. Denys R, Lund C, Worthington C. Assessing the acceptability of dried blood spot testing for HIV and STBBI among Métis people in a community driven pilot project in Alberta, Canada. BMC Health Serv Res 2022; 22:1496. [PMID: 36482470 PMCID: PMC9733141 DOI: 10.1186/s12913-022-08763-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/31/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Little literature exists on culturally grounded approaches for addressing human immunodeficiency virus (HIV) and sexually transmitted and blood-borne infections (STBBI) among Métis people. The goal of this mixed-methods research was to explore the experiences of Métis community members participating in a dried blood spot testing (DBST) for HIV/STBBI pilot for Métis communities in Alberta, Canada, with the aim of assessing the acceptability of this testing method. METHODS Grounded in community-based and Indigenous research approaches and working in partnership with a Métis community-based organization, data collection included a survey and four gathering circles with Métis DBST recipients at one of two community events, and semi-structured interviews with three DBST providers. RESULTS Twenty-six of the 30 DBST recipients completed surveys, and 19 DBST recipients participated in gathering circles. Survey results suggest DBST is a highly acceptable STBBI testing method to Métis community members. Thematic analysis of gathering circle and interview transcripts revealed four broad themes related to the participants' experiences with DBST related to its acceptability (i. ease of DBST process, ii. overcoming logistical challenges associated with existing STBBI testing, iii. Reducing stigma through health role models and event-based, and iv. Métis-specific services). CONCLUSIONS These findings illustrate the potential for DBST to be part of a culturally grounded, Métis-specific response to HIV and STBBI.
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Affiliation(s)
- Rachel Landy
- grid.143640.40000 0004 1936 9465School of Public Health and Social Policy, HSD Building, Room B202, University of Victoria, PO Box 1700 STN CSC, Victoria, BC V8W 2Y2 Canada
| | - Danielle Atkinson
- grid.143640.40000 0004 1936 9465School of Public Health and Social Policy, HSD Building, Room B202, University of Victoria, PO Box 1700 STN CSC, Victoria, BC V8W 2Y2 Canada
| | - Kandace Ogilvie
- Shining Mountains Living Community Services, 4925 46 St, Red Deer, AB T4N 1N2 Canada
| | - Raye St. Denys
- Shining Mountains Living Community Services, 4925 46 St, Red Deer, AB T4N 1N2 Canada
| | - Carrielynn Lund
- Communities, Alliances and Networks, PO Box 2978, Fort Qu’Appelle, SK S0G1S0 Canada
| | - Catherine Worthington
- grid.143640.40000 0004 1936 9465School of Public Health and Social Policy, HSD Building, Room B202, University of Victoria, PO Box 1700 STN CSC, Victoria, BC V8W 2Y2 Canada
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Popovic N, Williams A, Périnet S, Campeau L, Yang Q, Zhang F, Yan P, Feld J, Janjua N, Klein M, Krajden M, Wong W, Cox J. National Hepatitis C estimates: Incidence, prevalence, undiagnosed proportion and treatment, Canada, 2019. CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2022; 48:540-549. [PMID: 38222827 PMCID: PMC10786238 DOI: 10.14745/ccdr.v48i1112a07] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Estimates of the number of hepatitis C virus (HCV) infections are important for monitoring efforts aimed at preventing disease transmission, especially following the introduction of a highly effective treatment. This report provides updated estimates of HCV incidence, prevalence, undiagnosed proportion and treatment in Canada. Methods A combination of back calculation modelling and a modified version of the workbook method were used to estimate the incidence and prevalence of anti-HCV positive persons, the prevalence of chronic HCV infection and the undiagnosed proportion. The number of people treated for chronic HCV was estimated using administrative pharmaceutical data. Results An estimated 9,470 new infections occurred in 2019, corresponding to an incidence rate of 25 per 100,000 population, a 7.7% decrease since 2015. The estimated prevalence of anti-HCV antibodies in the Canadian population was 1.03% (plausible range: 0.83%-1.38%), and the estimated prevalence of chronic HCV was 0.54% (plausible range: 0.40%-0.79%). The overall proportion of anti-HCV positive persons who were undiagnosed was estimated at 24% of all infections, with individuals born between 1945 and 1975 being the priority population the most likely to be undiagnosed. An estimated 74,500 people with chronic HCV have been treated since the introduction of direct-acting antivirals in 2014. Conclusion Estimates of HCV incidence and prevalence are key metrics to guide interventions and resource allocation. While our estimates show that HCV incidence has decreased in Canada in recent years and treatment of chronic HCV has continued to increase, ongoing efforts are required to reduce the burden of HCV in Canada.
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Affiliation(s)
- Nashira Popovic
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON
| | - Anson Williams
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON
| | - Simone Périnet
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON
| | - Laurence Campeau
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON
| | - Qiuying Yang
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON
| | - Fan Zhang
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON
| | - Ping Yan
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON
| | - Jordan Feld
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, ON
| | - Naveed Janjua
- British Columbia Centre for Disease Control, Vancouver, BC
| | - Marina Klein
- Department of Medicine, McGill University Health Center, Montréal, QC
| | - Mel Krajden
- British Columbia Centre for Disease Control, Vancouver, BC
| | - William Wong
- School of Pharmacy, University of Waterloo, Kitchener, ON
| | - Joseph Cox
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON
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10
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Identifying barriers and enablers to opt-out hepatitis C virus screening in provincial prisons in Quebec, Canada: A multilevel, multi-theory informed qualitative study with correctional and healthcare professional stakeholders. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 109:103837. [PMID: 36030569 DOI: 10.1016/j.drugpo.2022.103837] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 08/10/2022] [Accepted: 08/12/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Diffuse implementation of hepatitis C virus (HCV) treatment is dependent on universal screening for HCV, but screening strategies are heterogenous across prisons in the province of Quebec (Canada). We sought to identify barriers and enablers to universal opt-out HCV screening and to describe the multisectoral decision-making processes related to HCV screening in Quebec provincial prisons. METHODS A multilevel, multi-theory informed qualitative descriptive approach was used to conduct semi-structured interviews. Interview guides and analyses with correctional stakeholders were informed by the Consolidated Framework for Implementation Research (CFIR) and those with healthcare professionals (HCPs) were based on the Theoretical Domains Framework (TDF). Directed content analysis was used to identify domains within CFIR and TDF reflecting barriers and enablers to opt-out HCV screening. RESULTS Sixteen interviews (correctional stakeholders: n = 8; HCPs: n = 8) were conducted in April-May 2021. Twelve CFIR constructs were identified as barriers, seven as enablers, and two as neutral factors for the implementation of opt-out HCV screening. Correctional stakeholders underscored the need for political will (construct: external policy and incentives), highlighted limited resources (construct: available resources), and expressed concerns for the lack of consideration of implementation issues (constructs: trialability, planning). Six TDF domains were identified among HCPs as relevant to the implementation of opt-out HCV screening: beliefs about consequences (mixed = enablers and barriers), environmental context and resources (barrier), social influences (barrier), optimism (mixed), emotions (mixed), and behavioural regulation (barrier). The decision-making processes vis-à-vis HCV care in Quebec correctional settings were found to be hierarchical and complex. CONCLUSIONS The use of CFIR and TDF was helpful in identifying barriers and enablers to HCV screening at multiple levels for people incarcerated in Quebec provincial prisons. Going forward, several political, structural, and organizational factors should be addressed through the engagement of stakeholders and people with lived experience of incarceration.
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Biondi MJ, Hirode G, Capraru C, Vanderhoff A, Karkada J, Wolfson-Stofko B, Smookler D, Friedman SM, Bates K, Mazzulli T, Juan JV, Shah H, Hansen BE, Feld JJ, Janssen HLA. Birth cohort hepatitis C antibody prevalence in real-world screening settings in Ontario. CANADIAN LIVER JOURNAL 2022; 5:362-371. [PMID: 36133900 PMCID: PMC9473558 DOI: 10.3138/canlivj-2021-0036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/11/2021] [Indexed: 07/29/2023]
Abstract
BACKGROUND Widespread screening and treatment of hepatitis C virus (HCV) is required to decrease late-stage liver disease and liver cancer. Clinical practice guidelines and Canadian Task Force on Preventative Health Care recommendations differ on the value of one-time birth cohort (1945-75) HCV screening in Canada. To assess the utility of this approach, we conducted a real-world analysis of HCV antibody (Ab) prevalence among birth cohort individuals seen in different clinical contexts. METHODS Cross-sectional study of individuals born between 1945 and 1975 who completed HCV Ab testing at multiple participating centres in Ontario, Canada between January 2016 and December 2020. Differences in prevalence were compared by year of birth, gender, and setting. RESULTS Among 16,672 birth cohort individuals tested, HCV Ab prevalence was 3.2%. Prevalence was higher among younger individuals which increased from 0.9% among those born between 1945 and 1956 to 4.6% among those born between 1966 and 1975. Prevalence was higher among males (4.4%) compared with females (2.0%) and differed by test site. In primary care, the prevalence was 0.5%, whereas the prevalence was highest among those tested at drug treatment centres (28.7%) and through community outreach (14.0%). CONCLUSIONS HCV Ab prevalence remains high in the 1945-1975 birth cohort. These data highlight the need to re-evaluate existing Canadian Preventative Task Force recommendations, to consider incorporating one-time birth cohort and/or other population-based approaches to HCV screening into the clinical workflow as a preventative health measure, and to increase training among community providers to screen for and treat HCV.
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Affiliation(s)
- Mia J Biondi
- These first authors contributed equally to this work
- Toronto Centre for Liver Disease/Viral Hepatitis Care Network (VIRCAN), University Health Network, Toronto, Ontario, Canada
| | - Grishma Hirode
- These first authors contributed equally to this work
- Toronto Centre for Liver Disease/Viral Hepatitis Care Network (VIRCAN), University Health Network, Toronto, Ontario, Canada
| | - Camelia Capraru
- Toronto Centre for Liver Disease/Viral Hepatitis Care Network (VIRCAN), University Health Network, Toronto, Ontario, Canada
| | - Aaron Vanderhoff
- Toronto Centre for Liver Disease/Viral Hepatitis Care Network (VIRCAN), University Health Network, Toronto, Ontario, Canada
| | - Joel Karkada
- Toronto Centre for Liver Disease/Viral Hepatitis Care Network (VIRCAN), University Health Network, Toronto, Ontario, Canada
| | - Brett Wolfson-Stofko
- Toronto Centre for Liver Disease/Viral Hepatitis Care Network (VIRCAN), University Health Network, Toronto, Ontario, Canada
| | - David Smookler
- Toronto Centre for Liver Disease/Viral Hepatitis Care Network (VIRCAN), University Health Network, Toronto, Ontario, Canada
| | - Steven M Friedman
- Department of Emergency Medicine, University Health Network, Toronto, Ontario, Canada
| | - Kathy Bates
- Emergency Department, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Tony Mazzulli
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Department of Microbiology, University Health Network/Sinai Health System, Toronto, Ontario, Canada
| | | | - Hemant Shah
- Toronto Centre for Liver Disease/Viral Hepatitis Care Network (VIRCAN), University Health Network, Toronto, Ontario, Canada
| | - Bettina E Hansen
- Toronto Centre for Liver Disease/Viral Hepatitis Care Network (VIRCAN), University Health Network, Toronto, Ontario, Canada
| | - Jordan J Feld
- These senior authors contributed equally to this work
- Toronto Centre for Liver Disease/Viral Hepatitis Care Network (VIRCAN), University Health Network, Toronto, Ontario, Canada
| | - Harry LA Janssen
- These senior authors contributed equally to this work
- Toronto Centre for Liver Disease/Viral Hepatitis Care Network (VIRCAN), University Health Network, Toronto, Ontario, Canada
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12
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Pedersen J, Moukandja IP, Ndidi S, Sørensen AL, Koumakpayi IH, Lekana-Douki JB, Vachon ML, Weis N, Kobinger G, Fausther-Bovendo H. An adaptable platform for in-house hepatitis C serology. J Virol Methods 2022; 308:114586. [PMID: 35850366 DOI: 10.1016/j.jviromet.2022.114586] [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: 03/14/2022] [Revised: 06/16/2022] [Accepted: 07/14/2022] [Indexed: 12/09/2022]
Abstract
Serology-based diagnosis remains one of the major tools for diagnosis and surveillance of infectious diseases. However, for many neglected diseases no or only few commercial assays are available and often with prices prohibiting large scale testing in low and middle-income countries (LMICs). We developed an adaptable enzyme-linked immunoassay (ELISA) using hepatitis C virus (HCV) as a proof-of-concept application. By combining the maltose-binding-protein with a multiepitope HCV protein, we were able to obtain a high concentration of protein suitable for downstream applications. Following optimization, the assay was verified using previously tested human samples from Canada, Denmark and Gabon in parallel with the use of a commercial protein. Sensitivity and specificity were calculated to 98 % and 97 % respectively, after accounting for non-specific binding and assay optimization. This study provides a thorough description of the development, and validation of a multiepitope ELISA-based diagnostic assay against HCV, which could be implemented at low cost. The described methodology can be readily adapted to develop novel ELISA-based diagnostic assays for other infectious pathogens with well-described immunogenic epitopes. This method could improve the diagnosis of neglected diseases for which affordable diagnostic assays are lacking.
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Affiliation(s)
- Jannie Pedersen
- Département de Microbiologie-Infectiologie et Immunologie, Faculté de Médecine, Université Laval, Québec, Canada
| | | | - Stella Ndidi
- Centre Hospitalier Universitaire de Libreville, Libreville BP2228, Gabon
| | - Anna-Louise Sørensen
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Jean-Bernard Lekana-Douki
- Unité d'Evolution Epidémiologie et Résistances Parasitaires, Centre Interdisciplinaire de Recherches Médicales de Franceville, Franceville, Gabon
| | - Marie-Louise Vachon
- Axe des Maladies Infectieuses et Immunitaires, Centre de Recherche du Centre Hospitalier Universitaire de Québec-Université Laval, Québec G1V 4G2, Canada
| | - Nina Weis
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Gary Kobinger
- Galveston National Laboratory, Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, USA
| | - Hugues Fausther-Bovendo
- Département de Microbiologie-Infectiologie et Immunologie, Faculté de Médecine, Université Laval, Québec, Canada; Global Urgent and Advanced Research and Development - GUARD, 911 Rue Principale, unit 100, Batiscan, Quebec G0X 1A0, Canada.
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13
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Young J, Ablona A, Klassen BJ, Higgins R, Kim J, Lavoie S, Knight R, Lachowsky NJ. Implementing community-based Dried Blood Spot (DBS) testing for HIV and hepatitis C: a qualitative analysis of key facilitators and ongoing challenges. BMC Public Health 2022; 22:1085. [PMID: 35642034 PMCID: PMC9158154 DOI: 10.1186/s12889-022-13525-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 05/23/2022] [Indexed: 11/10/2022] Open
Abstract
Background In 2018, the Community-Based Research Centre (CBRC) invited gay, bisexual, trans, queer men and Two-Spirit and non-binary people (GBT2Q) at Pride Festivals across Canada to complete in-person Sex Now surveys and provide optional dried blood spot (DBS) samples screening for human immunodeficiency virus (HIV) and hepatitis C virus (HCV). As there is a lack of research evaluating the implementation of DBS sampling for GBT2Q in community settings, we aimed to evaluate this intervention, identifying key facilitators and ongoing challenges to implementing community-based DBS screening for HIV/HCV among GBT2Q. Methods We conducted sixteen one-on-one interviews with individuals involved with the community-based DBS collection protocol, including research staff, site coordinators, and volunteer DBS collectors. Most individuals involved with DBS collection were “peers” (GBT2Q-identified). The Consolidated Framework for Implementation Research (CFIR) guided our data collection and analysis. Results Interviewees felt that DBS collection was a low-barrier, cost-effective, and simple way for peers to quickly screen a large number of Sex Now respondents. Interviewees also noted that the community and peer-based aspects of the research helped drive recruitment of Sex Now respondents. Most interviewees felt that the provision of results took too long, and that some Sex Now respondents would have preferred to receive their test results immediately (e.g., rapid or point-of-care testing). Conclusion Peer-based DBS sampling can be an effective and relatively simple way to screen GBT2Q at Pride Festivals for more than one sexually transmitted and blood borne infection. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13525-x.
