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Delport D, Sanderson B, Sacks-Davis R, Vaccher S, Dalton M, Martin-Hughes R, Mengistu T, Hogan D, Abeysuriya R, Scott N. A Framework for Assessing the Impact of Outbreak Response Immunization Programs. Diseases 2024; 12:73. [PMID: 38667531 PMCID: PMC11048879 DOI: 10.3390/diseases12040073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 03/29/2024] [Accepted: 04/02/2024] [Indexed: 04/28/2024] Open
Abstract
The impact of outbreak response immunization (ORI) can be estimated by comparing observed outcomes to modelled counterfactual scenarios without ORI, but the most appropriate metrics depend on stakeholder needs and data availability. This study developed a framework for using mathematical models to assess the impact of ORI for vaccine-preventable diseases. Framework development involved (1) the assessment of impact metrics based on stakeholder interviews and literature reviews determining data availability and capacity to capture as model outcomes; (2) mapping investment in ORI elements to model parameters to define scenarios; (3) developing a system for engaging stakeholders and formulating model questions, performing analyses, and interpreting results; and (4) example applications for different settings and pathogens. The metrics identified as most useful were health impacts, economic impacts, and the risk of severe outbreaks. Scenario categories included investment in the response scale, response speed, and vaccine targeting. The framework defines four phases: (1) problem framing and data sourcing (identification of stakeholder needs, metrics, and scenarios); (2) model choice; (3) model implementation; and (4) interpretation and communication. The use of the framework is demonstrated by application to two outbreaks, measles in Papua New Guinea and Ebola in the Democratic Republic of the Congo. The framework is a systematic way to engage with stakeholders and ensure that an analysis is fit for purpose, makes the best use of available data, and uses suitable modelling methodology.
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Affiliation(s)
- Dominic Delport
- Burnet Institute, Melbourne, VIC 3004, Australia; (B.S.); (R.S.-D.); (S.V.); (M.D.); (R.M.-H.); (R.A.); (N.S.)
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Ben Sanderson
- Burnet Institute, Melbourne, VIC 3004, Australia; (B.S.); (R.S.-D.); (S.V.); (M.D.); (R.M.-H.); (R.A.); (N.S.)
| | - Rachel Sacks-Davis
- Burnet Institute, Melbourne, VIC 3004, Australia; (B.S.); (R.S.-D.); (S.V.); (M.D.); (R.M.-H.); (R.A.); (N.S.)
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
- School of Population and Global Health, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Stefanie Vaccher
- Burnet Institute, Melbourne, VIC 3004, Australia; (B.S.); (R.S.-D.); (S.V.); (M.D.); (R.M.-H.); (R.A.); (N.S.)
| | - Milena Dalton
- Burnet Institute, Melbourne, VIC 3004, Australia; (B.S.); (R.S.-D.); (S.V.); (M.D.); (R.M.-H.); (R.A.); (N.S.)
| | - Rowan Martin-Hughes
- Burnet Institute, Melbourne, VIC 3004, Australia; (B.S.); (R.S.-D.); (S.V.); (M.D.); (R.M.-H.); (R.A.); (N.S.)
| | - Tewodaj Mengistu
- Gavi, The Vaccine Alliance, 1218 Geneva, Switzerland; (T.M.); (D.H.)
| | - Dan Hogan
- Gavi, The Vaccine Alliance, 1218 Geneva, Switzerland; (T.M.); (D.H.)
| | - Romesh Abeysuriya
- Burnet Institute, Melbourne, VIC 3004, Australia; (B.S.); (R.S.-D.); (S.V.); (M.D.); (R.M.-H.); (R.A.); (N.S.)
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Nick Scott
- Burnet Institute, Melbourne, VIC 3004, Australia; (B.S.); (R.S.-D.); (S.V.); (M.D.); (R.M.-H.); (R.A.); (N.S.)
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
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Harney BL, Sacks-Davis R, van Santen DK, Traeger MW, Wilkinson AL, Asselin J, Fairley CK, Roth N, Bloch M, Matthews GV, Donovan B, Guy R, Stoové M, Hellard ME, Doyle JS. Hepatitis C virus reinfection incidence among gay and bisexual men with HIV in Australia from 2016 to 2020. Liver Int 2024; 44:1024-1031. [PMID: 38291946 DOI: 10.1111/liv.15841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 12/02/2023] [Accepted: 01/04/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND There is some concern that hepatitis C virus (HCV) reinfection might impact HCV micro-elimination efforts among gay and bisexual men (GBM) with HIV. However, there is a limited understanding of reinfection incidence in the context of unrestricted government-funded HCV treatment. We aimed to estimate HCV reinfection incidence among GBM with HIV in Australia from 2016 to 2020. METHODS Data were from 39 clinics participating in ACCESS, a sentinel surveillance network for blood borne viruses and sexually transmissible infections across Australia. GBM with HIV who had evidence of treatment or spontaneous clearance with at least one positive HCV RNA test, a subsequent negative HCV RNA test, and at least one additional HCV RNA test between 1st January 2016 and 31st December 2020 were eligible for inclusion. A new HCV RNA positive test and/or detectable viral load was defined as a reinfection. Generalised linear modelling was used to examine trends in reinfection. RESULTS Among 12 213 GBM with HIV who had at least one HCV test, 540 were included in the reinfection incidence analysis, of whom 38 (7%) had evidence of reinfection during the observation period. Over 1124 person-years of follow-up, the overall rate of reinfection was 3.4/100PY (95% CI 2.5-4.6). HCV reinfection incidence declined on average 30% per calendar year (Incidence Rate Ratio 0.70, 95% CI 0.54-0.91). CONCLUSION HCV reinfection incidence has declined among GBM with HIV in Australia since government-funded unrestricted DAAs were made available. Ongoing HCV RNA testing following cure and prompt treatment for anyone newly diagnosed is warranted to sustain this.
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Affiliation(s)
- Brendan L Harney
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Infectious Disease, Alfred Health & Monash University, Melbourne, Victoria, Australia
| | - Rachel Sacks-Davis
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Daniela K van Santen
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Michael W Traeger
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | - Anna L Wilkinson
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jason Asselin
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Norman Roth
- Prahran Market Clinic, Melbourne, Victoria, Australia
| | - Mark Bloch
- Holdsworth House Medical Practice, Sydney, New South Wales, Australia
| | - Gail V Matthews
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Basil Donovan
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Rebecca Guy
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark Stoové
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia
| | - Margaret E Hellard
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Infectious Disease, Alfred Health & Monash University, Melbourne, Victoria, Australia
- Doherty Institute and School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Joseph S Doyle
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Infectious Disease, Alfred Health & Monash University, Melbourne, Victoria, Australia
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Harney BL, Sacks-Davis R, Agius P, van Santen DK, Traeger MW, Wilkinson AL, Asselin J, Fairley CK, Roth N, Bloch M, Matthews GV, Donovan B, Guy R, Stoové M, Hellard ME, Doyle JS. Risk of Primary Incident Hepatitis C Infection Following Bacterial Sexually Transmissible Infections Among Gay and Bisexual Men in Australia From 2016 to 2020. Open Forum Infect Dis 2024; 11:ofae099. [PMID: 38560602 PMCID: PMC10977630 DOI: 10.1093/ofid/ofae099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/15/2024] [Indexed: 04/04/2024] Open
Abstract
Background In Australia, the incidence of hepatitis C virus (HCV) has declined among gay and bisexual men (GBM) with human immunodeficiency virus (HIV) since 2015 and is low among GBM using HIV preexposure prophylaxis (PrEP). However, ongoing HCV testing and treatment remains necessary to sustain this. To assess the potential utility of sexually transmissible infections (STIs) to inform HCV testing among GBM with HIV and GBM using PrEP, we examined the association between bacterial STI diagnoses and subsequent primary HCV infection. Methods Data were from a national network of 46 clinics participating in the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance. GBM included had ≥1 HCV antibody negative test result and ≥1 subsequent HCV antibody and/or RNA test. Discrete time survival analysis was used to estimate the association between a positive syphilis, rectal chlamydia, and rectal gonorrhea diagnosis in the previous 2 years and a primary HCV diagnosis, defined as a positive HCV antibody or RNA test result. Results Among 6529 GBM with HIV, 92 (1.4%) had an incident HCV infection. A prior positive syphilis diagnosis was associated with an incident HCV diagnosis (adjusted hazard ratio, 1.99 [95% confidence interval, 1.11-3.58]). Among 13 061 GBM prescribed PrEP, 48 (0.4%) had an incident HCV diagnosis. Prior rectal chlamydia (adjusted hazard ratio, 2.75 [95% confidence interval, 1.42-5.32]) and rectal gonorrhea (2.54 [1.28-5.05]) diagnoses were associated with incident HCV. Conclusions Diagnoses of bacterial STIs in the past 2 years was associated with HCV incidence. These findings suggest that STIs might be useful for informing HCV testing decisions and guidelines for GBM with HIV and GBM using PrEP.
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Affiliation(s)
- Brendan L Harney
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Infectious Disease, Alfred Health & Monash University, Melbourne, Victoria Australia
| | - Rachel Sacks-Davis
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Paul Agius
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Daniela K van Santen
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Michael W Traeger
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | - Anna L Wilkinson
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jason Asselin
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Christopher K Fairley
- Alfred Health, Melbourne Sexual Health Centre, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Norman Roth
- Prahran Market Clinic, Melbourne, Victoria, Australia
| | - Mark Bloch
- Holdsworth House Medical Practice, Sydney, New South Wales, Australia
| | - Gail V Matthews
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Basil Donovan
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Rebecca Guy
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark Stoové
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia
| | - Margaret E Hellard
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Infectious Disease, Alfred Health & Monash University, Melbourne, Victoria Australia
- Doherty Institute and School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Joseph S Doyle
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Infectious Disease, Alfred Health & Monash University, Melbourne, Victoria Australia
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Hearps AC, Vootukuru N, Ebrahimnezhaddarzi S, Harney BL, Boo I, Nguyen L, Pavlyshyn D, Dietze PM, Drummer HE, Thompson AJ, Jaworowski A, Hellard ME, Sacks-Davis R, Doyle JS. Injecting drug use and hepatitis C virus infection independently increase biomarkers of inflammatory disease risk which are incompletely restored by curative direct-acting antiviral therapy. Front Immunol 2024; 15:1352440. [PMID: 38420130 PMCID: PMC10899672 DOI: 10.3389/fimmu.2024.1352440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 01/25/2024] [Indexed: 03/02/2024] Open
Abstract
Background Hepatitis C virus (HCV) infections are more prevalent in people who inject drugs (PWID) who often experience additional health risks. HCV induces inflammation and immune alterations that contribute to hepatic and non-hepatic morbidities. It remains unclear whether curative direct acting antiviral (DAA) therapy completely reverses immune alterations in PWID. Methods Plasma biomarkers of immune activation associated with chronic disease risk were measured in HCV-seronegative (n=24) and HCV RNA+ (n=32) PWID at baseline and longitudinally after DAA therapy. Adjusted generalised estimating equations were used to assess longitudinal changes in biomarker levels. Comparisons between community controls (n=29) and HCV-seronegative PWID were made using adjusted multiple regression modelling. Results HCV-seronegative PWID exhibited significantly increased levels of inflammatory biomarkers including soluble (s) TNF-RII, IL-6, sCD14 and sCD163 and the diabetes index HbA1c as compared to community controls. CXCL10, sTNF-RII, vascular cell adhesion molecule-1 and lipopolysaccharide binding protein (LBP) were additionally elevated in PWID with viremic HCV infection as compared to HCV- PWID. Whilst curative DAA therapy reversed some biomarkers, others including LBP and sTNF-RII remained elevated 48 weeks after HCV cure. Conclusion Elevated levels of inflammatory and chronic disease biomarkers in PWID suggest an increased risk of chronic morbidities such as diabetes and cardiovascular disease. HCV infection in PWID poses an additional disease burden, amplified by the incomplete reversal of immune dysfunction following DAA therapy. These findings highlight the need for heightened clinical surveillance of PWID for chronic inflammatory diseases, particularly those with a history of HCV infection.
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Affiliation(s)
- Anna C. Hearps
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, VIC, Australia
| | - Nikil Vootukuru
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- Department of Gastroenterology, Eastern Health and Monash University, Melbourne, VIC, Australia
| | | | - Brendan L. Harney
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Irene Boo
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
| | - Long Nguyen
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
| | - Damian Pavlyshyn
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
| | - Paul M. Dietze
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- National Drug Research Institute, Curtin University, Melbourne, VIC, Australia
| | - Heidi E. Drummer
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia
- Department of Microbiology, Monash University, Melbourne, VIC, Australia
| | - Alexander J. Thompson
- Department of Gastroenterology, St Vincent’s Hospital and the University of Melbourne, Melbourne, VIC, Australia
| | - Anthony Jaworowski
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, VIC, Australia
| | - Margaret E. Hellard
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Rachel Sacks-Davis
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Joseph S. Doyle
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, VIC, Australia
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Sacks-Davis R, van Santen DK, Boyd A, Young J, Stewart A, Doyle JS, Rauch A, Mugglin C, Klein M, van der Valk M, Smit C, Jarrin I, Berenguer J, Lacombe K, Requena MB, Wittkop L, Leleux O, Bonnet F, Salmon D, Matthews GV, Guy R, Martin NK, Spelman T, Prins M, Stoove M, Hellard M. Changes in incidence of hepatitis C virus reinfection and access to direct-acting antiviral therapies in people with HIV from six countries, 2010-19: an analysis of data from a consortium of prospective cohort studies. Lancet HIV 2024; 11:e106-e116. [PMID: 38224708 DOI: 10.1016/s2352-3018(23)00267-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Reinfection after successful treatment with direct-acting antivirals is hypothesised to undermine efforts to eliminate hepatitis C virus (HCV) infection among people with HIV. We aimed to assess changes in incidence of HCV reinfection among people with HIV following the introduction of direct-acting antivirals, and the proportion of all incident cases attributable to reinfection. METHODS We pooled individual-level data on HCV reinfection in people with HIV after spontaneous or treatment-induced clearance of HCV from six cohorts contributing data to the International Collaboration on Hepatitis C Elimination in HIV Cohorts (InCHEHC) in Australia, Canada, France, the Netherlands, Spain, and Switzerland between Jan 1, 2010, and Dec 31, 2019. Participants were eligible if they had evidence of an HCV infection (HCV antibody or RNA positive test) followed by spontaneous clearance or treatment-induced clearance, with at least one HCV RNA test after clearance enabling measurement of reinfection. We assessed differences in first reinfection incidence between direct-acting antiviral access periods (pre-direct-acting antiviral, limited access [access restricted to people with moderate or severe liver disease and other priority groups], and broad access [access for all patients with chronic HCV]) using Poisson regression. We estimated changes in combined HCV incidence (primary and reinfection) and the relative contribution of infection type by calendar year. FINDINGS Overall, 6144 people with HIV who were at risk of HCV reinfection (median age 49 years [IQR 42-54]; 4989 [81%] male; 2836 [46%] men who have sex with men; 2360 [38%] people who inject drugs) were followed up for 17 303 person-years and were included in this analysis. The incidence of first HCV reinfection was stable during the period before the introduction of direct-acting antivirals (pre-introduction period; 4·1 cases per 100 person-years, 95% CI 2·8-6·0). Compared with the pre-introduction period, the average incidence of reinfection was 4% lower during the period of limited access (incidence rate ratio [IRR] 0·96, 95% CI 0·78-1·19), and 28% lower during the period of broad access (0·72, 0·60-0·86). Between 2015 and 2019, the proportion of incident HCV infections due to reinfection increased, but combined incidence declined by 34%, from 1·02 cases per 100 person-years (95% CI 0·96-1·07) in 2015 to 0·67 cases per 100 person-years (95% CI 0·59-0·75) in 2019. INTERPRETATION HCV reinfection incidence and combined incidence declined in people with HIV following direct-acting antiviral introduction, suggesting reinfection has not affected elimination efforts among people with HIV in InCHEHC countries. The proportion of incident HCV cases due to reinfection was highest during periods of broad access to direct-acting antivirals, highlighting the importance of reducing ongoing risks and continuing testing in people at risk. FUNDING Australian National Health and Medical Research Council.
