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Richmond JA, Hassall M, Wallace J. Hepatitis C elimination: amplifying the role of primary care nurses in Australia. Aust J Prim Health 2024; 30:PY23198. [PMID: 39265059 DOI: 10.1071/py23198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 08/27/2024] [Indexed: 09/14/2024]
Abstract
Background Australia's commitment to eliminate hepatitis C by 2030 is underpinned by the mobilisation of the primary care sector. Primary care nurses are well placed to contribute to achieving elimination given their unique access to people with/at risk of hepatitis C and their person-centred approach to care delivery. This study examines the enablers to primary care nurse involvement in elimination efforts. Methods Primary care nurses involved in the care of people with/at risk of hepatitis C were recruited through two national nursing organisations. Participants provided verbal consent to participate in an electronically recorded, semi-structured interview. Interview data were transcribed verbatim, coded and analysed using a thematic analysis. Results Sixteen interviews were conducted with nurses working in general practice, community health, alcohol and other drug services, and custodial settings, with the findings framed using a social-ecological model. The study identified individual attributes, such as empathy and advocacy for clients deemed 'too hard for everyone else'. Interpersonal enablers included participants' ability to effectively communicate with clients and colleagues, and using trusted professional relationships to improve client access to care. Public policy that addressed community factors, including stigma and confidentiality, were seen as supportive. Conclusions This study identified the critical and varied role primary care nurses play in hepatitis C elimination. Effective scale up of hepatitis C care involves recognising the pivotal role of primary care nurses, which will help to create an enabling environment that supports nurses to work to their full scope of practice and enhance their contribution to the elimination response.
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Affiliation(s)
- Jacqueline A Richmond
- The Burnet Institute, Melbourne, Vic, Australia; and Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Vic, Australia
| | - Melinda Hassall
- Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) Health, Sydney, NSW, Australia
| | - Jack Wallace
- The Burnet Institute, Melbourne, Vic, Australia; and Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Vic, Australia; and Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
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2
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Kagan D, Seear K, Lenton E, Farrugia A, Valentine K, Mulcahy S. 'I'm not hep C free': afterlives of hepatitis C in the era of cure. MEDICAL HUMANITIES 2023; 49:678-687. [PMID: 37451865 DOI: 10.1136/medhum-2023-012653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/12/2023] [Indexed: 07/18/2023]
Abstract
Since the advent of more effective, new-generation treatment for hepatitis C, immense resources have been devoted to delivering cure to as many people with the virus as possible. The scale-up of treatment aims to prevent liver disease, liver cancer and onward transmission of hepatitis C, but social research shows that people also approach treatment with its social promises in mind, including the hope that it might reduce or eradicate stigma from their lives. Such hopes reflect broader ideas about medical cure, which is seen as an end point to illness and its effects, and capable of restoring the self to a (previous) state of health and well-being. But what does cure mean among people for whom treatment does not produce an end to the social effects of a heavily stigmatised disease? While new treatments promise to eliminate hepatitis C, accounts of post-cure life suggest that hepatitis C can linger in various ways. This article draws on interviews with people who have undergone treatment with direct-acting antivirals (n=30) in Australia to explore the meanings they attach to cure and their experiences of post-cure life. We argue that dominant biomedical understandings of cure as an 'ending' and a 'restoration' can foreclose insight into the social and other effects of illness that linger after medical cure, and how individuals grapple with those afterlives. Drawing on recent conceptual re-framings of cure from medical anthropology and disability studies, we suggest that thinking at the limits of 'curative reason' helps to better address the afterlives of chronic illness. In the case of hepatitis C, reconceptualising cure could inform improved and less stigmatising ways of addressing people's post-cure needs. And in the era of hepatitis C elimination, such reconceptualisation is increasingly important as the cohort of people undergoing treatment and cure expands worldwide.
