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Zhang K, Han Y, Gu F, Gu Z, Zhao J, Chen J, Chen B, Gao M, Hou Z, Yu X, Cai T, Gao Y, Xie J, Liu T, Liu K. Association between dietary total choline and abdominal aorta calcification among older US adults: A cross-sectional study of the National Health and Nutrition Examination Survey. JPEN J Parenter Enteral Nutr 2024; 48:155-164. [PMID: 37932919 DOI: 10.1002/jpen.2577] [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: 04/12/2023] [Revised: 10/23/2023] [Accepted: 10/26/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Numerous studies indicate a potential bidirectional association between dietary choline intake and its derivative, betaine, and subclinical atherosclerosis. However, little research has been conducted on the relationship between dietary choline and severe abdominal aortic calcification (SAAC). METHODS This cross-sectional study analyzed population-based data from the National Health and Nutrition Examination Survey (2013-2014). Choline intake and food sources were measured using two 24-h dietary-recall interviews. The abdominal aortic calcification score was measured using a dual-emission x-ray absorptiometry scan. To assess the relationship between choline intake and SAAC, the study utilized restricted cubic spline and a multivariable logistic regression model. RESULTS Among the 2640 individuals included in the study, 10.9% had SAAC. After adjusting for all selected covariates, compared with the lowest quartile of dietary choline, the odds ratios of SAAC for the second-quartile, third-quartile, and fourth-quartile dietary choline intake were 0.63 (95% confidence interval [CI], 0.43-0.93), 0.63 (95% CI, 0.42-0.94), and 0.77 (95% CI, 0.5-1.16), respectively. The study found an L-shaped relationship between dietary choline and SAAC in the dose-response analysis. Subgroup analyses did not demonstrate any statistically significant interaction effects for any subgroup. CONCLUSION The study found that a higher intake of dietary choline is associated with a lower prevalence of SAAC. The dose-response analysis revealed an L-shaped relationship between dietary choline and SAAC. However, further studies are warranted to investigate the direct role of choline in the development of SAAC.
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Affiliation(s)
- Kai Zhang
- Cardiovascular Surgery Department of Jilin University Second Hospital, Changchun, China
| | - Yu Han
- Department of Ophthalmology, First Hospital of Jilin University, Changchun, China
| | - Fangmin Gu
- Cardiovascular Surgery Department of Jilin University Second Hospital, Changchun, China
| | - Zhaoxuan Gu
- Cardiovascular Surgery Department of Jilin University Second Hospital, Changchun, China
| | - JiaYu Zhao
- Cardiovascular Surgery Department of Jilin University Second Hospital, Changchun, China
| | - Jianguo Chen
- Bethune First College of Clinical Medicine, Jilin University, Changchun, China
| | - Bowen Chen
- Bethune First College of Clinical Medicine, Jilin University, Changchun, China
| | - Min Gao
- Department of Cancer Center, The First Hospital of Jilin University, Changchun, China
| | - Zhengyan Hou
- Bethune Second School of Clinical Medicine, Jilin University, Changchun, China
| | - Xiaoqi Yu
- Bethune Second School of Clinical Medicine, Jilin University, Changchun, China
| | - Tianyi Cai
- Bethune Second School of Clinical Medicine, Jilin University, Changchun, China
| | - Yafang Gao
- Bethune Second School of Clinical Medicine, Jilin University, Changchun, China
| | - Jinyu Xie
- Cardiovascular Surgery Department of Jilin University Second Hospital, Changchun, China
| | - Tianzhou Liu
- Department of Gastrointestinal Surgery, The Second Hospital of Jilin University, Changchun, China
| | - Kexiang Liu
- Cardiovascular Surgery Department of Jilin University Second Hospital, Changchun, China
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Prasa J, Karim SS, Jacob B, Mustacchia P. Hepatitis C Prevalence on the Rise but Screening at Safety Net Institutions Lagging behind. Int J Hepatol 2023; 2023:3650746. [PMID: 38027071 PMCID: PMC10651336 DOI: 10.1155/2023/3650746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/23/2023] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction In the United States, the hepatitis C virus (HCV) is a leading contributor to liver-related illnesses and fatalities. Despite effective antiviral medications, acute infections have increased in recent years, likely due to IV drug use and the opioid epidemic. Previous guidelines recommended one-time screening for individuals born between 1945 and 1965. The CDC now recommends screening all adults over 18 unless there is a low prevalence in the area. Accurate measurement of HCV prevalence is essential for targeted prevention. In New York, over 100,000 individuals have HCV. We present data on HCV screening at a safety net hospital in Long Island, NY. Objective To identify screening rates for hepatitis C and the exposure prevalence and specific demographics of a community in Long Island, NY. Methods We performed a review of all patients seen in our hospital from 2012 to 2019. We identified patients born in the years 1945 to 1965 using our electronic medical record (EMR) system and subsequently analyzed those who were anti-HCV positive. We reviewed their demographics, including age, gender, and ethnicity, as well as their history of intravenous drug use and HIV coinfection status. Basic statistical analysis was used. Results Our study identified 21,722 patients born between 1945 and 1965 and found that only 8.5% or 1,858 individuals were screened for hepatitis C. Among them, we found that 5.9% (109) tested positive for HCV antibody, with 3.0% (56) having an active infection. Demographic characteristics of those with HCV antibodies included 70.6% male, 53.2% Caucasian, 33.9% Black, and 15.6% persons who inject drugs (PWID). Conclusion Our study findings suggest that a significant portion of patients in our community had missed opportunities for screening in our hospital. Our community had an estimated 5.9% prevalence, higher than the national and state averages. Caucasian men had higher prevalences. This study suggests the need for broader screening initiatives and more focused resource allocation, perhaps to safety net institutions, to decrease the burden of HCV.
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Affiliation(s)
- Jarin Prasa
- Department of Internal Medicine, Staten Island University Hospital, NY, USA
| | - Syed S. Karim
- Department of Gastroenterology, NYC Health and Hospitals, South Brooklyn Health, NY, USA
| | - Bobby Jacob
- Department of Gastroenterology, Parkview Regional Medical Center, IN, USA
| | - Paul Mustacchia
- Department of Internal Medicine and Department of Gastroenterology, Nassau University Medical Center, NY, USA
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Nakayama J, Hertzberg VS, Ho JC, Simpson RL, Cartwright EJ. Hepatitis C care cascade in a large academic healthcare system, 2012 to 2018. Medicine (Baltimore) 2023; 102:e32859. [PMID: 36897716 PMCID: PMC9997763 DOI: 10.1097/md.0000000000032859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/17/2023] [Indexed: 03/11/2023] Open
Abstract
To determine the hepatitis C virus (HCV) care cascade among persons who were born during 1945 to 1965 and received outpatient care on or after January 2014 at a large academic healthcare system. Deidentified electronic health record data in an existing research database were analyzed for this study. Laboratory test results for HCV antibody and HCV ribonucleic acid (RNA) indicated seropositivity and confirmatory testing. HCV genotyping was used as a proxy for linkage to care. A direct-acting antiviral (DAA) prescription indicated treatment initiation, an undetectable HCV RNA at least 20 weeks after initiation of antiviral treatment indicated a sustained virologic response. Of the 121,807 patients in the 1945 to 1965 birth cohort who received outpatient care between January 1, 2014 and June 30, 2017, 3399 (3%) patients were screened for HCV; 540 (16%) were seropositive. Among the seropositive, 442 (82%) had detectable HCV RNA, 68 (13%) had undetectable HCV RNA, and 30 (6%) lacked HCV RNA testing. Of the 442 viremic patients, 237 (54%) were linked to care, 65 (15%) initiated DAA treatment, and 32 (7%) achieved sustained virologic response. While only 3% were screened for HCV, the seroprevalence was high in the screened sample. Despite the established safety and efficacy of DAAs, only 15% initiated treatment during the study period. To achieve HCV elimination, improved HCV screening and linkage to HCV care and DAA treatment are needed.
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Affiliation(s)
- Jasmine Nakayama
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA
| | - Vicki S. Hertzberg
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA
- Emory University Department of Computer Science, Atlanta, GA
| | - Joyce C. Ho
- Emory University Department of Computer Science, Atlanta, GA
| | - Roy L. Simpson
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA
| | - Emily J. Cartwright
- Emory University School of Medicine, Atlanta, GA
- Atlanta VA Medical Center, Atlanta, GA
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4
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Brennan PN, Byrne CJ, Dillon JF. Decentralisation of hepatitis C virus care into community settings: A key approach on the path to elimination. Liver Int 2022; 42:1222-1224. [PMID: 35678037 DOI: 10.1111/liv.15229] [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: 12/01/2021] [Accepted: 12/15/2021] [Indexed: 02/13/2023]
Affiliation(s)
- Paul N Brennan
- University of Edinburgh, Edinburgh, UK.,Division of Molecular and Clinical Medicine, Ninewells Hospital, University of Dundee School of Medicine, Dundee, UK.,Department of Gastroenterology, NHS Tayside, Ninewells Hospital & Medical School, Dundee, UK
| | - Christopher J Byrne
- Division of Molecular and Clinical Medicine, Ninewells Hospital, University of Dundee School of Medicine, Dundee, UK.,Tayside Clinical Trials Unit, University of Dundee, Dundee, UK
| | - John F Dillon
- Division of Molecular and Clinical Medicine, Ninewells Hospital, University of Dundee School of Medicine, Dundee, UK.,Department of Gastroenterology, NHS Tayside, Ninewells Hospital & Medical School, Dundee, UK
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5
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Paul Noel B, Peter C, Emma R, Asthika A, Francis DJ. Cohort study: Apparent redundancy of fibrosis assessment in young persons with HCV; development of realistic approaches to break the paradigm. Ann Hepatol 2022; 27:100550. [PMID: 34606981 DOI: 10.1016/j.aohep.2021.100550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/28/2021] [Accepted: 05/31/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND OBJECTIVES Hepatitis C Virus (HCV) is a blood-borne, hepatotropic RNA virus causing both acute and chronic infection. Chronic HCV infection predisposes individuals to liver fibrosis, cirrhosis and hepatocellular carcinoma. Staging of fibrosis prior to treatment to determine either treatment choice or required follow up, is standard practice. However, this often acts as a barrier to treatment initiation. We sought to validate the hypothesis that those individuals; mono-infected with HCV, ≤35 years of age; with no additional hepatic insult were unlikely to have significant fibrosis. METHODS We performed a retrospective analysis of a Hepatitis C Virus database; with collation of relevant basic demographics including age, sex and baseline Transient Elastography measurements pre-treatment. Additionally, we compared the reliability of biochemical fibrosis scores with corresponding transient elastography scores. RESULTS Our results support the hypothesis that those individuals with chronic HCV ≤35 years old, with no additional risk for fibrogenesis did not have significant liver fibrosis within our cohort. CONCLUSION Patients ≤35 years old likely do not necessitate fibrosis assessment prior to Direct Acting Antiviral (DAA) treatment in the absence of other significant risk factors for fibrosis. Given the emerging evidence that DAA treatment results in a significant decrease in all-cause mortality and hepatocellular carcinoma development, treatment of those with chronic HCV represents a global priority.