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Affiliation(s)
- Rachel Sacks-Davis
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
| | - Daniela K van Santen
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, Netherlands
| | - Anders Boyd
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, Netherlands; Department of Infectious Diseases, University of Amsterdam, Amsterdam, Netherlands; Amsterdam Institute for Infection and Immunity, University of Amsterdam, Amsterdam, Netherlands; Stichting HIV Monitoring, Amsterdam, Netherlands
| | - Jim Young
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Ashleigh Stewart
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Joseph S Doyle
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia; Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, VIC, Australia
| | - Andri Rauch
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Catrina Mugglin
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marina Klein
- Division of Infectious Diseases, McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Marc van der Valk
- Department of Infectious Diseases, University of Amsterdam, Amsterdam, Netherlands; Amsterdam Institute for Infection and Immunity, University of Amsterdam, Amsterdam, Netherlands; Stichting HIV Monitoring, Amsterdam, Netherlands
| | - Colette Smit
- Stichting HIV Monitoring, Amsterdam, Netherlands
| | - Inmaculada Jarrin
- Instituto de Salud Carlos III, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Juan Berenguer
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain; Department of Infectious Diseases, Hospital General Universitario Gregorio Marañón (IiSGM), Madrid, Spain
| | - Karine Lacombe
- Sorbonne Université, INSERM, IPLESP, Paris, France; St Antoine Hospital, APHP, Paris, France
| | | | - Linda Wittkop
- Institut Bergonié, Université de Bordeaux, INSERM, Bordeaux, France; Service d'information médicale, Institut Bergonié, Centre Hospitalier Universitaire de Bordeaux, INSERM, Bordeaux, France; Inria équipe SISTM, Talence, France
| | - Olivier Leleux
- Institut Bergonié, Université de Bordeaux, INSERM, Bordeaux, France
| | - Fabrice Bonnet
- Institut Bergonié, Université de Bordeaux, INSERM, Bordeaux, France; Service de Médecine Interne et Maladies Infectieuses, Hôpital Saint-André Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Dominique Salmon
- Service Maladies Infectieuses et Tropicales, AP-HP, Hôpital Cochin, Université Paris Descartes, Paris, France
| | - Gail V Matthews
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Rebecca Guy
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Natasha K Martin
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, USA
| | - Tim Spelman
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
| | - Maria Prins
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, Netherlands; Department of Infectious Diseases, University of Amsterdam, Amsterdam, Netherlands; Amsterdam Institute for Infection and Immunity, University of Amsterdam, Amsterdam, Netherlands
| | - Mark Stoove
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Margaret Hellard
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, VIC, Australia
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6
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Requena MB, Protopopescu C, Stewart AC, van Santen DK, Klein MB, Jarrin I, Berenguer J, Wittkop L, Salmon D, Rauch A, Prins M, van der Valk M, Sacks-Davis R, Hellard ME, Carrieri P, Lacombe K. All-cause mortality before and after DAA availability among people living with HIV and HCV: An international comparison between 2010 and 2019. Int J Drug Policy 2024; 124:104311. [PMID: 38184902 DOI: 10.1016/j.drugpo.2023.104311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 12/18/2023] [Accepted: 12/21/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Among people living with HIV and hepatitis C virus (HCV), people who inject drugs (PWID) have historically experienced higher mortality rates. Direct-acting antivirals (DAA), which have led to a 90 % HCV cure rate independently of HIV co-infection, have improved mortality rates. However, DAA era mortality trends among PWID with HIV/HCV remain unknown. Using data from the International Collaboration on Hepatitis C Elimination in HIV Cohorts (InCHEHC), we compared pre/post-DAA availability mortality changes in three groups: PWID, men who have sex with men (MSM), and all other participants. METHODS We included InCHEHC participants with HIV/HCV followed between 2010 and 2019 in Canada, France, the Netherlands, Spain, and Switzerland. All-cause mortality hazard was compared in the three groups, using Cox proportional hazards regression models adjusted for sex, age, advanced fibrosis/cirrhosis, and pre/post DAA availability. RESULTS Of the 11,029 participants, 76 % were men, 46 % were PWID, baseline median age was 46 years (interquartile range [IQR] = 40;51), and median CD4 T-cell count was 490 cells/mm3 (IQR = 327;689). Over the study period (median follow-up = 7.2 years (IQR = 3.7;10.0)), 6143 (56 %) participants received HCV treatment, 4880 (44 %) were cured, and 1322 participants died (mortality rate = 1.81/100 person-years (PY) [95 % confidence interval (CI)=1.72-1.91]). Overall, PWID had higher mortality rates than MSM (2.5/100 PY [95 % CI = 2.3-2.6] vs. 0.8/100 PY [95 % CI = 0.7-0.9], respectively). Unlike women with other transmission modes, those who injected drugs had a higher mortality hazard than men who did not inject drugs and men who were not MSM (adjusted Hazard-Ratio (aHR) [95 % CI] = 1.3[1.0-1.6]). Post-DAA availability, mortality decreased among MSM in the Netherlands, Spain, and Switzerland and increased among PWID in Canada (aHR [95 % CI] = 1.73 [1.15-2.61]). CONCLUSION Post-DAA availability, all-cause mortality did not decrease in PWID. Determinants of cause-specific deaths (drug-related, HIV-related, or HCV-related) need to be identified to explain persistently high mortality among PWID in the DAA era.
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Affiliation(s)
- Maria-Bernarda Requena
- Sorbonne Université, INSERM, Pierre Louis Institute of Epidemiology and Public Health, iPLESP, Paris, France
| | - Camelia Protopopescu
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France.
| | - Ashleigh C Stewart
- Disease Elimination Program, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Daniela K van Santen
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Marina B Klein
- Division of Infectious Diseases, McGill University Health Centre, Montreal, Canada
| | - Inmaculada Jarrin
- Instituto de Salud Carlos III, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, CIBERINFEC, Madrid, Spain
| | - Juan Berenguer
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, CIBERINFEC, Madrid, Spain; Infectious Diseases. Hospital General Universitario Gregorio Marañón, IiSGM, Madrid, Spain
| | - Linda Wittkop
- Université de Bordeaux, ISPED, INSERM, Bordeaux Population Health Research Center, U1219, CIC-EC 1401, Bordeaux, France; Inria équipe SISTM, Talence, France; CHU de Bordeaux, Service d'information médicale, INSERM, Institut Bergonié, CIC-EC 1401, Bordeaux, France
| | - Dominique Salmon
- Université Paris Descartes, Service Maladies Infectieuses et Tropicales, AP-HP, Hôpital Cochin, Paris, France
| | - Andri Rauch
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Maria Prins
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands; Department of Infectious Diseases, Amsterdam Infection and Immunity Institute, AI&II, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Marc van der Valk
- Department of Infectious Diseases, Amsterdam Infection and Immunity Institute, AI&II, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Stichting HIV Monitoring, Amsterdam, the Netherlands
| | - Rachel Sacks-Davis
- Disease Elimination Program, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Margaret E Hellard
- Disease Elimination Program, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia; Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Australia
| | - Patrizia Carrieri
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Karine Lacombe
- Sorbonne Université, INSERM, Pierre Louis Institute of Epidemiology and Public Health, iPLESP, Paris, France; AP-HP, Department of Infectious Diseases, Saint-Antoine Hospital, Paris, France
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7
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van Santen DK, Stewart A, Doyle JS, Stoové MA, Asselin J, Klein MB, Young J, Berenguer J, Jarrin I, Lacombe K, Wittkop L, Leleux O, Salmon D, Bonnet F, Rauch A, Mugglin C, Matthews G, Prins M, Smit C, Boyd A, van der Valk M, Sacks-Davis R, Hellard ME. Cohort Profile: International Collaboration on Hepatitis C Elimination in HIV Cohorts (InCHEHC). Int J Epidemiol 2024; 53:dyad154. [PMID: 38066671 PMCID: PMC10859136 DOI: 10.1093/ije/dyad154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 11/06/2023] [Indexed: 02/12/2024] Open
Affiliation(s)
- Daniela K van Santen
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC Australia
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Ashleigh Stewart
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC Australia
| | - Joseph S Doyle
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- Department of Infectious Diseases, Alfred and Monash University, Melbourne, VIC, Australia
| | - Mark A Stoové
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC Australia
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, VIC, Australia
| | - Jason Asselin
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
| | - Marina B Klein
- Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
| | - Jim Young
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Juan Berenguer
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
- Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Inmaculada Jarrin
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
- Instituto de Salud Carlos III, Madrid, Spain
| | - Karine Lacombe
- Sorbonne Université, Inserm, IPLESP, Paris, France
- St Antoine Hospital, APHP, Paris, France
| | - Linda Wittkop
- Univ. Bordeaux, INSERM, Institut Bergonié, BPH, U1219, CIC-EC 1401, Bordeaux, France
- CHU de Bordeaux, Service d’information médicale, INSERM, Institut Bergonié, CIC-EC 1401, Bordeaux, France
- INRIA SISTM team, Talence, France
| | - Olivier Leleux
- Univ. Bordeaux, INSERM, Institut Bergonié, BPH, U1219, CIC-EC 1401, Bordeaux, France
| | - Dominique Salmon
- Université Paris Descartes, Service Maladies Infectieuses et Tropicales, AP-HP, Hôpital Cochin, Paris, France
| | - Fabrice Bonnet
- Univ. Bordeaux, INSERM, Institut Bergonié, BPH, U1219, CIC-EC 1401, Bordeaux, France
- CHU de Bordeaux, Service d’information médicale, INSERM, Institut Bergonié, CIC-EC 1401, Bordeaux, France
- CHU de Bordeaux, Hôpital Saint-André, Service de Médecine Interne et Maladies Infectieuses, F-33000 Bordeaux, France
| | - Andri Rauch
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Catrina Mugglin
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Gail Matthews
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Maria Prins
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity (AII), Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute (APH), Amsterdam, The Netherlands
- Stichting HIV Monitoring, Amsterdam, The Netherlands
| | - Colette Smit
- Stichting HIV Monitoring, Amsterdam, The Netherlands
| | - Anders Boyd
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
- Stichting HIV Monitoring, Amsterdam, The Netherlands
| | - Marc van der Valk
- Amsterdam Institute for Infection and Immunity (AII), Amsterdam, The Netherlands
- Stichting HIV Monitoring, Amsterdam, The Netherlands
- Amsterdam UMC location University of Amsterdam, Infectious Diseases, Amsterdam, The Netherlands
| | - Rachel Sacks-Davis
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Margaret E Hellard
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC Australia
- Department of Infectious Diseases, Alfred and Monash University, Melbourne, VIC, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
- Doherty Institute, University of Melbourne, Melbourne, VIC, Australia
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8
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Delport D, Sacks-Davis R, Abeysuriya RG, Hellard M, Scott N. Lives saved by public health restrictions over the Victorian COVID-19 Delta variant epidemic wave, Aug-Nov 2021. Epidemics 2023; 44:100702. [PMID: 37327657 PMCID: PMC10265399 DOI: 10.1016/j.epidem.2023.100702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 05/26/2023] [Accepted: 06/12/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Prior to mid-2021, Australia's approach to COVID-19 was to eliminate community transmission. However, between August-November 2021, the state of Victoria, Australia, experienced an outbreak of the Delta variant that continued to grow despite extensive lockdowns and public health measures in place. While these public health restrictions were ultimately unable to stop community transmission, they likely had a major impact reducing transmission and adverse health outcomes relative to voluntary risk-mitigation only (e.g., in response to rising cases and deaths, some people may avoid crowded settings, hospitality, retail, social occasions, or indoor settings). This study aims to estimate the impact of the August-November 2021 enforced public health restrictions in Victoria, compared to voluntary risk-mitigation only. METHODS An agent-based model was calibrated to Victorian epidemiological, health and behavioural data from 1 August to 30 November 2021, as well as policies that were implemented over that period. Two counter-factual scenarios were run for the same period with (a) no restrictions in place; or (b) voluntary risk-mitigation only, based on behaviour measured over the December-January Omicron BA.1 epidemic wave when restrictions were not in place. RESULTS Over August-November 2021, the baseline model scenario resulted in 97,000 (91,000-102,000) diagnoses, 9100 (8500-9700) hospital admissions, and 480 (430-530) deaths. Without any restrictions in place, there were 3,228,000 (3,200,000-3,253,000) diagnoses, 375,100 (370,200-380,900) hospital admissions, and 16,700 (16,000-17,500) deaths. With voluntary risk-mitigation equal to those observed during the Omicron BA.1 epidemic wave, there were 1,507,000 (1,469,000-1,549,000) diagnoses, 130,300 (124,500-136,000) hospital admissions, and 5500 (5000-6100) deaths. CONCLUSION Public health restrictions implemented in Victoria over August-November 2021 are likely to have averted more than 120,000 hospitalizations and 5000 deaths relative to voluntary risk-mitigation only. During a COVID-19 epidemic wave voluntary behaviour change can reduce transmission substantially, but not to the same extent as enforced restrictions.
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Affiliation(s)
- D Delport
- Disease Elimination Program, Burnet Institute, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
| | - R Sacks-Davis
- Disease Elimination Program, Burnet Institute, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; School of Population and Global Health, The University of Melbourne, Parkville, Australia
| | - R G Abeysuriya
- Disease Elimination Program, Burnet Institute, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - M Hellard
- Disease Elimination Program, Burnet Institute, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; School of Population and Global Health, The University of Melbourne, Parkville, Australia; Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Victoria, Australia; Department of Infectious Diseases, The University of Melbourne and Victorian Infectious Diseases Reference Laboratory, Parkville, Australia
| | - N Scott
- Disease Elimination Program, Burnet Institute, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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9
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Raggatt M, Wright CJC, Sacks-Davis R, Dietze PM, Hellard ME, Hocking JS, Lim MSC. Identifying the Most Effective Recruitment Strategy Using Financial Reimbursements for a Web-Based Peer Network Study With Young People Aged 16-18 Years: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e44813. [PMID: 37566448 PMCID: PMC10457703 DOI: 10.2196/44813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Peers are an important determinant of health and well-being during late adolescence; however, there is limited quantitative research examining peer influence. Previous peer network research with adolescents faced methodological limitations and difficulties recruiting young people. OBJECTIVE This study aims to determine whether a web-based peer network survey is effective at recruiting adolescent peer networks by comparing 2 strategies for reimbursement. METHODS This study will use a 2-group randomized trial design to test the effectiveness of reimbursements for peer referral in a web-based cross-sectional peer network survey. Young people aged 16-18 years recruited through Instagram, Snapchat, and a survey panel will be randomized to receive either scaled group reimbursement (the experimental group) or fixed individual reimbursement (the control group). All participants will receive a reimbursement of Aus $5 (US $3.70) for their own survey completion. In the experimental group (scaled group reimbursement), all participants within a peer network will receive an additional Aus $5 (US $3.70) voucher for each referred participant who completes the study, up to a maximum total value of Aus $30 (US $22.20) per participant. In the control group (fixed individual reimbursement), participants will only be reimbursed for their own survey completion. Participants' peer networks are assessed during the survey by asking about their close friends. A unique survey link will be generated to share with the participant's nominated friends for the recruitment of secondary participants. Outcomes are the proportion of a participant's peer network and the number of referred peers who complete the survey. The required sample size is 306 primary participants. Using a multilevel logistic regression model, we will assess the effect of the reimbursement intervention on the proportion of primary participants' close friends who complete the survey. The secondary aim is to determine participant characteristics that are associated with successfully recruiting close friends. Young people aged 16-18 years were involved in the development of the study design through focus groups and interviews (n=26). RESULTS Participant recruitment commenced in 2022. CONCLUSIONS A longitudinal web-based social network study could provide important data on how social networks and their influence change over time. This trial aims to determine whether scaled group reimbursement can increase the number of peers referred. The outcomes of this trial will improve the recruitment of young people to web-based network studies of sensitive health issues. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/44813.
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Affiliation(s)
- Michelle Raggatt
- Burnet Institute, Melbourne, Australia
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
| | - Cassandra J C Wright
- Burnet Institute, Melbourne, Australia
- Menzies School of Health Research, Darwin, Australia
| | - Rachel Sacks-Davis
- Burnet Institute, Melbourne, Australia
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, Australia
| | - Paul M Dietze
- Burnet Institute, Melbourne, Australia
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
- National Drug Research Institute, Curtin University, Melbourne, Australia
| | - Margaret E Hellard
- Burnet Institute, Melbourne, Australia
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
- Department of Infectious Diseases, Alfred Health, Melbourne, Australia
| | - Jane S Hocking
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, Australia
| | - Megan S C Lim
- Burnet Institute, Melbourne, Australia
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, Australia
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10
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Traeger MW, Harney BL, Sacks-Davis R, van Santen DK, Cornelisse VJ, Wright EJ, Hellard ME, Doyle JS, Stoové MA. Incidence and Prevalence of Hepatitis C Virus Among HIV-Negative Gay and Bisexual Men Using HIV Pre-exposure Prophylaxis (PrEP): A Systematic Review and Meta-analysis. Open Forum Infect Dis 2023; 10:ofad401. [PMID: 37593532 PMCID: PMC10428087 DOI: 10.1093/ofid/ofad401] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 07/27/2023] [Indexed: 08/19/2023] Open
Abstract
Background Gay and bisexual men using HIV pre-exposure prophylaxis (PrEP) are at increased risk for sexually transmissible infections. Hepatitis C virus (HCV) risk among PrEP users is less clear. We explored HCV prevalence and incidence among cohorts of gay and bisexual men using PrEP and sources of heterogeneity across studies. Methods This was a systematic review and meta-analysis of open-label PrEP studies to April 2022 reporting HCV prevalence at baseline or incidence during follow-up among gay and bisexual men using PrEP. Pooled prevalence and incidence estimates were calculated using random-effects meta-analysis, and subgroup analyses were performed by study- and country-level characteristics, including availability of HCV direct-acting antiviral (DAA) therapy at time of study. Results Twenty-four studies from 9 countries were included, with a total sample of 24 733 gay and bisexual men. Pooled HCV antibody baseline prevalence was 0.97% (95% CI, 0.63%-1.31%), and pooled HCV RNA baseline prevalence was 0.38% (95% CI, 0.19%-0.56%). Among 19 studies reporting HCV incidence, incidence ranged from 0.0 to 2.93/100 person-years (py); the pooled estimate was 0.83/100py (95% CI, 0.55-1.11). HCV incidence was higher in 12 studies that began follow-up before broad DAA availability (1.27/100py) than in 8 studies that began follow-up after broad DAA availability (0.34/100py) and higher in studies in Europe compared with North America and Australia. Conclusions Early reports of high HCV incidence among PrEP-using cohorts likely reflect enrollment of individuals based on specific risk-based eligibility criteria for smaller studies and enrollment before DAA scale-up. In contexts where both DAAs and PrEP have been implemented at scale, studies report lower HCV incidence. PrEP-specific HCV testing guidelines should be guided by local epidemiology.