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Affiliation(s)
- Dion Kagan
- Australian Research Centre for Sex, Health and Society, La Trobe University, Bundoora, Victoria, Australia
| | - Kate Seear
- Australian Research Centre for Sex, Health and Society, La Trobe University, Bundoora, Victoria, Australia
| | - Emily Lenton
- Australian Research Centre for Sex, Health and Society, La Trobe University, Bundoora, Victoria, Australia
| | - Adrian Farrugia
- Australian Research Centre for Sex, Health and Society, La Trobe University, Bundoora, Victoria, Australia
| | - Kylie Valentine
- Centre for Social Policy Research, University of New South Wales, Sydney, New South Wales, Australia
| | - Sean Mulcahy
- Australian Research Centre for Sex, Health and Society, La Trobe University, Bundoora, Victoria, Australia
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Jiang N, Bruneau J, Makarenko I, Minoyan N, Zang G, Høj SB, Larney S, Martel-Laferrière V. HCV treatment initiation in the era of universal direct acting antiviral coverage - Improvements in access and persistent barriers. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 113:103954. [PMID: 36758334 DOI: 10.1016/j.drugpo.2023.103954] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND Barriers to HCV treatment initiation persisted after the introduction of direct-acting antivirals (DAAs) in Canada among people who inject drugs (PWID); whether DAA universal coverage lifted these barriers remain unknown. We assessed the evolution of HCV treatment initiation and associated factors among PWID in Montreal, Canada, comparing eras of IFN-based regimens (2011-2013), of DAA restricted access (2014-02/2018), and universal coverage (03/2018-03/2020). METHODS We included chronically HCV-infected participants followed in a community-based PWID cohort in Montreal, Canada between 2011 and 03/2020 and collected data at 3-month intervals. Time-updated Cox regressions were conducted to examine 9 variables of interest associated with treatment initiation overall and for each of the three eras. RESULTS Of 276 participants, 126 initiated treatment during follow-up. Yearly initiation increased from 3% in 2011 to 19% in 2016, and 54% in 2018. PWID aged >40 (vs. ≤40) were twice as likely to initiate treatment in 2014-02/2018 (HR: 2.02 95%CI: [1.24-3.28]) but not in other periods (2011-2013: 0.55 [0.25-1.22]; 03/2018-03/2020: 1.14 [0.59-2.22])). Odds of initiation were lower for men than women in all periods, with women three times more likely to be treated under universal coverage (0.30 [0.11-0.77] vs 2011-2013: 0.67 [0.25-1.78] and 2014-02/2018: 0.75 [0.42-1.35]). Recent incarceration was negatively associated with initiation throughout all periods (2011-2013: 0.57 [0.13-2.43]; 2014-03/2018: 0.39 [0.17-0.91]; 03/2018-03/2020: 0.25 [0.07-0.83]). Barriers associated with high injection frequency appear to have diminished since DAA introduction (2014-02/2018: 0.71 [0.42-1.20]; 03/2018-03/2020: 1.05 [0.52-2.11] vs. 2011-2013: 0.26 [0.08-0.88]). Contact with a primary care physician and engagement in opioid agonist therapy were positively associated with treatment initiation, though estimates were attenuated under universal coverage relative to previous eras. CONCLUSION Treatment initiation rates have increased since the introduction of universal DAA coverage, though barriers such as incarceration persist.
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Affiliation(s)
- Nathalie Jiang
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), 900 rue St-Denis, Montréal, Québec, H2×0A9, Canada
| | - Julie Bruneau
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), 900 rue St-Denis, Montréal, Québec, H2×0A9, Canada; Département de Médecine Familiale et Médecine d'Urgence, Université de Montréal, C.P. 6128, succursale Centre-ville, Montréal, Québec, H3C 3J7, Canada
| | - Iuliia Makarenko
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), 900 rue St-Denis, Montréal, Québec, H2×0A9, Canada; Department of Family Medicine, McGill University, 845 rue Sherbrooke Ouest, Montreal, Quebec, H3A 0G4, Canada
| | - Nanor Minoyan
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), 900 rue St-Denis, Montréal, Québec, H2×0A9, Canada; École de Santé Publique de l'Université de Montréal, 7101 Avenue du Parc, Montréal, Québec, H3N 1×9, Canada
| | - Geng Zang
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), 900 rue St-Denis, Montréal, Québec, H2×0A9, Canada
| | - Stine Bordier Høj
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), 900 rue St-Denis, Montréal, Québec, H2×0A9, Canada
| | - Sarah Larney
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), 900 rue St-Denis, Montréal, Québec, H2×0A9, Canada
| | - Valérie Martel-Laferrière
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), 900 rue St-Denis, Montréal, Québec, H2×0A9, Canada; Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, C.P. 6128, succursale Centre-ville, Montréal, Québec, H3C 3J7, Canada.
