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Folch C, Saludes V, Reyes-Ureña J, Antuori A, Ibáñez N, Majó X, Colom J, Matas L, Casabona J, Martró E. The hepatitis C care cascade among people who inject drugs accessing harm reduction services in Catalonia: Major gaps for migrants. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 90:103057. [PMID: 33310634 DOI: 10.1016/j.drugpo.2020.103057] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 11/11/2020] [Accepted: 11/17/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND This study aimed to describe the HCV cascade of care among people who inject drugs (PWID) in Catalonia, as well as to compare the observed gaps in care between Spanish-born and migrant PWID. METHODS A cross-sectional study of PWID (N = 410) attending four harm reduction services (HRS) was performed in 2016-17 (HepCdetect II Study). Participants were tested for both HCV antibodies (rapid testing) and RNA (from dried blood spot samples). The HCV care cascade was estimated from HCV testing results combined with self-reported data on previous testing, diagnosis and treatment collected through a questionnaire. Logistic regressions were used to test for an association between migration status and the proportions observed in each step of the HCV care cascade adjusting for age, sex, years of injection, homelessness, and treatment for drug dependence. RESULTS Overall, 85.4% were men and 28.0% were migrants. Among Spanish-born (n = 295) and migrant (n = 115) PWID participants in the study, 96.6% vs. 88.6% had previously been HCV screened (AOR=3.11; 95% CI: 1.11-8.65), 79.3% vs. 80.9% were antibody positive, and 70.7% vs. 67.6% were HCV-RNA positive or cured with treatment; among the latter, 36.6% vs. 18.2% had started treatment (AOR=2.41; 95% CI: 1.09-5.34), and 20.6% vs. 9.1% had been cured by treatment, respectively. Unawareness of having hepatitis C was more common among migrants than Spanish-born PWID (46.0% and 31.5%, respectively; p<0.05). CONCLUSION This study estimates the HCV care cascade among Spanish-born and migrant PWID in Catalonia for the very first time, and highlights a higher attrition of migrant PWID in all HCV care cascade stages. The observed limited linkage to care and treatment by PWID that attend the HRS network warrants future implementation of decentralized diagnosis and antiviral treatment. Strategies focusing on migrants by increasing HCV screening coverage and treatment access will be especially relevant in our setting.
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Affiliation(s)
- Cinta Folch
- Centre for Epidemiological Studies on Sexually Transmitted Infections and HIV/AIDS of Catalonia (CEEISCAT), Catalonia Public Health Agency (ASPCAT), Badalona, Spain; Group 27, Biomedical Research Networking Centre in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Verónica Saludes
- Group 27, Biomedical Research Networking Centre in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain; Microbiology Department, Laboratori Clínic Metropolitana Nord, Hospital Universitari Germans Trias Pujol, Institut d'Investigació Germans Trias i Pujol (IGTP), Badalona, Spain; Genetics and Microbiology Department, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Juliana Reyes-Ureña
- Centre for Epidemiological Studies on Sexually Transmitted Infections and HIV/AIDS of Catalonia (CEEISCAT), Catalonia Public Health Agency (ASPCAT), Badalona, Spain; Group 27, Biomedical Research Networking Centre in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Adrián Antuori
- Microbiology Department, Laboratori Clínic Metropolitana Nord, Hospital Universitari Germans Trias Pujol, Institut d'Investigació Germans Trias i Pujol (IGTP), Badalona, Spain; Genetics and Microbiology Department, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Nuria Ibáñez
- Programme for Prevention, Control and Treatment of HIV, STIs and Viral Hepatitis. ASPCAT, Badalona, Spain
| | - Xavier Majó
- Programme for Prevention, Control and Treatment of HIV, STIs and Viral Hepatitis. ASPCAT, Badalona, Spain
| | - Joan Colom
- Programme for Prevention, Control and Treatment of HIV, STIs and Viral Hepatitis. ASPCAT, Badalona, Spain
| | - Lurdes Matas
- Group 27, Biomedical Research Networking Centre in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain; Microbiology Department, Laboratori Clínic Metropolitana Nord, Hospital Universitari Germans Trias Pujol, Institut d'Investigació Germans Trias i Pujol (IGTP), Badalona, Spain; Genetics and Microbiology Department, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Jordi Casabona
- Centre for Epidemiological Studies on Sexually Transmitted Infections and HIV/AIDS of Catalonia (CEEISCAT), Catalonia Public Health Agency (ASPCAT), Badalona, Spain; Group 27, Biomedical Research Networking Centre in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Elisa Martró
- Group 27, Biomedical Research Networking Centre in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain; Microbiology Department, Laboratori Clínic Metropolitana Nord, Hospital Universitari Germans Trias Pujol, Institut d'Investigació Germans Trias i Pujol (IGTP), Badalona, Spain; Genetics and Microbiology Department, Universitat Autònoma de Barcelona, Bellaterra, Spain.
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Beyond clinical outcomes: the social and healthcare system implications of hepatitis C treatment. BMC Infect Dis 2020; 20:702. [PMID: 32972393 PMCID: PMC7517680 DOI: 10.1186/s12879-020-05426-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/16/2020] [Indexed: 12/19/2022] Open
Abstract
Background Hepatitis C virus (HCV) infections in people who inject drugs (PWID) can now be treated and cured. However, the impact that HCV treatment has on drug-user health, practices and wellbeing is not known. The aim of this research was to understand the non-clinical impact that HCV treatment has in PWID and their reasons for accessing and completing treatment. Methods Participants aged 25–67 years who had injected opioids or stimulants (currently or in the past) and had completed direct-acting antiviral treatment were recruited from seven European countries. Participants completed a 30-min online survey administered face-to-face between September 2018 and April 2019. The questionnaire responses were used to assess the mental and physical impact of having completed treatment. Results Of the 124 participants who completed the survey questionnaire, 75% were male, 69% were over 45 years old and 65% were using opioids and/or stimulants at the start of HCV treatment. Participants reported improvements in the following areas after completing HCV treatment: outlook for the future (79%); self-esteem (73%); ability to plan for the future (69%); belief in their abilities (68%); confidence (67%); empowerment (62%); energy levels (59%); and ability to look after themselves (58%). The most common reasons for starting HCV treatment were: becoming aware of treatments that were well tolerated (77%) and effective (75%); and understanding the potentially severe consequences of HCV (75%). Conclusions The benefits of HCV treatment go beyond clinical outcomes and are linked to improved drug-user health and wellbeing. Sharing information about well-tolerated and effective HCV treatments, and raising awareness about the potentially severe consequences of untreated HCV are likely to increase the number of PWID who are motivated to access and complete HCV treatment in future.
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