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Affiliation(s)
- Michael W Traeger
- Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Brendan L Harney
- Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Australia
| | - Rachel Sacks-Davis
- Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Daniela K van Santen
- Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, the Netherlands
- Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Vincent J Cornelisse
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Australia
- Kirketon Road Centre, Sydney, Australia
- The Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Edwina J Wright
- Burnet Institute, Melbourne, Australia
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Australia
| | - Margaret E Hellard
- Burnet Institute, Melbourne, Australia
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Joseph S Doyle
- Burnet Institute, Melbourne, Australia
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Australia
| | - Mark A Stoové
- Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Koopsen J, Matthews G, Rockstroh J, Applegate TL, Bhagani S, Rauch A, Grebely J, Sacks-Davis R, Ingiliz P, Boesecke C, Rebers S, Feld J, Bruneau J, Martinello M, Hellard M, Dore GJ, Schinkel J, van der Valk M. Hepatitis C virus transmission between eight high-income countries among men who have sex with men: a whole-genome analysis. Lancet Microbe 2023; 4:e622-e631. [PMID: 37336226 DOI: 10.1016/s2666-5247(23)00108-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 02/23/2023] [Accepted: 03/20/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Microelimination of the hepatitis C virus (HCV) among men who have sex with men (MSM) could be complicated by continuous external introductions and the emergence of phylogenetic clusters harbouring clinically significant resistance-associated substitutions (RAS). To investigate international clustering and the prevalence and transmission of RAS, we aimed to analyse whole-genome HCV sequences from MSM with a recently acquired infection who participated in a large, international HCV treatment trial. METHODS For this whole-genome analysis, we obtained HCV sequences from 128 MSM who had acquired HCV within the past 12 months and were participating in the REACT trial. The participants from whom sequences were obtained were recruited at 24 sites in eight countries. We inferred maximum-likelihood phylogenies and identified transmission clusters for HCV genotypes separately. We constructed time-scaled phylogenies to estimate cluster introduction dates and used a Bayesian Skygrid approach to estimate the effective population size over the past 50 years. We calculated the prevalence of RAS and the extent of RAS transmission in the study population. FINDINGS The majority of recent HCV infections were part of international networks that arose in the late 1990s and early 2000s. Sequences obtained in the same country clustered frequently, and in 36% of subclusters since 2015 we found evidence of international transmission. European MSM were more likely than non-European MSM to be in a cluster (odds ratio 11·9 [95% CI 3·6-43·4], p<0·0001). The effective population size decreased rapidly since around 2015 in Europe. RAS associated with substantially diminished cure rates were infrequently detected and transmission of highly resistant viruses was not observed. INTERPRETATION Despite antiviral treatment becoming widely available, international transmission of HCV among MSM has still occurred over the past 8 years, which could complicate microelimination of the virus in this population. RAS-enriched clusters and widespread RAS transmission are currently not a threat to elimination goals. These findings support an international approach for HCV microelimination among MSM. FUNDING National Institutes of Health and Dr. C.J. Vaillant Fonds.
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Affiliation(s)
- Jelle Koopsen
- Laboratory of Applied Evolutionary Biology, Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.
| | - Gail Matthews
- Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; St Vincent's Hospital, Sydney, NSW, Australia
| | | | | | - Sanjay Bhagani
- Royal Free Hospital, London, UK; Division of Infection and Immunity, University College London, London, UK
| | - Andri Rauch
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Jason Grebely
- Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | | | - Patrick Ingiliz
- Zentrum für Infektiologie Berlin-Prenzlauer Berg, Berlin, Germany; Henri-Mondor University Hospital, Hepatology Department, INSERM U955, Créteil, France
| | | | - Sjoerd Rebers
- Section of Clinical Virology, Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Jordan Feld
- Toronto Centre for Liver Diseases, Toronto General Hospital, Toronto, ON, Canada
| | - Julie Bruneau
- Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | | | - Margaret Hellard
- Burnet Institute, Melbourne, VIC, Australia; The Alfred Hospital, Melbourne, VIC, Australia
| | - Gregory J Dore
- Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; St Vincent's Hospital, Sydney, NSW, Australia
| | - Janke Schinkel
- Section of Clinical Virology, Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Marc van der Valk
- Division of Infectious Diseases, Amsterdam Infection and Immunity Institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands; Stichting HIV Monitoring, Amsterdam, Netherlands
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12
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Abeysuriya RG, Sacks-Davis R, Heath K, Delport D, Russell FM, Danchin M, Hellard M, McVernon J, Scott N. Keeping kids in school: modelling school-based testing and quarantine strategies during the COVID-19 pandemic in Australia. Front Public Health 2023; 11:1150810. [PMID: 37333560 PMCID: PMC10272722 DOI: 10.3389/fpubh.2023.1150810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 05/05/2023] [Indexed: 06/20/2023] Open
Abstract
Background In 2021, the Australian Government Department of Health commissioned a consortium of modelling groups to generate evidence assisting the transition from a goal of no community COVID-19 transmission to 'living with COVID-19', with adverse health and social consequences limited by vaccination and other measures. Due to the extended school closures over 2020-21, maximizing face-to-face teaching was a major objective during this transition. The consortium was tasked with informing school surveillance and contact management strategies to minimize infections and support this goal. Methods Outcomes considered were infections and days of face-to-face teaching lost in the 45 days following an outbreak within an otherwise COVID-naïve school setting. A stochastic agent-based model of COVID-19 transmission was used to evaluate a 'test-to-stay' strategy using daily rapid antigen tests (RATs) for close contacts of a case for 7 days compared with home quarantine; and an asymptomatic surveillance strategy involving twice-weekly screening of all students and/or teachers using RATs. Findings Test-to-stay had similar effectiveness for reducing school infections as extended home quarantine, without the associated days of face-to-face teaching lost. Asymptomatic screening was beneficial in reducing both infections and days of face-to-face teaching lost and was most beneficial when community prevalence was high. Interpretation Use of RATs in school settings for surveillance and contact management can help to maximize face-to-face teaching and minimize outbreaks. This evidence supported the implementation of surveillance testing in schools in several Australian jurisdictions from January 2022.
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Affiliation(s)
- Romesh G. Abeysuriya
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Rachel Sacks-Davis
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Katherine Heath
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
| | - Dominic Delport
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
| | - Fiona M. Russell
- Murdoch Children’s Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - Margie Danchin
- Murdoch Children’s Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
- The Royal Children’s Hospital, Melbourne, VIC, Australia
| | - Margaret Hellard
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, VIC, Australia
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Jodie McVernon
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
- Victorian Infectious Diseases Epidemiology Unit, The Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Nick Scott
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Artenie A, Stone J, Fraser H, Stewart D, Arum C, Lim AG, McNaughton AL, Trickey A, Ward Z, Abramovitz D, Alary M, Astemborski J, Bruneau J, Clipman SJ, Coffin CS, Croxford S, DeBeck K, Emanuel E, Hayashi K, Hermez JG, Low-Beer D, Luhmann N, Macphail G, Maher L, Palmateer NE, Patel EU, Sacks-Davis R, Van Den Boom W, van Santen DK, Walker JG, Hickman M, Vickerman P. Incidence of HIV and hepatitis C virus among people who inject drugs, and associations with age and sex or gender: a global systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2023; 8:533-552. [PMID: 36996853 PMCID: PMC10817215 DOI: 10.1016/s2468-1253(23)00018-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/26/2023] [Accepted: 01/27/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Measuring the incidence of HIV and hepatitis C virus (HCV) infection among people who inject drugs (PWID) is key to track progress towards elimination. We aimed to summarise global data on HIV and primary HCV incidence among PWID and associations with age and sex or gender. METHODS In this systematic review and meta-analysis, we updated an existing database of HIV and HCV incidence studies among PWID by searching MEDLINE, Embase, and PsycINFO, capturing studies published between Jan 1, 2000, and Dec 12, 2022, with no language or study design restrictions. We contacted authors of identified studies for unpublished or updated data. We included studies that estimated incidence by longitudinally re-testing people at risk of infection or by using assays for recent infection. We pooled incidence and relative risk (RR; young [generally defined as ≤25 years] vs older PWID; women vs men) estimates using random-effects meta-analysis and assessed risk of bias with a modified Newcastle-Ottawa scale. This study is registered with PROSPERO, CRD42020220884. FINDINGS Our updated search identified 9493 publications, of which 211 were eligible for full-text review. An additional 377 full-text records from our existing database and five records identified through cross-referencing were assessed. Including 28 unpublished records, 125 records met the inclusion criteria. We identified 64 estimates of HIV incidence (30 from high-income countries [HICs] and 34 from low-income or middle-income countries [LMICs]) and 66 estimates of HCV incidence (52 from HICs and 14 from LMICs). 41 (64%) of 64 HIV and 42 (64%) of 66 HCV estimates were from single cities rather than being multi-city or nationwide. Estimates were measured over 1987-2021 for HIV and 1992-2021 for HCV. Pooled HIV incidence was 1·7 per 100 person-years (95% CI 1·3-2·3; I2=98·4%) and pooled HCV incidence was 12·1 per 100 person-years (10·0-14·6; I2=97·2%). Young PWID had a greater risk of HIV (RR 1·5, 95% CI 1·2-1·8; I2=66·9%) and HCV (1·5, 1·3-1·8; I2=70·6%) acquisition than older PWID. Women had a greater risk of HIV (RR 1·4, 95% CI 1·1-1·6; I2=55·3%) and HCV (1·2, 1·1-1·3; I2=43·3%) acquisition than men. For both HIV and HCV, the median risk-of-bias score was 6 (IQR 6-7), indicating moderate risk. INTERPRETATION Although sparse, available HIV and HCV incidence estimates offer insights into global levels of HIV and HCV transmission among PWID. Intensified efforts are needed to keep track of the HIV and HCV epidemics among PWID and to expand access to age-appropriate and gender-appropriate prevention services that serve young PWID and women who inject drugs. FUNDING Canadian Institutes of Health Research, Fonds de recherche du Québec-Santé, Canadian Network on Hepatitis C, UK National Institute for Health and Care Research, and WHO.
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Affiliation(s)
- Adelina Artenie
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK.
| | - Jack Stone
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Hannah Fraser
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Daniel Stewart
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; National Public Health Speciality Training Programme, South West, Bristol, UK
| | - Chiedozie Arum
- Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Aaron G Lim
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Anna L McNaughton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Adam Trickey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Zoe Ward
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | | | - Michel Alary
- Centre de recherche du CHU de Québec-Université Laval, Québec City, QC, Canada; Département de médecine sociale et préventive, Université Laval, Québec City, QC, Canada; Institut national de santé publique du Québec, Québec City, QC, Canada
| | - Jacquie Astemborski
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Julie Bruneau
- Département de Médecine Familiale et Médecine d'Urgence, Université de Montréal, Montréal, QC, Canada; Centre Hospitalier de l'Université de Montréal Research Center, Montréal, QC, Canada
| | - Steven J Clipman
- Department of Medicine, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Carla S Coffin
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sara Croxford
- Public Health and Clinical Directorate, UK Health Security Agency, London, UK
| | - Kora DeBeck
- School of Public Policy, Simon Fraser University, Vancouver, BC, Canada; BC Centre on Substance Use, Vancouver, BC, Canada
| | - Eva Emanuel
- Blood Safety, Hepatitis, STI and HIV Division, UK Health Security Agency, London, UK
| | - Kanna Hayashi
- BC Centre on Substance Use, Vancouver, BC, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Joumana G Hermez
- Department of Communicable Diseases, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Daniel Low-Beer
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Niklas Luhmann
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Gisela Macphail
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Infectious Diseases, CUPS Liver Clinic, Calgary, AB, Canada
| | - Lisa Maher
- Kirby Institute for Infection and Immunity, UNSW Sydney, Sydney, NSW, Australia
| | - Norah E Palmateer
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Public Health Scotland, Glasgow, UK
| | - Eshan U Patel
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Rachel Sacks-Davis
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | | | - Daniela K van Santen
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia; School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, Netherlands
| | - Josephine G Walker
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
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14
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Scott N, Abeysuriya RG, Delport D, Sacks-Davis R, Nolan J, West D, Sutton B, Wallace EM, Hellard M. COVID-19 epidemic modelling for policy decision support in Victoria, Australia 2020-2021. BMC Public Health 2023; 23:988. [PMID: 37237343 DOI: 10.1186/s12889-023-15936-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 05/19/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Policy responses to COVID-19 in Victoria, Australia over 2020-2021 have been supported by evidence generated through mathematical modelling. This study describes the design, key findings, and process for policy translation of a series of modelling studies conducted for the Victorian Department of Health COVID-19 response team during this period. METHODS An agent-based model, Covasim, was used to simulate the impact of policy interventions on COVID-19 outbreaks and epidemic waves. The model was continually adapted to enable scenario analysis of settings or policies being considered at the time (e.g. elimination of community transmission versus disease control). Model scenarios were co-designed with government, to fill evidence gaps prior to key decisions. RESULTS Understanding outbreak risk following incursions was critical to eliminating community COVID-19 transmission. Analyses showed risk depended on whether the first detected case was the index case, a primary contact of the index case, or a 'mystery case'. There were benefits of early lockdown on first case detection and gradual easing of restrictions to minimise resurgence risk from undetected cases. As vaccination coverage increased and the focus shifted to controlling rather than eliminating community transmission, understanding health system demand was critical. Analyses showed that vaccines alone could not protect health systems and need to be complemented with other public health measures. CONCLUSIONS Model evidence offered the greatest value when decisions needed to be made pre-emptively, or for questions that could not be answered with empiric data and data analysis alone. Co-designing scenarios with policy-makers ensured relevance and increased policy translation.
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Affiliation(s)
- Nick Scott
- Disease Elimination Program, Burnet Institute, 85 Commercial Rd, Melbourne, Victoria, Australia.
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
| | - Romesh G Abeysuriya
- Disease Elimination Program, Burnet Institute, 85 Commercial Rd, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Dominic Delport
- Disease Elimination Program, Burnet Institute, 85 Commercial Rd, Melbourne, Victoria, Australia
| | - Rachel Sacks-Davis
- Disease Elimination Program, Burnet Institute, 85 Commercial Rd, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jonathan Nolan
- Victorian Government Department of Health, Victoria, Australia
| | - Daniel West
- Victorian Government Department of Health, Victoria, Australia
| | - Brett Sutton
- Victorian Government Department of Health, Victoria, Australia
| | - Euan M Wallace
- Victorian Government Department of Health, Victoria, Australia
| | - Margaret Hellard
- Disease Elimination Program, Burnet Institute, 85 Commercial Rd, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Doherty Institute, The University of Melbourne, Parkville, Victoria, Australia
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15
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Isfordink CJ, Boyd A, Sacks-Davis R, van Santen DK, Smit C, Martinello M, Stoove M, Berenguer J, Wittkop L, Klein MB, Rauch A, Salmon D, Lacombe K, Stewart A, Schinkel J, Doyle JS, Hellard M, van der Valk M, Matthews GV. Reasons for not commencing direct-acting antiviral treatment despite unrestricted access for individuals with HIV and hepatitis C virus: a multinational, prospective cohort study. Lancet Public Health 2023; 8:e294-e304. [PMID: 36965984 DOI: 10.1016/s2468-2667(23)00056-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/23/2023] [Accepted: 02/27/2023] [Indexed: 03/27/2023]
Abstract
BACKGROUND Individuals with HIV and hepatitis C virus (HCV) who remain untreated with direct-acting antivirals can contribute to HCV transmission and HCV-related mortality. We aimed to compare rates of uptake of direct-acting antivirals following unrestricted access to this treatment in high-income countries and examine factors associated with remaining untreated. METHODS This multinational, prospective cohort study used data from the International Collaboration on Hepatitis C Elimination in HIV Cohorts (InCHEHC). We analysed data from nine observational cohorts participating in the InCHEHC, including data from six high-income countries (Australia, Canada, France, the Netherlands, Spain, and Switzerland). We included individuals aged 18 years and older, with HIV and HCV (ie, HCV-RNA positive without evidence of spontaneous clearance) during unrestricted access to interferon-free direct-acting antiviral treatment in each country. We calculated the cumulative proportion of participants who remained untreated with direct-acting antivirals, with follow-up starting after the date of unrestricted access or cohort inclusion, whichever occurred most recently. Factors associated with the commencement rate of direct-acting antiviral treatment were assessed using competing-risks regression with the Fine-Gray method. FINDINGS The date of unrestricted access to direct-acting antiviral treatment for people with HIV ranged from Nov 1, 2014, in France to Nov 1, 2017, in Switzerland. We included 4552 individuals with HIV-HCV, mainly men who have sex with men (MSM; n=2156 [47%]) and people who inject or have injected drugs (n=1453 [32%]). 1365 (30%) of 4552 participants remained untreated with direct-acting antivirals. For individuals treated with direct-acting antivirals, median time from start of follow-up to treatment was 5 months (IQR 2-12). For individuals who were not treated with direct-acting antivirals, median follow-up was 22 months (8-30). Being linked to care in Australia, France, or the Netherlands, on antiretroviral therapy, having undetectable HIV RNA, and shorter duration since first positive HCV test were independently associated with higher commencement rate of direct-acting antiviral treatment. Compared with MSM, male heterosexuals and females with unknown or other routes of HIV transmission (ie, neither injection drug use nor heterosexual transmission) had lower rates of commencement. INTERPRETATION Despite unrestricted access, almost a third of individuals with HIV-HCV remained untreated with direct-acting antivirals during follow-up, with variation in commencement rate of HCV treatment between countries and key populations. Increased efforts are required to reach the remaining individuals with HIV who are HCV-viraemic to achieve HIV-HCV micro-elimination. FUNDING None.