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4
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Greenwald ZR, Bouck Z, McLean E, Mason K, Lettner B, Broad J, Dodd Z, Nassau T, Scheim AI, Werb D. Integrated supervised consumption services and hepatitis C testing and treatment among people who inject drugs in Toronto, Canada: A cross-sectional analysis. J Viral Hepat 2023; 30:160-171. [PMID: 36461705 DOI: 10.1111/jvh.13780] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 10/31/2022] [Accepted: 11/25/2022] [Indexed: 12/09/2022]
Abstract
Despite the availability of publicly funded hepatitis C (HCV) treatment in Canada, treatment gaps persist, particularly among people who inject drugs. We estimate correlates of HCV care cascade engagement (testing, diagnosis, and treatment) among people who inject drugs in Toronto, Canada and examine the effect of accessing differing supervised consumption service (SCS) models on self-reported HCV testing and treatment. This is a cross-sectional baseline analysis of 701 people who inject drugs surveyed in the Toronto, Ontario integrated Supervised Injection Services (OiSIS-Toronto) study between November 2018 and March 2020. We examine correlates of self-reported HCV care cascade outcomes including SCS model, demographic, socio-structural, drug use, and harm reduction characteristics. Overall, 647 participants (92%) reported ever receiving HCV testing, of whom 336 (52%) had been diagnosed with HCV. Among participants who reported ever being diagnosed with HCV, 281 (84%) reported chronic HCV, of whom 130 (46%) reported HCV treatment uptake and 151 (54%) remained untreated. Compared to those with no SCS use, participants who had ever injected at an integrated SCS model with co-located HCV care had greater prevalence of both ever receiving HCV testing (adjusted prevalence ratio [aPR]: 1.12, 95% confidence interval [CI]: 1.02-1.24) and ever receiving HCV treatment (aPR: 1.67, 95% CI: 1.04-2.69). Over half of participants diagnosed with chronic HCV reported remaining untreated. Our findings suggest that integrated SCS models with co-located HCV care represent key strategies for linkage to HCV care, but that more is needed to support scale-up.
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Affiliation(s)
- Zoë R Greenwald
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Centre on Drug Policy Evaluation, MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Zachary Bouck
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Centre on Drug Policy Evaluation, MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Elizabeth McLean
- Centre on Drug Policy Evaluation, MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Kate Mason
- South Riverdale Community Health Centre, Toronto, Ontario, Canada
| | | | - Jennifer Broad
- South Riverdale Community Health Centre, Toronto, Ontario, Canada
| | - Zoë Dodd
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Tanner Nassau
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Ayden I Scheim
- Centre on Drug Policy Evaluation, MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA.,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Dan Werb
- Centre on Drug Policy Evaluation, MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Division of Infectious Diseases and Global Public Health, University of California San Diego School of Medicine, La Jolla, California, USA
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5
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Austin EJ, Gojic AJ, Bhatraju EP, Pierce KA, Pickering EI, Tung EL, Scott JD, Hansen RN, Glick SN, Stekler JD, Connolly NC, Villafuerte S, McPadden M, Deutsch S, Ninburg M, Kubiniec R, Williams EC, Tsui JI. Barriers and facilitators to implementing a Pharmacist, Physician, and Patient Navigator-Collaborative Care Model (PPP-CCM) to treat hepatitis C among people who inject drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 111:103924. [PMID: 36521197 PMCID: PMC9868078 DOI: 10.1016/j.drugpo.2022.103924] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/21/2022] [Accepted: 11/26/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Direct-acting antivirals (DAAs) offer an unprecedented opportunity to eliminate hepatitis C virus (HCV) infection, yet barriers among people who inject drugs (PWID) remain. Having pharmacists provide care through collaborative drug therapy agreements (CDTAs) offers a promising solution. We developed and piloted a Pharmacist, Physician, and Patient Navigator-Collaborative Care Model (PPP-CCM) which utilized pharmacists to directly deliver HCV care at community organizations serving PWID. We conducted formative evaluation of the PPP-CCM pilot to characterize implementation experiences. METHODS The PPP-CCM was implemented from November of 2020 through July of 2022. Formative evaluation team members observed implementation-related meetings and conducted multiple site visits, taking detailed fieldnotes. Fieldnotes were iteratively reviewed to identify barriers and facilitators to implementation and used to inform 7 key informant interviews conducted with programmatic staff at the end of the pilot. All data were analyzed using a Rapid Assessment Process (RAP) guided by the Consolidated Framework for Implementation Research (CFIR). The formative evaluation team shared results with program stakeholders (pharmacists, physicians, and other site staff) to verify and expand on learnings. RESULTS Evaluation of PPP-CCM revealed 5 themes, encompassing all CFIR domains: 1) PPP-CCM was feasible but challenging to deliver efficiently; 2) the pharmacist role and characteristics (e.g., being flexible, available, and patient-centered) were key to PPP-CCM successes; 3) the PPP-CCM team met challenges engaging patients over time, but some team-based strategies helped; 4) community site characteristics (e.g., existing trusting relationships with PWID and physical space that enabled program visibility) were important contributors; and 5) financial barriers may limit PPP-CCM scale-up and sustainability. CONCLUSION PPP-CCM is a novel and promising approach to HCV care delivery for PWID who may previously lack engagement in traditional care models, but careful attention needs to be paid to financial barriers to ensure scalability and sustainability.