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Affiliation(s)
- James Young
- Community-Based Research Centre, 1007-808 Nelson Street, Vancouver, BC, V6Z 2H2, Canada.,Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Aidan Ablona
- Community-Based Research Centre, 1007-808 Nelson Street, Vancouver, BC, V6Z 2H2, Canada
| | - Benjamin J Klassen
- Community-Based Research Centre, 1007-808 Nelson Street, Vancouver, BC, V6Z 2H2, Canada
| | - Rob Higgins
- Community-Based Research Centre, 1007-808 Nelson Street, Vancouver, BC, V6Z 2H2, Canada.,School of Public Health and Social Policy, University of Victoria, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada
| | - John Kim
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 Arlington Street, Winnipeg, MB, R3E 3R2, Canada
| | - Stephanie Lavoie
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 Arlington Street, Winnipeg, MB, R3E 3R2, Canada
| | - Rod Knight
- British Columbia Centre On Substance Use, Providence Health Care, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.,Department of Medicine, Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Nathan J Lachowsky
- Community-Based Research Centre, 1007-808 Nelson Street, Vancouver, BC, V6Z 2H2, Canada. .,School of Public Health and Social Policy, University of Victoria, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada.
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14
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Dunn KPR, Williams KP, Egan CE, Potestio ML, Lee SS. ECHO+: Improving access to hepatitis C care within Indigenous communities in Alberta, Canada. CANADIAN LIVER JOURNAL 2022; 5:113-123. [PMID: 35991479 PMCID: PMC9236587 DOI: 10.3138/canlivj-2021-0027] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 09/15/2021] [Indexed: 07/29/2023]
Abstract
BACKGROUND Indigenous populations experience higher rates of hepatitis C virus (HCV) infections in Canada. The Extension for Community Health Outcomes+ (ECHO+) telehealth model was implemented in Alberta to support HCV screening and treatment, using Zoom technology to support Indigenous patient access to specialist care closer to home. Our goal was to expand this program to more Indigenous communities in Alberta, using various Indigenous-led or co-designed methods. METHODS The ECHO+ team implemented a Two-Eyed Seeing framework, incorporating Indigenous wholistic approaches alongside Western treatment. This approach works with principles of respect, reciprocity, and relationality. The ECHO+ team identified Indigenous-specific challenges, including access to liver specialist care, HCV awareness, stigma, barriers to screening and lack of culturally relevant approaches. RESULTS Access to HCV care via this program significantly increased HCV antiviral use in the past 5 years. Key lessons learned include Indigenous-led relationship building and development of project outputs in response to community needs influences impact and increases relevant changes increasing access to HCV care. Implementation of ECHO+ was carried out through biweekly telehealth sessions, problem solving in partnership with Indigenous communities, increased HCV awareness, and flexibility resulting from the impacts of COVID-19. CONCLUSION Improving Indigenous patient lives and reducing inequity requires supporting local primary health care providers to create and sustain integrated HCV prevention, diagnosis, treatment, and support services within a culturally safe and reciprocal model. ECHO+ uses telehealth and culturally appropriate methodology and interventions alongside multiple stakeholder collaborations to improve health outcomes for HCV.
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Affiliation(s)
- Kate PR Dunn
- Indigenous Wellness Core, Alberta Health Services, Calgary, Alberta, Canada
- These authors contributed equally and are co-first authors
| | - Kienan P Williams
- Indigenous Wellness Core, Alberta Health Services, Calgary, Alberta, Canada
- These authors contributed equally and are co-first authors
| | - Cari E Egan
- Indigenous Wellness Core, Alberta Health Services, Calgary, Alberta, Canada
| | - Melissa L Potestio
- Indigenous Wellness Core, Alberta Health Services, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Co-senior authors
| | - Samuel S Lee
- Liver Unit, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Co-senior authors
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15
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Lim J, Pavalagantharajah S, Verschoor CP, Lentz E, Loeb M, Levine M, Smieja M, Mbuagbaw L, Kalina D, Tarride JE, O’Shea T, Cvetkovic A, van Gaalen S, Findlater AR, Lennox R, Bassim C, Lokker C, Alvarez E. Infectious diseases, comorbidities and outcomes in hospitalized people who inject drugs (PWID). PLoS One 2022; 17:e0266663. [PMID: 35443003 PMCID: PMC9020696 DOI: 10.1371/journal.pone.0266663] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 03/24/2022] [Indexed: 11/19/2022] Open
Abstract
Injection drug use poses a public health challenge. Clinical experience indicates that people who inject drugs (PWID) are hospitalized frequently for infectious diseases, but little is known about outcomes when admitted. Charts were identified from local hospitals between 2013-2018 using consultation lists and hospital record searches. Included individuals injected drugs in the past six months and presented with infection. Charts were accessed using the hospital information system, undergoing primary and secondary reviews using Research Electronic Data Capture (REDCap). The Wilcoxon rank-sum test was used for comparisons between outcome categories. Categorical data were summarized as count and frequency, and compared using Fisher's exact test. Of 240 individuals, 33% were admitted to the intensive care unit, 36% underwent surgery, 12% left against medical advice (AMA), and 9% died. Infectious diagnoses included bacteremia (31%), abscess (29%), endocarditis (29%), cellulitis (20%), sepsis (10%), osteomyelitis (9%), septic arthritis (8%), pneumonia (7%), discitis (2%), meningitis/encephalitis (2%), or other (7%). Sixty-six percent had stable housing and 60% had a family physician. Fifty-four percent of patient-initiated discharges were seen in the emergency department within 30 days and 29% were readmitted. PWID are at risk for infections. Understanding their healthcare trajectory is essential to improve their care.
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Affiliation(s)
- Jacqueline Lim
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Eric Lentz
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Mark Loeb
- Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Mitchell Levine
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Marek Smieja
- Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Dale Kalina
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jean-Eric Tarride
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Ontario, Canada
| | - Tim O’Shea
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Anna Cvetkovic
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Sarah van Gaalen
- Department of Family Medicine, Queen’s University, Kingston, Ontario, Canada
| | | | - Robin Lennox
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Carol Bassim
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Cynthia Lokker
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Elizabeth Alvarez
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Ontario, Canada
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16
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Koo V, Tian F, Wong WWL. Cost-effectiveness analysis of hepatitis C virus (HCV) point-of-care assay for HCV screening. Liver Int 2022; 42:787-795. [PMID: 34847288 DOI: 10.1111/liv.15123] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 11/19/2021] [Accepted: 11/28/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND & AIMS Hepatitis C virus (HCV) continues to pose significant public health concerns with approximately 44% of chronically infected Canadians undiagnosed. The current HCV screening in Canada is a two-step diagnosis pathway consisting of anti-HCV testing and HCV ribonucleic acid (RNA) testing. The introduction of HCV point-of-care assays, such as the Xpert HCV viral load finger-stick assay, can facilitate HCV RNA diagnosis during a single visit and provide quick linkage to care. We evaluated the cost-effectiveness of HCV point-of-care testing compared with current HCV screening strategies for injection drug users (IDUs) from a Canadian provincial Ministry of Health perspective. METHODS A state-transition model based on published literature was developed to compare HCV point-of-care assay with the standard-of-care blood screening for a one-time HCV screening and treatment program. It adopted a lifetime time horizon and included health states related to treatment, fibrosis stages, and advanced liver disease clinical states. Outcomes were expressed in costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios. Sensitivity analyses were conducted to assess the robustness of the model. RESULTS HCV point-of-care assay generated an additional 0.035 QALYs/person at a cost reduction of $21.15 compared with the standard-of-care screening. The results were the most sensitive to the specificity of HCV point-of-care assay. CONCLUSIONS The implementation of HCV point-of-care screening in Canada is likely to be cost-saving for IDUs. Early detection and treatment of undiagnosed individuals can prolong people's life span and save healthcare costs associated with HCV-related complications.
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Affiliation(s)
- Vanessa Koo
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
| | - Feng Tian
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
| | - William W L Wong
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
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17
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Strobel S, Shanjer M, Faragalla K, Liu A(Y, Hossain R. A Population-Based Susceptible, Infected, Recovered Simulation Model of the Spread of Influenza-Like-Illness in the Homeless versus Non-Homeless Population. Ann Epidemiol 2022; 70:68-73. [DOI: 10.1016/j.annepidem.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 01/31/2022] [Accepted: 04/11/2022] [Indexed: 11/01/2022]
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18
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Yazdani K, Dolguikh K, Zhang W, Shayegi-Nik S, Ly J, Cooper S, Trigg J, Bartlett S, Barrios R, Montaner JSG, Salters K. Knowledge of hepatitis C and awareness of reinfection risk among people who successfully completed direct acting antiviral therapy. PLoS One 2022; 17:e0265811. [PMID: 35320316 PMCID: PMC8942206 DOI: 10.1371/journal.pone.0265811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/08/2022] [Indexed: 11/19/2022] Open
Abstract
Background Hepatitis C virus (HCV) education may be changing following the simplification of HCV treatment and emergence of direct acting antiviral (DAA). We aimed to characterize HCV knowledge among people who recently completed DAA therapy. Methods The Per-SVR (Preservation of Sustained Virologic Response) is a prospective cohort of patients who achieved a sustained virologic response upon successful completion of DAA therapy. The per-SVR study provided the sampling frame of participants who completed a psychometrically validated 19-item HCV knowledge scale at cohort entry (n = 227). To score the questionnaire, for each correct response one point was awarded, with no point for incorrect response. We assessed mean HCV knowledge score in the overall sample and mutually exclusive populations: people who inject drug (PWID) (n = 71); people with co-occurring HIV (n = 23); PWID and co-occurring HIV (n = 29), and others (n = 104) Using a latent class analysis based on distal outcome, we identified unobserved subgroups and assessed HCV knowledge amongst them. Results Total mean (SD) percent of correct responses were 83 (11) in the overall sample; 83 (10) in PWID; 79 (12) in people with co-occurring HIV; 81 (10) in PWID and co-occurring HIV, and 84 (11) in rest of the sample Three latent groups were identified: baby boomers who ever experienced homelessness (n = 126); women sex workers who ever experienced homelessness (n = 68); men who inject drug, ever experienced homelessness and had ever diagnosis of mental health disorders (n = 18). Mean percent of correct responses were 85 (8), 82 (11), 85 (10), in latent class 1, 2, and 3, respectively. Conclusion Patients successfully treated with DAAs had a high HCV knowledge. High knowledge and awareness of reinfection among complex patient groups often facing barriers to HCV care is encouraging and emphasizes the positive outcomes of universal access to treatment.
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Affiliation(s)
- Kiana Yazdani
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Katerina Dolguikh
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Wendy Zhang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Sara Shayegi-Nik
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Experimental Medicine Program, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Jessica Ly
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Shaughna Cooper
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Jason Trigg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Sophia Bartlett
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Rolando Barrios
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | | | - Kate Salters
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- * E-mail:
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19
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Petrosyan Y, Simmons JG, Kelly E, Cooper CL. Uptake and factors associated with direct-acting antiviral therapy for hepatitis C and treatment outcomes among Canadian immigrants: A retrospective cohort analysis. CANADIAN LIVER JOURNAL 2022; 5:388-401. [DOI: 10.3138/canlivj-2021-0037] [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: 11/03/2021] [Accepted: 01/15/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND: We sought to compare rates and factors associated with Direct Acting Antiviral (DAA) treatment uptake and sustained virological response (SVR) between Canadian-born and foreign-born patients. METHODS: The study was conducted utilizing a retrospective cohort of hepatitis C virus (HCV)-infected patients assessed at The Ottawa Hospital Viral Hepatitis Clinic between January 2015 and October 2021. Risk factors, income, and clinical characteristics of HCV infection associated with DAA therapy uptake and SVR were compared by immigration status using logistic regression. RESULTS: Of 1,459 HCV-infected patients, 264 (18.1%) were born outside of the country. A median 17 years passed from immigration to first assessment at the clinic. The proportion of patients initiating DAA therapy was similar between groups (65.2% versus 69.5%, p = 0.17). Characteristics associated with DAA therapy uptake included age at first assessment (OR = 1.02; 95% CI 1.01 to 1.03) and being cirrhotic (OR = 3.19; 95% CI 1.99 to 2.13). Crude SVR rate was higher in immigrants than in Canadian-born patients (91.5% versus 83.7%, p = 0.01). After controlling for other variables, only advancing age was associated with the likelihood of achieving crude SVR (OR = 1.04, 95% CI 1.02 to 1.05). CONCLUSIONS: We found that DAA therapy uptake and HCV cure rates were high in both groups suggesting equity of opportunity in those referred to our program. The older age at presentation suggests missed opportunities to diagnose and engage immigrants in HCV care. These findings emphasize the importance of early large-scale screening and engagement in care for HCV infection of immigrant populations to prevent future complications.
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Affiliation(s)
- Yelena Petrosyan
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Erin Kelly
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Curtis L Cooper
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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20
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Lanièce Delaunay C, Maheu-Giroux M, Marathe G, Saeed S, Martel-Laferrière V, Cooper CL, Walmsley S, Cox J, Wong A, Klein MB. Gaps in hepatitis C virus prevention and care for HIV-hepatitis C virus co-infected people who inject drugs in Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 103:103627. [PMID: 35218989 DOI: 10.1016/j.drugpo.2022.103627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 02/09/2022] [Accepted: 02/12/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND People who inject drugs (PWID) living with HIV are a priority population for eliminating hepatitis C virus (HCV) as a public health threat. Maximizing access to HCV prevention and treatment strategies are key steps towards elimination. We aimed to evaluate engagement in harm reduction programs and HCV treatment, and to describe injection practices among HIV-HCV co-infected PWID in Canada from 2003 to 2019. METHODS We included Canadian Coinfection Cohort study participants who reported injecting drugs between 2003 and 2019 in Quebec, Ontario, Saskatchewan, and British Columbia, Canada. We investigated temporal trends in HCV treatment uptake, efficacy, and effectiveness; injection practices; and engagement in harm reduction programs in three time periods based on HCV treatment availability: 1) interferon/ribavirin (2003-2010); 2) first-generation direct acting antivirals (DAAs) (2011-2013); 3) second-generation DAAs (2014-2019). Harm reduction services assessed included needle and syringe programs (NSP), opioid agonist therapy (OAT), and supervised injection sites (SIS). RESULTS Median age of participants (N = 1,077) at cohort entry was 44 years; 69% were males. Province-specific HCV treatment rates increased among HCV RNA-positive PWID, reaching 16 to 31 per 100 person-years in 2014-2019. Treatment efficacy improved from a 50 to 70% range in 2003-2010 to >90% across provinces in 2014-2019. Drug injecting patterns among active PWID varied by province, with an overall decrease in cocaine injection frequency and increasing opioid injections. In the most recent time period (2014-2019), needle/syringe sharing was reported at 8-22% of visits. Gaps remained in engagement in harm reduction programs: NSP use decreased (58-70% of visits), OAT engagement among opioid users was low (8-26% of visits), and participants rarely used SIS (1-15% of visits). CONCLUSION HCV treatment uptake and outcomes have improved among HIV-HCV coinfected PWID. Yet, this population remains exposed to drug-related harms, highlighting the need to tie HCV elimination strategies with enhanced harm reduction programs to improve overall health for this population.