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Affiliation(s)
- Brennan Paul Noel
- University of Edinburgh, Edinburgh BioQuarter, 5 Little France Drive, EH16 4UU United Kingdom; University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY, United Kingdom.
| | - Cartlidge Peter
- NHS Tayside, Ninewells Hospital and Medical School, Dundee DD1 9SY, United Kingdom
| | - Robinson Emma
- University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY, United Kingdom; NHS Tayside, Ninewells Hospital and Medical School, Dundee DD1 9SY, United Kingdom
| | - Amarthingalam Asthika
- University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY, United Kingdom
| | - Dillon John Francis
- University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY, United Kingdom; NHS Tayside, Ninewells Hospital and Medical School, Dundee DD1 9SY, United Kingdom
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Ocal S, Muir AJ. Addressing Hepatitis C in the American Incarcerated Population: Strategies for Nationwide Elimination. Curr HIV/AIDS Rep 2020; 17:18-25. [PMID: 31933274 DOI: 10.1007/s11904-019-00476-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE OF REVIEW The prevalence of Hepatitis C virus (HCV) in the US incarcerated population is disproportionately high, and when inmates with infection are released back into the general population, they play a substantial role in the spread of disease. This review provides support for targeting the jail/prison population to eliminate HCV in the general population. It will also summarize various screening/treatment models to curtail the burden of disease behind and beyond bars. RECENT FINDINGS Transitioning from risk-based testing to opt-out testing in prisons/jails would be cost-effective through greater identification of cases and treatment to prevent complications from cirrhosis. Other innovative strategies, such as the nominal pricing mechanism or the "Netflix" DAA subscription model, have the potential to be cost-effective and to increase access to treatment. Addressing HCV in the incarcerated population is a strategy to bring the US closer to successfully eradicating the epidemic. Such findings should incentivize policymakers to implement care models that target this population.
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Affiliation(s)
| | - Andrew J Muir
- Division of Gastroenterology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
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7
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Turner BJ, Rochat A, Lill S, Bobadilla R, Hernandez L, Choi A, Guerrero JA. Hepatitis C Virus Screening and Care: Complexity of Implementation in Primary Care Practices Serving Disadvantaged Populations. Ann Intern Med 2019; 171:865-874. [PMID: 31791065 DOI: 10.7326/m18-3573] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) disproportionately affects disadvantaged communities. OBJECTIVE To examine processes and outcomes of Screen, Treat, Or Prevent Hepatocellular Carcinoma (STOP HCC), a multicomponent intervention for HCV screening and care in safety-net primary care practices. DESIGN Mixed-methods retrospective analysis. SETTING 5 federally qualified health centers (FQHCs) and 1 family medicine residency program serving low-income communities in diverse locations with largely Hispanic populations. PATIENTS Persons born in 1945 through 1965 (baby boomers) who had never been tested for HCV and were followed through May 2018. INTERVENTION The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) model guided implementation and evaluation. Test costs were covered for uninsured patients. MEASUREMENTS All practices tested patients for anti-HCV antibody (anti-HCV) and HCV RNA. For uninsured patients with chronic HCV in 4 practices, quantitative data also enabled assessment of HCV staging, specialist teleconsultation, direct-acting antiviral (DAA) treatment, and sustained virologic response (SVR). Implementation fidelity and adaptation were assessed qualitatively. RESULTS Anti-HCV screening was done in 13 334 of 27 700 baby boomers (48.1%, varying by practice from 19.8% to 71.3%). Of 695 anti-HCV-positive patients, HCV RNA was tested in 520 (74.8%; 48.9% to 92.9% by practice), and 349 persons (2.6% of those screened) were diagnosed with chronic HCV. In 4 FQHCs, 174 (84.9%) of 205 uninsured patients with chronic HCV had disease staging, 145 (70.7%) had teleconsultation review, 119 (58.0%) were recommended to start DAA therapy, 82 (40.0%) initiated free DAA therapy, 74 (36.1%) completed therapy (27.8% to 60.0% by practice), and 70 (94.6% of DAA completers) achieved SVR. Implementation was promoted by multilevel practice engagement, patient navigation, and anti-HCV screening with reflex HCV RNA testing. LIMITATION No control practices were included, and data were missing for some variables. CONCLUSION Despite a similar framework for STOP HCC implementation, performance varied widely across safety-net practices, which may reflect practice engagement as well as infrastructure or cost challenges beyond practice control. PRIMARY FUNDING SOURCE Cancer Prevention & Research Institute of Texas and Centers for Medicare & Medicaid Services.
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Affiliation(s)
- Barbara J Turner
- Joe R. and Teresa Lozano Long School of Medicine and Center for Research to Advance Community Health, University of Texas Health Science Center at San Antonio, San Antonio, Texas, and Keck Medical Center and Gehr Center for Health Systems Science and Innovation, University of Southern California, Los Angeles, California (B.J.T.)
| | - Andrea Rochat
- Center for Research to Advance Community Health, University of Texas Health Science Center at San Antonio, San Antonio, Texas (A.R., S.L., R.B., L.H.)
| | - Sarah Lill
- Center for Research to Advance Community Health, University of Texas Health Science Center at San Antonio, San Antonio, Texas (A.R., S.L., R.B., L.H.)
| | - Raudel Bobadilla
- Center for Research to Advance Community Health, University of Texas Health Science Center at San Antonio, San Antonio, Texas (A.R., S.L., R.B., L.H.)
| | - Ludivina Hernandez
- Center for Research to Advance Community Health, University of Texas Health Science Center at San Antonio, San Antonio, Texas (A.R., S.L., R.B., L.H.)
| | - Aro Choi
- Joe R. and Teresa Lozano Long School of Medicine and Center for Research to Advance Community Health, University of Texas Health Science Center at San Antonio, San Antonio, Texas (A.C.)
| | - Juan A Guerrero
- Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas (J.A.G.)
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8
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Barocas JA, Tasillo A, Eftekhari Yazdi G, Wang J, Vellozzi C, Hariri S, Isenhour C, Randall L, Ward JW, Mermin J, Salomon JA, Linas BP. Population-level Outcomes and Cost-Effectiveness of Expanding the Recommendation for Age-based Hepatitis C Testing in the United States. Clin Infect Dis 2019; 67:549-556. [PMID: 29420742 DOI: 10.1093/cid/ciy098] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 02/03/2018] [Indexed: 12/20/2022] Open
Abstract
Background The US Centers for Disease Control and Prevention and the U.S. Preventive Services Task Force recommend one-time hepatitis C virus (HCV) testing for persons born 1945-1965 and targeted testing for high-risk persons. This strategy targets HCV testing to a prevalent population at high risk for HCV morbidity and mortality, but does not include younger populations with high incidence. To address this gap and improve access to HCV testing, age-based strategies should be considered. Methods We used a simulation of HCV to estimate the effectiveness and cost-effectiveness of HCV testing strategies: 1) standard of care (SOC) - recommendation for one-time testing for all persons born 1945-1965, 2) recommendation for one-time testing for adults ≥40 years (≥40 strategy), 3) ≥30 years (≥30 strategy), and 4) ≥18 years (≥18 strategy). All strategies assumed targeted testing of high-risk persons. Inputs were derived from national databases, observational cohorts and clinical trials. Outcomes included quality-adjusted life expectancy, costs, and cost-effectiveness. Results Expanded age-based testing strategies increased US population lifetime case identification and cure rates. Greatest increases were observed in the ≥18 strategy. Compared to the SOC, this strategy resulted in an estimated 256,000 additional infected persons identified and 280,000 additional cures at the lowest cost per QALY gained (ICER = $28,000/QALY). Conclusions In addition to risk-based testing, one-time HCV testing of persons 18 and older appears to be cost-effective, leads to improved clinical outcomes and identifies more persons with HCV than the current birth cohort recommendations. These findings could be considered for future recommendation revisions.