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Affiliation(s)
- Elizabeth J Austin
- Department of Health Systems and Population Health, University of Washington, Seattle WA, United States.
| | - Alexander J Gojic
- Department of Medicine, Division of General Internal Medicine University of Washington, Seattle WA, United States
| | - Elenore P Bhatraju
- Department of Medicine, Division of General Internal Medicine University of Washington, Seattle WA, United States
| | - Kathleen A Pierce
- Department of Pharmacy, University of Washington, Seattle WA, United States; Kelley-Ross Pharmacy Group, Seattle WA, United States
| | - Eleanor I Pickering
- Department of Social and Behavioral Sciences, Yale School of Public Health, United States
| | - Elyse L Tung
- Department of Pharmacy, University of Washington, Seattle WA, United States; Kelley-Ross Pharmacy Group, Seattle WA, United States
| | - John D Scott
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle WA, United States
| | - Ryan N Hansen
- Department of Pharmacy, University of Washington, Seattle WA, United States; Kelley-Ross Pharmacy Group, Seattle WA, United States
| | - Sara N Glick
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle WA, United States; HIV/STD Program, Public Health - Seattle & King County, Seattle WA, United States
| | - Joanne D Stekler
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle WA, United States
| | - Nancy C Connolly
- Department of Medicine, Division of General Internal Medicine University of Washington, Seattle WA, United States
| | - Sarah Villafuerte
- Hepatitis Education Project, Seattle WA, United States (affiliation at the time of research)
| | - Madison McPadden
- Hepatitis Education Project, Seattle WA, United States (affiliation at the time of research)
| | - Sarah Deutsch
- Hepatitis Education Project, Seattle WA, United States (affiliation at the time of research)
| | - Michael Ninburg
- Hepatitis Education Project, Seattle WA, United States (affiliation at the time of research)
| | | | - Emily C Williams
- Department of Health Systems and Population Health, University of Washington, Seattle WA, United States; Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, VA Puget Sound, Seattle WA, United States
| | - Judith I Tsui
- Department of Medicine, Division of General Internal Medicine University of Washington, Seattle WA, United States
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6
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Lu Y, Windsor C, Hollingdrake O. A Scoping Review of Nursing Roles in Hepatitis C Virus Telehealth. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2022.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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7
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Biondi MJ, Hirode G, Capraru C, Vanderhoff A, Karkada J, Wolfson-Stofko B, Smookler D, Friedman SM, Bates K, Mazzulli T, Juan JV, Shah H, Hansen BE, Feld JJ, Janssen HLA. Birth cohort hepatitis C antibody prevalence in real-world screening settings in Ontario. CANADIAN LIVER JOURNAL 2022; 5:362-371. [PMID: 36133900 PMCID: PMC9473558 DOI: 10.3138/canlivj-2021-0036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/11/2021] [Indexed: 07/29/2023]
Abstract
BACKGROUND Widespread screening and treatment of hepatitis C virus (HCV) is required to decrease late-stage liver disease and liver cancer. Clinical practice guidelines and Canadian Task Force on Preventative Health Care recommendations differ on the value of one-time birth cohort (1945-75) HCV screening in Canada. To assess the utility of this approach, we conducted a real-world analysis of HCV antibody (Ab) prevalence among birth cohort individuals seen in different clinical contexts. METHODS Cross-sectional study of individuals born between 1945 and 1975 who completed HCV Ab testing at multiple participating centres in Ontario, Canada between January 2016 and December 2020. Differences in prevalence were compared by year of birth, gender, and setting. RESULTS Among 16,672 birth cohort individuals tested, HCV Ab prevalence was 3.2%. Prevalence was higher among younger individuals which increased from 0.9% among those born between 1945 and 1956 to 4.6% among those born between 1966 and 1975. Prevalence was higher among males (4.4%) compared with females (2.0%) and differed by test site. In primary care, the prevalence was 0.5%, whereas the prevalence was highest among those tested at drug treatment centres (28.7%) and through community outreach (14.0%). CONCLUSIONS HCV Ab prevalence remains high in the 1945-1975 birth cohort. These data highlight the need to re-evaluate existing Canadian Preventative Task Force recommendations, to consider incorporating one-time birth cohort and/or other population-based approaches to HCV screening into the clinical workflow as a preventative health measure, and to increase training among community providers to screen for and treat HCV.