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Affiliation(s)
- Charlotte Lanièce Delaunay
- Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, Faculty of Medicine, McGill University, 1020 Avenue des Pins Ouest, H3A 1A2, Montreal QC, Canada; Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 Boulevard de Maisonneuve Ouest, H4A 3S5, Montreal QC, Canada
| | - Mathieu Maheu-Giroux
- Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, Faculty of Medicine, McGill University, 1020 Avenue des Pins Ouest, H3A 1A2, Montreal QC, Canada
| | - Gayatri Marathe
- Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, Faculty of Medicine, McGill University, 1020 Avenue des Pins Ouest, H3A 1A2, Montreal QC, Canada; Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 Boulevard de Maisonneuve Ouest, H4A 3S5, Montreal QC, Canada
| | - Sahar Saeed
- Institute for Public Health, Washington University, 600 S Taylor Avenue, St. Louis, MO 63110, United States of America
| | - Valérie Martel-Laferrière
- Département de Médecine Spécialisée et de Médecine des Laboratoires, Centre Hospitalier de L'Université de Montréal, 264 Boulevard René-Lévesque Est, H2×1P1, Montreal QC, Canada; Centre de Recherche du Centre Hospitalier de L'Université de Montréal, 900 Rue Saint-Denis, H2×0A9, Montreal QC, Canada; Département de Microbiologie, Maladies Infectieuses, et Immunologie, Université de Montréal, 2900 Boulevard Édouard-Monpetit, H3T 1J4, Montreal QC, Canada
| | - Curtis L Cooper
- Division of Infectious Diseases, Department of Medicine, Ottawa Hospital Research Institute, 725 Parkdale Avenue, K1Y 4E9, Ottawa ON, Canada
| | - Sharon Walmsley
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, University of Toronto, 6 Queen's Park Crescent West, M5S 3H2, Toronto ON, Canada; University Health Network, University of Toronto, 190 Elizabeth Street, M5G 2C4, Toronto ON, Canada
| | - Joseph Cox
- Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, Faculty of Medicine, McGill University, 1020 Avenue des Pins Ouest, H3A 1A2, Montreal QC, Canada; Department of Medicine, Division of Infectious Disease and Chronic Viral Illness Service, McGill University Health Centre, 1001 Boulevard Décarie, H4A 3J1, Montreal QC, Canada
| | - Alexander Wong
- Division of Infectious Diseases, Department of Medicine, University of Saskatchewan, 107 Wiggins Road, S7N 5E5, Saskatoon SK, Canada
| | - Marina B Klein
- Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, Faculty of Medicine, McGill University, 1020 Avenue des Pins Ouest, H3A 1A2, Montreal QC, Canada; Department of Medicine, Division of Infectious Disease and Chronic Viral Illness Service, McGill University Health Centre, 1001 Boulevard Décarie, H4A 3J1, Montreal QC, Canada; Canadian HIV Trials Network, Canadian Institutes of Health Research, 588-1081 Burrard Street, V6Z 1Y6, Vancouver BC, Canada.
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21
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Shakeri A, Hayes KN, Gomes T, Tadrous M. Comparison of public and private payments for direct-acting antivirals (DAAs) across Canada. CANADIAN LIVER JOURNAL 2021; 4:426-429. [PMID: 35989895 PMCID: PMC9235118 DOI: 10.3138/canlivj-2020-0041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 01/11/2021] [Indexed: 07/29/2023]
Affiliation(s)
- Ahmad Shakeri
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
| | - Kaleen N Hayes
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Tara Gomes
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Mina Tadrous
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
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22
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Pearce ME, Bartlett SR, Yu A, Lamb J, Reitz C, Wong S, Alvarez M, Binka M, Velásquez Garcia H, Jeong D, Clementi E, Adu P, Samji H, Wong J, Buxton J, Yoshida E, Elwood C, Sauve L, Pick N, Krajden M, Janjua NZ. Women in the 2019 hepatitis C cascade of care: findings from the British Columbia Hepatitis Testers cohort study. BMC Womens Health 2021; 21:330. [PMID: 34511082 PMCID: PMC8436483 DOI: 10.1186/s12905-021-01470-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 08/31/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Women living with hepatitis C virus (HCV) are rarely addressed in research and may be overrepresented within key populations requiring additional support to access HCV care and treatment. We constructed the HCV care cascade among people diagnosed with HCV in British Columbia, Canada, as of 2019 to compare progress in care and treatment and to assess sex/gender gaps in HCV treatment access. METHODS The BC Hepatitis Testers Cohort includes 1.7 million people who tested for HCV, HIV, reported cases of hepatitis B, and active tuberculosis in BC from 2000 to 2019. Test results were linked to medical visits, hospitalizations, cancers, prescription drugs, and mortality data. Six HCV care cascade stages were identified: (1) antibody diagnosed; (2) RNA tested; (3) RNA positive; (4) genotyped; (5) initiated treatment; and (6) achieved sustained virologic response (SVR). HCV care cascade results were assessed for women, and an 'inverse' cascade was created to assess gaps, including not being RNA tested, genotyped, or treatment initiated, stratified by sex. RESULTS In 2019, 52,638 people with known sex were anti-HCV positive in BC; 37% (19,522) were women. Confirmatory RNA tests were received by 86% (16,797/19,522) of anti-HCV positive women and 83% (27,353/33,116) of men. Among people who had been genotyped, 68% (6756/10,008) of women and 67% (12,640/18,828) of men initiated treatment, with 94% (5023/5364) of women and 92% (9147/9897) of men achieving SVR. Among the 3252 women and 6188 men not yet treated, higher proportions of women compared to men were born after 1975 (30% vs. 21%), had a mental health diagnosis (42% vs. 34%) and had used injection drugs (50% vs. 45%). Among 1619 women and 2780 men who had used injection drugs and were not yet treated, higher proportions of women than men used stimulants (64% vs. 57%), and opiates (67% vs. 60%). CONCLUSIONS Women and men appear to be equally engaged into the HCV care cascade; however, women with concurrent social and health conditions are being left behind. Treatment access may be improved with approaches that meet the needs of younger women, those with mental health diagnoses, and women who use drugs.
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Affiliation(s)
- Margo E Pearce
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.
- School of Population and Public Health, University of British Columbia (UBC), Vancouver, BC, Canada.
| | - Sofia R Bartlett
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, UBC, Vancouver, BC, Canada
| | - Amanda Yu
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Jess Lamb
- AIDS Network Kootenay Outreach and Support Society, Kimberly, BC, Canada
| | - Cheryl Reitz
- East Kootenay Network of People who Use Drugs, Kimberly, BC, Canada
- British Columbia Hepatitis Network Society, Vancouver, BC, Canada
| | - Stanley Wong
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Maria Alvarez
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Mawuena Binka
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | | | - Dahn Jeong
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia (UBC), Vancouver, BC, Canada
| | - Emilia Clementi
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia (UBC), Vancouver, BC, Canada
| | - Prince Adu
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia (UBC), Vancouver, BC, Canada
| | - Hasina Samji
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Jason Wong
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia (UBC), Vancouver, BC, Canada
| | - Jane Buxton
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia (UBC), Vancouver, BC, Canada
| | - Eric Yoshida
- Division of Gastroenterology, Department of Medicine, UBC, Vancouver, BC, Canada
- Vancouver General Hospital, Vancouver, BC, Canada
| | - Chelsea Elwood
- Department of Obstetrics and Gynecology, UBC, Vancouver, Canada
- BC Women's Hospital Research Institute, Vancouver, BC, Canada
| | - Laura Sauve
- BC Women's Hospital Research Institute, Vancouver, BC, Canada
- Division of Infectious Diseases, Department of Pediatrics, UBC, Vancouver, Canada
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Neora Pick
- BC Women's Hospital Research Institute, Vancouver, BC, Canada
- Division of Infectious Diseases, Department of Medicine, UBC, Vancouver, BC, Canada
| | - Mel Krajden
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, UBC, Vancouver, BC, Canada
| | - Naveed Z Janjua
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia (UBC), Vancouver, BC, Canada
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Hamadeh A, Feng Z, Niergarth J, Wong WW. Estimation of COVID-19 Period Prevalence and the Undiagnosed Population in Canadian Provinces: Model-Based Analysis. JMIR Public Health Surveill 2021; 7:e26409. [PMID: 34228626 PMCID: PMC8432517 DOI: 10.2196/26409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 06/17/2021] [Accepted: 06/22/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The development of a successful COVID-19 control strategy requires a thorough understanding of the trends in geographic and demographic distributions of disease burden. In terms of the estimation of the population prevalence, this includes the crucial process of unravelling the number of patients who remain undiagnosed. OBJECTIVE This study estimates the period prevalence of COVID-19 between March 1, 2020, and November 30, 2020, and the proportion of the infected population that remained undiagnosed in the Canadian provinces of Quebec, Ontario, Alberta, and British Columbia. METHODS A model-based mathematical framework based on a disease progression and transmission model was developed to estimate the historical prevalence of COVID-19 using provincial-level statistics reporting seroprevalence, diagnoses, and deaths resulting from COVID-19. The framework was applied to three different age cohorts (< 30; 30-69; and ≥70 years) in each of the provinces studied. RESULTS The estimates of COVID-19 period prevalence between March 1, 2020, and November 30, 2020, were 4.73% (95% CI 4.42%-4.99%) for Quebec, 2.88% (95% CI 2.75%-3.02%) for Ontario, 3.27% (95% CI 2.72%-3.70%) for Alberta, and 2.95% (95% CI 2.77%-3.15%) for British Columbia. Among the cohorts considered in this study, the estimated total number of infections ranged from 2-fold the number of diagnoses (among Quebecers, aged ≥70 years: 26,476/53,549, 49.44%) to 6-fold the number of diagnoses (among British Columbians aged ≥70 years: 3108/18,147, 17.12%). CONCLUSIONS Our estimates indicate that a high proportion of the population infected between March 1 and November 30, 2020, remained undiagnosed. Knowledge of COVID-19 period prevalence and the undiagnosed population can provide vital evidence that policy makers can consider when planning COVID-19 control interventions and vaccination programs.
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Affiliation(s)
- Abdullah Hamadeh
- School of Pharmacy, University of Waterloo, Kitchener, ON, Canada
| | - Zeny Feng
- Department of Mathematics and Statistics, University of Guelph, Guelph, ON, Canada
| | - Jessmyn Niergarth
- Department of Mathematics and Statistics, University of Guelph, Guelph, ON, Canada
| | - William Wl Wong
- School of Pharmacy, University of Waterloo, Kitchener, ON, Canada
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Moqueet N, Grewal R, Mazzulli T, Cooper C, Gardner SL, Salit IE, Kroch A, Burchell AN. Hepatitis C virus testing in a clinical HIV cohort in Ontario, Canada, 2000 to 2015. Health Sci Rep 2021; 4:e358. [PMID: 34568583 PMCID: PMC8449285 DOI: 10.1002/hsr2.358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 06/11/2021] [Accepted: 07/26/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND HIV-positive individuals may acquire HCV via injection drug use (IDU) and condomless anal sex. HIV care provides opportunities for HCV testing and cure with direct-acting antiviral agents (DAAs). METHODS We analyzed data from the Ontario HIV Treatment Network Cohort Study. Among those not HCV-positive or diagnosed previously (n = 4586), we used Cox regression to test the rates of ever HCV testing (serological or RNA) in HIV care by DAA era (pre-DAA: 2000-2010; after DAA: 2011-2015) and compared the proportion diagnosed with HCV. We identified correlates of annual proportions of serological testing using Poisson generalized estimating equations. RESULTS After DAA vs pre-DAA, the hazard rate ratio (95% CI) of ever HCV testing was 1.70 (1.59, 1.81). The proportion (95% CI) tested annually increased from 9.2% (8.0%, 10.7%) in 2000 to 39.1% (37.1%, 41.1%) in 2015 (P < 0.0001). The proportion diagnosed with HCV declined by 74% pre-DAA to 11% after DAAs. Annual testing increased per calendar year (16% steeper slope after DAA vs pre-DAA) and was more common among men who have sex with men; those more educated (post-secondary vs ≤ high school); and those positive for syphilis or reporting any IDU. Annual testing decreased per decade of age and time since HIV diagnosis. DISCUSSION Annual HCV testing increased over time with higher testing among those reporting sexual or IDU risk factors, but fell short of clinical guidelines. Targeted interventions to boost testing may be needed to close these gaps and reach WHO 2030 HCV elimination targets.
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Affiliation(s)
- Nasheed Moqueet
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's HospitalUnity Health TorontoTorontoOntarioCanada
| | - Ramandip Grewal
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's HospitalUnity Health TorontoTorontoOntarioCanada
| | - Tony Mazzulli
- Department of MicrobiologyMount Sinai Hospital and University Health NetworkTorontoOntarioCanada
- Public Health OntarioTorontoOntarioCanada
- Toronto General HospitalUniversity Health NetworkTorontoOntarioCanada
- Department of Laboratory Medicine and PathobiologyUniversity of TorontoTorontoOntarioCanada
| | - Curtis Cooper
- The Ottawa Hospital‐Division of Infectious DiseasesOttawaOntarioCanada
| | - Sandra L. Gardner
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
- Rotman Research InstituteTorontoOntarioCanada
| | - Irving E. Salit
- Toronto General HospitalUniversity Health NetworkTorontoOntarioCanada
| | - Abigail Kroch
- The Ontario HIV Treatment NetworkTorontoOntarioCanada
| | - Ann N. Burchell
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's HospitalUnity Health TorontoTorontoOntarioCanada
- Department of Family and Community Medicine, Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
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Kronfli N, Dussault C, Bartlett S, Fuchs D, Kaita K, Harland K, Martin B, Whitten-Nagle C, Cox J. Disparities in hepatitis C care across Canadian provincial prisons: Implications for hepatitis C micro-elimination. CANADIAN LIVER JOURNAL 2021; 4:292-310. [PMID: 35992251 PMCID: PMC9202774 DOI: 10.3138/canlivj-2020-0035] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 11/26/2020] [Indexed: 04/06/2024]
Abstract
BACKGROUND Delivery of hepatitis C virus (HCV) care to people in prison is essential to HCV elimination. We aimed to describe current HCV care practices across Canada's adult provincial prisons. METHODS One representative per provincial prison health care team (except Ontario) was invited to participate in a web-based survey from January to June 2020. The outcomes of interest were HCV screening and treatment, treatment restrictions, and harm reduction services. The government ministry responsible for health care was determined. Non-nominal data were aggregated by province and ministry; descriptive statistical analyses were used to report outcomes. RESULTS The survey was completed by 59/65 (91%) prisons. On-demand, risk-based, opt-in, and opt-out screening are offered by 19 (32%), 10 (17%), 18 (31%), and 9 (15%) prisons, respectively; 3 prisons offer no HCV screening. Liver fibrosis assessments are rare (8 prisons access transient elastography, and 15 use aspartate aminotransferase to platelet ratio or Fibrosis-4); 20 (34%) prisons lack linkage to care programs. Only 32 (54%) prisons have ever initiated HCV treatment on site. Incarceration length and a fibrosis staging of ≥F2 are the most common eligibility restrictions for treatment. Opioid agonist therapy is available in 83% of prisons; needle and syringe programs are not available anywhere. Systematic screening and greater access to treatment and harm reduction services are more common where the Ministry of Health is responsible. CONCLUSIONS Tremendous variability exists in HCV screening and care practices across Canada's provincial prisons. To advance HCV care, adopting opt-out screening and removing eligibility restrictions may be important initial strategies.