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Affiliation(s)
- Joshua A Barocas
- Division of Infectious Diseases, Massachusetts General Hospital, Atlanta, Georgia
| | - Abriana Tasillo
- Division of Infectious Diseases, Boston Medical Center, Massachusetts, Atlanta, Georgia
| | | | - Jianing Wang
- Division of Infectious Diseases, Boston Medical Center, Massachusetts, Atlanta, Georgia
| | - Claudia Vellozzi
- Division of Viral Hepatitis, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan Hariri
- Division of Viral Hepatitis, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Cheryl Isenhour
- Division of Viral Hepatitis, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - John W Ward
- Division of Viral Hepatitis, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jonathan Mermin
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Benjamin P Linas
- Division of Infectious Diseases, Boston Medical Center, Massachusetts, Atlanta, Georgia.,Boston University School of Medicine, Massachusetts
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Surjadi M, Nuchols B, Souza D, Wolfe L, Burgel B. Hepatitis C Competency and Outreach of Occupational Health Nurses. Workplace Health Saf 2019; 67:399-413. [PMID: 31179906 DOI: 10.1177/2165079919841637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
In the United States, approximately one half of individuals with chronic hepatitis C virus (HCV) are not aware of their status. Current HCV treatment is highly successful and is associated with a decrease in all-cause mortality. Occupational health nurses (OHNs) are often the sole health care providers at worksites and have a unique opportunity to provide HCV education, screening, and linkage to care. This project measured changes in OHN HCV competency and outreach, and identified barriers to screening. In June 2017, Survey 1 was emailed to 3,414 American Association of Occupational Health Nurse (AAOHN) members. For HCV competence, HCV knowledge and confidence in educating and counseling employees regarding HCV were assessed. HCV outreach and barriers to screening were identified. The HCV educational campaign launched in October 2017 with a webinar, a webpage/toolkit, and educational emails. Survey 2 was emailed in January 2018 to assess for changes in HCV competency and outreach. A total of 445 OHNs responded to Survey 1, and 111 completed both surveys, and participant demographics represented AAOHN membership base (95% female, mean age 56.4). The average HCV knowledge pretest score was 76% and posttest score was 77%. Confidence in educating/counseling employees about HCV increased from 2.6 to 2.9 (on a 1-5 scale; p = .052). Higher pretest scores were associated with bachelor's degree (BS/BA) education or above, greater confidence in HCV education/counseling of employees, and HCV education participation within the prior 12 months. There are ongoing HCV learning needs for OHNs and greater opportunities for HCV outreach in worksites.
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10
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Plant A, Snow EG, Montoya JA, Young S, Javanbakht M, Klausner JD. Test4HepC: Promoting Hepatitis C Testing to Baby Boomers Using Social Media. Health Promot Pract 2019; 21:780-790. [PMID: 30854905 DOI: 10.1177/1524839919833987] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Individuals born between 1945 and 1965 ("baby boomers") account for an estimated three quarters of all hepatitis C (HCV) infections in the United States. This article describes the evaluation of Test4HepC, a program that uses social media and a website to promote HCV testing to baby boomers in Los Angeles County, California. The first 16 months of Test4HepC were evaluated using an online survey (n = 302), qualitative interviews (n = 20), website and social media analytics, and records of free testing offered though the program. Test4HepC.org had 6,919 visitors; 48 individuals used the free testing offered. Within 1 month of visiting the website, 24.5% (74) of survey participants tested for HCV, 67.6% (50) received a negative HCV antibody test result, 2.7% (2) received a positive HCV antibody test result, and 25.7% (19) had not received their results as of taking the survey. Most of those not tested (60.5%) reported intention to test. In multivariable analysis, male sex and high perceived usefulness of the program website were associated with HCV testing. Qualitative interviews suggested that Test4HepC increased baby boomers' HCV risk perception and encouraged testing. Social media is a promising strategy for promoting HCV testing to baby boomers. Expanding Test4HepC to other areas and prioritizing the highest risk baby boomers could enable many people with HCV to benefit from new treatments.
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Affiliation(s)
- Aaron Plant
- Sentient Research, Inc., Los Angeles, CA, USA
| | | | | | - Sean Young
- University of California, Los Angeles, CA, USA
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11
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Altındis M, Demiray T, Köröğlu M, Atasoy AR, Keşli R, Tosun S, Özdemir M, Aksözek A, Ece G, Çetinkol Y, Altındis S, Güdücüoğlu H. Hepatitis C testing among adults born between 1945 and 1965 in Turkey: a multicentre study. Cent Eur J Public Health 2018; 26:83-86. [PMID: 30102494 DOI: 10.21101/cejph.a4502] [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: 07/20/2015] [Accepted: 04/20/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Hepatitis C virus (HCV) infection is a major public health problem and affects large populations all over the world. Serum anti-HCV level is a valuable marker to determine HCV infection. Anti-HCV testing has been recommended for high-risk population. The Center for Disease Control (CDC) and Prevention in the United States proposed a new high-risk population group - adults born between 1945-1965. Under this perspective, we designed a multicentre retrospective study to determine the seropositivity of anti-HCV among adults born between 1945 and 1965 and adults born after 1965 in Turkey. With the data collected, we aimed to determine whether there was a need for anti-HCV testing especially in people born between 1945 and 1965. METHODS We requested data from ten different medical centres in ten different provinces. Each medical centre collected the anti-HCV test results of adult patients for five-year period between 2009 and 2014 from hospital records. RESULTS A total of 974,449 anti-HCV test results were included in this study. When the seropositivity rates in the two groups of adults were compared, anti-HCV seropositivity rates were higher in nine medical centres out of ten. Anti-HCV seropositivity in adults born between 1945-1965 was significantly higher than in adults born after 1965 (p < 0.05). CONCLUSIONS We determined that the anti-HCV seropositivity rate is significantly higher in adults born between 1945-1965 compared to the younger adults as indicated in the literature. According to data from this study together with the WHO and CDC suggestions, we believe that it is appropriate to offer anti-HCV serology testing for people over 50 years of age since the anti- HCV seroprevalence in this age group is relatively high.
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Affiliation(s)
- Mustafa Altındis
- Department of Medical Microbiology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Tayfur Demiray
- Department of Medical Microbiology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Mehmet Köröğlu
- Department of Medical Microbiology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Ali Rıza Atasoy
- Department of Medical Microbiology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Recep Keşli
- Department of Medical Microbiology, School of Medicine, Afyon Kocatepe University, Afyon, Turkey
| | - Selma Tosun
- Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Mehmet Özdemir
- Department of Medical Microbiology, School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Alper Aksözek
- Department of Medical Microbiology, School of Medicine, Mugla University, Mugla, Turkey
| | - Gülfem Ece
- Medical Microbiology Laboratory, Medical Park Hospital, Izmir, Turkey
| | - Yeliz Çetinkol
- Department of Medical Microbiology, School of Medicine, Ordu University, Ordu, Turkey
| | - Selma Altındis
- Department of Healthcare Management, School of Management, Sakarya University, Sakarya Turkey
| | - Hüseyin Güdücüoğlu
- Department of Medical Microbiology, School of Medicine, Yuzuncu Yil University, Van, Turkey
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Kondili LA, Robbins S, Blach S, Gamkrelidze I, Zignego AL, Brunetto MR, Raimondo G, Taliani G, Iannone A, Russo FP, Santantonio TA, Zuin M, Chessa L, Blanc P, Puoti M, Vinci M, Erne EM, Strazzabosco M, Massari M, Lampertico P, Rumi MG, Federico A, Orlandini A, Ciancio A, Borgia G, Andreone P, Caporaso N, Persico M, Ieluzzi D, Madonia S, Gori A, Gasbarrini A, Coppola C, Brancaccio G, Andriulli A, Quaranta MG, Montilla S, Razavi H, Melazzini M, Vella S, Craxì A. Forecasting Hepatitis C liver disease burden on real-life data. Does the hidden iceberg matter to reach the elimination goals? Liver Int 2018; 38:2190-2198. [PMID: 29900654 PMCID: PMC6282782 DOI: 10.1111/liv.13901] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 06/03/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Advances in direct-acting antiviral treatment of HCV have reinvigorated public health initiatives aimed at identifying affected individuals. We evaluated the possible impact of only diagnosed and linked-to-care individuals on overall HCV burden estimates and identified a possible strategy to achieve the WHO targets by 2030. METHODS Using a modelling approach grounded in Italian real-life data of diagnosed and treated patients, different linkage-to-care scenarios were built to evaluate potential strategies in achieving the HCV elimination goals. RESULTS Under the 40% linked-to-care scenario, viraemic burden would decline (60%); however, eligible patients to treat will be depleted by 2025. Increased case finding through a targeted screening strategy in 1948-1978 birth cohorts could supplement the pool of diagnosed patients by finding 75% of F0-F3 cases. Under the 60% linked-to-care scenario, viraemic infections would decline by 70% by 2030 but the patients eligible for treatment will run out by 2028. If treatment is to be maintained, a screening strategy focusing on 1958-1978 birth cohorts could capture 55% of F0-F3 individuals. Under the 80% linked-to-care scenario, screening limited in 1968-1978 birth cohorts could sustain treatment at levels required to achieve the HCV elimination goals. CONCLUSION In Italy, which is an HCV endemic country, the eligible pool of patients to treat will run out between 2025 and 2028. To maintain the treatment rate and achieve the HCV elimination goals, increased case finding in targeted, high prevalence groups is required.