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Affiliation(s)
- Cas J Isfordink
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam Institute for Infection and Immunity, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Anders Boyd
- Stichting HIV Monitoring, Amsterdam, Netherlands; Department of Infectious Diseases, Research, and Prevention, Public Health Service of Amsterdam, Amsterdam, Netherlands
| | - Rachel Sacks-Davis
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Doherty Institute and School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Daniela K van Santen
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam Institute for Infection and Immunity, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands; Department of Infectious Diseases, Research, and Prevention, Public Health Service of Amsterdam, Amsterdam, Netherlands; Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Colette Smit
- Stichting HIV Monitoring, Amsterdam, Netherlands
| | | | - Mark Stoove
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia; School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Juan Berenguer
- Infectious Diseases, Hospital General Universitario Gregorio Marañón (IiSGM), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Linda Wittkop
- University of Bordeaux, INSERM, Institut Bergonié, BPH, U1219, CIC-EC 1401, Bordeaux, France; INRIA, Talence, France; CHU de Bordeaux, Service d'Information Médicale, INSERM, Institut Bergonié, CIC-EC 1401, Bordeaux, France
| | - Marina B Klein
- Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Andri Rauch
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dominique Salmon
- Service Maladies Infectieuses et Tropicales, AP-HP Centre, Hôspital Cochin Hôtel Dieu, Paris, France
| | - Karine Lacombe
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, IPLESP, Paris, France
| | - Ashleigh Stewart
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
| | - Janke Schinkel
- Department of Medical Microbiology and Infection Prevention, Section of Clinical Virology, Amsterdam Infection and Immunity Institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Joseph S Doyle
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia; Department of Infectious Diseases, The Alfred Hospital, Melbourne, VIC, Australia
| | - Margaret Hellard
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Doherty Institute and School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; Department of Infectious Diseases, The Alfred Hospital, Melbourne, VIC, Australia
| | - Marc van der Valk
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam Institute for Infection and Immunity, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands; Stichting HIV Monitoring, Amsterdam, Netherlands.
| | - Gail V Matthews
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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16
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Altermatt A, Heath K, Saich F, Lee Wilkinson A, Scott N, Sacks-Davis R, Young K, Stoové M, Gibney KB, Hellard M. Estimating the proportion of Victorians infected with COVID-19 during the Omicron BA.1 epidemic wave of January 2022 in Australia. Aust N Z J Public Health 2023; 47:100007. [PMID: 36706552 PMCID: PMC9874236 DOI: 10.1016/j.anzjph.2022.100007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/20/2022] [Accepted: 10/30/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE To estimate the proportion of Victorians infected with COVID-19 in January 2022. METHODS Between 11-19 February 2022 we conducted a nested cross-sectional survey on experiences of COVID-19 testing, symptoms, test outcome and barriers to testing during January 2022 in Victoria, Australia. Respondents were participants of the Optimise Study, a prospective cohort of adults considered at increased risk of COVID-19 or the unintended consequences of COVID-19-related interventions. RESULTS Of the 577 participants, 78 (14%) reported testing positive to COVID-19, 240 (42%) did not test in January 2022 and 91 of those who did not test (38%) reported COVID-19-like symptoms. Using two different definitions of symptoms, we calculated symptomatic (27% and 39%) and asymptomatic (4% and 11%) test positivity. We extrapolated these positivity rates to participants who did not test and estimated 19-22% of respondents may have had COVID-19 infection in January 2022. CONCLUSION The proportion of Victorians infected with COVID-19 in January 2022 was likely considerably higher than officially reported numbers. IMPLICATIONS FOR PUBLIC HEALTH Our estimate is approximately double the COVID-19 case numbers obtained from official case reporting. This highlights a major limitation of diagnosis data that must be considered when preparing for future waves of infection.
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Affiliation(s)
- Aimée Altermatt
- Disease Elimination, Burnet Institute, Melbourne, VIC, Australia.
| | - Katherine Heath
- Disease Elimination, Burnet Institute, Melbourne, VIC, Australia
| | - Freya Saich
- Disease Elimination, Burnet Institute, Melbourne, VIC, Australia
| | - Anna Lee Wilkinson
- Disease Elimination, Burnet Institute, Melbourne, VIC, Australia,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Nick Scott
- Disease Elimination, Burnet Institute, Melbourne, VIC, Australia,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Rachel Sacks-Davis
- Disease Elimination, Burnet Institute, Melbourne, VIC, Australia,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Kathryn Young
- Disease Elimination, Burnet Institute, Melbourne, VIC, Australia
| | - Mark Stoové
- Disease Elimination, Burnet Institute, Melbourne, VIC, Australia,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Katherine B. Gibney
- Department of Infectious Diseases, University of Melbourne, At the Peter Doherty Institute for Infection and Immunity, Victoria, 3000, Australia
| | - Margaret Hellard
- Disease Elimination, Burnet Institute, Melbourne, VIC, Australia,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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17
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van Santen DK, Sacks-Davis R, Stewart A, Boyd A, Young J, van der Valk M, Smit C, Rauch A, Braun DL, Jarrin I, Berenguer J, Lazarus JV, Lacombe K, Requena MB, Wittkop L, Leleux O, Salmon D, Bonnet F, Matthews G, Doyle JS, Spelman T, Klein MB, Prins M, Asselin J, Stoové MA, Hellard M. Treatment as prevention effect of direct-acting antivirals on primary hepatitis C virus incidence: Findings from a multinational cohort between 2010 and 2019. EClinicalMedicine 2023; 56:101810. [PMID: 36618902 PMCID: PMC9816910 DOI: 10.1016/j.eclinm.2022.101810] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 12/08/2022] [Accepted: 12/08/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Broad direct-acting antiviral (DAA) access may reduce hepatitis C virus (HCV) incidence through a "treatment as prevention" (TasP) effect. We assessed changes in primary HCV incidence following DAA access among people living with HIV (PLHIV). METHODS We used pooled individual-level data from six cohorts from the International Collaboration on Hepatitis C Elimination in HIV Cohorts (InCHEHC). Follow-up started from the first recorded negative HCV antibody test date and ended at last negative antibody test or estimated infection date. Follow-up was restricted to 2010-2019. We used segmented Poisson regression to model trends across pre-, limited- (i.e., restrictions on access) and broad-DAA access periods. FINDINGS Overall, 45,942 participants had at least one HCV antibody negative result and follow-up between 2010 and 2019. We observed 2042 incident HCV infections over 248,189 person-years (PY). Pooled incidence decreased from 0.91 per 100 PY in 2015 to 0.41 per 100 PY in 2019. Compared to the average pre-DAA period incidence (0.90 per 100 PY), average incidence was similar during the limited-DAA access period (Incidence rate ratio [IRR] = 0.98; 95%CI = 0.87, 1.11), and 52% lower during the broad-DAA access period (IRR = 0.48; 95%CI = 0.42, 0.52). The average annual decline in HCV incidence was 2% in the pre-DAA period; an additional 9% annual decline in incidence was observed during the limited-DAA access period (IRR = 0.91; 95%CI = 0.82, 1.00) and a further 20% decline in the broad-DAA access period (IRR = 0.80, 95%CI = 0.73, 0.89). INTERPRETATION Our findings suggest that broad DAA access has a TasP effect on primary HCV incidence among PLHIV. Based on the initial years of DAA availability, the countries in the InCHEHC collaboration are on track to meet the World Health Organization's 80% HCV incidence reduction target for PLHIV by 2030. FUNDING This study was funded by the Australian Government National Health and Medical Research Council (Grant number GNT1132902).
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Affiliation(s)
- Daniela K. van Santen
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Corresponding author.
| | - Rachel Sacks-Davis
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Ashleigh Stewart
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Anders Boyd
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
- Stichting Hiv Monitoring, Amsterdam, the Netherlands
| | - Jim Young
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Marc van der Valk
- Stichting Hiv Monitoring, Amsterdam, the Netherlands
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam Institute for Infection and Immunity (AI&II), Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Colette Smit
- Stichting Hiv Monitoring, Amsterdam, the Netherlands
| | - Andri Rauch
- Department of Infectious Diseases, Inselspital, University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Dominique L. Braun
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Inmaculada Jarrin
- Instituto de Salud Carlos III, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Juan Berenguer
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
- Infectious Diseases. Hospital General Universitario Gregorio Marañón (IsSGM), Madrid, Spain
| | - Jeffrey V. Lazarus
- Barcelona Institute for Global Health, Hospital Clínic, University of Barcelona, Barcelona, Spain
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Karine Lacombe
- Sorbonne Université, IPLESP INSERM UMR-S1136, St Antoine Hospital, APHP, Paris, France
| | | | - Linda Wittkop
- Univ. Bordeaux, INSERM, Institut Bergonié BPH U1219, CIC-EC 1401, F-33000, Bordeaux, France
- INRIA SISTM Team, Talence, France
- CHU de Bordeaux, Service d'information Médicale, INSERM, Institut Bergonié, CIC-EC 1401, F-33000, Bordeaux, France
| | - Olivier Leleux
- Univ. Bordeaux, INSERM, Institut Bergonié BPH U1219, CIC-EC 1401, F-33000, Bordeaux, France
| | - Dominique Salmon
- Université Paris Descartes, Service Maladies Infectieuses et Tropicales, AP-HP, Hôpital Cochin, Paris, France
| | - Fabrice Bonnet
- Univ. Bordeaux, INSERM, Institut Bergonié BPH U1219, CIC-EC 1401, F-33000, Bordeaux, France
- CHU de Bordeaux, Service de Médecine Interne et Maladies Infectieuses, F-33000, Bordeaux, France
| | - Gail Matthews
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Joseph S. Doyle
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Australia
| | - Tim Spelman
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
| | - Marina B. Klein
- Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada
| | - Maria Prins
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
- Department of Infectious Diseases, Amsterdam Infection and Immunity Institute (AI&II), Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Jason Asselin
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
| | - Mark A. Stoové
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Margaret Hellard
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Australia
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18
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Wilkinson AL, van Santen DK, Traeger MW, Sacks-Davis R, Asselin J, Scott N, Harney BL, Doyle JS, El-Hayek C, Howell J, Bramwell F, McManus H, Donovan B, Stoové M, Hellard M, Pedrana A. Hepatitis C incidence among patients attending primary care health services that specialise in the care of people who inject drugs, Victoria, Australia, 2009 to 2020. Int J Drug Policy 2022; 103:103655. [PMID: 35349964 DOI: 10.1016/j.drugpo.2022.103655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 02/27/2022] [Accepted: 03/10/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Monitoring trends in hepatitis C virus (HCV) incidence is critical for evaluating strategies aimed at eliminating HCV as a public health threat. We estimate HCV incidence and assess trends in incidence over time among primary care patients. METHODS Data were routinely extracted, linked electronic medical records from 12 primary care health services. Patients included were aged ≥16 years, tested HCV antibody negative on their first test recorded and had at least one subsequent HCV antibody or RNA test (January 2009-December 2020). HCV incident infections were defined as a positive HCV antibody or RNA test. A generalised linear model assessed the association between HCV incidence and calendar year. RESULTS In total, 6711 patients contributed 17,098 HCV test records, 210 incident HCV infections and 19,566 person-years; incidence was 1.1 per 100 person-years (95% confidence interval (CI): 0.9 to 1.2). Among 559 (8.2%) patients ever prescribed opioid-related pharmacotherapy (ORP) during the observation period, 135 infections occurred during 2,082 person-years (incidence rate of 6.5 per 100 person-years (95% CI: 5.4 to 7.7)). HCV incidence declined 2009-2020 overall (incidence rate ratio per calendar year 0.8 (95% CI: 0.8 to 0.9) and among patients ever prescribed ORT (incidence rate ratio per calendar year 0.9, 95% CI: 0.75 to 1.0). CONCLUSION HCV incidence declined among patients at primary care health services including among patients ever prescribed ORP and during the period following increased access to DAA therapy. SUMMARY Among a retrospective cohort of ∼6,700 primary care health services patients, this study estimated a hepatitis C virus (HCV) infection incidence of 1.1 per 100 person-years (95% confidence interval: 0.9 to 1.2). HCV infection incidence declined between 2009 and 2020.
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Affiliation(s)
- Anna Lee Wilkinson
- Disease Elimination Program, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Daniela K van Santen
- Disease Elimination Program, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Michael W Traeger
- Disease Elimination Program, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Rachel Sacks-Davis
- Disease Elimination Program, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jason Asselin
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
| | - Nick Scott
- Disease Elimination Program, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Brendan L Harney
- Disease Elimination Program, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Australia
| | - Joseph S Doyle
- Disease Elimination Program, Burnet Institute, Melbourne, Australia; Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Australia
| | - Carol El-Hayek
- Disease Elimination Program, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jessica Howell
- Disease Elimination Program, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Department of Gastroenterology, St Vincent's Hospital, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia
| | | | | | | | - Mark Stoové
- Disease Elimination Program, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Margaret Hellard
- Disease Elimination Program, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Australia; Doherty Institute and Melbourne School of Population and Global Health, University of Melbourne, Melbourne 3000, Australia
| | - Alisa Pedrana
- Disease Elimination Program, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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19
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van Gemert C, Tarivonda L, Tapo PS, Natuman S, Clark G, Mariasua J, Scott N, Craig A, Abel M, Cornish MJ, Hellard M, Sacks-Davis R. Mathematical Modeling for Removing Border Entry and Quarantine Requirements for COVID-19, Vanuatu. Emerg Infect Dis 2022; 28:1053-1055. [PMID: 35271791 PMCID: PMC9045451 DOI: 10.3201/eid2805.211757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The Pacific Island country of Vanuatu is considering strategies to remove border restrictions implemented during 2020 to prevent imported coronavirus disease. We performed mathematical modeling to estimate the number of infectious travelers who had different entry scenarios and testing strategies. Travel bubbles and testing on entry have the greatest importation risk reduction.
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20
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Abeysuriya RG, Delport D, Stuart RM, Sacks-Davis R, Kerr CC, Mistry D, Klein DJ, Hellard M, Scott N. Preventing a cluster from becoming a new wave in settings with zero community COVID-19 cases. BMC Infect Dis 2022; 22:232. [PMID: 35255823 PMCID: PMC8899797 DOI: 10.1186/s12879-022-07180-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 02/18/2022] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND In settings with zero community transmission, any new SARS-CoV-2 outbreaks are likely to be the result of random incursions. The level of restrictions in place at the time of the incursion is likely to considerably affect possible outbreak trajectories, but the probability that a large outbreak eventuates is not known. METHODS We used an agent-based model to investigate the relationship between ongoing restrictions and behavioural factors, and the probability of an incursion causing an outbreak and the resulting growth rate. We applied our model to the state of Victoria, Australia, which has reached zero community transmission as of November 2020. RESULTS We found that a future incursion has a 45% probability of causing an outbreak (defined as a 7-day average of > 5 new cases per day within 60 days) if no restrictions were in place, decreasing to 23% with a mandatory masks policy, density restrictions on venues such as restaurants, and if employees worked from home where possible. A drop in community symptomatic testing rates was associated with up to a 10-percentage point increase in outbreak probability, highlighting the importance of maintaining high testing rates as part of a suppression strategy. CONCLUSIONS Because the chance of an incursion occurring is closely related to border controls, outbreak risk management strategies require an integrated approaching spanning border controls, ongoing restrictions, and plans for response. Each individual restriction or control strategy reduces the risk of an outbreak. They can be traded off against each other, but if too many are removed there is a danger of accumulating an unsafe level of risk. The outbreak probabilities estimated in this study are of particular relevance in assessing the downstream risks associated with increased international travel.
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Affiliation(s)
- Romesh G Abeysuriya
- Burnet Institute, Melbourne, VIC, Australia.