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Affiliation(s)
- Nadine Kronfli
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University, Montreal, Quebec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Camille Dussault
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Sofia Bartlett
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Dennaye Fuchs
- ID Clinic, Saskatchewan Health Authority, Regina, Saskatchewan, Canada
| | - Kelly Kaita
- Department of Medicine, John Buhler Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kate Harland
- Centre for Research, Education and Clinical Care of At-Risk Populations, Saint John, New Brunswick, Canada
| | - Brandi Martin
- Department of Justice and Public Safety, Community and Correctional Services, Government of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - Cindy Whitten-Nagle
- Department of Justice and Public Safety, Adult Corrections, Government of Newfoundland and Labrador, St. John’s, Newfoundland and Labrador, Canada
| | - Joseph Cox
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University, Montreal, Quebec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
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26
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Mendlowitz A, Bremner KE, Walker JD, Wong WWL, Feld JJ, Sander B, Jones L, Isaranuwatchai W, Krahn M. Hepatitis C virus infection in First Nations populations in Ontario from 2006 to 2014: a population-based retrospective cohort analysis. CMAJ Open 2021; 9:E886-E896. [PMID: 34584007 PMCID: PMC8486470 DOI: 10.9778/cmajo.20200164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) infection causes substantial morbidity and mortality in Canada and is of concern among First Nations communities. In partnership with the Ontario First Nations HIV/AIDS Education Circle, we described trends in HCV testing and epidemiologic features among Status First Nations people in Ontario. METHODS In this retrospective study, we used health administrative databases for 2006-2014 in Ontario with 3 cohorts of Status First Nations people: those tested for HCV for the first time, those who tested positive for HCV antibodies or RNA, and those with no HCV laboratory or testing records. We examined cohort characteristics, and the annual prevalence and incidence of testing and diagnosis of HCV infection. Outcomes were stratified by region, sex and residence within or outside of First Nations communities. RESULTS During the study period, 2423 Status First Nations people were diagnosed with HCV infection, 20 481 received their first test, and 135 185 had no test record. The point prevalence of ever having been tested increased from 6.3 (95% confidence interval [CI] 6.2-6.5) per 100 people in 2006 to 16.2 (95% CI 16.0-16.4) per 100 people in 2014. The point prevalence of diagnosed HCV infection increased from 0.9 (95% CI 0.9-1.0) to 2.0 (95% CI 1.9-2.0) per 100 people. The incidence of first test and of diagnosis increased from 12.1 (95% CI 11.5-12.6) to 21.3 (95% CI 20.5-22.1) per 1000 person-years and from 1.3 (95% CI 1.1-1.5) to 2.3 (95% CI 2.1-2.6) per 1000 person-years, respectively. Testing, diagnosis and prevalence of HCV infection were consistently higher among people living outside of versus within First Nations communities, but larger increases over time were observed among those living within First Nations communities. INTERPRETATION Testing and diagnosis of HCV infection increased from 2006 to 2014 among Status First Nations people in Ontario. Our findings indicate the need for population-level efforts to eliminate hepatitis C in First Nations communities.
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Affiliation(s)
- Andrew Mendlowitz
- Institute of Health Policy, Management and Evaluation (Mendlowitz, Sander, Isaranuwatchai, Krahn), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Mendlowitz, Bremner, Sander, Krahn), University Health Network; ICES Central (Mendlowitz, Walker, Sander, Krahn), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; School of Pharmacy (Wong), University of Waterloo, Waterloo, Ont.; Toronto Centre for Liver Disease (Feld), Toronto General Hospital; Public Health Ontario (Sander), Toronto, Ont.; Ontario First Nations HIV/AIDS Education Circle (Jones), London, Ont.; St. Michael's Hospital (Isaranuwatchai), Unity Health Toronto, Toronto, Ont.
| | - Karen E Bremner
- Institute of Health Policy, Management and Evaluation (Mendlowitz, Sander, Isaranuwatchai, Krahn), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Mendlowitz, Bremner, Sander, Krahn), University Health Network; ICES Central (Mendlowitz, Walker, Sander, Krahn), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; School of Pharmacy (Wong), University of Waterloo, Waterloo, Ont.; Toronto Centre for Liver Disease (Feld), Toronto General Hospital; Public Health Ontario (Sander), Toronto, Ont.; Ontario First Nations HIV/AIDS Education Circle (Jones), London, Ont.; St. Michael's Hospital (Isaranuwatchai), Unity Health Toronto, Toronto, Ont
| | - Jennifer D Walker
- Institute of Health Policy, Management and Evaluation (Mendlowitz, Sander, Isaranuwatchai, Krahn), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Mendlowitz, Bremner, Sander, Krahn), University Health Network; ICES Central (Mendlowitz, Walker, Sander, Krahn), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; School of Pharmacy (Wong), University of Waterloo, Waterloo, Ont.; Toronto Centre for Liver Disease (Feld), Toronto General Hospital; Public Health Ontario (Sander), Toronto, Ont.; Ontario First Nations HIV/AIDS Education Circle (Jones), London, Ont.; St. Michael's Hospital (Isaranuwatchai), Unity Health Toronto, Toronto, Ont
| | - William W L Wong
- Institute of Health Policy, Management and Evaluation (Mendlowitz, Sander, Isaranuwatchai, Krahn), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Mendlowitz, Bremner, Sander, Krahn), University Health Network; ICES Central (Mendlowitz, Walker, Sander, Krahn), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; School of Pharmacy (Wong), University of Waterloo, Waterloo, Ont.; Toronto Centre for Liver Disease (Feld), Toronto General Hospital; Public Health Ontario (Sander), Toronto, Ont.; Ontario First Nations HIV/AIDS Education Circle (Jones), London, Ont.; St. Michael's Hospital (Isaranuwatchai), Unity Health Toronto, Toronto, Ont
| | - Jordan J Feld
- Institute of Health Policy, Management and Evaluation (Mendlowitz, Sander, Isaranuwatchai, Krahn), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Mendlowitz, Bremner, Sander, Krahn), University Health Network; ICES Central (Mendlowitz, Walker, Sander, Krahn), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; School of Pharmacy (Wong), University of Waterloo, Waterloo, Ont.; Toronto Centre for Liver Disease (Feld), Toronto General Hospital; Public Health Ontario (Sander), Toronto, Ont.; Ontario First Nations HIV/AIDS Education Circle (Jones), London, Ont.; St. Michael's Hospital (Isaranuwatchai), Unity Health Toronto, Toronto, Ont
| | - Beate Sander
- Institute of Health Policy, Management and Evaluation (Mendlowitz, Sander, Isaranuwatchai, Krahn), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Mendlowitz, Bremner, Sander, Krahn), University Health Network; ICES Central (Mendlowitz, Walker, Sander, Krahn), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; School of Pharmacy (Wong), University of Waterloo, Waterloo, Ont.; Toronto Centre for Liver Disease (Feld), Toronto General Hospital; Public Health Ontario (Sander), Toronto, Ont.; Ontario First Nations HIV/AIDS Education Circle (Jones), London, Ont.; St. Michael's Hospital (Isaranuwatchai), Unity Health Toronto, Toronto, Ont
| | - Lyndia Jones
- Institute of Health Policy, Management and Evaluation (Mendlowitz, Sander, Isaranuwatchai, Krahn), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Mendlowitz, Bremner, Sander, Krahn), University Health Network; ICES Central (Mendlowitz, Walker, Sander, Krahn), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; School of Pharmacy (Wong), University of Waterloo, Waterloo, Ont.; Toronto Centre for Liver Disease (Feld), Toronto General Hospital; Public Health Ontario (Sander), Toronto, Ont.; Ontario First Nations HIV/AIDS Education Circle (Jones), London, Ont.; St. Michael's Hospital (Isaranuwatchai), Unity Health Toronto, Toronto, Ont
| | - Wanrudee Isaranuwatchai
- Institute of Health Policy, Management and Evaluation (Mendlowitz, Sander, Isaranuwatchai, Krahn), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Mendlowitz, Bremner, Sander, Krahn), University Health Network; ICES Central (Mendlowitz, Walker, Sander, Krahn), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; School of Pharmacy (Wong), University of Waterloo, Waterloo, Ont.; Toronto Centre for Liver Disease (Feld), Toronto General Hospital; Public Health Ontario (Sander), Toronto, Ont.; Ontario First Nations HIV/AIDS Education Circle (Jones), London, Ont.; St. Michael's Hospital (Isaranuwatchai), Unity Health Toronto, Toronto, Ont
| | - Murray Krahn
- Institute of Health Policy, Management and Evaluation (Mendlowitz, Sander, Isaranuwatchai, Krahn), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Mendlowitz, Bremner, Sander, Krahn), University Health Network; ICES Central (Mendlowitz, Walker, Sander, Krahn), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; School of Pharmacy (Wong), University of Waterloo, Waterloo, Ont.; Toronto Centre for Liver Disease (Feld), Toronto General Hospital; Public Health Ontario (Sander), Toronto, Ont.; Ontario First Nations HIV/AIDS Education Circle (Jones), London, Ont.; St. Michael's Hospital (Isaranuwatchai), Unity Health Toronto, Toronto, Ont
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Mendlowitz A, Bremner KE, Walker JD, Wong WWL, Feld JJ, Sander B, Jones L, Isaranuwatchai W, Krahn M. Health care costs associated with hepatitis C virus infection in First Nations populations in Ontario: a retrospective matched cohort study. CMAJ Open 2021; 9:E897-E906. [PMID: 34584004 PMCID: PMC8486469 DOI: 10.9778/cmajo.20200247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Colonization and marginalization have affected the risk for and experience of hepatitis C virus (HCV) infection for First Nations people in Canada. In partnership with the Ontario First Nations HIV/AIDS Education Circle, we estimated the publicly borne health care costs associated with HCV infection among Status First Nations people in Ontario. METHODS In this retrospective matched cohort study, we used linked health administrative databases to identify Status First Nations people in Ontario who tested positive for HCV antibodies or RNA between 2004 and 2014, and Status First Nations people who had no HCV testing records or only a negative test result (control group, matched 2:1 to case participants). We estimated total and net costs (difference between case and control participants) for 4 phases of care: prediagnosis (6 mo before HCV infection diagnosis), initial (after diagnosis), late (liver disease) and terminal (6 mo before death), until death or Dec. 31, 2017, whichever occurred first. We stratified costs by sex and residence within or outside of First Nations communities. All costs were measured in 2018 Canadian dollars. RESULTS From 2004 to 2014, 2197 people were diagnosed with HCV infection. The mean net total costs per 30 days of HCV infection were $348 (95% confidence interval [CI] $277 to $427) for the prediagnosis phase, $377 (95% CI $288 to $470) for the initial phase, $1768 (95% CI $1153 to $2427) for the late phase and $893 (95% CI -$1114 to $3149) for the terminal phase. After diagnosis of HCV infection, net costs varied considerably among those who resided within compared to outside of First Nations communities. Net costs were higher for females than for males except in the terminal phase. INTERPRETATION The costs per 30 days of HCV infection among Status First Nations people in Ontario increased substantially with progression to advanced liver disease and finally to death. These estimates will allow for planning and evaluation of provincial and territorial population-specific hepatitis C control efforts.
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Affiliation(s)
- Andrew Mendlowitz
- Institute of Health Policy, Management and Evaluation (Mendlowitz, Sander, Isaranuwatchai, Krahn), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Mendlowitz, Bremner, Sander, Krahn), University Health Network; ICES Central (Mendlowitz, Walker, Sander, Krahn), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; School of Pharmacy (Wong), University of Waterloo, Waterloo, Ont.; Toronto Centre for Liver Disease (Feld), Toronto General Hospital; Public Health Ontario (Sander), Toronto, Ont.; Ontario First Nations HIV/AIDS Education Circle (Jones), London, Ont.; St. Michael's Hospital (Isaranuwatchai), Unity Health Toronto, Toronto, Ont.