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Affiliation(s)
| | - Sarah Robbins
- Center for Disease AnalysisCDA Foundation | Polaris ObservatoryLafayetteCOUSA
| | - Sarah Blach
- Center for Disease AnalysisCDA Foundation | Polaris ObservatoryLafayetteCOUSA
| | - Ivane Gamkrelidze
- Center for Disease AnalysisCDA Foundation | Polaris ObservatoryLafayetteCOUSA
| | - Anna L. Zignego
- Department of Experimental and Clinical MedicineInterdepartmental Centre MASVEUniversity of FlorenceFlorenceItaly
| | - Maurizia R. Brunetto
- Internal MedicineDepartment of Clinical and Experimental Medicine University of Pisa and Liver UnitPisa University HospitalPisaItaly
| | - Giovanni Raimondo
- Department of Internal MedicineUniversity Hospital of MessinaMessinaItaly
| | - Gloria Taliani
- Infectious and Tropical Diseases UnitUmberto I HospitalSapienza UniversityRomeItaly
| | - Andrea Iannone
- Department of GastroenterologyUniversity Hospital of BariBariItaly
| | | | | | - Massimo Zuin
- Liver and Gastroenterology UnitASST Santi Paolo e CarloMilanItaly
| | | | - Pierluigi Blanc
- Department of Infectious DiseaseS.M. Annunziata HospitalFlorenceItaly
| | - Massimo Puoti
- Department of Infectious DiseaseNiguarda HospitalMilanItaly
| | | | - Elke M. Erne
- Department of Infectious DiseaseUniversity Hospital of PaduaPaduaItaly
| | | | - Marco Massari
- Department of Infectious DiseaseArcispedale Santa Maria NuovaReggio EmiliaItaly
| | - Pietro Lampertico
- Department of Gastroenterology and HepatologyFondazione IRCCS Cà Granda Ospedale Maggiore PoliclinicoUniversity of MilanMilanItaly
| | - Maria G. Rumi
- Department of Gastroenterology and HepatologySan Giuseppe HospitalMilanItaly
| | - Alessandro Federico
- Department of Hepatology and GastroenterologyUniversità della Campania Luigi VanvitelliNaplesItaly
| | | | - Alessia Ciancio
- Gastoenterology UnitCittà della Salute e della Scienza‐Ospedale MolinetteTurinItaly
| | - Guglielmo Borgia
- Department of Infectious DiseaseFederico II UniversityNaplesItaly
| | | | | | - Marcello Persico
- Department of Internal Medicine and HepatologyUniversity of SalernoSalernoItaly
| | | | | | - Andrea Gori
- Department of Infectious DiseaseSan Gerardo HospitalMonzaItaly
| | - Antonio Gasbarrini
- Department of Internal Medicine and GastroenterologyCatholic University of RomeRomeItaly
| | | | - Giuseppina Brancaccio
- Infectious DiseasesDepartment of Mental and Physical Health and Preventive MedicineUniversità della Campania Luigi VanvitelliNaplesItaly
| | - Angelo Andriulli
- Division of GastroenterologyIstituto di Ricovero e Cura a Carattere ScientificoCasa Sollievo Sofferenza HospitalSan Giovanni Rotondo, FoggiaItaly
| | | | | | - Homie Razavi
- Center for Disease AnalysisCDA Foundation | Polaris ObservatoryLafayetteCOUSA
| | | | - Stefano Vella
- Center for Global HealthIstituto Superiore di SanitàRomeItaly
| | - Antonio Craxì
- Gastroenterolgy and Liver UnitDiBiMISUniversity of PalermoPalermoItaly
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Barocas JA, Wang J, White LF, Tasillo A, Salomon JA, Freedberg KA, Linas BP. Hepatitis C Testing Increased Among Baby Boomers Following The 2012 Change To CDC Testing Recommendations. Health Aff (Millwood) 2018; 36:2142-2150. [PMID: 29200354 DOI: 10.1377/hlthaff.2017.0684] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In 2012 the Centers for Disease Control and Prevention recommended routine testing for hepatitis C for people born in the period 1945-65. Until now, the recommendation's impact on hepatitis C screening rates in the United States has not been fully understood. We used an interrupted time series with comparison group design to analyze hepatitis C screening rates in the period 2010-14 among 2.8 million commercially insured adults in the MarketScan database. Hepatitis C screening rates increased yearly between 2010 and 2014, from 1.65 to 2.59 per 100 person-years. A 49 percent increase in screening rates among people born during 1945-65 followed the release of the recommendation, but no such increase was observed among adults born after 1965. The effect among the target population was sustained, and by twenty-four months after the recommendation's release, screening rates had increased 106 percent. We conclude that the hepatitis C testing policy change resulted in significantly increased testing among the target population and may have decreased the magnitude of the hepatitis C epidemic.
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Affiliation(s)
- Joshua A Barocas
- Joshua A. Barocas ( ) is an assistant in medicine in the Division of Infectious Diseases at Massachusetts General Hospital and an instructor in medicine at Harvard Medical School, both in Boston
| | - Jianing Wang
- Jianing Wang is a statistical analyst in the Division of Infectious Diseases at Boston Medical Center, in Massachusetts
| | - Laura F White
- Laura F. White is a senior biostatistician at the Boston University School of Public Health, in Massachusetts
| | - Abriana Tasillo
- Abriana Tasillo is a research assistant in the Division of Infectious Diseases at Boston Medical Center
| | - Joshua A Salomon
- Joshua A. Salomon is a professor of medicine at Stanford University, in California
| | - Kenneth A Freedberg
- Kenneth A. Freedberg is a professor of medicine in the Divisions of General Internal Medicine and Infectious Diseases and director of the HIV Research Program, Medical Practice Evaluation Center, at Massachusetts General Hospital, and a professor in the Department of Health Policy and Management at the Harvard T. H. Chan School of Public Health, in Boston
| | - Benjamin P Linas
- Benjamin P. Linas is an associate professor of medicine in the Division of Infectious Diseases at Boston Medical Center and an associate professor of epidemiology at the Boston University School of Public Health
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Abstract
Hepatitis C virus (HCV) is the most common blood-borne infection in the United States and is of concern in older adults. HCV infection is associated with not only hepatic but also extrahepatic comorbidities common to the aging patient including diabetes, kidney and cardiovascular diseases, and neurocognitive impairment. The effect of direct-acting antiviral agents to treat HCV on these outcomes is limited. This article summarizes the literature regarding the epidemiology and natural history of HCV infection; the impact of age on clinical outcomes in HCV-infected persons; and current knowledge regarding safety and efficacy of HCV treatment regimens in the older patient.
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Affiliation(s)
- Michael Reid
- Department of Medicine, University of California, San Francisco, 513 Parnassus Avenue, San Francisco, CA 94122, USA
| | - Jennifer C Price
- Department of Medicine, University of California, San Francisco, 513 Parnassus Avenue, San Francisco, CA 94122, USA
| | - Phyllis C Tien
- Department of Medicine, University of California, San Francisco, 513 Parnassus Avenue, San Francisco, CA 94122, USA; Medical Service, Department of Veteran Affairs Medical Center, San Francisco, CA 94121, USA.
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15
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Isho NY, Kachlic MD, Marcelo JC, Martin MT. Pharmacist-initiated hepatitis C virus screening in a community pharmacy to increase awareness and link to care at the medical center. J Am Pharm Assoc (2003) 2018; 57:S259-S264. [PMID: 28506379 DOI: 10.1016/j.japh.2017.03.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 03/10/2017] [Accepted: 03/13/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To describe the design and implementation of a pharmacist-led hepatitis C virus (HCV) screening and education program in a community pharmacy with a protocol for linkage to care at the affiliated hepatology clinic for patients born between 1945 and 1965. SETTING Outpatient pharmacy affiliated with the University of Illinois Hospital and Health Sciences System. PRACTICE DESCRIPTION The community pharmacist resident conducted the HCV screening at the health system-based community pharmacy. PRACTICE INNOVATION Community pharmacists provided patients with HCV screening and education while patients waited for their prescriptions to be ready or upon appointment. Patients were given a questionnaire before and after HCV education to assess the impact of pharmacist-provided education on patient knowledge. A protocol was developed to link patients with a positive HCV antibody test result to care with a hepatologist for confirmatory testing at a follow-up appointment at the medical center. EVALUATION Investigators assessed the feasibility of providing the screening and education, recorded the number of patients screened, and recorded the differences in the questionnaire responses before and after education. RESULTS Pharmacist-led HCV screening services were implemented successfully at the community pharmacy. All patients had a negative antibody result; therefore, linkage to care at the medical center, although available, was not necessary. The self-reported posttest HCV knowledge scores were significantly higher than pretest scores. CONCLUSION This article outlines the methodology for providing a multidisciplinary HCV screening, education, and referral program in a community pharmacy affiliated with a medical center. Pharmacist-initiated HCV screening in a community pharmacy can assist with identifying patients at risk for HCV infection and provide patients with linkage to care in the health system. This report may encourage community pharmacists to conduct future prospective trials to evaluate clinical and economic outcomes of community-based HCV screenings.
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16
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Yartel AK, Rein DB, Brown KA, Krauskopf K, Massoud OI, Jordan C, Kil N, Federman AD, Nerenz DR, Brady JE, Kruger DL, Smith BD. Hepatitis C virus testing for case identification in persons born during 1945-1965: Results from three randomized controlled trials. Hepatology 2018; 67:524-533. [PMID: 28941361 PMCID: PMC7593980 DOI: 10.1002/hep.29548] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 09/15/2017] [Accepted: 09/19/2017] [Indexed: 12/25/2022]
Abstract
The Centers for Disease Control and Prevention and US Preventive Services Task Force recommend one-time hepatitis C virus (HCV) testing for persons born during 1945-1965 (birth cohort). However, few studies estimate the effect of birth cohort (BC) testing implementation on HCV diagnoses in primary care settings. We aimed to determine the probability of identifying HCV infections in primary care using targeted BC testing compared with usual care at three academic medical centers. From December 2012 to March 2014, each center compared one of three distinct interventions with usual care using an independently designed randomized controlled trial. Across centers, BC patients with no clinical documentation of previous HCV testing or diagnosis were randomly assigned to receive a one-time offering of HCV antibody (anti-HCV) testing via one of three independent implementation strategies (repeated-mailing outreach, electronic medical record-integrated provider best practice alert [BPA], and direct patient solicitation) or assigned to receive usual care. We estimated model-adjusted risk ratios (aRR) of anti-HCV-positive (anti-HCV+) identification using BC testing versus usual care. In the repeated mailing trial, 8992 patients (intervention, n = 2993; control, n = 5999) were included in the analysis. The intervention was eight times as likely to identify anti-HCV+ patients compared with controls (aRR, 8.0; 95% confidence interval [CI], 2.8-23.0; adjusted probabilities: intervention, 0.27%; control, 0.03%). In the BPA trial, data from 14,475 patients (BC, n = 8928; control, n = 5,547) were analyzed. The intervention was 2.6 times as likely to identify anti-HCV+ patients versus controls (aRR, 2.6; 95% CI, 1.1-6.4; adjusted probabilities: intervention, 0.29%; control, 0.11%). In the patient-solicitation trial, 8873 patients (BC, n = 4307; control, n = 4566) were analyzed. The intervention was five times as likely to identify anti-HCV+ patients compared with controls (aRR, 5.3; 95% CI, 2.3-12.3; adjusted probabilities: intervention, 0.68%; control, 0.11%). Conclusion: BC testing was effective in identifying previously undiagnosed HCV infections in primary care settings. (Hepatology 2018;67:524-533).