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
| | | | - Robyn M Stuart
- Burnet Institute, Melbourne, VIC, Australia
- Department of Mathematical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Cliff C Kerr
- Institute for Disease Modeling at the Bill & Melinda Gates Foundation, Seattle, USA
- School of Physics, University of Sydney, Sydney, NSW, Australia
| | - Dina Mistry
- Institute for Disease Modeling at the Bill & Melinda Gates Foundation, Seattle, USA
| | - Daniel J Klein
- Institute for Disease Modeling at the Bill & Melinda Gates Foundation, Seattle, USA
| | - Margaret Hellard
- Burnet Institute, Melbourne, VIC, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Nick Scott
- Burnet Institute, Melbourne, VIC, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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21
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Harney BL, Whitton B, Paige E, Brereton R, Weiss R, Membrey D, Wade AJ, Iser D, Kemp W, Roberts SK, Spelman T, Sacks-Davis R, Hellard ME, Doyle JS. A multi-site, nurse-coordinated hepatitis C model of care in primary care and community services in Melbourne, Australia. Liver Int 2022; 42:522-531. [PMID: 34821021 DOI: 10.1111/liv.15107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/10/2021] [Accepted: 11/18/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Hepatitis C virus (HCV) treatment through primary care and community-based services will be a critical component of HCV elimination. We evaluated a nurse-coordinated programme providing care across eight sites and analysed progression through the HCV care cascade. METHODS People-accessing services from six primary care clinics, a homeless crisis accommodation provider and a mental health service were directly referred to nurses or engaged by nurses during regular clinic visits. Nurses supported HCV testing, treatment and follow-up. The prescription was provided by affiliated clinicians. Logistic regression was used to examine factors associated with treatment commencement and sustained virological response (SVR) testing. RESULTS Of 640 people referred to and/or engaged by the nurses from January 2017 to July 2019, 518 had an HCV RNA test of whom 381 (74%) were HCV RNA positive. Treatment was commenced by 281 (74%) people of whom 161 had an SVR test, 157 (97.5%) were cured. Opioid agonist therapy was associated with treatment commencement (aOR 2.68, 95% CI 1.48-4.88). People who were homeless/unstably housed were less likely to commence treatment (aOR 0.45, 95% CI 0.23-0.87). Treatment prescription from a specialist (aOR 2.39, 95% CI 1.20-4.74) and recent injection drug use (<6 months) (aOR 2.15, 95% CI 1.07-4.31) was associated with SVR testing. CONCLUSION A nurse-coordinated model of care led to high levels of HCV treatment uptake and cure amongst people attending primary care and community services. More tailored models of care may be beneficial for people who are homeless or have unstable housing. These results support primary care and community-based hepatitis C treatment.
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Affiliation(s)
- Brendan L Harney
- Department of Infectious Diseases, Alfred Health & Monash University, Melbourne, Australia.,Disease Elimination Program, Burnet Institute, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Bradley Whitton
- Department of Infectious Diseases, Alfred Health & Monash University, Melbourne, Australia
| | - Emma Paige
- Department of Infectious Diseases, Alfred Health & Monash University, Melbourne, Australia
| | - Rebecca Brereton
- St Kilda Road Clinic & South City Clinic, Alfred Community Mental & Addiction Health, Melbourne, Australia
| | | | | | - Amanda J Wade
- Disease Elimination Program, Burnet Institute, Melbourne, Australia.,Department of Infectious Diseases, Barwon Health, Geelong, Australia
| | - David Iser
- Department of Infectious Diseases, Alfred Health & Monash University, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
| | - William Kemp
- Department of Gastroenterology, Alfred Health, Melbourne, Australia.,Department of Medicine, Monash University, Melbourne, Australia
| | - Stuart K Roberts
- Department of Gastroenterology, Alfred Health, Melbourne, Australia.,Department of Medicine, Monash University, Melbourne, Australia
| | - Tim Spelman
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
| | - Rachel Sacks-Davis
- Disease Elimination Program, Burnet Institute, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Margaret E Hellard
- Department of Infectious Diseases, Alfred Health & Monash University, Melbourne, Australia.,Disease Elimination Program, Burnet Institute, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Doherty Institute and School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Joseph S Doyle
- Department of Infectious Diseases, Alfred Health & Monash University, Melbourne, Australia.,Disease Elimination Program, Burnet Institute, Melbourne, Australia
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22
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Harney BL, Sacks-Davis R, van Santen DK, Traeger M, Wilkinson AL, Asselin J, El-Hayek C, Fairley CK, Roth N, Bloch M, Matthews G, Donovan B, Guy R, Stoové M, Hellard ME, Doyle JS. The Incidence of Hepatitis C Among Gay, Bisexual, and Other Men Who Have Sex With Men in Australia, 2009-2019. Clin Infect Dis 2021; 74:1804-1811. [PMID: 34698338 DOI: 10.1093/cid/ciab720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) infection has been reported among gay, bisexual, and other men who have sex with men (GBM) globally including GBM with human immunodeficiency virus (HIV) and HIV-negative GBM, particularly those using HIV preexposure prophylaxis (PrEP). In Australia, HCV direct-acting antiviral treatment (DAA) was government-funded from 2016. Large implementation studies of PrEP also began in 2016. We examined HCV incidence among GBM to assess whether HCV incidence has changed since 2015. METHODS Data were drawn from the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance. We included GBM who tested HCV antibody negative at their first test and had ≥1 subsequent test. Generalized linear modeling (Poisson distribution) was used to examine HCV incidence from 2009 to 2019 stratified by HIV status, and among HIV-negative GBM prescribed PrEP from 2016 to 2019. RESULTS Among 6744 GBM with HIV, HCV incidence was 1.03 per 100 person-years (PY). Incidence declined by 78% in 2019 compared to 2015 (incidence rate ratio [IRR], 0.22 [95% confidence interval {CI}: .09-.55]). Among 20 590 HIV-negative GBM, HCV incidence was 0.20/100 PY, with no significant change over time. Among 11 661 HIV-negative GBM prescribed PrEP, HCV incidence was 0.29/100 PY. Compared to 2016, incidence among GBM prescribed PrEP declined by 80% in 2019 (IRR, 0.20 [95% CI: .06-.64]). CONCLUSIONS HCV incidence among GBM living with HIV declined following DAA availability. There was no observed change in HCV incidence among HIV-negative GBM overall. Among GBM prescribed PrEP, incidence declined since the early years of PrEP implementation in Australia. Australia is on track to eliminate HCV among GBM before global 2030 targets.
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Affiliation(s)
- Brendan L Harney
- Disease Elimination Program, Burnet Institute, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Australia
| | - Rachel Sacks-Davis
- Disease Elimination Program, Burnet Institute, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Daniela K van Santen
- Disease Elimination Program, Burnet Institute, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Michael Traeger
- Disease Elimination Program, Burnet Institute, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Anna L Wilkinson
- Disease Elimination Program, Burnet Institute, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jason Asselin
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
| | - Carol El-Hayek
- Disease Elimination Program, Burnet Institute, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia.,Central Clinical School, Monash University, Melbourne, Australia
| | | | - Mark Bloch
- Holdsworth House Medical Practice, Sydney, Australia
| | - Gail Matthews
- Kirby Institute, University of New South Wales Sydney, Sydney, Australia
| | - Basil Donovan
- Kirby Institute, University of New South Wales Sydney, Sydney, Australia
| | - Rebecca Guy
- Kirby Institute, University of New South Wales Sydney, Sydney, Australia
| | - Mark Stoové
- Disease Elimination Program, Burnet Institute, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Margaret E Hellard
- Disease Elimination Program, Burnet Institute, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Australia
| | - Joseph S Doyle
- Disease Elimination Program, Burnet Institute, Melbourne, Australia.,Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Australia
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23
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Brown C, Siegele M, Wright M, Cook C, Parkes J, I Khakoo S, Sacks-Davis R, Buchanan RM. Injecting network structure determines the most efficient strategy to achieve Hepatitis C elimination in people who inject drugs. J Viral Hepat 2021; 28:1274-1283. [PMID: 34048117 DOI: 10.1111/jvh.13554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/05/2021] [Accepted: 05/16/2021] [Indexed: 12/09/2022]
Abstract
Transmission of Hepatitis C (HCV) continues via sharing of injection equipment between people who inject drugs (PWID). Network-based modelling studies have produced conflicting results about whether random treatment is preferable to targeting treatment at PWID with multiple partners. We hypothesise that differences in the modelled injecting network structure produce this heterogeneity. The study aimed to test how changing network structure affects HCV transmission and treatment effects. We created three dynamic injecting network structures connecting 689 PWID (UK-net, AUS-net and USA-net) based on published empirical data. We modelled HCV in the networks and at 5 years compared prevalence of HCV 1) with no treatment, 2) with randomly targeted treatment and 3) with treatment targeted at PWID with the most injecting partnerships (degree-based treatment). HCV prevalence at 5 years without treatment differed significantly between the three networks (UK-net (42.8%) vs. AUS-net (38.2%), p < 0.0001 and vs. USA-net (54.0%), p < 0.0001). In the treatment scenarios UK-net and AUS-net showed a benefit of degree-based treatment with a 5-year prevalence of 1.0% vs. 9.6% p < 0.0001 and 0.15% vs. 0.44%, p < 0.0001. USA-net showed no significant difference (29.3% vs. 29.2%, p = 0.0681). Degree-based treatment was optimised with low prevalence, moderate treatment coverage conditions whereas random treatment was optimised in low treatment coverage, high prevalence conditions. In conclusion, injecting network structure determines the transmission rate of HCV and the most efficient treatment strategy. In real-world injecting network structures, the benefit of targeting HCV treatment at individuals with multiple injecting partnerships may have been underestimated.
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Affiliation(s)
- Chloe Brown
- Faculty of Medicine, University of Southampton, Southampton, UK
| | | | - Mark Wright
- University Hospital Southampton, Southampton, UK
| | - Charlotte Cook
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Julie Parkes
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Salim I Khakoo
- Faculty of Medicine, University of Southampton, Southampton, UK
| | | | - Ryan M Buchanan
- Faculty of Medicine, University of Southampton, Southampton, UK
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24
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Palmer AY, Wilkinson A, Aitken C, Dietze P, Dore GJ, Maher L, Sacks-Davis R, Stoove M, Wilson D, Hellard M, Scott N. Estimating the number of new hepatitis C infections in Australia in 2015, prior to the scale-up of direct-acting antiviral treatment. J Gastroenterol Hepatol 2021; 36:2270-2274. [PMID: 33691343 DOI: 10.1111/jgh.15485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/28/2021] [Accepted: 03/06/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM The recent downward revision of the estimated number of people living with chronic hepatitis C in Australia means that the annual number of new hepatitis C infections should also be revised. We aimed to estimate the annual number of new hepatitis C infections among people who inject drugs (PWID) in Australia in 2015, prior to the introduction of direct-acting antiviral (DAA) treatment for hepatitis C, as an updated baseline measure for assessing the impact of DAAs on hepatitis C incidence over the next 10 years. METHODS A systematic review identified articles estimating hepatitis C incidence rates among PWID between 2002 and 2015. Reported incidence rates were adjusted to account for unrepresentative needle and syringe program (NSP) coverage among study participants compared with PWID overall. The total number of PWID in Australia and the hepatitis C RNA prevalence among PWID were taken from published estimates. The annual number of new infections was estimated by multiplying the pooled NSP coverage-adjusted incidence rate by the number of susceptible PWID in 2015. RESULTS Five studies were included, with unadjusted incidence rates ranging from 7.6 to 12.8 per 100 person-years. The overall pooled incidence rate (after adjusting for NSP coverage) was 9.9 per 100 person-years (95% confidence interval: 8.3-11.8). This led to an estimate of 4126 (range 2499-6405) new hepatitis C infections in 2015. CONCLUSIONS Our updated estimate provides an important baseline for evaluating the impact of hepatitis C elimination efforts and can be used to validate outcomes of future modeling studies.
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Affiliation(s)
- Anna Y Palmer
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Anna Wilkinson
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Campbell Aitken
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Paul Dietze
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,National Drug Research Institute, Curtin University, Perth, Western Australia, Australia
| | - Gregory J Dore
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Lisa Maher
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Rachel Sacks-Davis
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mark Stoove
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - David Wilson
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Margaret Hellard
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Victoria, Australia.,Peter Doherty Institute for Infection and Immunity, Parkville, Victoria, Australia.,School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Nick Scott
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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25
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Sacks-Davis R, Chibo D, Peach E, Aleksic E, Crowe SM, El Hayek C, Marukutira T, Higgins N, Stoove M, Hellard M. Phylogenetic clustering networks among heterosexual migrants with new HIV diagnoses post-migration in Australia. PLoS One 2020; 15:e0237469. [PMID: 32870911 PMCID: PMC7462279 DOI: 10.1371/journal.pone.0237469] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/27/2020] [Indexed: 01/28/2023] Open
Abstract
Background It is estimated that approximately half of new HIV diagnoses among heterosexual migrants in Victoria, Australia, were acquired post-migration. We investigated the characteristics of phylogenetic clusters in notified cases of HIV among heterosexual migrants. Methods Partial HIV pol sequences obtained from routine clinical genotype tests were linked to Victorian HIV notifications with the following exposures listed on the notification form: heterosexual sexual contact, injecting drug use, bisexual sexual contact, male-to male sexual contact or heterosexual sexual contact in combination with injecting drug use, unknown exposure. Those with heterosexual sexual contact as the only exposure were the focus of this study, with the other exposures included to better understand transmission networks. Additional reference sequences were extracted from the Los Alamos database. Maximum likelihood methods were used to infer the phylogeny and the robustness of the resulting tree was assessed using bootstrap analysis. Phylogenetic clusters were defined on the basis of bootstrap and genetic distance. Results HIV pol sequences were available for 332 of 445 HIV notifications attributed to only heterosexual sexual contact in Victoria from 2005–2014. Forty-three phylogenetic clusters containing at least one heterosexual migrant were detected, 30 (70%) of which were pairs. The characteristics of these phylogenetic clusters varied considerably by cluster size. Pairs were more likely to be composed of people living with HIV from a single country of birth (p = 0.032). Larger clusters (n≥3) were more likely to contain people born in Australian/New Zealand (p = 0.002), migrants from more than one country of birth (p = 0.013) and viral subtype-B, the most common subtype in Australia (p = 0.006). Pairs were significantly more likely to contain females (p = 0.037) and less likely to include HIV diagnoses with male-to-male sexual contact reported as a possible exposure (p<0.001) compared to larger clusters (n≥3). Conclusion Migrants appear to be at elevated risk of HIV acquisition, in part due to intimate relationships between migrants from the same country of origin, and in part due to risks associated with the broader Australian HIV epidemic. However, there was no evidence of large transmission clusters driven by heterosexual transmission between migrants. A multipronged approach to prevention of HIV among migrants is warranted.
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Affiliation(s)
- Rachel Sacks-Davis
- Burnet Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- * E-mail:
| | - Doris Chibo
- Victorian Infectious Disease Reference Laboratory, Peter Doherty Institute, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Eman Aleksic
- Burnet Institute, Melbourne, Victoria, Australia
| | - Suzanne M. Crowe
- Burnet Institute, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Monash University, Melbourne, Victoria, Australia
| | - Carol El Hayek
- Burnet Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Tafireyi Marukutira
- Burnet Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Nasra Higgins
- Department of Health and Human Services, Melbourne, Victoria, Australia
| | - Mark Stoove
- Burnet Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Margaret Hellard
- Burnet Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Hepatitis Services, Department of Infectious Diseases, The Alfred Hospital, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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van Santen DK, Sacks-Davis R, Doyle JS, Scott N, Prins M, Hellard M. Measuring hepatitis C virus elimination as a public health threat: Beyond global targets. J Viral Hepat 2020; 27:770-773. [PMID: 32187431 DOI: 10.1111/jvh.13294] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/16/2020] [Accepted: 03/01/2020] [Indexed: 12/31/2022]
Abstract
An increasing number of countries are committing to meet the World Health Organization (WHO) targets to eliminate hepatitis C virus (HCV) as a public health threat by 2030. These include service coverage targets (90% diagnosed and 80% of diagnosed patients treated) and impact targets (80% and 65% reductions in incidence and mortality, respectively, compared to 2015 levels). Currently, a dozen countries are on track to reach 2030 WHO HCV targets. However, while striving for the WHO targets is important, it should be recognized that progress on impact targets is derived from mathematical models projecting decreases in incidence and mortality on a global scale. Despite HCV treatment access in many counties for a number of years, limited empirical data are available to evaluate progress towards elimination. In some countries, substantial incidence and mortality reductions based on reaching the WHO service coverage targets may be unachievable. For example, in countries with ageing hepatitis C-infected populations, even if they have a quality hepatitis C response, high hepatitis C-related morbidity at baseline may not be reversible even with increased HCV treatment uptake and diagnosis. Finally, WHO targets are not necessarily easily or reliably measurable. Measuring relative impact targets requires high-quality data at baseline (ie 2015) and longitudinal data to assess temporal trends. In this commentary, we propose alternative additional measures to track progress on reducing the HCV burden, offer examples where the WHO targets may not be informative or achievable, and potential practical solutions.
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Affiliation(s)
- Daniela K van Santen
- Department of Disease Elimination, Burnet Institute, Melbourne, VIC, Australia.,Department of Infectious Disease Research and Prevention, Public Health Service of Amsterdam, Amsterdam, The Netherlands.,School of Population Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Rachel Sacks-Davis
- Department of Disease Elimination, Burnet Institute, Melbourne, VIC, Australia.,School of Population Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Joseph S Doyle
- Department of Disease Elimination, Burnet Institute, Melbourne, VIC, Australia.,Department of Infectious Diseases, The Alfred and Monash University, Melbourne, VIC, Australia
| | - Nick Scott
- Department of Disease Elimination, Burnet Institute, Melbourne, VIC, Australia.,School of Population Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Maria Prins
- Department of Infectious Disease Research and Prevention, Public Health Service of Amsterdam, Amsterdam, The Netherlands.,Amsterdam UMC, University of Amsterdam, Department of Infectious Diseases, Amsterdam Infection and Immunity Institute (AI&II), Amsterdam, The Netherlands
| | - Margaret Hellard
- Department of Disease Elimination, Burnet Institute, Melbourne, VIC, Australia.,Department of Infectious Diseases, The Alfred and Monash University, Melbourne, VIC, Australia.,Doherty Institute and Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
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27
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Scott N, Sacks-Davis R, Wade AJ, Stoove M, Pedrana A, Doyle JS, Thompson AJ, Wilson DP, Hellard ME. Australia needs to increase testing to achieve hepatitis C elimination. Med J Aust 2020; 212:365-370. [PMID: 32167586 PMCID: PMC7317196 DOI: 10.5694/mja2.50544] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 10/25/2019] [Indexed: 12/19/2022]
Abstract
Objectives To assess progress in Australia toward the 2030 WHO hepatitis C elimination targets two years after the introduction of highly effective direct‐acting antiviral (DAA) treatments. Design Analysis of quarterly data on government‐subsidised hepatitis C RNA testing and hepatitis C treatment in Australia, January 2013 – June 2018. Changes in testing and treatment levels associated with DAA availability were assessed in an autoregressive integrated moving average (ARIMA) statistical model, and the impact by 2030 of different levels of testing and treatment were estimated using a mathematical model. Major outcome measures Hepatitis C prevalence among people who inject drugs; annual hepatitis C incidence relative to 2015 levels; projections for the hepatitis C care cascade in 2030. Results The mean annual number of treatments initiated for people with hepatitis C increased from 6747 during 2013–2015 (before the introduction of DAAs) to 28 022 during 2016–18; the mean annual number of diagnostic RNA tests increased from 17 385 to 23 819. If current trends in testing and treatment continue (ie, 2018 testing numbers are maintained but treatment numbers decline by 50%), it is projected that by 2030 only 72% of infected people would be treated (by 2025 all people diagnosed with hepatitis C would be treated). The incidence of hepatitis C in 2030 would be 59% lower than in 2015, well short of the WHO target of an 80% reduction. The identification and testing of people exposed to hepatitis C must be increased by at least 50% for Australia to reach the WHO elimination targets. Conclusion Hepatitis C elimination programs in Australia should focus on increasing testing rates and linkage with care to maintain adequate levels of treatment.