| | - Karen E Bremner
- Institute of Health Policy, Management and Evaluation (Mendlowitz, Sander, Isaranuwatchai, Krahn), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Mendlowitz, Bremner, Sander, Krahn), University Health Network; ICES Central (Mendlowitz, Walker, Sander, Krahn), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; School of Pharmacy (Wong), University of Waterloo, Waterloo, Ont.; Toronto Centre for Liver Disease (Feld), Toronto General Hospital; Public Health Ontario (Sander), Toronto, Ont.; Ontario First Nations HIV/AIDS Education Circle (Jones), London, Ont.; St. Michael's Hospital (Isaranuwatchai), Unity Health Toronto, Toronto, Ont
| | - Jennifer D Walker
- Institute of Health Policy, Management and Evaluation (Mendlowitz, Sander, Isaranuwatchai, Krahn), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Mendlowitz, Bremner, Sander, Krahn), University Health Network; ICES Central (Mendlowitz, Walker, Sander, Krahn), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; School of Pharmacy (Wong), University of Waterloo, Waterloo, Ont.; Toronto Centre for Liver Disease (Feld), Toronto General Hospital; Public Health Ontario (Sander), Toronto, Ont.; Ontario First Nations HIV/AIDS Education Circle (Jones), London, Ont.; St. Michael's Hospital (Isaranuwatchai), Unity Health Toronto, Toronto, Ont
| | - William W L Wong
- Institute of Health Policy, Management and Evaluation (Mendlowitz, Sander, Isaranuwatchai, Krahn), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Mendlowitz, Bremner, Sander, Krahn), University Health Network; ICES Central (Mendlowitz, Walker, Sander, Krahn), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; School of Pharmacy (Wong), University of Waterloo, Waterloo, Ont.; Toronto Centre for Liver Disease (Feld), Toronto General Hospital; Public Health Ontario (Sander), Toronto, Ont.; Ontario First Nations HIV/AIDS Education Circle (Jones), London, Ont.; St. Michael's Hospital (Isaranuwatchai), Unity Health Toronto, Toronto, Ont
| | - Jordan J Feld
- Institute of Health Policy, Management and Evaluation (Mendlowitz, Sander, Isaranuwatchai, Krahn), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Mendlowitz, Bremner, Sander, Krahn), University Health Network; ICES Central (Mendlowitz, Walker, Sander, Krahn), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; School of Pharmacy (Wong), University of Waterloo, Waterloo, Ont.; Toronto Centre for Liver Disease (Feld), Toronto General Hospital; Public Health Ontario (Sander), Toronto, Ont.; Ontario First Nations HIV/AIDS Education Circle (Jones), London, Ont.; St. Michael's Hospital (Isaranuwatchai), Unity Health Toronto, Toronto, Ont
| | - Beate Sander
- Institute of Health Policy, Management and Evaluation (Mendlowitz, Sander, Isaranuwatchai, Krahn), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Mendlowitz, Bremner, Sander, Krahn), University Health Network; ICES Central (Mendlowitz, Walker, Sander, Krahn), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; School of Pharmacy (Wong), University of Waterloo, Waterloo, Ont.; Toronto Centre for Liver Disease (Feld), Toronto General Hospital; Public Health Ontario (Sander), Toronto, Ont.; Ontario First Nations HIV/AIDS Education Circle (Jones), London, Ont.; St. Michael's Hospital (Isaranuwatchai), Unity Health Toronto, Toronto, Ont
| | - Lyndia Jones
- Institute of Health Policy, Management and Evaluation (Mendlowitz, Sander, Isaranuwatchai, Krahn), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Mendlowitz, Bremner, Sander, Krahn), University Health Network; ICES Central (Mendlowitz, Walker, Sander, Krahn), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; School of Pharmacy (Wong), University of Waterloo, Waterloo, Ont.; Toronto Centre for Liver Disease (Feld), Toronto General Hospital; Public Health Ontario (Sander), Toronto, Ont.; Ontario First Nations HIV/AIDS Education Circle (Jones), London, Ont.; St. Michael's Hospital (Isaranuwatchai), Unity Health Toronto, Toronto, Ont
| | - Wanrudee Isaranuwatchai
- Institute of Health Policy, Management and Evaluation (Mendlowitz, Sander, Isaranuwatchai, Krahn), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Mendlowitz, Bremner, Sander, Krahn), University Health Network; ICES Central (Mendlowitz, Walker, Sander, Krahn), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; School of Pharmacy (Wong), University of Waterloo, Waterloo, Ont.; Toronto Centre for Liver Disease (Feld), Toronto General Hospital; Public Health Ontario (Sander), Toronto, Ont.; Ontario First Nations HIV/AIDS Education Circle (Jones), London, Ont.; St. Michael's Hospital (Isaranuwatchai), Unity Health Toronto, Toronto, Ont
| | - Murray Krahn
- Institute of Health Policy, Management and Evaluation (Mendlowitz, Sander, Isaranuwatchai, Krahn), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Mendlowitz, Bremner, Sander, Krahn), University Health Network; ICES Central (Mendlowitz, Walker, Sander, Krahn), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; School of Pharmacy (Wong), University of Waterloo, Waterloo, Ont.; Toronto Centre for Liver Disease (Feld), Toronto General Hospital; Public Health Ontario (Sander), Toronto, Ont.; Ontario First Nations HIV/AIDS Education Circle (Jones), London, Ont.; St. Michael's Hospital (Isaranuwatchai), Unity Health Toronto, Toronto, Ont
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Duchesne L, Dussault C, Godin A, Maheu-Giroux M, Kronfli N. Implementing opt-out hepatitis C virus (HCV) screening in Canadian provincial prisons: A model-based cost-effectiveness analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 96:103345. [PMID: 34176704 DOI: 10.1016/j.drugpo.2021.103345] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/28/2021] [Accepted: 06/07/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Implementing opt-out hepatitis C virus (HCV) screening across Canadian provincial prisons is crucial to achieving micro-elimination. Given short incarceration lengths, the most cost-effective screening strategy remains unknown. We compared the cost-effectiveness of current standard of care (venipuncture-based HCV-antibody+HCV RNA) and 13 alternative strategies in Quebec's largest provincial prison. METHODS A prison cohort was simulated with a Markov micro-simulation model. Strategies differed in the biomarkers, sampling methods, and number of tests used. The model considered incarceration lengths, time to linkage to care (LTC), nursing costs, and tests' costs, performances, acceptability and turnaround times. Outcomes included costs (Canadian dollars, CAD$), number of true positives linked to care, and incremental cost-effectiveness ratios (ICERs, additional $/additional TP-L). A one-year time horizon and health-payer perspective were adopted. RESULTS Across all analyses, three strategies consistently provided the best value for money: venipuncture-based HCV-antibody+HCV-core antigen, venipuncture-based HCV-core antigen (base-case ICER=~ $720), and point-of-care HCV-antibody+HCV RNA (base-case ICER=$4,310). However, these strategies linked only 23%-29% viremic individuals to care. Main drivers of cost-effectiveness were the seroprevalence, proportion viremic, and time to LTC. CONCLUSION Alternative strategies would be more cost-effective than standard of care for implementing opt-out screening in provincial prisons. However, interventions to maximize LTC should be explored.
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Affiliation(s)
- Léa Duchesne
- Institut de Médecine et d'Epidémiologie Appliquée, Fondation Internationale Léon Mba, Paris, France
| | - Camille Dussault
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| | - Arnaud Godin
- Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Mathieu Maheu-Giroux
- Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Nadine Kronfli
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada; Department of Medicine, Division of Infectious Disease and Chronic Viral Illness Service, McGill University Health Centre, Montréal, Québec, Canada.
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Pandey M, Konrad S, Reed N, Ahenakew V, Isbister P, Isbister T, Gallagher L, Campbell T, Skinner S. Liver health events: an indigenous community-led model to enhance HCV screening and linkage to care. Health Promot Int 2021; 37:6298445. [PMID: 34125199 DOI: 10.1093/heapro/daab074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Despite high prevalence of hepatitis C virus (HCV), linkage to care and treatment for Indigenous people is low. In an Indigenous community in Saskatchewan, Canada a retrospective review identified 200 individuals (∼12% prevalence) had HCV antibodies though majority lacked ribonucleic acid (RNA) testing, and few received treatment despite availability of an effective cure. Following Indigenous oral traditions, focus group discussions were held with key community members and leadership. Participants emphasized the need for a community-based screening and treatment programme. A team of community members, peers and healthcare professionals developed a streamlined screening pathway termed 'liver health event' (LHE) to reduce stigma, reach undiagnosed, re-engage previously diagnosed, and ensure rapid linkage to care/treatment. LHEs began December 2016. Statistics were tracked for each event. As of July 2019, there were 10 LHEs with 540 participants, 227 hepatitis C tests and 346 FibroScans completed. This represented 294 unique individuals, of which 64.3% were tested, and of those, 40.8% were Ab positive. Among those positive for antibodies, 41.7% had active hepatitis C infections, and among these, 90% were linked to care, and 14 new positive individuals were identified. Following the success of LHEs, these were adapted and implemented in 10 other communities in this region, resulting in 17 additional LHEs. This intervention is reaching the undiagnosed and linking clients to care through a low-barrier and de-stigmatizing approach. It has facilitated collaboration, knowledge exchange and mentorship between Indigenous communities, significantly impacting health outcomes of Indigenous people in this region.
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Affiliation(s)
- Mamata Pandey
- Research, Saskatchewan Health Authority, 2180-23 Ave, Wascana Rehabilitation Centre, Regina, SK, S4S 0A5, Canada
| | - Stephanie Konrad
- First Nations Inuit Health Branch-Sask Region, Indigenous Services Canada, Government of Canada, 1783 Hamilton Street, 6th Floor, Alvin Hamilton Building, Regina, SK, S4P 2B6, Canada
| | - Noreen Reed
- Ahtahkakoop Health Centre P.O. Box 64 Mont Nebo, SK, S0J 1X0, Canada
| | - Vanessa Ahenakew
- Ahtahkakoop Health Centre P.O. Box 64 Mont Nebo, SK, S0J 1X0, Canada
| | - Patricia Isbister
- Ahtahkakoop Health Centre P.O. Box 64 Mont Nebo, SK, S0J 1X0, Canada
| | - Tanys Isbister
- Ahtahkakoop Health Centre P.O. Box 64 Mont Nebo, SK, S0J 1X0, Canada
| | - Lesley Gallagher
- Saskatchewan Infectious Disease Care Network, 320 Ave F South, Saskatoon, SK, S7M 1T2, Canada
| | - Trisha Campbell
- Wellness Wheel Regina General Hospital, 2nd Floor Medical Office Wing c/o Infectious Diseases Clinic 1440-14th Avenue, Regina, SK, S4P 0W5, Canada
| | - Stuart Skinner
- Wellness Wheel Regina General Hospital, 2nd Floor Medical Office Wing c/o Infectious Diseases Clinic 1440-14th Avenue, Regina, SK, S4P 0W5, Canada.,University of Saskatchewan, 1440, 14th Avenue, Regina, SK, S4P 0W5, Canada
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An outbreak of hepatitis C virus attributed to the use of multi-dose vials at a colonoscopy clinic, Waterloo Region, Ontario. ACTA ACUST UNITED AC 2021; 47:224-231. [PMID: 34035670 DOI: 10.14745/ccdr.v47i04a07] [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: 11/08/2022]
Abstract
Background Hepatitis C virus (HCV) transmission has been epidemiologically linked to healthcare settings, particularly out-of-hospital settings such as endoscopy clinics and hemodialysis clinics. These have been largely attributed to lapses in infection prevention and control practices (IPAC). Objective To describe the public health response to an outbreak of HCV that was detected among patients of a colonoscopy clinic in Ontario, and to highlight the risks of using multi-dose vials and the need for improved IPAC practices in out-of-hospital settings. Methods Screening for HCV was conducted on patients and staff who attended or worked at the clinic within the same timeframe as the index case's procedure. Blood samples from positive cases underwent viral sequencing. Inspections of the clinic assessed IPAC practices, and a chart review was done to identify plausible mechanisms for transmission. Outcome A total of 38% of patients who underwent procedures at the clinic on the same day as the index case tested positive for HCV. Genetic sequencing showed a high degree of similarity in the HCV genetic sequence among the samples positive for HCV. Chart review and clinic inspection identified use of multi-dose vials of anesthesia medication across multiple patients as the plausible mechanism for transmission. Conclusion Healthcare workers, especially those in out-of-hospital procedural/surgical premises, should be vigilant in following IPAC best practices, including those related to the use of multi-dose vials, to prevent the transmission of bloodborne infections in healthcare settings.
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Li J, Casey JL, Greenwald ZR, Yasseen III AS, Dickie M, Feld JJ, Cooper CL, Crawley AM. The 9th Canadian Symposium on Hepatitis C Virus: Advances in HCV research and treatment towards elimination. CANADIAN LIVER JOURNAL 2021; 4:59-71. [DOI: 10.3138/canlivj-2020-0026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 08/09/2020] [Indexed: 12/13/2022]
Abstract
Hepatitis C virus (HCV) elimination has evolved into a coordinated global effort. Canada, with more than 250,000 chronically infected individuals, is among the countries leading this effort. The 9th Canadian Symposium on HCV, held in February 2020, thus established and addressed its theme, ‘advances in HCV research and treatment towards elimination’, by gathering together basic scientists, clinicians, epidemiologists, social scientists, and community members interested in HCV research in Canada. Plenary sessions showcased topical research from prominent international and national researchers, complemented by select abstract presentations. This event was hosted by the Canadian Network on Hepatitis C (CanHepC), with support from the Public Health Agency of Canada and the Canadian Institutes of Health Research and in partnership with the Canadian Liver Meeting. CanHepC has an established record in HCV research by its members and in its advocacy activities to address the care, treatment, diagnosis, and immediate and long-term needs of those affected by HCV infection. Many challenges remain in tackling chronic HCV infection, such as the need for a vaccine; difficult-to-treat populations and unknown aspects of patient subgroups, including pregnant women and children; vulnerable people; and issues distinct to Indigenous peoples. There is also increasing concern about long-term clinical outcomes after successful treatment, with the rise in comorbidities such as diabetes, cardiovascular disease, and fatty liver disease and the remaining risk for hepatocellular carcinoma in cirrhotic individuals. The symposium addressed these topics in highlighting research advances that will collectively play an important role in eliminating HCV and minimizing subsequent health challenges.
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Affiliation(s)
- Jiafeng Li
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario, Canada
- Chronic Disease Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Centre for Infection, Immunity and Inflammation, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Julia L Casey
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Zoë R Greenwald
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Abdool S Yasseen III
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Melisa Dickie
- Knowledge Exchange Division, Community AIDS Treatment Information Exchange, Toronto, Ontario, Canada
| | - Jordan J Feld
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
- Toronto Centre for Liver Disease, Toronto General Hospital, Toronto, Ontario, Canada
| | - Curtis L Cooper
- Centre for Infection, Immunity and Inflammation, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Division of Infectious Diseases, The Ottawa Hospital, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Angela M Crawley
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario, Canada
- Chronic Disease Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Centre for Infection, Immunity and Inflammation, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Biology, Carleton University, Ottawa, Ontario, Canada
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Emhmed Ali S, Nguyen MH. Delayed diagnosis and disparity in hepatitis C virus-infected immigrants in North America: A call for action. Liver Int 2021; 41:420. [PMID: 33091237 DOI: 10.1111/liv.14709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 10/16/2020] [Indexed: 02/13/2023]
Affiliation(s)
- Saad Emhmed Ali
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA
| | - Mindie H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA
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Bartlett SR, Buxton J, Palayew A, Picchio CA, Janjua NZ, Kronfli N. Hepatitis C Virus Prevalence, Screening, and Treatment Among People Who Are Incarcerated in Canada: Leaving No One Behind in the Direct-Acting Antiviral Era. Clin Liver Dis (Hoboken) 2021; 17:75-80. [PMID: 33680440 PMCID: PMC7916434 DOI: 10.1002/cld.1023] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/21/2020] [Accepted: 08/02/2020] [Indexed: 02/04/2023] Open
Affiliation(s)
- Sofia R. Bartlett
- Department of Pathology and Laboratory MedicineFaculty of MedicineUniversity of British ColumbiaVancouverBCCanada
- The Kirby InstituteUniversity of New South WalesSydneyAustralia
- British Columbia Centre for Disease ControlProvincial Health Services AuthorityVancouverBCCanada
| | - Jane Buxton
- British Columbia Centre for Disease ControlProvincial Health Services AuthorityVancouverBCCanada
- School of Population and Public HealthFaculty of MedicineUniversity of British ColumbiaVancouverBCCanada
| | - Adam Palayew
- Department of Epidemiology, Biostatistics, and Occupational HealthMcGill UniversityMontrealQCCanada
| | - Camila A. Picchio
- Barcelona Institute for Global Health (ISGlobal)Hospital ClínicUniversity of BarcelonaBarcelonaSpain
| | - Naveed Z. Janjua
- British Columbia Centre for Disease ControlProvincial Health Services AuthorityVancouverBCCanada
- School of Population and Public HealthFaculty of MedicineUniversity of British ColumbiaVancouverBCCanada
| | - Nadine Kronfli
- Department of MedicineDivision of Infectious Diseases and Chronic Viral Illness ServiceMcGill UniversityMontrealQCCanada
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von Aesch Z, Craig-Neil A, Shah H, Antoniou T, Meaney C, Pinto AD. Family medicine-directed hepatitis C care and barriers to treatment: a mixed-methods study. CMAJ Open 2021; 9:E201-E207. [PMID: 33688028 PMCID: PMC8034373 DOI: 10.9778/cmajo.20190194] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Antivirals for the treatment of hepatitis C virus (HCV) infection are effective, but many patients remain untreated and treatment is not yet routine in primary care. We evaluated the characteristics of patients who engaged in HCV treatment, and clinician perspectives on the barriers and facilitators to treatment. METHODS Our mixed-method, parallel-design study was conducted at a multisite primary care centre in downtown Toronto. In a retrospective chart review, we searched records from 2011 to 2017 to collect quantitative data, including HCV infection status and HCV treatment status. To contextualize the data, we conducted in-depth interviews with select physicians between Aug. 1 and Nov. 1, 2017, and analyzed the transcripts using content analysis. RESULTS Of the 40 381 charts reviewed, 727 patients (1.8%, 95% confidence interval [CI] 1.7%-1.9%) were infected with HCV, and 542 (74.6%) had HCV infection requiring treatment. Of those, 255 patients (47.0%) had engaged in treatment. Patients who had engaged in treatment were more likely to be male (odds ratio [OR] 1.63, 95% CI 1.10-2.42), older (OR 1.04 per year increase in age, 95% CI 1.02-1.05) and housed (OR 2.2, 95% CI 1.36-3.75), and they were more likely not to have engaged in injection drug use (OR 1.87, 95% CI 1.33-2.63). Based on interviews with 8 physicians, treatment barriers included a lack of knowledge about HCV treatment, concerns that patients would not adhere to medications and challenges related to medication access. Facilitators of treatment included access to specialist consultation, pharmacist support and primary care treatment guidelines. Common themes that emerged in both quantitative and qualitative components were the roles of unstable housing and intravenous drug use as barriers to engaging in and completing treatment. INTERPRETATION Our study captured provider-identified barriers to HCV care and the key factors related to retention in HCV care, including gender, age, housing status and experience with drug use. Successful primary-care-led HCV treatment programs may incorporate specialist and pharmacy support and focus on younger, female, underhoused populations and people who use drugs.