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Affiliation(s)
| | | | | | | | | | | | - Natalie Kil
- Icahn School of Medicine at Mount Sinai, New York, NY
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17
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Silverman-Retana O, Serván-Mori E, McCoy SI, Larney S, Bautista-Arredondo S. Hepatitis C antibody prevalence among Mexico City prisoners injecting legal and illegal substances. Drug Alcohol Depend 2017; 181:140-145. [PMID: 29054033 DOI: 10.1016/j.drugalcdep.2017.09.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 09/18/2017] [Accepted: 09/23/2017] [Indexed: 01/26/2023]
Abstract
BACKGROUND Hepatitis C virus (HCV) infection is highly prevalent among prisoners and this prevalence estimates reach 64% among prisoners who inject illicit drugs. Prisons are important sites for HCV transmission in the absence of access to sterile injecting equipment; hence, it can be transmitted between prisoners who share contaminated needles and syringes. We aimed to estimate the prevalence of risk factors for anti-HCV prevalence, with particular interest on injecting behavior, and to assess correlates of anti-HCV positivity among Mexico City prisoners. METHODS Cross-sectional study based on information -collected in three male and two female prisons in Mexico City during 2010-2011- about sexually transmitted infections, socio-demographics, criminal history, substance use, vitamin injection, tattooing, among others (n=3,910). Weighted multivariable adjusted logistic regression models were estimated to assess the overall and differential odds for anti-HCV due to injecting behavior. RESULTS Overall prevalence of anti-HCV was 3.3%. This figure rose to 43.1% among prisoners with a history of illicit drug injection. Prisoners with history of vitamin injection showed a similar prevalence of anti-HCV (43.8%). After stratifying by substance injected, the adjusted odds ratio was 9.8 (95% CI: 4.0, 23.8) for illicit drug injection and 11.9 (95% CI: 5.8, 23.8) for illicit drug and vitamin injection. CONCLUSION Based on data from the most populous prisons in Mexico City, this study showed that anti-HCV is highly prevalent among prisoners with history of injecting behavior. In this sense, injecting behavior per-se, independent of the substance used, is associated with increased odds of anti-HCV positivity.
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Affiliation(s)
- Omar Silverman-Retana
- Center for Health System Research, National Institute of Public Health, Mexico, Universidad No. 655 Colonia Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera C.P. 62100, Cuernavaca, Morelos, México; Aarhus University, Department of Public Health, Section for Epidemiology, Building 1260, Batholins Allé 2, 8000 Aarhuc C, Denmark.
| | - Edson Serván-Mori
- Center for Health System Research, National Institute of Public Health, Mexico, Universidad No. 655 Colonia Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera C.P. 62100, Cuernavaca, Morelos, México.
| | - Sandra I McCoy
- Division of Epidemiology, School of Public Health, University of California, Berkeley 779 University Hall, MC 7360, Berkeley, CA, 94720, USA.
| | - Sarah Larney
- National Drug and Alcohol Research Centre, University of New South Wales. Sydney NSW 2052, Australia.
| | - Sergio Bautista-Arredondo
- Center for Health System Research, National Institute of Public Health, Mexico, Universidad No. 655 Colonia Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera C.P. 62100, Cuernavaca, Morelos, México.
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18
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Kondili LA, Romano F, Rolli FR, Ruggeri M, Rosato S, Brunetto MR, Zignego AL, Ciancio A, Di Leo A, Raimondo G, Ferrari C, Taliani G, Borgia G, Santantonio TA, Blanc P, Gaeta GB, Gasbarrini A, Chessa L, Erne EM, Villa E, Ieluzzi D, Russo FP, Andreone P, Vinci M, Coppola C, Chemello L, Madonia S, Verucchi G, Persico M, Zuin M, Puoti M, Alberti A, Nardone G, Massari M, Montalto G, Foti G, Rumi MG, Quaranta MG, Cicchetti A, Craxì A, Vella S. Modeling cost-effectiveness and health gains of a "universal" versus "prioritized" hepatitis C virus treatment policy in a real-life cohort. Hepatology 2017; 66:1814-1825. [PMID: 28741307 PMCID: PMC5765396 DOI: 10.1002/hep.29399] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 06/30/2017] [Accepted: 07/18/2017] [Indexed: 12/15/2022]
Abstract
We evaluated the cost-effectiveness of two alternative direct-acting antiviral (DAA) treatment policies in a real-life cohort of hepatitis C virus-infected patients: policy 1, "universal," treat all patients, regardless of fibrosis stage; policy 2, treat only "prioritized" patients, delay treatment of the remaining patients until reaching stage F3. A liver disease progression Markov model, which used a lifetime horizon and health care system perspective, was applied to the PITER cohort (representative of Italian hepatitis C virus-infected patients in care). Specifically, 8,125 patients naive to DAA treatment, without clinical, sociodemographic, or insurance restrictions, were used to evaluate the policies' cost-effectiveness. The patients' age and fibrosis stage, assumed DAA treatment cost of €15,000/patient, and the Italian liver disease costs were used to evaluate quality-adjusted life-years (QALY) and incremental cost-effectiveness ratios (ICER) of policy 1 versus policy 2. To generalize the results, a European scenario analysis was performed, resampling the study population, using the mean European country-specific health states costs and mean treatment cost of €30,000. For the Italian base-case analysis, the cost-effective ICER obtained using policy 1 was €8,775/QALY. ICERs remained cost-effective in 94%-97% of the 10,000 probabilistic simulations. For the European treatment scenario the ICER obtained using policy 1 was €19,541.75/QALY. ICER was sensitive to variations in DAA costs, in the utility value of patients in fibrosis stages F0-F3 post-sustained virological response, and in the transition probabilities from F0 to F3. The ICERs decrease with decreasing DAA prices, becoming cost-saving for the base price (€15,000) discounts of at least 75% applied in patients with F0-F2 fibrosis. CONCLUSION Extending hepatitis C virus treatment to patients in any fibrosis stage improves health outcomes and is cost-effective; cost-effectiveness significantly increases when lowering treatment prices in early fibrosis stages. (Hepatology 2017;66:1814-1825).
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Carlo Ferrari
- Azienda Ospedaliero‐Universitaria di ParmaParmaItaly
| | | | | | | | | | | | | | | | | | - Erica Villa
- University of Modena and Reggio EmiliaModenaItaly
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Marco Massari
- IRCSS‐Azienda Ospedaliera Santa Maria NuovaReggio EmiliaItaly
| | | | - Giuseppe Foti
- Bianchi Melacrino‐Morelli HospitalReggio CalabriaItaly
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19
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Patel RC, Vellozzi C, Smith BD. Results of Hepatitis C Birth-Cohort Testing and Linkage to Care in Selected U.S. Sites, 2012-2014. Public Health Rep 2017; 131 Suppl 2:12-9. [PMID: 27168656 DOI: 10.1177/00333549161310s203] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Following its recommendation for one-time hepatitis C virus (HCV) testing of people born between 1945 and 1965, CDC implemented the Hepatitis Testing and Linkage to Care (HepTLC) initiative to conduct birth-cohort hepatitis testing in U.S. health-care settings. We describe demographic characteristics, HCV infection prevalence, and HCV-related risk factors among people born between 1945 and 1965 who were tested as part of the program, which ran from 2012 to 2014. METHODS As part of the HepTLC initiative, 14 grantees supporting 104 health-care sites in 21 U.S. municipalities tested participants born between 1945 and 1965 for HCV antibody (anti-HCV). Demographic characteristics and HCV risk factors were reported for people tested for anti-HCV and who were anti-HCV or HCV RNA positive. We evaluated outcomes along the HCV testing-to-care continuum using the following indicators: anti-HCV positive, HCV RNA test offered, HCV RNA positive, referred to care, and attended first medical appointment. RESULTS Among 24,966 people tested for HCV infection, 2,900 (11.6%) were anti-HCV positive. Anti-HCV positivity was highest among those who self-identified as non-Hispanic black (n=1,701 of 12,202, 13.9%), men (n=2,073 of 12,130, 17.1%), and people born between 1951 and 1955 (n=795 of 5,768, 13.8%). Of the 2,900 people testing anti-HCV positive, 2,108 (72.7%) received an HCV RNA test, 1,497 (51.6%) were HCV RNA positive, 1,201 (41.4%) were referred to care, and 938 (32.3%) attended their first appointment. CONCLUSION Testing for HCV infection among those born between 1945 and 1965 without soliciting HCV risk factors was successful. Providers implementing birth-cohort testing should develop and evaluate strategies to improve outcomes along the testing-to-care continuum.
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Affiliation(s)
- Rajiv C Patel
- Oak Ridge Institute for Science and Education, Oak Ridge, TN
| | - Claudia Vellozzi
- Centers for Disease Control and Prevention, Division of Viral Hepatitis, Atlanta, GA
| | - Bryce D Smith
- Centers for Disease Control and Prevention, Division of Viral Hepatitis, Atlanta, GA; Current affiliation: Centers for Disease Control and Prevention, Division of Diabetes Translation, Translation, Health Education, and Evaluation Branch, Atlanta, GA
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20
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Goel A, Sanchez J, Paulino L, Feuille C, Arend J, Shah B, Dieterich D, Perumalswami PV. A systematic model improves hepatitis C virus birth cohort screening in hospital-based primary care. J Viral Hepat 2017; 24:477-485. [PMID: 28039935 DOI: 10.1111/jvh.12669] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 12/20/2016] [Indexed: 12/12/2022]
Abstract
Despite national and local governing board recommendations in the United States of America to perform an HCV screening test in baby boomers, screening rates remain low. Our goal was to study the impact of an HCV screening and link-to-care programme with patient navigation in two New York City primary care practices. This was a 2-year prospective study of patients born between 1945-1965 ("baby boomers") with encounters at two primary care practices at the Mount Sinai Hospital between November 1, 2013 and November 30, 2015. Baseline HCV screening rates were collected for four months. A multifaceted intervention was sequentially implemented involving electronic alerts, housestaff education, data feedback and patient navigation. HCV screening rates and link to care, defined as attending an appointment with a viral hepatitis specialist, were compared before and after these interventions. There were 14 642 primary care baby boomer patients of which 4419 (30.2%) were newly screened during the study. There was a significant increase in HCV screening rates from 55% to 75% (P<.01) with an HCV seropositive rate of 3.3%. Factors associated with being HCV seropositive included older age (P<.01), male sex (P<.01), African American race (P<.01) and receiving care in the housestaff practice (P<.01). With patient navigation, 78 of 84 (93%) newly diagnosed HCV-infected persons were referred to a specialist and 60 (77%) attended their first appointment. A structured, multifaceted HCV screening programme using well-studied principles identifies a large number of undiagnosed baby boomers within hospital-based primary care and improves access to specialty providers in a timely manner.