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28
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Sacks-Davis R, van Santen DK, Doyle JS. Commentary on Barré et al. (2020): Identifying remaining barriers to hepatitis C treatment in the DAA era. Addiction 2020; 115:583-584. [PMID: 31885116 DOI: 10.1111/add.14887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 11/04/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Rachel Sacks-Davis
- Disease Elimination Program, Burnet Institute, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Daniela K van Santen
- Disease Elimination Program, Burnet Institute, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Department of Infectious Disease Research and Prevention, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Joseph S Doyle
- Disease Elimination Program, Burnet Institute, Melbourne, Australia.,Central Clinical School, Monash University, Melbourne, Australia
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29
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Latham NH, Doyle JS, Palmer AY, Vanhommerig JW, Agius P, Goutzamanis S, Li Z, Pedrana A, Gottfredsson M, Bouscaillou J, Luhmann N, Mazhnaya A, Altice FL, Saeed S, Klein M, Falade-Nwulia OO, Aspinall E, Hutchinson S, Hellard ME, Sacks-Davis R. Staying hepatitis C negative: A systematic review and meta-analysis of cure and reinfection in people who inject drugs. Liver Int 2019; 39:2244-2260. [PMID: 31125496 DOI: 10.1111/liv.14152] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 05/16/2019] [Accepted: 05/19/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIMS Direct-acting antivirals (DAAs) are highly effective in treating hepatitis C. However, there is concern that cure rates may be lower, and reinfection rates higher, among people who inject drugs. We conducted a systematic review of treatment outcomes achieved with DAAs in people who inject drugs (PWID). METHODS A search strategy was used to identify studies that reported sustained viral response (SVR), treatment discontinuation, adherence or reinfection in recent PWID and/or opioid substitution therapy (OST) recipients. Study quality was assessed using the Newcastle-Ottawa Scale. Meta-analysis of proportions was used to estimate pooled SVR and treatment discontinuation rates. The pooled relative risk of achieving SVR and pooled reinfection rate were calculated using generalized mixed effects linear models. RESULTS The search identified 8075 references; 26 were eligible for inclusion. The pooled SVR for recent PWID was 88% (95% CI, 83%-92%) and 91% (95% CI 88%-95%) for OST recipients. The relative risk of achieving SVR for recent PWID compared to non-recent PWID was 0.99 (95% CI, 0.94-1.06). The pooled treatment discontinuation was 2% (95% CI, 1%-4%) for both recent PWID and OST recipients. Amongst recent PWID, the pooled incidence of reinfection was 1.94 per 100 person years (95% CI, 0.87-4.32). In OST recipients, the incidence of reinfection was 0.55 per 100 person years (95% CI, 0.17-1.76). CONCLUSIONS Treatment outcomes were similar in recent PWID compared to non-PWID treated with DAAs. People who report recent injecting or OST recipients should not be excluded from hepatitis C treatment.
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Affiliation(s)
- Ned H Latham
- Disease Elimination Program, Burnet Institute, Melbourne, Australia.,School of Medicine, Monash University, Melbourne, Australia
| | - Joseph S Doyle
- Disease Elimination Program, Burnet Institute, Melbourne, Australia.,Department of Infectious Diseases, The Alfred Hospital and Monash University, Melbourne, Australia
| | - Anna Y Palmer
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
| | | | - Paul Agius
- Disease Elimination Program, Burnet Institute, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Stelliana Goutzamanis
- Disease Elimination Program, Burnet Institute, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Zinia Li
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
| | - Alisa Pedrana
- Disease Elimination Program, Burnet Institute, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Magnus Gottfredsson
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland.,Division of Infectious Diseases, Landspitali University Hospital, Reykjavik, Iceland.,Department of Science, Landspitali University Hospital, Reykjavik, Iceland
| | | | | | - Alyona Mazhnaya
- The International Charitable Foundation Alliance for Public Health, Kyiv, Ukraine.,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore
| | - Frederick L Altice
- Section of Infectious Diseases, Yale University School of Medicine, New Haven.,Division of Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven
| | - Sahar Saeed
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Marina Klein
- Department of Medicine, McGill University Health Centre, Montreal, Canada
| | | | - Esther Aspinall
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom.,Health Protection Scotland, National Services Scotland, Glasgow, United Kingdom
| | - Sharon Hutchinson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom.,Health Protection Scotland, National Services Scotland, Glasgow, United Kingdom
| | - Margaret E Hellard
- Disease Elimination Program, Burnet Institute, Melbourne, Australia.,Department of Infectious Diseases, The Alfred Hospital and Monash University, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Doherty Institute, University of Melbourne, Melbourne, Australia
| | - Rachel Sacks-Davis
- Disease Elimination Program, Burnet Institute, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.,Department of Medicine, University of Melbourne, Australia
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30
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Major M, Gutfraind A, Shekhtman L, Cui Q, Kachko A, Cotler SJ, Hajarizadeh B, Sacks-Davis R, Page K, Boodram B, Dahari H. Modeling of patient virus titers suggests that availability of a vaccine could reduce hepatitis C virus transmission among injecting drug users. Sci Transl Med 2019; 10:10/449/eaao4496. [PMID: 29997251 DOI: 10.1126/scitranslmed.aao4496] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 02/24/2018] [Accepted: 06/22/2018] [Indexed: 12/15/2022]
Abstract
The major route of hepatitis C virus (HCV) transmission in the United States is injection drug use. We hypothesized that if an HCV vaccine were available, vaccination could affect HCV transmission among people who inject drugs by reducing HCV titers after viral exposure without necessarily achieving sterilizing immunity. To investigate this possibility, we developed a mathematical model to determine transmission probabilities relative to the HCV RNA titers of needle/syringe-sharing donors. We simulated sharing of two types of syringes fitted with needles that retain either large or small amounts of fluid after expulsion. Using previously published viral kinetics data from both naïve subjects infected with HCV and reinfected individuals who had previously cleared an HCV infection, we estimated transmission risk between pairs of serodiscordant injecting drug users, accounting for syringe type, rinsing, and sharing frequency. We calculated that the risk of HCV transmission through syringe sharing increased ~10-fold as viral titers (log10 IU/ml) increased ~25-fold. Cumulative analyses showed that, assuming sharing episodes every 7 days, the mean transmission risk over the first 6 months was >90% between two people sharing syringes when one had an HCV RNA titer >5 log10 IU/ml. For those with preexisting immunity that rapidly controlled HCV, the cumulative risk decreased to 1 to 25% depending on HCV titer and syringe type. Our modeling approach demonstrates that, even with transient viral replication after exposure during injection drug use, HCV transmission among people sharing syringes could be reduced through vaccination if an HCV vaccine were available.
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Affiliation(s)
- Marian Major
- Division of Viral Products, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD 20993, USA.
| | - Alexander Gutfraind
- Program for Experimental and Theoretical Modeling, Division of Hepatology, Department of Medicine, Loyola University Chicago, Maywood, IL 60153, USA.,Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Louis Shekhtman
- Program for Experimental and Theoretical Modeling, Division of Hepatology, Department of Medicine, Loyola University Chicago, Maywood, IL 60153, USA.,Department of Physics, Bar-Ilan University, Ramat Gan 52990, Israel
| | - Qingwen Cui
- Division of Viral Products, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD 20993, USA
| | - Alla Kachko
- Division of Viral Products, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD 20993, USA
| | - Scott J Cotler
- Program for Experimental and Theoretical Modeling, Division of Hepatology, Department of Medicine, Loyola University Chicago, Maywood, IL 60153, USA
| | - Behzad Hajarizadeh
- The Kirby Institute, University of New South Wales, Sydney, New South Wales 2052, Australia
| | - Rachel Sacks-Davis
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria 3004, Australia.,Department of Medicine, University of Melbourne, Parkville, Victoria 3010, Australia
| | - Kimberly Page
- Division of Epidemiology, Biostatistics and Preventive Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
| | - Basmattee Boodram
- Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Harel Dahari
- Program for Experimental and Theoretical Modeling, Division of Hepatology, Department of Medicine, Loyola University Chicago, Maywood, IL 60153, USA.
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Sacks-Davis R, Doyle JS, Rauch A, Beguelin C, Pedrana AE, Matthews GV, Prins M, van der Valk M, Klein MB, Saeed S, Lacombe K, Chkhartishvili N, Altice FL, Hellard ME. Linkage and retention in HCV care for HIV-infected populations: early data from the DAA era. J Int AIDS Soc 2019; 21 Suppl 2:e25051. [PMID: 29633559 PMCID: PMC5978682 DOI: 10.1002/jia2.25051] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 12/19/2017] [Indexed: 12/17/2022] Open
Abstract
Introduction There is currently no published data on the effectiveness of DAA treatment for elimination of HCV infection in HIV‐infected populations at a population level. However, a number of relevant studies and initiatives are emerging. This research aims to report cascade of care data for emerging HCV elimination initiatives and studies that are currently being evaluated in HIV/HCV co‐infected populations in the context of implementation science theory. Methods HCV elimination initiatives and studies in HIV co‐infected populations that are currently underway were identified. Context, intervention characteristics and cascade of care data were synthesized in the context of implementation science frameworks. Results Seven HCV elimination initiatives and studies were identified in HIV co‐infected populations, mainly operating in high‐income countries. Four were focused mainly on HCV elimination in HIV‐infected gay and bisexual men (GBM), and three included a combination of people who inject drugs (PWID), GBM and other HIV‐infected populations. None were evaluating treatment delivery in incarcerated populations. Overall, HCV RNA was detected in 4894 HIV‐infected participants (range within studies: 297 to 994): 48% of these initiated HCV treatment (range: 21% to 85%; within studies from a period where DAAs were broadly available the total is 57%, range: 36% to 74%). Among studies with treatment completion data, 96% of 1109 initiating treatment completed treatment (range: 94% to 99%). Among those who could be assessed for sustained virological response at 12 weeks (SVR12), 1631 of 1757 attained SVR12 (93%, range: 86% to 98%). Conclusions Early results from emerging research on HCV elimination in HIV‐infected populations suggest that HCV treatment uptake is higher than reported levels prior to DAA treatment availability, but approximately half of patients remain untreated. These results are among diagnosed populations and additional effort is required to increase diagnosis rates. Among those who have initiated treatment, completion and SVR rates are promising. More data are required in order to evaluate the effectiveness of these elimination programmes in the long term, assess which intervention components are effective, and whether they need to be tailored to particular population groups.
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Affiliation(s)
- Rachel Sacks-Davis
- Disease Elimination Program, Burnet Institute, Melbourne, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Joseph S Doyle
- Disease Elimination Program, Burnet Institute, Melbourne, Australia.,Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Australia
| | - Andri Rauch
- Department of Infectious Diseases, University Hospital and University of Bern, Bern, Switzerland
| | - Charles Beguelin
- Department of Infectious Diseases, University Hospital and University of Bern, Bern, Switzerland
| | - Alisa E Pedrana
- Disease Elimination Program, Burnet Institute, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Gail V Matthews
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Maria Prins
- Public Health Service Amsterdam, Amsterdam, the Netherlands
| | - Marc van der Valk
- International Antiviral Therapy Evaluation Center and Department of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Centre, Amsterdam, the Netherlands
| | - Marina B Klein
- Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada
| | - Sahar Saeed
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Karine Lacombe
- Infectious Diseases, AP-HP, Sorbonne Universités and Inserm UMR-S1136, Paris, France
| | | | - Frederick L Altice
- Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA.,Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA.,Centre of Excellence in Research in AIDS, University of Malaya, Kuala Lumpur, Malaysia
| | - Margaret E Hellard
- Disease Elimination Program, Burnet Institute, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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Khan SI, Reza MM, Crowe SM, Rahman M, Hellard M, Sarker MS, Chowdhury EI, Rana AM, Sacks-Davis R, Banu S, Ross AG. People who inject drugs in Bangladesh — The untold burden! Int J Infect Dis 2019; 83:109-115. [DOI: https:/doi.org/10.1016/j.ijid.2019.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023] Open
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Doyle JS, Scott N, Sacks-Davis R, Pedrana AE, Thompson AJ, Hellard ME. Treatment access is only the first step to hepatitis C elimination: experience of universal anti-viral treatment access in Australia. Aliment Pharmacol Ther 2019; 49:1223-1229. [PMID: 30908706 DOI: 10.1111/apt.15210] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 06/13/2018] [Accepted: 02/09/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Global targets to eliminate hepatitis C (HCV) might be met by sustained treatment uptake. AIM To describe factors facilitating HCV treatment uptake and potential challenges to sustaining treatment levels after universal access to direct-acting anti-virals (DAA) across Australia. METHODS We analysed national Pharmaceutical Benefits Scheme data to determine the number of DAA prescriptions commenced before and after universal access from March 2016 to June 2017. We inferred facilitators and barriers to treatment uptake, and challenges that will prevent local and global jurisdictions reaching elimination targets. RESULTS In 2016, 32 877 individuals (14% of people living with HCV in Australia) commenced HCV DAA treatment, and 34 952 (15%) individuals commenced treatment in the first year of universal access. Treatment uptake peaked at 13 109 DAA commencements per quarter immediately after universal access, but more than halved (to 5320 in 2017 Q2) within 12 months. General practitioners have written 24% of all prescriptions but with a significantly increased proportion over time (9% in 2016 Q1 to 37% in 2017 Q2). In contrast, hepatology or infectious diseases specialists have written a declining share from 74% to 38% during the same period. General practitioners provided a greater proportion (47%) of care in regional/remote areas than major cities. CONCLUSIONS Broad treatment access led to rapid initial increases in treatment uptake, but this uptake has not been sustained. Our results suggest achieving global elimination targets requires more than treatment availability: people with HCV need easy access to testing and linkage to care in community settings employing a diverse prescriber base.
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Affiliation(s)
- Joseph S Doyle
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Vic., Australia.,Disease Elimination Program, Burnet Institute, Melbourne, Vic., Australia
| | - Nick Scott
- Disease Elimination Program, Burnet Institute, Melbourne, Vic., Australia.,School of Population Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - Rachel Sacks-Davis
- Disease Elimination Program, Burnet Institute, Melbourne, Vic., Australia
| | - Alisa E Pedrana
- Disease Elimination Program, Burnet Institute, Melbourne, Vic., Australia.,School of Population Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - Alexander J Thompson
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Vic., Australia.,Department of Medicine, University of Melbourne, Melbourne, Vic., Australia
| | - Margaret E Hellard
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Vic., Australia.,Disease Elimination Program, Burnet Institute, Melbourne, Vic., Australia.,School of Population Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
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Stone J, Fraser H, Lim AG, Walker JG, Ward Z, MacGregor L, Trickey A, Abbott S, Strathdee SA, Abramovitz D, Maher L, Iversen J, Bruneau J, Zang G, Garfein RS, Yen YF, Azim T, Mehta SH, Milloy MJ, Hellard ME, Sacks-Davis R, Dietze PM, Aitken C, Aladashvili M, Tsertsvadze T, Mravčík V, Alary M, Roy E, Smyrnov P, Sazonova Y, Young AM, Havens JR, Hope VD, Desai M, Heinsbroek E, Hutchinson SJ, Palmateer NE, McAuley A, Platt L, Martin NK, Altice FL, Hickman M, Vickerman P. Incarceration history and risk of HIV and hepatitis C virus acquisition among people who inject drugs: a systematic review and meta-analysis. Lancet Infect Dis 2018; 18:1397-1409. [PMID: 30385157 PMCID: PMC6280039 DOI: 10.1016/s1473-3099(18)30469-9] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 05/30/2018] [Accepted: 07/12/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND People who inject drugs (PWID) experience a high prevalence of incarceration and might be at high risk of HIV and hepatitis C virus (HCV) infection during or after incarceration. We aimed to assess whether incarceration history elevates HIV or HCV acquisition risk among PWID. METHODS In this systematic review and meta-analysis, we searched MEDLINE, Embase, and PsycINFO databases for studies in any language published from Jan 1, 2000 until June 13, 2017 assessing HIV or HCV incidence among PWID. We included studies that measured HIV or HCV incidence among community-recruited PWID. We included only studies reporting original results and excluded studies that evaluated incident infections by self-report. We contacted authors of cohort studies that met the inclusion or exclusion criteria, but that did not report on the outcomes of interest, to request data. We extracted and pooled data from the included studies using random-effects meta-analyses to quantify the associations between recent (past 3, 6, or 12 months or since last follow-up) or past incarceration and HIV or HCV acquisition (primary infection or reinfection) risk among PWID. We assessed the risk of bias of included studies using the Newcastle-Ottawa Scale. Between-study heterogeneity was evaluated using the I2 statistic and the P-value for heterogeneity. FINDINGS We included published results from 20 studies and unpublished results from 21 studies. These studies originated from Australasia, western and eastern Europe, North and Latin America, and east and southeast Asia. Recent incarceration was associated with an 81% (relative risk [RR] 1·81, 95% CI 1·40-2·34) increase in HIV acquisition risk, with moderate heterogeneity between studies (I2=63·5%; p=0·001), and a 62% (RR 1·62, 95% CI 1·28-2·05) increase in HCV acquisition risk, also with moderate heterogeneity between studies (I2=57·3%; p=0·002). Past incarceration was associated with a 25% increase in HIV (RR 1·25, 95% CI 0·94-1·65) and a 21% increase in HCV (1·21, 1·02-1·43) acquisition risk. INTERPRETATION Incarceration is associated with substantial short-term increases in HIV and HCV acquisition risk among PWID and could be a significant driver of HCV and HIV transmission among PWID. These findings support the need for developing novel interventions to minimise the risk of HCV and HIV acquisition, including addressing structural risks associated with drug laws and excessive incarceration of PWID. FUNDING Engineering and Physical Sciences Research Council, National Institute for Health Research, National Institutes of Health.
