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Ford MM, Jordan AE, Johnson N, Rude E, Laraque F, Varma JK, Hagan H. Check Hep C: A Community-Based Approach to Hepatitis C Diagnosis and Linkage to Care in High-Risk Populations. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2018; 24:41-48. [PMID: 28141668 DOI: 10.1097/phh.0000000000000519] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
CONTEXT In New York City (NYC), an estimated 146 500 people, or 2.4% of the adult population, have chronic hepatitis C virus (HCV) infection and half may be unaware of their infection. Despite a 2014 state law requiring health care providers to screen for HCV infection in primary care settings, many high-risk HCV-positive persons are not, and a large proportion of those screened do not receive RNA testing to confirm infection, or antiviral therapies. OBJECTIVE The NYC Department of Health's Check Hep C program was designed to increase hepatitis C diagnosis and improve linkage to care at community-based organizations. DESIGN Coordinated, evidence-based practices were implemented at 12 sites, including HCV antibody testing, immediate blood draw for RNA testing, and patient navigation to clinical services. RESULTS From May 2012 through April 2013, a total of 4751 individuals were tested for HCV infection and 880 (19%) were antibody-positive. Of antibody-positive participants, 678 (77%) had an RNA test, and of those, 512 (76%) had current infection. Of all participants, 1901 were born between 1945 and 1965, and of those, 201 (11%) were RNA-positive. Ever having injected drugs was the strongest risk factor for HCV infection (40% vs 3%; adjusted odds ratio [AOR] = 19.1), followed by a history of incarceration (18% vs 4%; AOR = 2.2). Of the participants with current infection, 85% attended at least 1 follow-up hepatitis C medical appointment. Fourteen patients initiated hepatitis C treatment at a Check Hep C site and 6 initiators achieved cure. CONCLUSION The community-based model successfully identified persons with HCV infection and linked a large proportion to care. The small number of patients initiating hepatitis C treatment in the program identified the need for patient navigation in high-risk populations. Results can be used to inform screening and linkage-to-care strategies and to support the execution of hepatitis C screening recommendations.
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Affiliation(s)
- Mary M Ford
- Bureau of Communicable Disease (Mss Ford and Johnson, Mr Rude, Dr Laraque) and Division of Disease Control (Mr Varma), New York City Department of Health and Mental Hygiene, Long Island City, New York; and Center for Drug Use and HIV Research, New York University College of Nursing, New York, New York (Dr Hagan and Ms Jordan)
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Pafundi PC, Parrella A, Iossa D, Molaro R, Battimelli C, Falco E, Sodano G, Utili R, Durante-Mangoni E. Viability of pegIFNα-RBV for CHC in the direct acting antiviral era: a practical algorithm between efficacy and cost containment. J Chemother 2016; 29:94-101. [PMID: 27351356 DOI: 10.1080/1120009x.2016.1171467] [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] [Indexed: 10/21/2022]
Abstract
The classical pegylated interferon α (peg-IFNα) and ribavirin (RBV) treatment of chronic hepatitis C (CHC) is progressively being replaced by new direct acting antivirals, whose costs remain a major barrier to widespread use. Using baseline data and viral kinetics, we developed a predictive algorithm to allocate to DAA patients who are not going to respond to peg-IFNα/RBV. This prospective study evaluated 205 CHC patients treated with peg-IFNα/RBV. HCVRNA kinetics during the initial 3 days of therapy and baseline variables including age, genotype, fibrosis and ALTs were used to construct a prediction rule in terms of sustained virological response (SVR). One hundred and twenty-one patients achieved an SVR (59%). Variables independently associated with SVR were HCVRNA, ALT, glycaemia, viral genotype, and fibrosis. The decline of viremia from baseline to 48/72 h was significantly different in SVR compared to non-SVR patients (2.2 vs. 0.65 log10 IU/mL; p < 0.001), and was influenced by viral genotype, levels of ALT, stage of fibrosis and IL28B polymorphism. In genotype 1, HCVRNA decline <0.8 logs had a negative predictive value of 90%, and in genotype 2, HCVRNA decline >1.2 logs had a positive predictive value of 92%. A combination of HCVRNA kinetics and a score based on pre-treatment parameters was highly accurate in predicting SVR in most patients. Outcome of peg-IFNα/RBV treatment may be predicted combining evaluation of baseline variables and HCVRNA kinetics. This allows to individualize treatment, reserving newer and more expensive DAAs to CHC patients who are in most need of them.