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Affiliation(s)
- A Goel
- Division of Liver Diseases, Department of Medicine, Icahn School of Medicine Mount Sinai, New York, NY, USA
| | - J Sanchez
- Division of Liver Diseases, Department of Medicine, Icahn School of Medicine Mount Sinai, New York, NY, USA
| | - L Paulino
- Division of Liver Diseases, Department of Medicine, Icahn School of Medicine Mount Sinai, New York, NY, USA
| | - C Feuille
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine Mount Sinai, New York, NY, USA
| | - J Arend
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine Mount Sinai, New York, NY, USA
| | - B Shah
- Division of Gastroenterology, Department of Medicine, Icahn School of Medicine Mount Sinai, New York, NY, USA
| | - D Dieterich
- Division of Liver Diseases, Department of Medicine, Icahn School of Medicine Mount Sinai, New York, NY, USA
| | - P V Perumalswami
- Division of Liver Diseases, Department of Medicine, Icahn School of Medicine Mount Sinai, New York, NY, USA
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21
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Jordan AE, Perlman DC, Neurer J, Smith DJ, Des Jarlais DC, Hagan H. Prevalence of hepatitis C virus infection among HIV+ men who have sex with men: a systematic review and meta-analysis. Int J STD AIDS 2017; 28:145-159. [PMID: 26826159 PMCID: PMC4965334 DOI: 10.1177/0956462416630910] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Since 2000, an increase in hepatitis C virus infection among HIV-infected (HIV+) men who have sex with men has been observed. Evidence points to blood exposure during sex as the medium of hepatitis C virus transmission. Hepatitis C virus prevalence among HIV + MSM overall and in relation to injection drug use is poorly characterized. In this study, a systematic review and meta-analysis examining global hepatitis C virus antibody prevalence and estimating active hepatitis C virus prevalence among HIV + MSM were conducted; 42 reports provided anti-hepatitis C virus prevalence data among HIV + MSM. Pooled prevalence produced an overall anti-hepatitis C virus prevalence among HIV + MSM of 8.1%; active HCV prevalence estimate was 5.3%-7.3%. Anti-hepatitis C virus prevalence among injection drug use and non-injection drug use HIV + MSM was 40.0% and 6.7%, respectively. Among HIV + MSM, hepatitis C virus prevalence increased significantly over time among the overall and non-injection drug use groups, and decreased significantly among injection drug use HIV + MSM. We identified a moderate prevalence of hepatitis C virus among all HIV + MSM and among non-injection drug use HIV + MSM; for both, prevalence was observed to be increasing slightly. Pooled prevalence of hepatitis C virus among HIV + MSM was higher than that observed in the 1945-1965 US birth cohort. The modest but rising hepatitis C virus prevalence among HIV + MSM suggests an opportunity to control HCV among HIV + MSM; this combined with data demonstrating a rising hepatitis C virus incidence highlights the temporal urgency to do so.
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Affiliation(s)
- Ashly E Jordan
- 1 New York University, New York, NY, USA
- 2 Center for Drug Use and HIV Research, New York, NY, USA
| | - David C Perlman
- 2 Center for Drug Use and HIV Research, New York, NY, USA
- 3 Icahn School of Medicine, Mount Sinai Beth Israel, New York, NY, USA
| | | | | | - Don C Des Jarlais
- 2 Center for Drug Use and HIV Research, New York, NY, USA
- 3 Icahn School of Medicine, Mount Sinai Beth Israel, New York, NY, USA
| | - Holly Hagan
- 1 New York University, New York, NY, USA
- 2 Center for Drug Use and HIV Research, New York, NY, USA
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Plummer M, de Martel C, Vignat J, Ferlay J, Bray F, Franceschi S. Global burden of cancers attributable to infections in 2012: a synthetic analysis. Lancet Glob Health 2016; 4:e609-16. [PMID: 27470177 DOI: 10.1016/s2214-109x(16)30143-7] [Citation(s) in RCA: 965] [Impact Index Per Article: 120.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 06/09/2016] [Accepted: 06/13/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Infections with certain viruses, bacteria, and parasites are strong risk factors for specific cancers. As new cancer statistics and epidemiological findings have accumulated in the past 5 years, we aimed to assess the causal involvement of the main carcinogenic agents in different cancer types for the year 2012. METHODS We considered ten infectious agents classified as carcinogenic to human beings by the International Agency for Research on Cancer. We calculated the number of new cancer cases in 2012 attributable to infections by country, by combining cancer incidence estimates (from GLOBOCAN 2012) with estimates of attributable fraction (AF) for the infectious agents. AF estimates were calculated from the prevalence of infection in cancer cases and the relative risk for the infection (for some sites). Estimates of infection prevalence, relative risk, and corresponding 95% CIs for AF were obtained from systematic reviews and pooled analyses. FINDINGS Of 14 million new cancer cases in 2012, 2·2 million (15·4%) were attributable to carcinogenic infections. The most important infectious agents worldwide were Helicobacter pylori (770 000 cases), human papillomavirus (640 000), hepatitis B virus (420 000), hepatitis C virus (170 000), and Epstein-Barr virus (120 000). Kaposi's sarcoma was the second largest contributor to the cancer burden in sub-Saharan Africa. The AFs for infection varied by country and development status-from less than 5% in the USA, Canada, Australia, New Zealand, and some countries in western and northern Europe to more than 50% in some countries in sub-Saharan Africa. INTERPRETATION A large potential exists for reducing the burden of cancer caused by infections. Socioeconomic development is associated with a decrease in infection-associated cancers; however, to reduce the incidence of these cancers without delay, population-based vaccination and screen-and-treat programmes should be made accessible and available. FUNDING Fondation de France.
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Affiliation(s)
- Martyn Plummer
- International Agency for Research on Cancer, 69372 Lyon Cedex 08, France.
| | | | - Jerome Vignat
- International Agency for Research on Cancer, 69372 Lyon Cedex 08, France
| | - Jacques Ferlay
- International Agency for Research on Cancer, 69372 Lyon Cedex 08, France
| | - Freddie Bray
- International Agency for Research on Cancer, 69372 Lyon Cedex 08, France
| | - Silvia Franceschi
- International Agency for Research on Cancer, 69372 Lyon Cedex 08, France
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Sayiner M, Wymer M, Golabi P, Ford J, Srishord I, Younossi ZM. Presence of hepatitis C (HCV) infection in Baby Boomers with Medicare is independently associated with mortality and resource utilisation. Aliment Pharmacol Ther 2016; 43:1060-8. [PMID: 26991652 DOI: 10.1111/apt.13592] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 11/09/2015] [Accepted: 03/02/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hepatitis C virus is common among Baby Boomers (BB). As this cohort ages, they will increasingly become Medicare eligible. AIM To evaluate resource utilisation and mortality of BB-Medicare recipients with HCV. METHODS We used in-patient and out-patient Medicare databases (2005-2010). HCV was identified using ICD-9 codes. Outcomes included resource utilisation [payment/case and in-patient length of stay (LOS)] and short-term mortality. RESULTS Of 1 153 862 BB Medicare recipients (2005-2010), 3.2% (N = 37 365) had HCV. During this period, in-patient Medicare-BB (39 793-55 235) and their claims (78 924-106 232) increased. Furthermore, their overall mortality increased from 8.94% to 10.25% (P < 0.0001). In multivariate analysis, HCV [OR = 1.23 (1.16-1.29)], older age [OR = 1.98 (1.82-2.14)], male gender [OR = 1.25 (1.22-1.29)], ESRD [OR = 1.31 (1.26-1.36)], Charlson score [OR = 1.41 (1.40-1.42)] and LOS [OR = 1.02 (1.02-1.02)] predicted mortality. LOS decreased from 12.98 to 11.74 days (P < 0.0001), whereas total payments increased from $22 157 to $23 185 (P < .0001). During the study, the number of out-patient Medicare BB patients (123 097-192 110) and claims (863 978-1 340 260) also increased. Furthermore, overall mortality increased from 3.15% to 3.31% (P = 0.0131). Again, HCV [OR = 1.23 (1.16-1.30)], older age [OR = 2.03 (1.89-2.17)], ESRD [OR = 3.40 (3.28-3.51)], disabled status [OR = 1.49 (1.40-1.58)] and Charlson score [OR = 1.39 (1.38-1.40)] predicted mortality. Annual total out-patient payments increased from $3781 to $4001 (P < 0.0001). HCV [36.04% [34.28-37.82%)], 45-49 age [4.21% (3.14-5.28%)], ESRD [966.31% (954.86-977.88%)], disabled status [43.22% (41.67-44.80%)], Charlson score [46.78% (46.31-47.26%)] and study year [2.72% (2.58-2.85%)] independently predicted increases in payments. CONCLUSIONS In Baby Boomer Medicare recipients, diagnosis of HCV is independently associated with higher mortality and resource utilisation.