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Affiliation(s)
- Zoë von Aesch
- Department of Family and Community Medicine (von Aesch, Antoniou, Pinto), St. Michael's Hospital; Department of Family and Community Medicine, Faculty of Medicine (von Aesch, Antoniou, Meaney, Pinto), University of Toronto; Upstream Lab, MAP Centre for Urban Health Solutions (Craig-Neil, Pinto), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Francis Family Liver Clinic, University Health Network, Department of Medicine (Shah); Department of Medicine, Faculty of Medicine (Shah); Li Ka Shing Knowledge Institute (Antoniou), St. Michael's Hospital, Toronto, Ont.
| | - Amy Craig-Neil
- Department of Family and Community Medicine (von Aesch, Antoniou, Pinto), St. Michael's Hospital; Department of Family and Community Medicine, Faculty of Medicine (von Aesch, Antoniou, Meaney, Pinto), University of Toronto; Upstream Lab, MAP Centre for Urban Health Solutions (Craig-Neil, Pinto), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Francis Family Liver Clinic, University Health Network, Department of Medicine (Shah); Department of Medicine, Faculty of Medicine (Shah); Li Ka Shing Knowledge Institute (Antoniou), St. Michael's Hospital, Toronto, Ont
| | - Hemant Shah
- Department of Family and Community Medicine (von Aesch, Antoniou, Pinto), St. Michael's Hospital; Department of Family and Community Medicine, Faculty of Medicine (von Aesch, Antoniou, Meaney, Pinto), University of Toronto; Upstream Lab, MAP Centre for Urban Health Solutions (Craig-Neil, Pinto), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Francis Family Liver Clinic, University Health Network, Department of Medicine (Shah); Department of Medicine, Faculty of Medicine (Shah); Li Ka Shing Knowledge Institute (Antoniou), St. Michael's Hospital, Toronto, Ont
| | - Tony Antoniou
- Department of Family and Community Medicine (von Aesch, Antoniou, Pinto), St. Michael's Hospital; Department of Family and Community Medicine, Faculty of Medicine (von Aesch, Antoniou, Meaney, Pinto), University of Toronto; Upstream Lab, MAP Centre for Urban Health Solutions (Craig-Neil, Pinto), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Francis Family Liver Clinic, University Health Network, Department of Medicine (Shah); Department of Medicine, Faculty of Medicine (Shah); Li Ka Shing Knowledge Institute (Antoniou), St. Michael's Hospital, Toronto, Ont
| | - Christopher Meaney
- Department of Family and Community Medicine (von Aesch, Antoniou, Pinto), St. Michael's Hospital; Department of Family and Community Medicine, Faculty of Medicine (von Aesch, Antoniou, Meaney, Pinto), University of Toronto; Upstream Lab, MAP Centre for Urban Health Solutions (Craig-Neil, Pinto), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Francis Family Liver Clinic, University Health Network, Department of Medicine (Shah); Department of Medicine, Faculty of Medicine (Shah); Li Ka Shing Knowledge Institute (Antoniou), St. Michael's Hospital, Toronto, Ont
| | - Andrew D Pinto
- Department of Family and Community Medicine (von Aesch, Antoniou, Pinto), St. Michael's Hospital; Department of Family and Community Medicine, Faculty of Medicine (von Aesch, Antoniou, Meaney, Pinto), University of Toronto; Upstream Lab, MAP Centre for Urban Health Solutions (Craig-Neil, Pinto), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Francis Family Liver Clinic, University Health Network, Department of Medicine (Shah); Department of Medicine, Faculty of Medicine (Shah); Li Ka Shing Knowledge Institute (Antoniou), St. Michael's Hospital, Toronto, Ont
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Hamadeh A, Haines A, Feng Z, Thein HH, Janjua NZ, Krahn M, Wong WWL. Estimating chronic hepatitis C prevalence in British Columbia and Ontario, Canada, using population-based cohort studies. J Viral Hepat 2020; 27:1419-1429. [PMID: 32810886 DOI: 10.1111/jvh.13373] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/23/2020] [Accepted: 07/30/2020] [Indexed: 12/19/2022]
Abstract
Patients identified as having chronic hepatitis C (CHC) infection can be effectively and rapidly treated using direct-acting antiviral agents. However, there remains a substantial burden of subclinical undetected infection. This study estimates the prevalence and undiagnosed proportion of CHC in British Columbia (BC) and Ontario, Canada, using a model-based approach, informed by provincial population-level health administrative data. A two-step approach was used: Step 1) Two population-based retrospective analyses of administrative health data for a cohort of British Columbians and a cohort of Ontarians with CHC were conducted to generate population-level statistics of CHC-related health events; Step 2) using a validated natural history model of hepatitis C virus (HCV) infection, the historical prevalence of CHC was back-calculated from the data collected in Step 1. Our retrospective study found that, in BC and Ontario, the number of newly diagnosed CHC cases is declining yearly while the complications of the disease are increasing yearly. BC had a 2014 CHC prevalence of 1.04% (95% CI: 0.84%-1.44%), with 33.3% (95% CI: 25.5%-42.0%) of CHC cases undiagnosed. Ontario had a 2014 CHC prevalence of 0.91% (95% CI: 0.83%-1.02%) with 36.0% (95% CI: 31.2%-38.9%) of CHC cases undiagnosed. Our study offers robust estimates based on the integration of a validated natural history model with population-level health administrative data on HCV-related events, which can provide vital evidence for policymakers to develop appropriate policies to achieve elimination targets. Our approach can also be applied to produce robust region-specific estimates in other countries.
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Affiliation(s)
- Abdullah Hamadeh
- School of Pharmacy, University of Waterloo, Kitchener, ON, Canada
| | - Alex Haines
- Toronto Health Economics and Technology Assessment Collaborative (THETA), University Health Network, Toronto, ON, Canada
| | - Zeny Feng
- Department of Mathematics and Statistics, University of Guelph, Guelph, ON, Canada
| | - Hla-Hla Thein
- Toronto Health Economics and Technology Assessment Collaborative (THETA), University Health Network, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada
| | - Naveed Z Janjua
- BC Centre for Disuse Control, University of British Columbia, Vancouver, BC, Canada
| | - Murray Krahn
- Toronto Health Economics and Technology Assessment Collaborative (THETA), University Health Network, Toronto, ON, Canada.,ICES, Toronto, ON, Canada
| | - William W L Wong
- School of Pharmacy, University of Waterloo, Kitchener, ON, Canada.,Toronto Health Economics and Technology Assessment Collaborative (THETA), University Health Network, Toronto, ON, Canada.,ICES, Toronto, ON, Canada
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Cooper CL, Read D, Vachon ML, Conway B, Wong A, Ramji A, Borgia S, Tam E, Barrett L, Smyth D, Feld JJ, Lee S. Hepatitis C virus infection characteristics and treatment outcomes in Canadian immigrants. BMC Public Health 2020; 20:1345. [PMID: 32883249 PMCID: PMC7469277 DOI: 10.1186/s12889-020-09464-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 08/27/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND There are multiple obstacles encountered by immigrants attempting to engage hepatitis C virus (HCV) care and treatment. We evaluated the diversity and treatment outcomes of HCV-infected immigrants evaluated for Direct Acting Antiviral (DAA) therapy in Canada. METHODS The Canadian Network Undertaking against Hepatitis C (CANUHC) Cohort contains demographic information and DAA treatment information prospectively collected at 10 Canadian sites. Information on country of origin and race are collected. Characteristics and outcomes (sustained virological response; SVR) were compared by immigration status and race. RESULTS Between January 2016 and May 2018, 725 HCV-infected patients assessed for DAA therapy were enrolled in CANUHC (mean age: 52.66 ± 12.68 years); 65.66% male; 82.08% White, 5.28% Indigenous, 4.64% South East Asian, 4.64% East Indian, 3.36% Black). 18.48% were born outside of Canada. Mean age was similar [immigrants: 54.36 ± 13.95 years), Canadian-born: 52.27 ± 12.35 years); (p = 0.085)]. The overall baseline fibrosis score (in kPa measured by transient elastography) was similar among Canadian and foreign-born patients. Fibrosis score was not predicted by race or genotype. The proportion initiating DAA therapy was similar by immigrant status (56.72% vs 49.92%). SVR rates by intent-to-treat analysis were similar (immigrants-89.47%, Canadian-born-92.52%; p = 0.575). CONCLUSION A diverse immigrant population is engaging care in Canada, initiating HCV antiviral therapy in an equitable fashion and achieving SVR proportions similar to Canada-born patients. Our Canadian experience may be of value in informing HCV elimination efforts in economically developed regions.
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Affiliation(s)
- Curtis L Cooper
- University of Ottawa, Roger Guindon Hall, 451 Smyth Rd #2044, Ottawa, ON, K1H 8M5, Canada.
- University of Ottawa, The Ottawa Hospital-General Campus, G12-501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada.
| | - Daniel Read
- University of Ottawa, Roger Guindon Hall, 451 Smyth Rd #2044, Ottawa, ON, K1H 8M5, Canada
| | - Marie-Louise Vachon
- Laval University, Ferdinand Vandry Pavillon, 1050 Avenue de la Médecine, Quebec City, Quebec, G1V 0A6, Canada
| | - Brian Conway
- Vancouver Infectious Diseases Centre, 1200 Burrard St, Vancouver, BC, V6Z 2C7, Canada
| | - Alexander Wong
- University of Saskatchewan, 107 Wiggins Rd, Saskatoon, SK, S7N 5E5, Canada
| | - Alnoor Ramji
- University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Sergio Borgia
- McMaster University, Michael DeGroote Centre for Learning and Discovery (MDCL) - 3104, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Ed Tam
- Liver Health Centre, 750 W Broadway, Vancouver, BC, V5Z 1H2, Canada
| | - Lisa Barrett
- Dalhousie University, 5849 University Ave, Halifax, NS, B3H 4R2, Canada
| | - Dan Smyth
- Dalhousie University, 5849 University Ave, Halifax, NS, B3H 4R2, Canada
| | - Jordan J Feld
- Toronto General Hospital Research Institute, 200 Elizabeth St, Toronto, ON, M5G 2C4, Canada
| | - Sam Lee
- Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
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Alvarez E, Joshi S, Lokker C, Wang A, Pavalagantharajah S, Qiu Y, Sidhu H, Mbuagbaw L, Qutob M, Henedi A, Levine M, Lennox R, Tarride JE, Kalina D. Health programmes and services addressing the prevention and management of infectious diseases in persons who inject drugs in Canada: a systematic integrative review protocol. BMJ Open 2020; 10:e035188. [PMID: 32792428 PMCID: PMC7430337 DOI: 10.1136/bmjopen-2019-035188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 02/29/2020] [Accepted: 06/29/2020] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION Injection drug use (IDU) and intravenous drug use (IVDU) are of concern to the people using drugs, their families and health systems. One of the complications of IDU/IVDU is the risk of infection. Clinical experience has shown that persons who inject drugs (PWID) are hospitalised and re-hospitalised frequently. In Canada there are sparse data about the reasons for which PWID are admitted to hospital and their health trajectories, especially for infectious diseases. There are special concerns regarding PWID with infections who leave the hospital against medical advice and those who leave with a peripherally inserted central catheter line in place for administration of long-term antibiotics or other therapies. Improving our understanding of current programmes and services addressing the prevention and management of infectious diseases and their complications in PWID could lead to focused interventions to enhance care in this population. METHODS AND ANALYSIS An integrative systematic review allows for inclusion of a variety of methodologies to understand a health issue from different viewpoints. PubMed, CINAHL, Web of Science Databases and websites of the Public Health Agency of Canada, Canadian Institute for Substance Use Research, and Canadian Centre on Substance Use and Addiction will be searched using terms for infectious diseases, drug use and geography (Canada) and limited to the last 10 years (2009-2019). The Quality Appraisal Tool in Studies with Diverse Designs will be used to appraise the quality of identified studies and documents. Quantitative, qualitative or mixed methods data synthesis will be used as needed. ETHICS AND DISSEMINATION This study is a secondary analysis of publicly available documents; therefore, no ethics approval is required. This information will inform a research agenda to further investigate interventions that aim to address these issues. PROSPERO REGISTRATION NUMBER CRD42020142947.
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Affiliation(s)
- Elizabeth Alvarez
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Ontario, Canada
| | - Siddharth Joshi
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Cynthia Lokker
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Annie Wang
- Department of Life Sciences, McMaster University, Hamilton, Ontario, Canada
| | | | - Yun Qiu
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- School of Health Sciences, Jiangsu Vocational Institute of Commerce, Nanjing City, Jiangsu, China
| | - Hargun Sidhu
- Department of Undergraduate Medical Education, McMaster University, Hamilton, Ontario, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Majdi Qutob
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Alia Henedi
- Eastern Mediterranean University, Cyprus, Turkey
| | - Mitchell Levine
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Ontario, Canada
| | - Robin Lennox
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jean-Eric Tarride
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Ontario, Canada
| | - Dale Kalina
- Infectious Diseases, Joseph Brant Hospital, Burlington, Ontario, Canada
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Butt ZA, Wong S, Rossi C, Binka M, Wong J, Yu A, Darvishian M, Alvarez M, Chapinal N, Mckee G, Gilbert M, Tyndall MW, Krajden M, Janjua NZ. Concurrent Hepatitis C and B Virus and Human Immunodeficiency Virus Infections Are Associated With Higher Mortality Risk Illustrating the Impact of Syndemics on Health Outcomes. Open Forum Infect Dis 2020; 7:ofaa347. [PMID: 32964065 PMCID: PMC7489531 DOI: 10.1093/ofid/ofaa347] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 08/10/2020] [Indexed: 02/06/2023] Open
Abstract
Background Hepatitis C virus (HCV), hepatitis B virus (HBV), and human immunodeficiency virus (HIV) infections are associated with significant mortality globally and in North America. However, data on impact of concurrent multiple infections on mortality risk are limited. We evaluated the effect of HCV, HBV, and HIV infections and coinfections and associated factors on all-cause mortality in British Columbia (BC), Canada. Methods The BC Hepatitis Testers Cohort includes ~1.7 million individuals tested for HCV or HIV, or reported as a case of HCV, HIV, or HBV from 1990 to 2015, linked to administrative databases. We followed people with HCV, HBV, or HIV monoinfection, coinfections, and triple infections from their negative status to date of death or December 31, 2016. Extended Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for factors associated with all-cause mortality. Results Of 658 704 individuals tested for HCV, HBV, and HIV, there were 33 804 (5.13%) deaths. In multivariable Cox regression analysis, individuals with HCV/HBV/HIV (HR, 8.9; 95% CI, 8.2–9.7) infections had the highest risk of mortality followed by HCV/HIV (HR, 4.8; 95% CI, 4.4–5.1), HBV/HIV (HR, 4.1; 95% CI, 3.5–4.8), HCV/HBV (HR, 3.9; 95% CI, 3.7–4.2), HCV (HR, 2.6; 95% CI, 2.6–2.7), HBV (HR, 2.2; 95% CI, 2.0–2.3), and HIV (HR, 1.6; 95% CI, 1.5–1.7). Additional factors associated with mortality included injection drug use, problematic alcohol use, material deprivation, diabetes, chronic kidney disease, heart failure, and hypertension. Conclusions Concurrent multiple infections are associated with high mortality risk. Substance use, comorbidities, and material disadvantage were significantly associated with mortality independent of coinfection. Preventive interventions, including harm reduction combined with coinfection treatments, can significantly reduce mortality.