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Affiliation(s)
- Pia Clara Pafundi
- a Internal Medicine , Second University of Naples, AORN dei Colli Ospedale Monaldi , Napoli , Italy
| | - Antonio Parrella
- a Internal Medicine , Second University of Naples, AORN dei Colli Ospedale Monaldi , Napoli , Italy
| | - Domenico Iossa
- a Internal Medicine , Second University of Naples, AORN dei Colli Ospedale Monaldi , Napoli , Italy
| | - Rosa Molaro
- a Internal Medicine , Second University of Naples, AORN dei Colli Ospedale Monaldi , Napoli , Italy
| | - Carminia Battimelli
- a Internal Medicine , Second University of Naples, AORN dei Colli Ospedale Monaldi , Napoli , Italy
| | - Erasmo Falco
- b Microbiology and Virology , AORN dei Colli Monaldi-Cotugno-CTO , Napoli , Italy
| | - Giuseppe Sodano
- b Microbiology and Virology , AORN dei Colli Monaldi-Cotugno-CTO , Napoli , Italy
| | - Riccardo Utili
- a Internal Medicine , Second University of Naples, AORN dei Colli Ospedale Monaldi , Napoli , Italy
| | - Emanuele Durante-Mangoni
- a Internal Medicine , Second University of Naples, AORN dei Colli Ospedale Monaldi , Napoli , Italy
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Ruta S, Cernescu C. Injecting drug use: A vector for the introduction of new hepatitis C virus genotypes. World J Gastroenterol 2015; 21:10811-10823. [PMID: 26478672 PMCID: PMC4600582 DOI: 10.3748/wjg.v21.i38.10811] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 06/19/2015] [Accepted: 09/15/2015] [Indexed: 02/06/2023] Open
Abstract
Hepatitis C virus (HCV) genotypes’ monitoring allows real-time insight into the dynamic changes that occur in the global epidemiological picture of HCV infection. Intravenous drug use is currently the primary driver for HCV transmission in developed and developing countries. The distribution of HCV genotypes/subtypes differs significantly between people who inject drugs (PWID) and the general population. HCV genotypes that previously exhibited a limited geographical distribution (3a, 4) are becoming more prevalent in this high-risk group. Immigration from HCV-endemic countries and the evolving networks of HCV transmission in PWID influence HCV genotypes distribution in Europe. Social vulnerabilities (e.g., unemployment, homelessness, and limited access to social and healthcare insurances systems) are important triggers for illicit drug use, which increases the associated risks of HCV infection and the frequent emergence of less prevalent genotypes. Genotype/subtype determination bears important clinical consequences in the progression of liver disease, susceptibility to antiviral therapies and the emergence of resistance-associated variants. An estimated half of the chronically HCV-infected PWID are unaware of their infection, and only one in ten of those diagnosed enter treatment. Nevertheless, PWID exhibit high response rates to new antiviral regimens, and the level of HCV reinfection is unexpectedly low. The focus of the healthcare system must be on the early detection and treatment of infection, to avoid late presentations that are associated with high levels of viremia and liver fibrosis, which may diminish the therapeutic success rate.