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Affiliation(s)
- M Sayiner
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - M Wymer
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - P Golabi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - J Ford
- Department of Medicine, Center for Liver Disease, Inova Fairfax Hospital, Falls Church, VA, USA
| | - I Srishord
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - Z M Younossi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA.,Department of Medicine, Center for Liver Disease, Inova Fairfax Hospital, Falls Church, VA, USA
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Yan M, Ha J, Aguilar M, Bhuket T, Liu B, Gish RG, Cheung R, Wong RJ. Birth cohort-specific disparities in hepatocellular carcinoma stage at diagnosis, treatment, and long-term survival. J Hepatol 2016; 64:326-332. [PMID: 26386160 DOI: 10.1016/j.jhep.2015.09.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Revised: 08/05/2015] [Accepted: 09/09/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Individuals born between 1945 and 1965 account for nearly 75% of hepatitis C virus (HCV) infections in the United States. As this cohort ages, progressive HCV-related liver disease leading to cirrhosis and hepatocellular carcinoma (HCC) will place a significant burden on the healthcare system. We aim to evaluate birth cohort-specific disparities in HCC stage at diagnosis, treatment rates, and overall survival with a focus on the 1945-1965 birth cohort. METHODS A population-based retrospective cohort study of adult patients with HCC identified in the Surveillance, Epidemiology, and End Results 2003-2011 registry evaluated birth cohort-specific disparities in the prevalence and outcomes of HCC, including multivariate logistic regression models to evaluate disparities in HCC stage at diagnosis and HCC treatment received. Birth cohort-specific survival was evaluated with Kaplan-Meier methods and multivariate Cox proportional hazard models. RESULTS The proportion of HCC represented by the 1945-1965 cohort increased by 64% from 2003-2011, and accounted for 57.4% of all HCC in 2011. Compared to patients born after 1965, the 1945-1965 cohort were more likely to have HCC within Milan criteria (OR, 3.66; 95% CI, 3.13-4.28; p<0.001). However, among patients with HCC within Milan criteria, the 1945-1965 cohort had no difference in receipt of surgical treatment, but had higher overall long-term survival (HR, 0.82; 95% CI, 0.69-0.97; p<0.03). CONCLUSIONS The 1945-1965 birth cohort accounts for the majority of HCC in the United States. Despite earlier HCC stage at diagnosis, no difference in receipt of surgical treatment was observed, but higher overall survival was achieved.
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Affiliation(s)
- Melissa Yan
- Department of Medicine, Alameda Health System - Highland Hospital, Oakland, CA, United States
| | - John Ha
- Department of Medicine, Alameda Health System - Highland Hospital, Oakland, CA, United States
| | - Maria Aguilar
- Department of Medicine, Alameda Health System - Highland Hospital, Oakland, CA, United States
| | - Taft Bhuket
- Division of Gastroenterology and Hepatology, Alameda Health System - Highland Hospital, Oakland, CA, United States
| | - Benny Liu
- Division of Gastroenterology and Hepatology, Alameda Health System - Highland Hospital, Oakland, CA, United States
| | - Robert G Gish
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, United States
| | - Ramsey Cheung
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, United States; Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States
| | - Robert J Wong
- Division of Gastroenterology and Hepatology, Alameda Health System - Highland Hospital, Oakland, CA, United States.
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Southern WN, Norton B, Steinman M, DeLuca J, Drainoni ML, Smith BD, Litwin AH. A Birth-cohort testing intervention identified hepatitis c virus infection among patients with few identified risks: a cross-sectional study. BMC Infect Dis 2015; 15:553. [PMID: 26626449 PMCID: PMC4667399 DOI: 10.1186/s12879-015-1283-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 11/19/2015] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND International guidelines and U.S. guidelines prior to 2012 only recommended testing for hepatitis C virus (HCV) infection among patients at risk, but adherence to guidelines is poor, and the majority of those infected remain undiagnosed. A strategy to perform one-time testing of all patients born during 1945-1965, birth cohort testing, may diagnose HCV infection among patients whose risk remains unknown. We sought to determine if a birth-cohort testing intervention for HCV antibody positivity helped identify patients with fewer documented risk factors or medical indications than a pre-intervention, risk-based testing strategy. METHODS We used a cross-sectional design with retrospective electronic medical record review to examine patients identified with HCV antibody positivity (Ab+) during a pre-intervention (risk-based) phase, the standard of care at the time, vs. a birth-cohort testing intervention phase. We compared demographic and clinical characteristics and HCV risk-associated factors among patients whose HCV Ab + was identified during the pre-intervention (risk-based testing) vs. post birth-cohort intervention phases. Study subjects were patients identified as HCV-Ab + in the baseline (risk-based) and birth-cohort testing phases of the Hepatitis C Assessment and Testing (HepCAT) Project. RESULTS Compared to the risk-based phase, patients newly diagnosed with HCV Ab + after the birth-cohort intervention were significantly less likely to have a history of any substance abuse (30.5% vs. 49.5%, p = 0.02), elevated alanine transaminase levels of > 40 U/L (22.0% vs. 46.7%, p = 0.002), or the composite any risk-associated factor (55.9% vs. 79.0%, p = 0.002). CONCLUSIONS Birth-cohort testing is an useful strategy for identifying previously undiagnosed HCV Ab + because it does not require providers ask risk-based questions, or patients to disclose risk behaviors, and appears to identify HCV Ab + in patients who would not have been identified using a risk-based testing strategy.
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Affiliation(s)
- William N Southern
- Division of Hospital Medicine, 111 East 210th Street, Bronx, 10467, NY, USA.
- Montefiore Medical Center, 111 East 210th Street, Bronx, NY, 10467, USA.
- Department of Medicine, Montefiore Medical Center, 111 East 210th Street, Bronx, NY, 10467, USA.
| | - Brianna Norton
- Montefiore Medical Center, 111 East 210th Street, Bronx, NY, 10467, USA.
- Division of General Internal Medicine, 111 East 210th Street, Bronx, 10467, NY, USA.
| | - Meredith Steinman
- Montefiore Medical Center, 111 East 210th Street, Bronx, NY, 10467, USA.
- Division of General Internal Medicine, 111 East 210th Street, Bronx, 10467, NY, USA.
| | - Joseph DeLuca
- Montefiore Medical Center, 111 East 210th Street, Bronx, NY, 10467, USA
- Division of General Internal Medicine, 111 East 210th Street, Bronx, 10467, NY, USA
| | - Mari-Lynn Drainoni
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, 72 East Concord Street, Boston, MA, 02118, USA.
| | - Bryce D Smith
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, National Center for HIV/Viral Hepatitis/STD/TB Prevention, 1600 Clifton Road, Atlanta, GA, 30329, USA.
| | - Alain H Litwin
- Montefiore Medical Center, 111 East 210th Street, Bronx, NY, 10467, USA.
- Division of General Internal Medicine, 111 East 210th Street, Bronx, 10467, NY, USA.
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Turner BJ, Taylor BS, Hanson J, Liang Y, Veerapaneni P, Villarreal R, Perez M, Hernandez L, Sandhu J, Fiebelkorn K. High priority for hepatitis C screening in safety net hospitals: Results from a prospective cohort of 4582 hospitalized baby boomers. Hepatology 2015; 62:1388-95. [PMID: 26250753 DOI: 10.1002/hep.28018] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 07/29/2015] [Indexed: 12/19/2022]
Abstract
UNLABELLED Low-income populations are disproportionately affected by hepatitis C virus (HCV) infection. Thus, implementing baby boomer screening (born 1945-1965) for HCV may be a high priority for safety net hospitals. We report the prevalence and predictors of HCV infection and advanced fibrosis or cirrhosis based on the Fibrosis-4 score plus imaging for a baby boomer cohort admitted to a safety net hospital over a 21-month interval with >9 months of follow-up. Anti-HCV antibody testing was performed for 4582, or 90%, of all never-screened patients, of whom 312 (6.7%) tested positive. Adjusted odds ratios of testing anti-HCV-positive were 2.66 for men versus women (P<0.001), 1.25 for uninsured versus insured (P=0.06), 0.70 for Hispanics versus non-Hispanic whites (P=0.005), and 0.93 per year of age (P<0.001). Among 287 patients tested for HCV RNA (91% of all anti-HCV-positive cases), 175 (61%) were viremic (3.8% overall prevalence in cohort), which was 5% less likely per year of age (P<0.03). Noninvasive staging of 148 (84.6%) chronic HCV patients identified advanced fibrosis or cirrhosis in 50 (33.8%), with higher adjusted odds ratios of 3.21 for Hispanics versus non-Hispanic whites/Asians (P=0.02) and 1.18 per year of age (P=0.001). Other factors associated with significantly higher adjusted odds ratios of advanced fibrosis or cirrhosis were alcohol abuse/dependence, obesity, and being uninsured. CONCLUSION In this low-income, hospitalized cohort, 4% of 4582 screened baby boomers were diagnosed with chronic HCV, nearly twice the rate in the community; one-third had noninvasive testing that indicated advanced fibrosis or cirrhosis, which was significantly more likely for Hispanics, those of older age, those with obesity, those with alcohol abuse/dependence, and those who lacked insurance.
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Affiliation(s)
- Barbara J Turner
- Department of Medicine and Center for Research to Advance Community Health, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Barbara S Taylor
- Department of Medicine and Center for Research to Advance Community Health, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Joshua Hanson
- Department of Medicine and Center for Research to Advance Community Health, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Yuanyuan Liang
- Department of Epidemiology and Biostatistics and Center for Research to Advance Community Health, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Poornachand Veerapaneni
- Center for Research to Advance Community Health, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | | | - Mary Perez
- Department of Pathology, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Ludivina Hernandez
- Center for Research to Advance Community Health, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Jasdeep Sandhu
- School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Kristin Fiebelkorn
- Department of Pathology, University of Texas Health Science Center at San Antonio, San Antonio, TX
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Maan R, Toes-Zoutendijk E, Veldt BJ, Hansen BE, van der Meer AJ, de Knegt RJ. Epidemiological trends among the population with chronic HCV infection in the Netherlands. Antivir Ther 2015; 21:207-15. [PMID: 26436201 DOI: 10.3851/imp2996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND As the field of antiviral therapy for chronic HCV infection is rapidly evolving, this study aimed to assess the epidemiological changes in patient and disease characteristics among individuals with chronic HCV infection. METHODS This study included all consecutive patients with chronic HCV monoinfection who were referred between 1990 and 2013 to the Erasmus MC University Medical Center Rotterdam, a large tertiary centre in the Netherlands. To identify trends over time, the study population was divided into six equal eras based on date of first visit to the outpatient clinic. RESULTS A total of 1,779 patients were diagnosed with chronic HCV infection. Mean age increased over time from 43.6 (sd 13.8) years to 51.7 (sd 11.2) years (P<0.001). The number of patients who were referred with cirrhosis increased over time, from 31 (25%) patients in Era 1 to 118 (42%) patients in Era 6 (P<0.001), respectively. More patients were referred with HCV genotype 1a and 3 in the last era, with 27 (48.2%) and 15 (14.0%) patients in Era 1 and 58 (54.2%) and 60 (21.8%) patients in Era 6 (P<0.001 both), respectively. The vast majority of patients (69.5%) were born between 1950 to 1975, with 62.5% of the patients being born between 1945 and 1965. CONCLUSIONS The HCV-infected population is ageing and is more often referred with severe liver disease. This study stresses the importance of urgently implementing national HCV screening programmes in order to be able to decrease the future burden of chronic HCV infection in the Netherlands.