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Affiliation(s)
- Jack Stone
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Hannah Fraser
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Aaron G Lim
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Josephine G Walker
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Zoe Ward
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Louis MacGregor
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Adam Trickey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sam Abbott
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Steffanie A Strathdee
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Daniela Abramovitz
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Lisa Maher
- Kirby Institute for Infection and Immunity, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Jenny Iversen
- Kirby Institute for Infection and Immunity, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Julie Bruneau
- Department of Family Medicine, Université de Montréal, Montréal, QC, Canada; Centre hospitalier de l'Université de Montreal, Montréal, QC, Canada
| | - Geng Zang
- Centre hospitalier de l'Université de Montreal, Montréal, QC, Canada
| | - Richard S Garfein
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Yung-Fen Yen
- Section of Infectious Diseases, Taipei City Hospital, Taipei City Government, Taipei, Taiwan
| | - Tasnim Azim
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michael-John Milloy
- BC Centre for Excellence in HIV/AIDS and Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Margaret E Hellard
- Burnet Institute, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Rachel Sacks-Davis
- Burnet Institute, Melbourne, VIC, Australia; Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | | | | | - Malvina Aladashvili
- Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
| | - Tengiz Tsertsvadze
- Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia; Faculty of Medicine, Tbilisi State University, Tbilisi, Georgia
| | - Viktor Mravčík
- National Monitoring Centre for Drugs and Addiction, Prague, Czech Republic; Department of Addictology, The First Medical Faculty, Charles University and General University Hospital in Prague, Prague, Czech Republic; National Institute of Mental Health, Klecany, Czech Republic
| | - Michel Alary
- University Hospital Centre of Québec Research Centre-Laval University, QC, Canada; National Institute of Public Health of Québec, QC, Canada
| | - Elise Roy
- National Institute of Public Health of Québec, QC, Canada; Faculty of Medicine and Health Sciences, University of Sherbrooke, Longueuil, QC, Canada
| | - Pavlo Smyrnov
- International Charitable Foundation Alliance for Public Health, Kiev, Ukraine
| | - Yana Sazonova
- International Charitable Foundation Alliance for Public Health, Kiev, Ukraine
| | - April M Young
- Department of Epidemiology, University of Kentucky College of Public Health, KY, USA; Center on Drug and Alcohol Research, University of Kentucky, KY, USA
| | - Jennifer R Havens
- Center on Drug and Alcohol Research, University of Kentucky, KY, USA
| | - Vivian D Hope
- Public Health Institute, Liverpool John Moores University, Liverpool, UK; National Infection Service, Public Health England, London, UK
| | - Monica Desai
- National Infection Service, Public Health England, London, UK
| | | | - Sharon J Hutchinson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, National Health Service National Services Scotland, Glasgow, UK
| | - Norah E Palmateer
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, National Health Service National Services Scotland, Glasgow, UK
| | - Andrew McAuley
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Lucy Platt
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Natasha K Martin
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Frederick L Altice
- Yale School of Medicine, Department of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Scott N, Sacks-Davis R, Pedrana A, Doyle J, Thompson A, Hellard M. Eliminating hepatitis C: The importance of frequent testing of people who inject drugs in high-prevalence settings. J Viral Hepat 2018; 25:1472-1480. [PMID: 30047625 DOI: 10.1111/jvh.12975] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 06/27/2018] [Accepted: 06/30/2018] [Indexed: 12/11/2022]
Abstract
Modelling suggests that more frequent screening of people who inject drugs (PWID) and an improved care cascade are required to achieve the WHO hepatitis C virus (HCV) elimination target of an 80% reduction in incidence by 2030. We determined the testing frequencies (2-yearly, annually, 6-monthly and 3-monthly) and retention in care required among PWID to achieve the HCV incidence reduction target through treatment as prevention in low (25%), medium (50%) and high (75%) chronic HCV prevalence settings. Mathematical modelling of HCV transmission among PWID, capturing testing, treatment and other features of the care cascade were employed. In low-prevalence settings, 2-yearly antibody testing of PWID was estimated to reach the elimination target by 2027-2030 depending on retention in care, with annual testing reducing the time by up to 3 years. In medium-prevalence settings, if close to 90% testing coverage were achieved, then annual antibody testing of PWID would be sufficient. If testing coverage were lower (80%), 6-monthly antibody testing with at least 70% retention in care or annual HCV RNA/cAg testing would be required. In high-prevalence settings, even 3-monthly HCV RNA/cAg testing of PWID was unable to achieve the incidence reduction target. Thus, for geographical areas or subpopulations with high prevalence, WHO incidence targets are unlikely to be met without 3-monthly RNA/cAg testing accompanied by other prevention measures. Novel testing strategies, such as rapid point-of-care antibody testing or replacing antibody testing with RNA/cAg tests as a screening tool, can provide additional population-level impacts to compensate for imperfect follow-up or testing coverage.
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Affiliation(s)
- Nick Scott
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Rachel Sacks-Davis
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Alisa Pedrana
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Joseph Doyle
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia.,Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Victoria, Australia
| | - Alexander Thompson
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
| | - Margaret Hellard
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia.,Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Victoria, Australia
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36
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Sacks-Davis R, Pedrana AE, Scott N, Doyle JS, Hellard ME. Eliminating HIV/HCV co-infection in gay and bisexual men: is it achievable through scaling up treatment? Expert Rev Anti Infect Ther 2018; 16:411-422. [PMID: 29722275 DOI: 10.1080/14787210.2018.1471355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Broad availability of direct-acting antiviral therapy for hepatitis C virus (HCV) raises the possibility that HCV prevalence and incidence can be reduced through scaling-up treatment, leading to the elimination of HCV. High rates of linkage to HIV care among HIV-infected gay and bisexual men may facilitate high uptake of HCV treatment, possibly making HCV elimination more achievable in this group. Areas covered: This review covers HCV elimination in HIV-infected gay and bisexual men, including epidemiology, spontaneous clearance and long term sequelae in the absence of direct-acting antiviral therapy; direct-acting antiviral therapy uptake and effectiveness in this group; HCV reinfection following successful treatment; and areas for further research. Expert commentary: Early data from the direct-acting antiviral era suggest that treatment uptake is increasing among HIV infected GBM, and SVR rates are very promising. However, in order to sustain current treatment rates, additional interventions at the behavioral, physician, and structural levels may be required to increase HCV diagnosis, including prompt detection of HCV reinfection. Timely consideration of these issues is required to maximize the population-level impact of HCV direct-acting antiviral therapy. Potential HCV transmissions from HIV-uninfected GBM, across international borders, and from those who are not GBM also warrant consideration.
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Affiliation(s)
- Rachel Sacks-Davis
- a Disease Elimination Program , Burnet Institute , Melbourne , Australia.,b Department of Medicine , University of Melbourne , Parkville , Australia
| | - Alisa E Pedrana
- a Disease Elimination Program , Burnet Institute , Melbourne , Australia.,c Department of Epidemiology and Preventive Medicine , Monash University , Melbourne , Australia
| | - Nick Scott
- a Disease Elimination Program , Burnet Institute , Melbourne , Australia.,c Department of Epidemiology and Preventive Medicine , Monash University , Melbourne , Australia
| | - Joseph S Doyle
- a Disease Elimination Program , Burnet Institute , Melbourne , Australia.,d Central Clinical School , Monash University , Melbourne , Australia
| | - Margaret E Hellard
- a Disease Elimination Program , Burnet Institute , Melbourne , Australia.,c Department of Epidemiology and Preventive Medicine , Monash University , Melbourne , Australia
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37
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Scott N, Hainsworth SW, Sacks-Davis R, Pedrana A, Doyle J, Wade A, Hellard M. Heterogeneity in hepatitis C treatment prescribing and uptake in Australia: a geospatial analysis of a year of unrestricted treatment access. J Virus Erad 2018. [DOI: 10.1016/s2055-6640(20)30253-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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38
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Scott N, Hainsworth SW, Sacks-Davis R, Pedrana A, Doyle J, Wade A, Hellard M. Heterogeneity in hepatitis C treatment prescribing and uptake in Australia: a geospatial analysis of a year of unrestricted treatment access. J Virus Erad 2018. [PMID: 29682303 DOI: 10.1016/s0168-8278(18)30505-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background and aim Direct-acting antiviral (DAA) treatments became available for all people living with hepatitis C virus (HCV) in Australia in March 2016. We assess variations in treatment rates and prescribing patterns across Australia's 338 Statistical Area 3 (SA3) geographical units. Methods Geocoded DAA treatment initiation data were analysed for the period 1 March 2016 to 30 June 2017. Regression models tested associations between the population demographics and healthcare service coverage of geographical areas and (a) their treatment rates; and (b) the proportion of prescriptions written by specialists compared to non-specialists. Results Across the 320 areas (95%) recording treatments, a median 76 (interquartile range [IQR] 35-207, range 4-3834) per 100,000 were initiated, corresponding to an estimated median 7.9% (IQR 2.9-23.6%, range 0-100%) treatment uptake. Major cities, areas of socioeconomic advantage and areas with lower proportions of the population born overseas had the highest per capita treatment rates. Non-specialists prescribed 46% (20,323/44,382) of treatment initiations. Prescriptions were written by non-specialists only in 163 areas (51%), while in other areas a median 40.0% (IQR 21.8-62.5%) of prescriptions were written by non-specialists. Non-specialist prescribing was higher in regional areas, as well as areas that had greater proportions of Indigenous Australians. Conclusions High national-level treatment uptake of 20% in Australia masks underlying health system limitations; more than half of geographical areas may have treated less than 8% of people living with HCV. Areas of socioeconomic disadvantage and areas with a higher proportion of the population born overseas may need targeting with interventions to improve treatment uptake.
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Affiliation(s)
| | - Samuel W Hainsworth
- Disease Elimination Program, Burnet Institute, Melbourne, VIC 3004, Australia
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39
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Hellard M, Scott N, Sacks-Davis R, Pedrana A. Achieving hepatitis C elimination in Europe - To treatment scale-up and beyond. J Hepatol 2018; 68:383-385. [PMID: 29233629 DOI: 10.1016/j.jhep.2017.12.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 12/03/2017] [Indexed: 12/16/2022]
Affiliation(s)
- M Hellard
- Burnet Institute, Melbourne, VIC 3004, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Clayton, VIC 3008, Australia; Department of Infectious Diseases, The Alfred Hospital and Monash University, Melbourne, VIC 3004, Australia.
| | - N Scott
- Burnet Institute, Melbourne, VIC 3004, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Clayton, VIC 3008, Australia
| | - R Sacks-Davis
- Burnet Institute, Melbourne, VIC 3004, Australia; Department of Medicine, University of Melbourne, Parkville, VIC 3010
| | - A Pedrana
- Burnet Institute, Melbourne, VIC 3004, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Clayton, VIC 3008, Australia
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40
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Pedrana AE, Sacks-Davis R, Doyle JS, Hellard ME. Pathways to the elimination of hepatitis C: prioritising access for all. Expert Rev Clin Pharmacol 2017; 10:1023-1026. [DOI: 10.1080/17512433.2017.1383894] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Alisa E. Pedrana
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Rachel Sacks-Davis
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Joseph S. Doyle
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Australia
| | - Margaret E. Hellard
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Australia
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41
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Sacks-Davis R, Daniel M, Roy É, Kestens Y, Zang G, Ramos Y, Hellard M, Jutras Aswad D, Bruneau J. The role of living context in prescription opioid injection and the associated risk of hepatitis C infection. Addiction 2016; 111:1985-1996. [PMID: 27238912 DOI: 10.1111/add.13470] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 04/06/2016] [Accepted: 05/23/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIMS Prescription opioid injection (POI) is a leading risk factor for hepatitis C virus (HCV). Residential context relates to high‐risk injection behaviour. This study assessed whether residence in the inner city (versus surrounding areas in Montréal Island) modified the effects of correlates of POI or the relationship between POI and HCV incidence. DESIGN Prospective cohort study. SETTING Montréal, Canada. PARTICIPANTS A total of 854 people who inject drugs (18% female, 25% age < 30 years), living on Montréal Island, were interviewed every 3–6 months from 2004 to 2012. MEASUREMENTS Study visits included HCV antibody testing and an interviewer‐administered questionnaire. Generalized estimating equations were used to test whether place of residence modified the effects of correlates of POI. Cox regression was used to test whether place of residence modified the relationship between POI and HCV incidence. FINDINGS At baseline, inner‐city participants were more likely to report POI in the past month (40 versus 25%, P < 0.001). The association between POI and heroin injection, syringe sharing and sharing of injecting equipment varied according to place of residence and was greater in the inner city. The hazard of HCV infection associated with POI was greater among inner‐city participants compared to those in the surrounding areas [adjusted hazard ratio (HR) = 3.38, 95% confidence interval (CI) = 1.88–6.07 versus HR = 1.26, 95% CI = 0.65–2.42, P = 0.025]. CONCLUSIONS Among people who inject prescription opioids in Montréal, Canada, those who live in inner‐city areas are more likely to engage in injecting‐related risk behaviours and have a higher risk of hepatitis C virus infection than those who live in the suburbs.
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Affiliation(s)
- Rachel Sacks-Davis
- Department of Medicine, University of Melbourne, Melbourne, Australia.,Burnet Institute, Melbourne, Australia
| | - Mark Daniel
- School of Population Health, University of South Australia, Adelaide, Australia.,Department of Medicine, St Vincent's Hospital, The University of Melbourne, Melbourne, Australia.,South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Élise Roy
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Canada.,Institut National de Santé Publique, Montréal, Canada
| | - Yan Kestens
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada
| | - Geng Zang
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada
| | - Yuddy Ramos
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada
| | - Margaret Hellard
- Burnet Institute, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Didier Jutras Aswad
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada.,Department of Psychiatry, Université de Montréal, Montréal, Canada
| | - Julie Bruneau
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada. .,Department of Family and Emergency Medicine, Université de Montréal, Montréal, Canada.
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42
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Bradshaw D, Raghwani J, Jacka B, Sacks-Davis R, Lamoury F, Down I, Prestage G, Applegate TL, Hellard M, Sasadeusz J, Dore GJ, Pybus OG, Matthews GV, Danta M. Venue-Based Networks May Underpin HCV Transmissions amongst HIV-Infected Gay and Bisexual Men. PLoS One 2016; 11:e0162002. [PMID: 27584149 PMCID: PMC5008823 DOI: 10.1371/journal.pone.0162002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 08/16/2016] [Indexed: 01/18/2023] Open
Abstract
Background This study aimed to investigate the potential influence of venue-based networks on HCV transmission in HIV-positive gay and bisexual men (GBM). Methods This was a prospectively recruited cohort of HIV-infected GBM with recently-acquired HCV infection resident in Melbourne and Sydney. Clinical and demographic data were collected together with blood samples for HCV sequencing. Phylogenies were inferred and clusters of individuals infected with HCV with genetic sequence homology were identified. Venues used for sourcing sexual partners were identified; sourcing partners from the same venue was considered a potential social link. Using the Jaccard similarity coefficient, associations were identified between the network of sites where men sourced sex partners and transmission relationships as defined by phylogenetic clustering. Results Forty individuals were recruited, of whom 62.5% were considered to have sexually- and 37.5% IDU-acquired HCV. Venue use was consistent with men being members of a more sexually adventurous gay community subculture. Six phylogenetically-determined pairs or clusters were identified, comprising fifteen (15/28, 53.6%) individuals. Participants belonging to phylogenetic clusters were observed within the same networks. There was a significant correlation between the network and phylogenetic clustering when both cities were considered simultaneously (p = 0.005), raising the possibility that social connections may be important for HCV transmissions. Conclusions Venue-based network elicitation is a promising approach for elucidating HCV transmissions amongst HIV-infected GBM. Public health approaches targeting individuals and venues prominent within networks may reduce onward HCV transmission.