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Affiliation(s)
- Mia J Biondi
- These first authors contributed equally to this work
- Toronto Centre for Liver Disease/Viral Hepatitis Care Network (VIRCAN), University Health Network, Toronto, Ontario, Canada
| | - Grishma Hirode
- These first authors contributed equally to this work
- Toronto Centre for Liver Disease/Viral Hepatitis Care Network (VIRCAN), University Health Network, Toronto, Ontario, Canada
| | - Camelia Capraru
- Toronto Centre for Liver Disease/Viral Hepatitis Care Network (VIRCAN), University Health Network, Toronto, Ontario, Canada
| | - Aaron Vanderhoff
- Toronto Centre for Liver Disease/Viral Hepatitis Care Network (VIRCAN), University Health Network, Toronto, Ontario, Canada
| | - Joel Karkada
- Toronto Centre for Liver Disease/Viral Hepatitis Care Network (VIRCAN), University Health Network, Toronto, Ontario, Canada
| | - Brett Wolfson-Stofko
- Toronto Centre for Liver Disease/Viral Hepatitis Care Network (VIRCAN), University Health Network, Toronto, Ontario, Canada
| | - David Smookler
- Toronto Centre for Liver Disease/Viral Hepatitis Care Network (VIRCAN), University Health Network, Toronto, Ontario, Canada
| | - Steven M Friedman
- Department of Emergency Medicine, University Health Network, Toronto, Ontario, Canada
| | - Kathy Bates
- Emergency Department, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Tony Mazzulli
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Department of Microbiology, University Health Network/Sinai Health System, Toronto, Ontario, Canada
| | | | - Hemant Shah
- Toronto Centre for Liver Disease/Viral Hepatitis Care Network (VIRCAN), University Health Network, Toronto, Ontario, Canada
| | - Bettina E Hansen
- Toronto Centre for Liver Disease/Viral Hepatitis Care Network (VIRCAN), University Health Network, Toronto, Ontario, Canada
| | - Jordan J Feld
- These senior authors contributed equally to this work
- Toronto Centre for Liver Disease/Viral Hepatitis Care Network (VIRCAN), University Health Network, Toronto, Ontario, Canada
| | - Harry LA Janssen
- These senior authors contributed equally to this work
- Toronto Centre for Liver Disease/Viral Hepatitis Care Network (VIRCAN), University Health Network, Toronto, Ontario, Canada
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8
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Annual Meeting of the Canadian Association for the Study of the Liver (CASL), the Canadian Network on Hepatitis C (CanHepC), the Canadian Association of Hepatology Nurses (CAHN), and the Canadian NASH Network 2022 Abstracts. CANADIAN LIVER JOURNAL 2022; 5:169-317. [PMID: 35991483 PMCID: PMC9236590 DOI: 10.3138/canlivj.5.2.abst] [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: 03/23/2022] [Accepted: 03/23/2022] [Indexed: 09/17/2023]
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9
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Dale CH, Smith E, Biondi MJ. Nurse practitioners as primary care site champions for the screening and treatment of hepatitis C virus. J Am Assoc Nurse Pract 2022; 34:688-695. [PMID: 35066534 DOI: 10.1097/jxx.0000000000000689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 12/06/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Primary care providers are often the first point of contact for hepatitis C virus (HCV) care, yet treatment initiation in primary care continues to be low. Nurse practitioners (NPs) are autonomous providers who, in Ontario, currently prescribe HCV therapy; however, methods to engage primary care NPs in HCV care have not occurred. PURPOSE To assess the feasibility of a systematic approach to train and support NPs in HCV testing, care, and treatment. METHODOLOGY Nurse practitioners from Canada's largest family health team (FHT) were recruited. Nurse practitioners received six hours of training and develop approaches to screen and treat at FHT sites. Treatment algorithms were given, and the number and types of inquiries from NPs were recorded. RESULTS Over 1 year, 9 NPs screened 1,026 patients; 87.4% were screened based on the identification of a risk factor. A mail-out approach for birth cohort screening occurred at a single site, resulting in rapid uptake in screening. Antibody prevalence was 1.66%, with 76.5% RNA positivity. All RNA-positive treatment-eligible individuals were treated by an NP and completed treatment. Thirty-eight consults occurred over 1 year, the majority related to HCV or liver disease staging. CONCLUSIONS Formalized initiatives to engage and educate NPs lead to innovative strategies to test for HCV. Nurse practitioners can safely and effectively treat HCV in primary care with minimal support. IMPLICATIONS This work could be extrapolated to NPs in other primary care settings. Implementing formalized strategies has the potential to create NP leaders in the treatment and elimination of HCV in Ontario, Canada, and globally.