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Affiliation(s)
- Zahid A Butt
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada.,British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stanley Wong
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Carmine Rossi
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Mawuena Binka
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Jason Wong
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Amanda Yu
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | | | - Maria Alvarez
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | | | - Geoff Mckee
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Mark Gilbert
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mark W Tyndall
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mel Krajden
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,BCCDC Public Health Laboratory, Vancouver, British Columbia, Canada
| | - Naveed Z Janjua
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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39
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Tam E, Tremblay J, Fraser C, Conway B, Ramji A, Borgia S, Tsoi K, Yoshida EM, Rajendran B, Macphail G, Wong A, Cooper C, Patel K, Puglia M, Stewart K, Trottier B, Deshaies L, Doucette K, Ghali P, Lee S, Halsey-Brandt J, Trepanier JB. The Z-Profile Study: a multicenter, retrospective cohort study to assess the real-world use and effectiveness of elbasvir/grazoprevir in Canadian adult patients with chronic hepatitis C. CANADIAN LIVER JOURNAL 2020; 3:251-262. [DOI: 10.3138/canlivj-2019-0029] [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: 12/05/2019] [Accepted: 12/30/2019] [Indexed: 11/20/2022]
Abstract
Background: Canada was the first country to approve elbasvir/grazoprevir (EBR/GZR) for the treatment of chronic HCV infection for genotypes 1 and 4 with or without ribavirin and genotype 3 with sofosbuvir, with no recommendation for baseline resistance testing. The aim of this study was to describe the effectiveness of EBR/GZR and the profile of patients selected for treatment in a Canadian real-world setting. Methods: This multicenter retrospective study of HCV-infected patients treated with EBR/GZR took place among selected Canadian health care providers, with no exclusion criteria. Primary outcome measures included parameters associated with patient profile and sustained virologic response at 12 weeks (SVR12) and 24 weeks after treatment. Results: A total of 408 patients were included; 244 had available SVR12 information (per-protocol population [PP]). Genotype distribution included 1a (54.7%), 1b (17.2%), 3 (11.8%), 4 (10.0%), and other (6.4%). The majority (88.7%) of participants were treated for 12 weeks without ribavirin. Fifty-nine (14.5%) participants, predominantly with genotype 1a (49/59) infection, were tested for baseline resistance-associated substitutions (bRAS). SVR12 was achieved by 95.9% of the PP. In an exploratory analysis assessing potential predictors of SVR12, participants who had undergone bRAS testing (OR 0.14, 95% CI 0.03–0.64) and participants who had undergone liver transplant (OR 0.05, 95% CI 0.00–0.68) had significantly lower odds of achieving SVR12. Conclusions: This study supports the real-world effectiveness of EBR/GZR—including a broad range of genotypes and diverse fibrosis stages—in the absence of bRAS testing and in special populations.
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Affiliation(s)
- Edward Tam
- LAIR Centre, Vancouver, British Columbia, Canada
| | | | - Chris Fraser
- The Cool Aid Community Health Centre, Victoria, British Columbia, Canada
| | - Brian Conway
- Vancouver Infectious Diseases Centre, Vancouver, British Columbia, Canada
| | - Alnoor Ramji
- Gastroenterology Division, GI Research Institute (GIRI), Vancouver, British Columbia, Canada
| | - Sergio Borgia
- William Osler Health System, Brampton, Ontario, Canada
| | - Keith Tsoi
- St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Eric M Yoshida
- Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Gisela Macphail
- Calgary Urban Project Society (CUPS), Calgary, Alberta, Canada
| | - Alexander Wong
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Curtis Cooper
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Keyur Patel
- University Health Network, Toronto, Ontario, Canada
| | - Marco Puglia
- Hamilton Health Sciences, Hamilton, Ontario, Canada
| | | | - Benoit Trottier
- Clinique de Médecine Urbaine du Quartier Latin, Montreal, Quebec, Canada
| | | | - Karen Doucette
- Division of Infectious Diseases, University of Alberta, Edmonton, Alberta, Canada
| | - Peter Ghali
- McGill University Health Center, Montreal, Quebec, Canada
| | - Samuel S Lee
- Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada
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40
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Biondi MJ, Feld JJ. Hepatitis C models of care: approaches to elimination. CANADIAN LIVER JOURNAL 2020; 3:165-176. [PMID: 35991853 PMCID: PMC9202783 DOI: 10.3138/canlivj.2019-0002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 01/27/2019] [Indexed: 07/29/2023]
Abstract
Hepatitis C direct-acting antivirals (DAAs) have an efficacy of 95% or greater, with pangenotypic options. Many regions in Canada have recently abolished the need to demonstrate fibrosis before treatment with DAAs, and several combination therapies are available under public and private insurance coverage. As a result, efforts to increase treatment are largely focused on engaging specific populations and providers. With minimal side effects and decreased need for monitoring, hepatitis C screening, linkage, and treatment can largely be done in a single setting. In this article, we highlight both Canadian and international examples of the specialist's ongoing role and discuss the task shifting of hepatitis C treatment to primary care; specialized community clinics; and mental health, corrections, addictions, and opioid substitution therapy settings. Although specialists continue to support most models of care described in the literature, we highlight the potential for non-specialist care in working toward the elimination of hepatitis C in Canada.
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Affiliation(s)
- Mia J Biondi
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario
- Arthur Labatt Family School of Nursing, Western University, London, Ontario
| | - Jordan J Feld
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario
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41
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Haines AG, Mendlowitz AB, Wong WWL, Krahn M. Strategies to achieve population control of HCV infection: results of a multidisciplinary focus group. CANADIAN LIVER JOURNAL 2020; 3:224-231. [PMID: 35991858 PMCID: PMC9202787 DOI: 10.3138/canlivj-2019-0017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 11/11/2019] [Indexed: 08/20/2023]
Abstract
BACKGROUND To meet the World Health Organization's ambitious target to eradicate hepatitis C virus (HCV) by 2030, a comprehensive strategy is needed in Canada to ensure everyone infected with HCV is identified, diagnosed, and treated. The purpose of this study was to highlight the barriers to any strategy aimed at achieving this goal. METHODS A focus group was formed (N = 11) that consisted of clinicians, patients, drug program budget managers, industry representatives, and individuals from provincial public health and federal agencies in Canada. The group met in person for a half-day focus group session. Two discussions were held: one on future barriers related to HCV treatment and one related to HCV screening. A grounded theory approach was used to elicit key themes from the day's discussion. RESULTS Nine themes were identified. Four themes related to HCV screening: public awareness and engagement, resource infrastructure and capacity, heterogeneity between provinces, and mechanisms of screening. Three themes related to HCV treatment: access to treatment and illicit drug use, linkage to care, and predicting post-treatment outcomes. Two overarching themes that contributed to most discussions were a focus on baby boomers versus persons who inject drugs and the need for further education and training. CONCLUSION The views and findings extracted from this qualitative research complement proposals of national strategies from organizations such as the Canadian Network on Hepatitis C. This work highlights the financial, logistical, and ethical constraints that need to be tackled to make HCV elimination proposals a reality.
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Affiliation(s)
- Alexander G Haines
- Toronto Health Economics and Technology Assessment Collaborative, Toronto, Ontario, Canada
| | - Andrew B Mendlowitz
- Toronto Health Economics and Technology Assessment Collaborative, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - William WL Wong
- School of Pharmacy, University of Waterloo, Kitchener, Ontario, Canada
| | - Murray Krahn
- Toronto Health Economics and Technology Assessment Collaborative, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
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42
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Biondi MJ, Feld JJ. Hepatitis C models of care: approaches to elimination. CANADIAN LIVER JOURNAL 2020. [DOI: 10.3138/canlivj-2019-0002] [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] [Indexed: 11/20/2022]
Abstract
Hepatitis C direct-acting antivirals (DAAs) have an efficacy of 95% or greater, with pangenotypic options. Many regions in Canada have recently abolished the need to demonstrate fibrosis before treatment with DAAs, and several combination therapies are available under public and private insurance coverage. As a result, efforts to increase treatment are largely focused on engaging specific populations and providers. With minimal side effects and decreased need for monitoring, hepatitis C screening, linkage, and treatment can largely be done in a single setting. In this article, we highlight both Canadian and international examples of the specialist’s ongoing role and discuss the task shifting of hepatitis C treatment to primary care; specialized community clinics; and mental health, corrections, addictions, and opioid substitution therapy settings. Although specialists continue to support most models of care described in the literature, we highlight the potential for non-specialist care in working toward the elimination of hepatitis C in Canada.
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Affiliation(s)
- Mia J Biondi
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario
- Arthur Labatt Family School of Nursing, Western University, London, Ontario
| | - Jordan J Feld
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario
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43
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Mendlowitz AB, Naimark D, Wong WWL, Capraru C, Feld JJ, Isaranuwatchai W, Krahn M. The emergency department as a setting-specific opportunity for population-based hepatitis C screening: An economic evaluation. Liver Int 2020; 40:1282-1291. [PMID: 32267604 DOI: 10.1111/liv.14458] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 03/06/2020] [Accepted: 03/28/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS The World Health Organization's hepatitis C virus (HCV) elimination strategy recognizes the need for interventions that identify populations most affected by infection. The emergency department (ED) has been suggested as a setting for HCV screening. The study objective was to explore the health and economic impact of HCV screening in the ED setting. METHODS We used a microsimulation model to conduct a cost-utility analysis evaluating two ED setting-specific strategies: no screening, and screening and subsequent treatment. Strategies were examined for two populations: (a) the general ED patient population; and (b) ED patients born between 1945 and 1975. The analysis was conducted from a healthcare payer perspective over a lifetime time horizon. A reference and high ED HCV seroprevalence measure were examined in the Canadian healthcare setting.US costs of chronic infection were used for a scenario analysis of screening in the US healthcare setting. RESULTS For birth cohort screening, in comparison to no screening, one liver-related death was averted for every 760 and 123 persons screened for the reference and high seroprevalence measures. For general population screening, one liver-related death was averted for every 831 and 147 persons screened for the reference and high seroprevalence measures. In comparison to no screening, birth cohort screening was cost-effective at CAN$25,584/quality-adjusted life year (QALY) and US$42,615/QALY. General population screening was cost-effective at CAN$19,733/QALY and US$32,187/QALY. CONCLUSIONS ED screening may represent a cost-effective component of population-based strategies to eliminate HCV. Further studies are warranted to explore the feasibility and acceptability of this approach.
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Affiliation(s)
- Andrew B Mendlowitz
- Toronto Health Economics and Technology Assessment Collaborative, Toronto, ON, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - David Naimark
- Department of Medicine, Sunnybrook Hospital, Toronto, ON, Canada
| | - William W L Wong
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| | - Camelia Capraru
- Toronto Centre for Liver Disease, Toronto General Hospital, Toronto, ON, Canada
| | - Jordan J Feld
- Toronto Centre for Liver Disease, Toronto General Hospital, Toronto, ON, Canada
| | - Wanrudee Isaranuwatchai
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Murray Krahn
- Toronto Health Economics and Technology Assessment Collaborative, Toronto, ON, Canada.,University Health Network - Toronto General Hospital, Toronto, ON, Canada
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44
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Mandel E, E Kendall C, Mason K, Guyton M, Lettner B, Broad J, Altenberg J, Donelle J, Powis J. Impact of comprehensive care on health care use among a cohort of marginalized people living with hepatitis C in Toronto. CANADIAN LIVER JOURNAL 2020. [DOI: 10.3138/canlivj-2019-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background: The majority of new hepatitis C (HCV) cases occur among people who inject drugs. In recent years, multidisciplinary models of HCV treatment have emerged that demonstrate successful treatment outcomes for this population, as well as broad positive individual- and system-level impacts. Our objective was to evaluate changes in health care use among a cohort of people living with HCV before and after engagement with one such program. Methods: Program data were uniquely linked to provincial health administrative databases. Rates of emergency department (ED) visits and hospital admissions of clients from 2011 through 2015 ( N = 103) were evaluated using linkages with administrative data for the 2 years before and after program initiation. Data were evaluated using negative binomial regression models with a covariance structure to account for within-individual correlations. Results: Of participants, 72.8% were men (mean age 47 years), and 38% experienced high rates of physical and mental health comorbidity (Aggregated Diagnosis Group score ≥10). Female clients had significantly fewer ED visits 2 years after program initiation (5.04 versus 3.12; risk ratio [RR] 0.61 [95% CI 0.44% to 0.86%]). ED visits for infectious diseases and soft tissue injury were significantly lower for the cohort overall (RRs 0.58 0.51 [95% CIs 0.35% to 0.95% and 0.29% to 0.90%], respectively). Conclusion: Co-locating HCV treatment within comprehensive primary care and harm reduction services appears to have benefits beyond HCV, including a reduction in ED visits among women and a decrease in ED visits for soft tissue infections for all participants.
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Affiliation(s)
- Erin Mandel
- Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario
| | - Claire E Kendall
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario
- C.T. Lamont Primary Health Care Research Centre, Bruyere Research Institute, Ottawa, Ontario
| | - Kate Mason
- South Riverdale Community Health Centre, Toronto, Ontario
| | | | | | - Jennifer Broad
- South Riverdale Community Health Centre, Toronto, Ontario
| | | | | | - Jeff Powis
- South Riverdale Community Health Centre, Toronto, Ontario
- Michael Garron Hospital, Toronto, Ontario
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45
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Mandel E, E Kendall C, Mason K, Guyton M, Lettner B, Broad J, Altenberg J, Donelle J, Powis J. Impact of comprehensive care on health care use among a cohort of marginalized people living with hepatitis C in Toronto. CANADIAN LIVER JOURNAL 2020; 3:203-211. [DOI: 10.3138/canlivj.2019-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 09/14/2019] [Indexed: 11/20/2022]
Abstract
Background: The majority of new hepatitis C (HCV) cases occur among people who inject drugs. In recent years, multidisciplinary models of HCV treatment have emerged that demonstrate successful treatment outcomes for this population, as well as broad positive individual- and system-level impacts. Our objective was to evaluate changes in health care use among a cohort of people living with HCV before and after engagement with one such program. Methods: Program data were uniquely linked to provincial health administrative databases. Rates of emergency department (ED) visits and hospital admissions of clients from 2011 through 2015 ( N = 103) were evaluated using linkages with administrative data for the 2 years before and after program initiation. Data were evaluated using negative binomial regression models with a covariance structure to account for within-individual correlations. Results: Of participants, 72.8% were men (mean age 47 years), and 38% experienced high rates of physical and mental health comorbidity (Aggregated Diagnosis Group score ≥10). Female clients had significantly fewer ED visits 2 years after program initiation (5.04 versus 3.12; risk ratio [RR] 0.61 [95% CI 0.44% to 0.86%]). ED visits for infectious diseases and soft tissue injury were significantly lower for the cohort overall (RRs 0.58 0.51 [95% CIs 0.35% to 0.95% and 0.29% to 0.90%], respectively). Conclusion: Co-locating HCV treatment within comprehensive primary care and harm reduction services appears to have benefits beyond HCV, including a reduction in ED visits among women and a decrease in ED visits for soft tissue infections for all participants.