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Zuchowski JL, Hamilton AB, Pyne JM, Clark JA, Naik AD, Smith DL, Kanwal F. Qualitative analysis of patient-centered decision attributes associated with initiating hepatitis C treatment. BMC Gastroenterol 2015; 15:124. [PMID: 26429337 PMCID: PMC4591706 DOI: 10.1186/s12876-015-0356-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 09/23/2015] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND In this era of a constantly changing landscape of antiviral treatment options for chronic viral hepatitis C (CHC), shared clinical decision-making addresses the need to engage patients in complex treatment decisions. However, little is known about the decision attributes that CHC patients consider when making treatment decisions. We identify key patient-centered decision attributes, and explore relationships among these attributes, to help inform the development of a future CHC shared decision-making aid. METHODS Semi-structured qualitative interviews with CHC patients at four Veterans Health Administration (VHA) hospitals, in three comparison groups: contemplating CHC treatment at the time of data collection (Group 1), recently declined CHC treatment (Group 2), or recently started CHC treatment (Group 3). Participant descriptions of decision attributes were analyzed for the entire sample as well as by patient group and by gender. RESULTS Twenty-nine Veteran patients participated (21 males, eight females): 12 were contemplating treatment, nine had recently declined treatment, and eight had recently started treatment. Patients on average described eight (range 5-13) decision attributes. The attributes most frequently reported overall were: physical side effects (83%); treatment efficacy (79%), new treatment drugs in development (55%); psychological side effects (55%); and condition of the liver (52%), with some variation based on group and gender. Personal life circumstance attributes (such as availability of family support and the burden of financial responsibilities) influencing treatment decisions were also noted by all participants. Multiple decision attributes were interrelated in highly complex ways. CONCLUSIONS Participants considered numerous attributes in their CHC treatment decisions. A better understanding of these attributes that influence patient decision-making is crucial in order to inform patient-centered clinical approaches to care (such as shared decision-making augmented with relevant decision-making aids) that respond to patients' needs, preferences, and circumstances.
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Affiliation(s)
- Jessica L Zuchowski
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, 16111 Plummer St. Bldg. 25, North Hills, CA, 91343, USA.
| | - Alison B Hamilton
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, 16111 Plummer St. Bldg. 25, North Hills, CA, 91343, USA. .,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA.
| | - Jeffrey M Pyne
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, 2200 Fort Roots Drive, North Little Rock, AR, 72114, USA. .,Psychiatric Research Institute, University of Arkansas for Medical Sciences, 4300 West 7th Street, Little Rock, AR, 72205, USA.
| | - Jack A Clark
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, 200 Springs Rd, Bedford, MA, 01730, USA. .,Department of Health Policy and Management, Boston University School of Public Health, 715 Albany St. #358w, Boston, MA, 02118, USA.
| | - Aanand D Naik
- VA HSR&D Center for Innovations in Quality, Effectiveness & Safety, Michael E DeBakey VA Medical Center, 2002 Holcombe Boulevard, Houston, TX, 77030, USA. .,Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA.
| | - Donna L Smith
- VA HSR&D Center for Innovations in Quality, Effectiveness & Safety, Michael E DeBakey VA Medical Center, 2002 Holcombe Boulevard, Houston, TX, 77030, USA.
| | - Fasiha Kanwal
- VA HSR&D Center for Innovations in Quality, Effectiveness & Safety, Michael E DeBakey VA Medical Center, 2002 Holcombe Boulevard, Houston, TX, 77030, USA. .,Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA.
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Janardhan SV, Reau NS. Should NS5A inhibitors serve as the scaffold for all-oral anti-HCV combination therapies? ACTA ACUST UNITED AC 2015; 7:11-20. [PMID: 25926761 PMCID: PMC4403691 DOI: 10.2147/hmer.s79584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Chronic hepatitis C virus (HCV) infection represents a global health problem that affects up to 130–150 million people worldwide. The HCV treatment landscape has been transformed recently by the introduction of direct-acting antiviral (DAA) agents that target viral proteins, including the NS3 protease, the NS5B polymerase, and the NS5A protein. Treatment with multiple DAAs in combination has been shown to result in high rates of sustained virologic response, without the need for pegylated interferon, and a shorter duration of therapy compared with interferon-based regimens; however, the optimal combination of DAAs has yet to be determined. The class of NS5A inhibitors has picomolar potency with pangenotypic activity, and recent clinical studies have shown these inhibitors to be an important component of DAA combination regimens. This review discusses the rational design of an optimal anti-HCV DAA cocktail, with a focus on the role of NS5A in the HCV life cycle, the attributes of the NS5A class of inhibitors, and the potential for NS5A inhibitors to act as a scaffold for DAA-only treatment regimens.
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Affiliation(s)
- Sujit V Janardhan
- Center for Liver Diseases, Section of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Nancy S Reau
- Center for Liver Diseases, Section of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Chicago, Chicago, IL, USA
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