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Affiliation(s)
- Cheryl H Dale
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
| | - Elizabeth Smith
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
- Thames Valley Family Health Team, London, Ontario, Canada
| | - Mia J Biondi
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
- Viral Hepatitis Care Network (VIRCAN) Study Group, Toronto Centre for Liver Disease, Toronto, Ontario, Canada
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10
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Lee SS, Williams SA, Pinto J, Israelson H, Liu H. Treating hepatitis C during the COVID-19 pandemic in Alberta. CANADIAN LIVER JOURNAL 2021; 4:79-81. [PMID: 35991768 PMCID: PMC9204936 DOI: 10.3138/canlivj-2021-0007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 02/20/2021] [Indexed: 07/29/2023]
Affiliation(s)
- Samuel S Lee
- Calgary Liver Unit, Alberta Health Services, Calgary, Alberta, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sarah A Williams
- Calgary Liver Unit, Alberta Health Services, Calgary, Alberta, Canada
| | - Jacqueline Pinto
- Calgary Liver Unit, Alberta Health Services, Calgary, Alberta, Canada
| | - Heidi Israelson
- Calgary Liver Unit, Alberta Health Services, Calgary, Alberta, Canada
| | - Hongqun Liu
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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11
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Brown SJ, Cosgrove LT, Lee SS. Achieving HCV micro-elimination in rural communities. CANADIAN LIVER JOURNAL 2021; 4:1-3. [PMID: 35991477 PMCID: PMC9203165 DOI: 10.3138/canlivj-2020-0022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 07/12/2020] [Indexed: 07/29/2023]
Affiliation(s)
| | - Linh T Cosgrove
- London Drugs Pharmacy Operations Alberta/Manitoba, Calgary, Alberta, Canada
| | - Samuel S Lee
- Liver Unit, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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12
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Li J, Casey JL, Greenwald ZR, Yasseen III AS, Dickie M, Feld JJ, Cooper CL, Crawley AM. The 9th Canadian Symposium on Hepatitis C Virus: Advances in HCV research and treatment towards elimination. CANADIAN LIVER JOURNAL 2021; 4:59-71. [PMID: 35991475 PMCID: PMC9203168 DOI: 10.3138/canlivj-2020-0026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 08/09/2020] [Indexed: 08/31/2024]
Abstract
Hepatitis C virus (HCV) elimination has evolved into a coordinated global effort. Canada, with more than 250,000 chronically infected individuals, is among the countries leading this effort. The 9th Canadian Symposium on HCV, held in February 2020, thus established and addressed its theme, 'advances in HCV research and treatment towards elimination', by gathering together basic scientists, clinicians, epidemiologists, social scientists, and community members interested in HCV research in Canada. Plenary sessions showcased topical research from prominent international and national researchers, complemented by select abstract presentations. This event was hosted by the Canadian Network on Hepatitis C (CanHepC), with support from the Public Health Agency of Canada and the Canadian Institutes of Health Research and in partnership with the Canadian Liver Meeting. CanHepC has an established record in HCV research by its members and in its advocacy activities to address the care, treatment, diagnosis, and immediate and long-term needs of those affected by HCV infection. Many challenges remain in tackling chronic HCV infection, such as the need for a vaccine; difficult-to-treat populations and unknown aspects of patient subgroups, including pregnant women and children; vulnerable people; and issues distinct to Indigenous peoples. There is also increasing concern about long-term clinical outcomes after successful treatment, with the rise in comorbidities such as diabetes, cardiovascular disease, and fatty liver disease and the remaining risk for hepatocellular carcinoma in cirrhotic individuals. The symposium addressed these topics in highlighting research advances that will collectively play an important role in eliminating HCV and minimizing subsequent health challenges.