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Affiliation(s)
- Erin Mandel
- Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario
| | - Claire E Kendall
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario
- C.T. Lamont Primary Health Care Research Centre, Bruyere Research Institute, Ottawa, Ontario
| | - Kate Mason
- South Riverdale Community Health Centre, Toronto, Ontario
| | | | | | - Jennifer Broad
- South Riverdale Community Health Centre, Toronto, Ontario
| | | | | | - Jeff Powis
- South Riverdale Community Health Centre, Toronto, Ontario
- Michael Garron Hospital, Toronto, Ontario
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46
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Kendall CE, Fitzgerald M, Donelle J, Kwong JC, Galanakis C, Boyd R, Cooper CL. A cross-sectional study of prolonged disengagement from clinic among people with HCV receiving care in a low-threshold, multidisciplinary clinic. CANADIAN LIVER JOURNAL 2020; 3:212-223. [DOI: 10.3138/canlivj.2019-0020] [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: 07/16/2019] [Accepted: 09/22/2019] [Indexed: 11/20/2022]
Abstract
Background: Disengagement from care can affect treatment outcomes of patients with hepatitis C virus (HCV). We assessed the extent and determinants of disengagement among HCV patients receiving care at the Ottawa Hospital Viral Hepatitis Program (TOHVHP). Methods: We linked clinical data of adult patients, categorized as ever or never disengaged from clinic (no TOHVHP encounters over 18 months), receiving care between April 1, 2002, and October 1, 2015, to provincial health administrative databases and calculated primary care use in the year after disengagement. We used adjusted Cox proportional hazards models to analyze variables associated with disengagement. Results: Those disengaged from care ( n = 657) were younger at presentation (46.6 [SD 11.1] versus 51.9 [SD 11.0] years), p < 0.001) and had lower comorbidity. After multivariable adjustment, we observed lower hazards of disengagement among those with higher compared with lower fibrosis scores (F3, hazard ratio [HR] 0.21 [95% CI 0.08–0.57]; F4, HR 0.32 [95% CI 0.19–0.55]) and those treated compared with never treated (received direct-acting antivirals [DAAs], HR 0.71 [95% CI 0.58–0.88]; received interferon but not DAA, HR 0.66 [95% CI 0.55–0.80]). We found no association with mental health or substance use disorders. In the year after disengagement, 74.3% ( n = 488), 37.1% ( n = 244), and 17.7% ( n = 116) had at least one family physician visit, emergency department visit, and hospitalization, respectively. Conclusions: Better integration of HCV specialty and primary care could improve disengagement rates among people with HCV.
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Affiliation(s)
- Claire E Kendall
- Bruyère Research Institute, Ottawa, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Ontario, Canada
| | | | | | - Jeffrey C Kwong
- ICES, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada
| | - Chrissi Galanakis
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Rob Boyd
- Sandy Hill Community Health Centre, Ottawa, Ontario, Canada
| | - Curtis L Cooper
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Binka M, Janjua NZ, Grebely J, Estes C, Schanzer D, Kwon JA, Shoukry NH, Kwong JC, Razavi H, Feld JJ, Krajden M. Assessment of Treatment Strategies to Achieve Hepatitis C Elimination in Canada Using a Validated Model. JAMA Netw Open 2020; 3:e204192. [PMID: 32374397 PMCID: PMC7203608 DOI: 10.1001/jamanetworkopen.2020.4192] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 03/04/2020] [Indexed: 12/19/2022] Open
Abstract
Importance Achievement of the World Health Organization (WHO) target of eliminating hepatitis C virus (HCV) by 2030 will require an increase in key services, including harm reduction, HCV screening, and HCV treatment initiatives in member countries. These data are not available for Canada but are important for informing a national HCV elimination strategy. Objective To use a decision analytical model to explore the association of different treatment strategies with HCV epidemiology and HCV-associated mortality in Canada and to assess the levels of service increase needed to meet the WHO elimination targets by 2030. Design, Setting, and Participants Study participants in this decision analytical model included individuals with hepatitis C virus infection in Canada. Five HCV treatment scenarios (optimistic, very aggressive, aggressive, gradual decrease, and rapid decrease) were applied using a previously validated Markov-type mathematical model. The optimistic and very aggressive treatment scenarios modeled a sustained annual treatment of 10 200 persons and 14 000 persons, respectively, from 2018 to 2030. The aggressive, gradual decrease, and rapid decrease scenarios assessed decreases in treatment uptake from 14 000 persons to 10 000 persons per year, 12 000 persons to 8500 persons per year, and 12 000 persons to 4500 persons per year, respectively, between 2018 and 2030. Main Outcomes and Measures Hepatitis C virus prevalence and HCV-associated health outcomes were assessed for each of the 5 treatment scenarios with the goal of identifying strategies to achieve HCV elimination by 2030. Results An estimated mean 180 142 persons (95% CI, 122 786-196 862 persons) in Canada had chronic HCV infection at the end of 2017. The optimistic and gradual decrease scenarios estimated a decrease in HCV prevalence from 180 142 persons to 37 246 persons and 37 721 persons, respectively, by 2030. Relative to 2015, this decrease in HCV prevalence was associated with 74%, 69%, and 69% reductions in the prevalence of decompensated cirrhosis, hepatocellular carcinoma, and liver-associated mortality, respectively, leading to HCV elimination by 2030. More aggressive treatment uptake (very aggressive scenario) could result in goal achievement up to 3 years earlier than 2030, although a rapid decrease in the initiation of treatment (rapid decrease scenario) would preclude Canada from reaching the HCV elimination goal by 2030. Conclusions and Relevance The study findings suggest that Canada could meet the WHO goals for HCV elimination by 2030 by sustaining the current national HCV treatment rate during the next decade. This target will not be achieved if treatment uptake is allowed to decrease rapidly.
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Affiliation(s)
- Mawuena Binka
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Naveed Z. Janjua
- British Columbia Centre for Disease Control, Vancouver, Canada
- Canadian Network on Hepatitis C, Montreal, Quebec, Canada
- University of British Columbia, Vancouver, Canada
| | - Jason Grebely
- Canadian Network on Hepatitis C, Montreal, Quebec, Canada
- Kirby Institute, University of New South Wales Sydney, Sydney, Australia
| | - Chris Estes
- Center for Disease Analysis, Lafayette, Colorado
| | - Dena Schanzer
- Canadian Network on Hepatitis C, Montreal, Quebec, Canada
| | - Jisoo A. Kwon
- Kirby Institute, University of New South Wales Sydney, Sydney, Australia
| | - Naglaa H. Shoukry
- Canadian Network on Hepatitis C, Montreal, Quebec, Canada
- Centre de Recherche du Centre Hospitalier de l’Universite de Montreal, Montreal, Quebec, Canada
| | - Jeffrey C. Kwong
- Canadian Network on Hepatitis C, Montreal, Quebec, Canada
- ICES, Toronto, Ontario, Canada
| | - Homie Razavi
- Center for Disease Analysis, Lafayette, Colorado
| | - Jordan J. Feld
- Canadian Network on Hepatitis C, Montreal, Quebec, Canada
- Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada
| | - Mel Krajden
- British Columbia Centre for Disease Control, Vancouver, Canada
- Canadian Network on Hepatitis C, Montreal, Quebec, Canada
- University of British Columbia, Vancouver, Canada
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48
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Apau Bediako R. The Ethics of Screening and Treating Persons with Hepatitis C: A Canadian Perspective. CANADIAN JOURNAL OF BIOETHICS 2020. [DOI: 10.7202/1068763ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In this article, I argue that the Canadian government’s position against screening for hepatitis C virus (HCV) and publicly funding HCV treatment is ethically unjustifiable. Cost of medication and likelihood of widening existing health inequality are the government’s argument for not funding HCV treatment and for also not having a screening program. I object to this position and argue in favour of a screening program and public funding of HCV treatment. I argue that these barriers are ethically unjust. Conclusively, being denied screening and early treatment is to be denied the best possible outcome.
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Affiliation(s)
- Ramseyer Apau Bediako
- Centre for Bioethics, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Canada
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49
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The role of prison-based interventions for hepatitis C virus (HCV) micro-elimination among people who inject drugs in Montréal, Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 88:102738. [PMID: 32278651 DOI: 10.1016/j.drugpo.2020.102738] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 02/21/2020] [Accepted: 03/17/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND In Canada, hepatitis C virus (HCV) transmission primarily occurs among people who inject drugs (PWID) and people with experience in the prison system bare a disproportionate disease burden. These overlapping groups of individuals have been identified as priority populations for HCV micro-elimination in Canada, which is currently not on track to achieve its elimination targets. Considering the missed opportunities to intervene in provincial prisons, this study aims to estimate the population-level impact of prison-based interventions and post-release risk reduction strategies on HCV transmission among PWID in Montréal, a Canadian city with high HCV burden. METHODS A dynamic HCV transmission model among PWID was developed and calibrated to community and prison bio-behavioural surveys in Montréal. Then, the relative impact of prison-based testing and treatment or post-release linkage to care (both 90% testing and 75% treatment coverage), alone or in combination with strategies that reduce the heightened post-release transmission risk by 50%, was estimated from 2018 to 2030, and compared to counterfactual scenarios. RESULTS Prison-based test-and-treat strategies could lead to the greatest declines in incidence (48%; 95%CrI: 38-57%) over 2018-2030 and prevent the most new first chronic infections (22%; 95%CrI: 16-28%) among people never exposed to HCV. Prison testing and post-release linkage to care lead to a slightly lower decrease in incidence and prevented fraction of new chronic infections. Combining test-and-treat with risk reduction measures could further its epidemiological impact, preventing 35% (95%CrI: 29-40%) of new first chronic infections. When implemented concomitantly with community-based treatment scale-up, prison-based interventions had synergistic effects, averting a higher fraction of new first chronic infections. CONCLUSION Offering HCV testing and treatment in provincial prisons, where incarcerations are frequent and sentences short, could change the course of the HCV epidemic in Montréal. Prison-based interventions with potential integration of post-release risk reduction measures should be considered as an integral part of HCV micro-elimination strategies in this setting.
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50
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Darvishian M, Wong S, Binka M, Yu A, Ramji A, Yoshida EM, Wong J, Rossi C, Butt ZA, Bartlett S, Pearce ME, Samji H, Cook D, Alvarez M, Chong M, Tyndall M, Krajden M, Janjua NZ. Loss to follow-up: A significant barrier in the treatment cascade with direct-acting therapies. J Viral Hepat 2020; 27:243-260. [PMID: 31664755 DOI: 10.1111/jvh.13228] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 09/19/2019] [Accepted: 10/22/2019] [Indexed: 12/15/2022]
Abstract
Effectiveness of direct-acting antiviral (DAA) therapies could be influenced by patient characteristics such as comorbid conditions, which could lead to premature treatment discontinuation and/or irregular medical follow-ups. Here, we evaluate loss to follow-up and treatment effectiveness of sofosbuvir/ledipasvir ± ribavirin (SOF/LDV ± RBV), ombitasvir/paritaprevir/ritonavir + dasabuvir ± ribavirin (OBV/PTV/r + DSV ± RBV) for hepatitis C virus (HCV) genotype 1 (GT1) and sofosbuvir + ribavirin (SOF + RBV) for genotype 3 (GT3) in British Columbia Canada: The British Columbia Hepatitis Testers Cohort includes data on individuals tested for HCV since 1992, integrated with medical visit, hospitalization and prescription drug data. HCV-positive individuals who initiated DAA regimens, irrespective of treatment completion, for GT1 and GT3 until 31 December, 2017 were included. Factors associated with sustained virological response (SVR) and loss to follow-up were assessed by using multivariable logistic regression models. In total 4477 individuals initiated DAAs. The most common prescribed DAA was SOF/LDV ± RBV with SVR of 95%. The highest SVR of 99.5% was observed among OBV/PTV/r + DSV-treated patients. Overall, 453 (10.1%) individuals were lost to follow-up. Higher loss to follow-up was observed among GT1 patients treated with OBV (17.8%) and GT3 patients (15.7%). The loss to follow-up rate was significantly higher among individuals aged <60 years, those with a history of injection drug use (IDU), on opioid substitution therapy and with cirrhosis. Our findings indicate that loss to follow-up exceeds viral failure in HCV DAA therapy and its rate varies significantly by genotype and treatment regimen. Depending on the aetiology of lost to follow-up, personalized case management for those with medical complications and supporting services among IDU are needed to achieve the full benefits of effective treatments.
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Affiliation(s)
- Maryam Darvishian
- BC Centre for Disease Control, Vancouver, BC, Canada.,University of British Columbia, Vancouver, BC, Canada.,BC Cancer Research Centre, Vancouver, BC, Canada.,Population Oncology, Vancouver, BC, Canada
| | - Stanley Wong
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - Mawuena Binka
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - Amanda Yu
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - Alnoor Ramji
- University of British Columbia, Vancouver, BC, Canada
| | - Eric M Yoshida
- Division of Gastroenterology of the Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jason Wong
- BC Centre for Disease Control, Vancouver, BC, Canada.,University of British Columbia, Vancouver, BC, Canada
| | - Carmine Rossi
- BC Centre for Disease Control, Vancouver, BC, Canada.,University of British Columbia, Vancouver, BC, Canada
| | - Zahid A Butt
- BC Centre for Disease Control, Vancouver, BC, Canada.,University of British Columbia, Vancouver, BC, Canada
| | - Sofia Bartlett
- BC Centre for Disease Control, Vancouver, BC, Canada.,University of British Columbia, Vancouver, BC, Canada
| | - Margo E Pearce
- BC Centre for Disease Control, Vancouver, BC, Canada.,University of British Columbia, Vancouver, BC, Canada
| | - Hasina Samji
- BC Centre for Disease Control, Vancouver, BC, Canada.,Simon Fraser University, Burnaby, BC, Canada
| | - Darrel Cook
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - Maria Alvarez
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - Mei Chong
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - Mark Tyndall
- BC Centre for Disease Control, Vancouver, BC, Canada.,University of British Columbia, Vancouver, BC, Canada
| | - Mel Krajden
- BC Centre for Disease Control, Vancouver, BC, Canada.,University of British Columbia, Vancouver, BC, Canada
| | - Naveed Z Janjua
- BC Centre for Disease Control, Vancouver, BC, Canada.,University of British Columbia, Vancouver, BC, Canada
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