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Affiliation(s)
- Raoel Maan
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands.
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Direct-acting antiviral drugs for the treatment of chronic hepatitis C virus infection: Interferon free is now. Clin Pharmacol Ther 2015; 98:394-402. [DOI: 10.1002/cpt.185] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 07/09/2015] [Indexed: 02/06/2023]
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Laufer CB, Carroll MB. Hepatitis C Virus in the US Military Retiree Population: To Screen, or Not to Screen? J Clin Med Res 2015; 7:757-61. [PMID: 26345480 PMCID: PMC4554214 DOI: 10.14740/jocmr2233w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2015] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND In 2012, the Centers for Disease Control (CDC) recommended hepatitis C virus (HCV) screening for those born between 1945 and 1965. Prior recommendations endorsed screening based on risk factors (RFs). Because United States (US) military retirees have had at least 20 years of access to free comprehensive health care, mandatory physical fitness tests, periodic health assessments and mandatory drug screening, we hypothesized that the prevalence of HCV amongst military retirees is lower than the national average. Thus the new CDC screening guidelines may not be applicable or cost effective in this particular population. METHODS A quality improvement (QI) initiative implemented the new birth-cohort CDC screening guidelines for the internal medicine (IM) clinic of our hospital (QI group). An age-matched group from the same IM clinic, screened based on RFs for HCV infection, served as the comparator (RF group). The prevalence of the anti-HCV antibody and chronic infection was determined and compared with each other and with the national average. RESULTS The prevalence of the HCV antibody was 2.1% and 2.3% in the QI and RF groups, respectively (odds ratio (OR): 1.08, 95% CI: 0.37 - 3.21, P = 1.000). The prevalence of chronic infection was 0.4% and 1.8% in the QI and RF groups, respectively (OR: 4.39, 95% CI: 0.80 - 24.13, P = 0.083). When our data were compared with the national average, there were no statistical differences in the prevalence of the HCV antibody; however, there was statistically more viral clearance, and subsequently less chronic infection, in the QI group versus the national average. CONCLUSIONS The military retiree population did not have a lower prevalence of the HCV antibody than the American populace whether screened based on age or traditional RFs. Thus, the CDC guidelines are applicable in this population. One interesting finding of this study is the higher rate of viral clearance in military retirees when compared with the national average. It is therefore possible that military retirees may be more likely to have natural viral eradication than the civilian population.
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Affiliation(s)
- Christin B Laufer
- Department of Internal Medicine, Keesler Medical Center, 301 Fisher Street, Biloxi, MS 39534, USA
| | - Matthew B Carroll
- Department of Internal Medicine, Keesler Medical Center, 301 Fisher Street, Biloxi, MS 39534, USA ; Department of Rheumatology, Keesler Medical Center, 301 Fisher Street, Biloxi, MS 39534, USA
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Scheidell J, Khan M, Clifford L, Dunne E, Keen II. L, Latimer W. Gender differences in planning ability and hepatitis C virus among people who inject drugs. Addict Behav 2015; 47:33-7. [PMID: 25863005 DOI: 10.1016/j.addbeh.2015.03.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 02/20/2015] [Accepted: 03/16/2015] [Indexed: 12/19/2022]
Abstract
Hepatitis C virus (HCV) is primarily spread through risky injection practices, including sharing needles, cookers, cottons, rinse water, and the practice of backloading. An important aspect of harm reduction for people who inject drugs (PWID) is to identify factors that contribute to safer injection. Planning ability may influence risky injection practices and gender differences in factors that drive injection practices indicate a need to examine associations between planning and injection behaviors in men versus women. Data from the NEURO-HIV Epidemiologic Study was restricted to those who had ever injected in their lifetime (n=456). Impaired planning ability was assessed with the Tower of London and defined as a standardized total excess move score below the 10th percentile. We used logistic regression to estimate the gender-specific adjusted odds ratios (AOR) and 95% confidence intervals (CI) for associations between impaired planning, each injection practice, and biologically-confirmed HCV. Impaired planning ability was associated with sharing needles (AOR=2.93, 95% CI: 1.33, 6.47), cookers (AOR=3.13, 95% CI: 1.22, 8.02), cottons (AOR=2.89, 95% CI: 1.23, 6.78), rinse water (AOR=2.43, 95% CI: 1.15, 5.14), and backloading (AOR=2.68, 95% CI: 1.26, 5.70) and HCV (AOR=3.42, 95% CI: 1.03, 11.38) among men. Planning ability was not significantly associated with the injection behaviors or HCV among women, suggesting that other factors likely contribute to risky injection practices. Interventions to promote harm reduction among PWID should ascertain and strengthen planning ability. Women may have additional barriers to practicing safe injection beyond impaired planning abilities, which should also be addressed.
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Kuo M, Janjua NZ, Burchell AN, Buxton JA, Krajden M, Gilbert M. Decreasing Hepatitis C Incidence Among a Population With Repeated Tests: British Columbia, Canada, 1993-2011. Am J Public Health 2015; 105:1604-10. [PMID: 26066920 DOI: 10.2105/ajph.2015.302591] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES We estimated HCV incidence among individuals who repeatedly underwent anti-HCV testing. METHODS We studied HCV-negative individuals who had at least 2 tests between April 1992 and September 2012 in British Columbia, Canada. We calculated incidence as the number of new infections per 100 person-years at risk. RESULTS From 1992 to 2012, 323 598 individuals who persistently tested negative and 7490 HCV seroconverters contributed 1 774 262 person-years of observation time. Incidence rates ranged from 2.66 infections per 100 person-years (95% confidence interval [CI] = 2.07, 3.35) in 1993 to 0.25 infections per 100 person-years (95% CI = 0.21, 0.29) in 2011. Rates declined sharply in the 1990s and declined more gradually in the 2000s. Incidence declined with age; highest incidence rates were among those aged 15 to 24 years. Incidence among male repeat testers exceeded that of female repeat testers across all years, although the gap narrowed over time. CONCLUSIONS Addictions treatment, harm reduction, prevention education, and novel initiatives to remove barriers in health infrastructure need to be intensified for those who inject drugs, particularly men and younger persons.
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Affiliation(s)
- Margot Kuo
- At the time of the writing, all of the authors were with the British Columbia Centre for Disease Control, Vancouver, Canada. Ann N. Burchell is with the Ontario HIV Treatment Network, Toronto, Canada
| | - Naveed Z Janjua
- At the time of the writing, all of the authors were with the British Columbia Centre for Disease Control, Vancouver, Canada. Ann N. Burchell is with the Ontario HIV Treatment Network, Toronto, Canada
| | - Ann N Burchell
- At the time of the writing, all of the authors were with the British Columbia Centre for Disease Control, Vancouver, Canada. Ann N. Burchell is with the Ontario HIV Treatment Network, Toronto, Canada
| | - Jane A Buxton
- At the time of the writing, all of the authors were with the British Columbia Centre for Disease Control, Vancouver, Canada. Ann N. Burchell is with the Ontario HIV Treatment Network, Toronto, Canada
| | - Mel Krajden
- At the time of the writing, all of the authors were with the British Columbia Centre for Disease Control, Vancouver, Canada. Ann N. Burchell is with the Ontario HIV Treatment Network, Toronto, Canada
| | - Mark Gilbert
- At the time of the writing, all of the authors were with the British Columbia Centre for Disease Control, Vancouver, Canada. Ann N. Burchell is with the Ontario HIV Treatment Network, Toronto, Canada
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Gardenier D, Kwong J, Olson MC, Epstein R. Epidemiology, Screening, and Pretreatment Evaluation of the Patient With Chronic Hepatitis C Infection. J Nurse Pract 2015. [DOI: 10.1016/j.nurpra.2014.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Smith BD, Yartel AK. Comparison of hepatitis C virus testing strategies: birth cohort versus elevated alanine aminotransferase levels. Am J Prev Med 2014; 47:233-41. [PMID: 25145616 PMCID: PMC5759754 DOI: 10.1016/j.amepre.2014.05.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 04/12/2014] [Accepted: 05/06/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Hepatitis C virus (HCV) infection is unidentified in an estimated 40%-85% of infected adults. Surveillance and modeling data have found significant increases in HCV-associated morbidity and mortality. PURPOSE To compare two HCV antibody (anti-HCV) testing strategies based on (1) elevated alanine aminotransferase levels (ALT) and (2) a birth cohort approach for people born during 1945-1965. METHODS Data from 19,055 adults aged 20-70 years who completed the National Health and Nutrition Examination Survey in 1999-2008 were analyzed in 2013. Two independent models were evaluated, based on membership in the 1945-1965 birth cohort or elevated ALT, to compare the number of identified anti-HCV-positive (anti-HCV+) individuals; proportion of total identified cases; and the number of people that would be tested using either strategy. RESULTS The prevalence of anti-HCV among adults aged 20-70 years was estimated at 2.0% (95% CI=1.8%, 2.3%), representing about 3.6 million people. The birth cohort strategy would result in testing about 85.4 million people and identifying nearly 2.8 million anti-HCV+ people with a sensitivity of 76.6%. The ALT strategy would test about 21.5 million adults and identify approximately 1.8 million anti-HCV+ people with a sensitivity of 50.0%. Implementing both strategies concurrently would identify 87.3% of anti-HCV+ adults. CONCLUSIONS The birth cohort strategy, which is recommended by both the CDC and the U.S. Preventive Services Task Force, would identify 1 million more anti-HCV+ people than the elevated ALT approach. Concurrent implementation would identify an even larger number of individuals ever infected.
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