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Affiliation(s)
- Jiafeng Li
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario, Canada
- Chronic Disease Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Centre for Infection, Immunity and Inflammation, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Julia L Casey
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Zoë R Greenwald
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Abdool S Yasseen III
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Melisa Dickie
- Knowledge Exchange Division, Community AIDS Treatment Information Exchange, Toronto, Ontario, Canada
| | - Jordan J Feld
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
- Toronto Centre for Liver Disease, Toronto General Hospital, Toronto, Ontario, Canada
| | - Curtis L Cooper
- Centre for Infection, Immunity and Inflammation, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Division of Infectious Diseases, The Ottawa Hospital, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Angela M Crawley
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario, Canada
- Chronic Disease Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Centre for Infection, Immunity and Inflammation, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Biology, Carleton University, Ottawa, Ontario, Canada
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Tadrous M, Mason K, Dodd Z, Guyton M, Powis J, McCormack D, Gomes T. Prescribing trends in direct-acting antivirals for the treatment of hepatitis C in Ontario, Canada. CANADIAN LIVER JOURNAL 2021; 4:51-58. [PMID: 35991476 PMCID: PMC9203166 DOI: 10.3138/canlivj-2020-0025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 09/06/2020] [Indexed: 08/31/2024]
Abstract
Background Direct-acting antivirals (DAA) offer an opportunity to cure hepatitis C. Reimbursement for DAAs has changed on two occasions since their inclusion on the Ontario public formulary. Whether these changes have appreciably modified prescribing patterns and increased access to DAAs is unknown. Methods We conducted a repeated cross-sectional study of DAA reimbursement by the Ontario Public Drug Programs from January 1, 2012, to December 31, 2018, to summarize the use of DAAs in Ontario and describe changes in DAA prescribing physician specialties over this period. We measured the total number of users quarterly. Results are reported overall and by prescriber type. Results A total of 27,116 individuals received a publicly funded prescription for a DAA from the first quarter (Q1) of 2012 to the fourth quarter (Q4) of 2018. Nearly two-thirds (n = 17,813; 65.7%) of all DAAs were prescribed by gastroenterologists, hepatologists, or infectious disease specialists. Use of DAAs over time appears to have had three major phases in uptake: (1) the introduction of DAA treatments on the Ontario public drug formulary as a prior authorization benefit in Q1 2015, (2) expanded listing of all DAAs as limited-use products on the formulary in Q1 2017, and (3) the introduction of newer DAAs in Q2 2018. Conclusions Changes in listing of these agents had a direct impact on the use of DAAs overall. Generally, broader listing expanded access but did not appear to shift utilization patterns to primary care prescribers. Further understanding of who is not receiving treatment is needed.
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Affiliation(s)
- Mina Tadrous
- Women’s College Research Institute, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Kate Mason
- South Riverdale Community Health Centre, Toronto, Ontario, Canada
| | - Zoë Dodd
- South Riverdale Community Health Centre, Toronto, Ontario, Canada
| | | | - Jeff Powis
- Sherbourne Health, Toronto, Ontario, Canada
| | | | - Tara Gomes
- ICES, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
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