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Affiliation(s)
- Daniel Bradshaw
- The Kirby Institute for Infection and Immunity in Society, UNSW Australia, Sydney, NSW, Australia
- Department of HIV/GU Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
- * E-mail:
| | - Jayna Raghwani
- Department of Zoology, Oxford University, Oxford, United Kingdom
| | - Brendan Jacka
- The Kirby Institute for Infection and Immunity in Society, UNSW Australia, Sydney, NSW, Australia
| | | | - Francois Lamoury
- The Kirby Institute for Infection and Immunity in Society, UNSW Australia, Sydney, NSW, Australia
| | - Ian Down
- The Kirby Institute for Infection and Immunity in Society, UNSW Australia, Sydney, NSW, Australia
| | - Garrett Prestage
- The Kirby Institute for Infection and Immunity in Society, UNSW Australia, Sydney, NSW, Australia
| | - Tanya L. Applegate
- The Kirby Institute for Infection and Immunity in Society, UNSW Australia, Sydney, NSW, Australia
| | - Margaret Hellard
- Burnet Institute, Melbourne University, Melbourne, Victoria, Australia
| | - Joe Sasadeusz
- Department of Infectious Diseases, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Gregory J. Dore
- The Kirby Institute for Infection and Immunity in Society, UNSW Australia, Sydney, NSW, Australia
| | - Oliver G. Pybus
- Department of Zoology, Oxford University, Oxford, United Kingdom
| | - Gail V. Matthews
- The Kirby Institute for Infection and Immunity in Society, UNSW Australia, Sydney, NSW, Australia
| | - Mark Danta
- St Vincent’s Clinical School, UNSW Australia, Sydney, NSW, Australia
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43
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Hellard M, Sacks-Davis R, Doyle J. Hepatitis C elimination by 2030 through treatment and prevention: think global, act in local networks. J Epidemiol Community Health 2016; 70:1151-1154. [PMID: 27343304 DOI: 10.1136/jech-2015-205454] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- M Hellard
- Centre for Population Health, Burnet Institute, Melbourne, Victoria, Australia.,Department of Infectious Diseases, The Alfred, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - R Sacks-Davis
- Centre for Population Health, Burnet Institute, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - J Doyle
- Centre for Population Health, Burnet Institute, Melbourne, Victoria, Australia.,Department of Infectious Diseases, The Alfred, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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44
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Doyle JS, Deterding K, Grebely J, Wedemeyer H, Sacks-Davis R, Spelman T, Matthews G, Rice TM, Morris MD, McGovern BH, Kim AY, Bruneau J, Lloyd AR, Page K, Manns MP, Hellard ME, Dore GJ. Response to treatment following recently acquired hepatitis C virus infection in a multicentre collaborative cohort. J Viral Hepat 2015; 22:1020-32. [PMID: 26098993 PMCID: PMC4618180 DOI: 10.1111/jvh.12429] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 05/06/2015] [Indexed: 12/21/2022]
Abstract
Pegylated interferon therapy is highly effective in recently acquired HCV. The optimal timing of treatment, regimen and influence of host factors remains unclear. We aimed to measure sustained virological response (SVR) during recent HCV infection and identify predictors of response. Data were from five prospective cohorts of high-risk individuals in Australia, Canada, Germany and the United States. Individuals with acute or early chronic HCV who commenced pegylated interferon therapy were included. The main outcome was SVR, and predictors were assessed using logistic regression. Among 516 with documented recent HCV infection, 237 were treated (pegylated interferon n = 161; pegylated interferon/ribavirin n = 76) (30% female, median age 35 years, 56% ever injected drugs, median duration of infection 6.2 months). Sixteen per cent (n = 38) were HIV/HCV co-infected. SVR among those with HCV mono-infection was 64% by intention to treat; SVR was 68% among HCV/HIV co-infection. Independent predictors of SVR in HCV mono-infection were duration of HCV infection (the odds of SVR declined by 8% per month of infection, aOR 0.92, 95% CI 0.85-0.99, P = 0.033), IFNL4 genotype (adjusted OR 2.27, 95% CI 1.13-4.56, P = 0.021), baseline HCV RNA <400 000 IU/mL (aOR 2.06, 95% CI 1.03-4.12, P = 0.041) and age ≥40 years (vs <30: aOR 2.92, 95% CI 1.31-6.49, P = 0.009), with no difference by drug regimen, HCV genotype, symptomatic infection or gender. The effect of infection duration on odds of SVR was greater among genotype-1 infection. Interferon-based HCV treatment is highly effective in recent HCV infection. Duration of infection, IFNL4 genotype and baseline HCV RNA levels can predict virological response and may inform clinical decision-making.
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Affiliation(s)
- Joseph S. Doyle
- Centre for Population Health, Burnet Institute, Melbourne, Australia,School of Population Health and Preventive Medicine, Monash University, Melbourne, Australia,Department of Infectious Diseases, The Alfred Hospital, Melbourne, Australia
| | - Katja Deterding
- Hannover Medical School, Hannover, Germany,Hep-Net Study House: German Network of Competence on Viral Hepatitis, Germany
| | | | - Heiner Wedemeyer
- Hannover Medical School, Hannover, Germany,Hep-Net Study House: German Network of Competence on Viral Hepatitis, Germany,German Centre for Infection Research (DZIF), Hannover-Braunschweig, Germany
| | - Rachel Sacks-Davis
- Centre for Population Health, Burnet Institute, Melbourne, Australia,School of Population Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Tim Spelman
- Centre for Population Health, Burnet Institute, Melbourne, Australia
| | | | - Thomas M. Rice
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, USA
| | - Meghan D. Morris
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, USA
| | | | | | | | - Andrew R. Lloyd
- School of Medical Sciences, UNSW Australia, Sydney, Australia
| | - Kimberly Page
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, USA
| | - Michael P. Manns
- Hannover Medical School, Hannover, Germany,Hep-Net Study House: German Network of Competence on Viral Hepatitis, Germany,German Centre for Infection Research (DZIF), Hannover-Braunschweig, Germany
| | - Margaret E. Hellard
- Centre for Population Health, Burnet Institute, Melbourne, Australia,School of Population Health and Preventive Medicine, Monash University, Melbourne, Australia,Department of Infectious Diseases, The Alfred Hospital, Melbourne, Australia
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45
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Sacks-Davis R, McBryde E, Grebely J, Hellard M, Vickerman P. Many hepatitis C reinfections that spontaneously clear may be undetected: Markov-chain Monte Carlo analysis of observational study data. J R Soc Interface 2015; 12:20141197. [PMID: 25589564 DOI: 10.1098/rsif.2014.1197] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Hepatitis C virus (HCV) reinfection rates are probably underestimated due to reinfection episodes occurring between study visits. A Markov model of HCV reinfection and spontaneous clearance was fitted to empirical data. Bayesian post-estimation was used to project reinfection rates, reinfection spontaneous clearance probability and duration of reinfection. Uniform prior probability distributions were assumed for reinfection rate (more than 0), spontaneous clearance probability (0-1) and duration (0.25-6.00 months). Model estimates were 104 per 100 person-years (95% CrI: 21-344), 0.84 (95% CrI: 0.59-0.98) and 1.3 months (95% CrI: 0.3-4.1) for reinfection rate, spontaneous clearance probability and duration, respectively. Simulation studies were used to assess model validity, demonstrating that the Bayesian model estimates provided useful information about the possible sources and magnitude of bias in epidemiological estimates of reinfection rates, probability of reinfection clearance and duration or reinfection. The quality of the Bayesian estimates improved for larger samples and shorter test intervals. Uncertainty in model estimates notwithstanding, findings suggest that HCV reinfections frequently and quickly result in spontaneous clearance, with many reinfection events going unobserved.
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Affiliation(s)
- Rachel Sacks-Davis
- Centre for Population Health, Burnet Institute, Melbourne, Australia Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Emma McBryde
- Centre for Population Health, Burnet Institute, Melbourne, Australia Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Australia Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Jason Grebely
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Margaret Hellard
- Centre for Population Health, Burnet Institute, Melbourne, Australia Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Peter Vickerman
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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46
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Hajarizadeh B, Grady B, Page K, Kim AY, McGovern BH, Cox AL, Rice TM, Sacks-Davis R, Bruneau J, Morris M, Amin J, Schinkel J, Applegate T, Maher L, Hellard M, Lloyd AR, Prins M, Geskus RB, Dore GJ, Grebely J. Factors associated with hepatitis C virus RNA levels in early chronic infection: the InC3 study. J Viral Hepat 2015; 22:708-17. [PMID: 25580520 PMCID: PMC4496327 DOI: 10.1111/jvh.12384] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 12/09/2014] [Indexed: 02/06/2023]
Abstract
Improved understanding of natural history of hepatitis C virus (HCV) RNA levels in chronic infection provides enhanced insights into immunopathogenesis of HCV and has implications for the clinical management of chronic HCV infection. This study assessed factors associated with HCV RNA levels during early chronic infection in a population with well-defined early chronic HCV infection. Data were from an international collaboration of nine prospective cohorts studying acute HCV infection (InC(3) study). Individuals with persistent HCV and detectable HCV RNA during early chronic infection (one year [±4 months] postinfection) were included. Distribution of HCV RNA levels during early chronic infection was compared by selected host and virological factors. A total of 308 individuals were included. Median HCV RNA levels were significantly higher among males (vs females; 5.15 vs 4.74 log IU/mL; P < 0.01) and among individuals with HIV co-infection (vs no HIV; 5.89 vs 4.86; P = 0.02). In adjusted logistic regression, male sex (vs female, adjusted odds ratio [AOR]: 1.93; 95%CI: 1.01, 3.69), interferon lambda 4 (IFNL4) rs12979860 CC genotype (vs TT/CT; AOR: 2.48; 95%CI: 1.42, 4.35), HIV co-infection (vs no HIV; AOR: 3.27; 95%CI: 1.35, 7.93) and HCV genotype G2 (vs G3; AOR: 5.40; 95%CI: 1.63, 17.84) were independently associated with high HCV RNA levels (>5.6 log IU/mL = 400 000 IU/mL). In conclusion, this study demonstrated that IFNL4 rs12979860 CC genotype, male sex, HIV co-infection and HCV genotype G2 are associated with high HCV RNA levels in early chronic infection. These factors exert their role as early as one year following infection.
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Affiliation(s)
| | - Bart Grady
- Cluster Infectious Diseases, GGD Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Kimberly Page
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | | | | | - Andrea L. Cox
- Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Thomas M. Rice
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Rachel Sacks-Davis
- Burnet Institute, Melbourne, VIC, Australia,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Julie Bruneau
- CRCHUM, Université de Montréal, Montreal, QC, Canada
| | - Meghan Morris
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Janaki Amin
- The Kirby Institute, UNSW Australia, Sydney, NSW, Australia
| | | | | | - Lisa Maher
- The Kirby Institute, UNSW Australia, Sydney, NSW, Australia
| | - Margaret Hellard
- Burnet Institute, Melbourne, VIC, Australia,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Andrew R. Lloyd
- Inflammation and Infection Research Centre, School of Medical Sciences, UNSW Australia, Sydney, NSW, Australia
| | - Maria Prins
- Cluster Infectious Diseases, GGD Public Health Service of Amsterdam, Amsterdam, The Netherlands,Academic Medical Center, Amsterdam, The Netherlands
| | - Ronald B Geskus
- Cluster Infectious Diseases, GGD Public Health Service of Amsterdam, Amsterdam, The Netherlands,Academic Medical Center, Amsterdam, The Netherlands
| | | | - Jason Grebely
- The Kirby Institute, UNSW Australia, Sydney, NSW, Australia
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47
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Higgs P, Sacks-Davis R, Aitken C, Hellard M. How "hidden" are unobserved networks among people who inject drugs? Am J Public Health 2015; 105:e3. [PMID: 25879147 DOI: 10.2105/ajph.2015.302667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Peter Higgs
- Peter Higgs is with the Melbourne Office of the National Drug Research Institute, Melbourne, Australia. Rachel Sacks-Davis is with the Doherty Institute, Melbourne. Campbell Aitken and Margaret Hellard are with the Centre for Population Health, the Burnet Institute, Melbourne
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48
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Sacks-Davis R, Grebely J, Dore GJ, Osburn W, Cox AL, Rice TM, Spelman T, Bruneau J, Prins M, Kim AY, McGovern BH, Shoukry NH, Schinkel J, Allen TM, Morris M, Hajarizadeh B, Maher L, Lloyd AR, Page K, Hellard M. Hepatitis C Virus Reinfection and Spontaneous Clearance of Reinfection--the InC3 Study. J Infect Dis 2015; 212:1407-19. [PMID: 25883387 DOI: 10.1093/infdis/jiv220] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 03/30/2015] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND We aimed to characterize the natural history of hepatitis C virus (HCV) reinfection and spontaneous clearance following reinfection (reclearance), including predictors of HCV reclearance. METHODS Data were synthesized from the 9 prospective cohorts of the International Collaboration of Incident Human Immunodeficiency Virus and HCV in Injecting Cohorts study, which evaluated HCV infection outcomes among people who inject drugs. Participants with primary HCV infection were classified as having achieved viral suppression if they had negative results of at least 1 subsequent HCV RNA test. Those with positive results of an HCV RNA test following viral suppression were investigated for reinfection. Viral sequence analysis was used to identify reinfection (defined as detection of heterologous virus with no subsequent detection of the original viral strain). RESULTS Among 591 participants with acute primary HCV infection, 118 were investigated for reinfection. Twenty-eight participants were reinfected (12.3 cases/100 person-years; 95% confidence interval [CI], 8.5-17.8). Peak HCV RNA level was lower during reinfection than primary infection (P = .011). The proportion of individuals with reclearance 6 months after reinfection was 52% (95% CI, 33%-73%). After adjustment for study site, females with the IFNL4 (formerly IFNL3 and IL28B) rs12979860 CC genotype detected were more likely to have reclearance (hazard ratio, 4.16; 95% CI, 1.24-13.94; P = .021). CONCLUSIONS Sex and IFNL4 genotype are associated with spontaneous clearance after reinfection.
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Affiliation(s)
- Rachel Sacks-Davis
- Burnet Institute, Monash University, Melbourne Department of Epidemiology and Preventive Medicine, Monash University, Melbourne
| | - Jason Grebely
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Gregory J Dore
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - William Osburn
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Andrea L Cox
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Thomas M Rice
- Department of Epidemiology and Biostatistics, University of California-San Francisco
| | - Timothy Spelman
- Burnet Institute, Monash University, Melbourne Department of Epidemiology and Preventive Medicine, Monash University, Melbourne
| | | | - Maria Prins
- GGD Public Health Service of Amsterdam, Amsterdam, The Netherlands Academic Medical Center, Amsterdam, The Netherlands
| | | | | | | | | | | | - Meghan Morris
- Department of Epidemiology and Biostatistics, University of California-San Francisco
| | | | - Lisa Maher
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Andrew R Lloyd
- School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Kimberly Page
- Department of Epidemiology and Biostatistics, University of California-San Francisco
| | - Margaret Hellard
- Burnet Institute, Monash University, Melbourne Department of Epidemiology and Preventive Medicine, Monash University, Melbourne
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49
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Hajarizadeh B, Grady B, Page K, Kim AY, McGovern BH, Cox AL, Rice TM, Sacks-Davis R, Bruneau J, Morris M, Amin J, Schinkel J, Applegate T, Maher L, Hellard M, Lloyd AR, Prins M, Dore GJ, Grebely J. Patterns of hepatitis C virus RNA levels during acute infection: the InC3 study. PLoS One 2015; 10:e0122232. [PMID: 25837807 PMCID: PMC4383375 DOI: 10.1371/journal.pone.0122232] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 02/10/2015] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Understanding the patterns of HCV RNA levels during acute hepatitis C virus (HCV) infection provides insights into immunopathogenesis and is important for vaccine design. This study evaluated patterns of HCV RNA levels and associated factors among individuals with acute infection. METHODS Data were from an international collaboration of nine prospective cohorts of acute HCV (InC3 Study). Participants with well-characterized acute HCV infection (detected within three months post-infection and interval between the peak and subsequent HCV RNA levels ≤ 120 days) were categorised by a priori-defined patterns of HCV RNA levels: i) spontaneous clearance, ii) partial viral control with persistence (≥ 1 log IU/mL decline in HCV RNA levels following peak) and iii) viral plateau with persistence (increase or <1 log IU/mL decline in HCV RNA levels following peak). Factors associated with HCV RNA patterns were assessed using multinomial logistic regression. RESULTS Among 643 individuals with acute HCV, 162 with well-characterized acute HCV were identified: spontaneous clearance (32%), partial viral control with persistence (27%), and viral plateau with persistence (41%). HCV RNA levels reached a high viraemic phase within two months following infection, with higher levels in the spontaneous clearance and partial viral control groups, compared to the viral plateau group (median: 6.0, 6.2, 5.3 log IU/mL, respectively; P = 0.018). In the two groups with persistence, Interferon lambda 3 (IFNL3) CC genotype was independently associated with partial viral control compared to viral plateau (adjusted odds ratio [AOR]: 2.75; 95%CI: 1.08, 7.02). In the two groups with viral control, female sex was independently associated with spontaneous clearance compared to partial viral control (AOR: 2.86; 95%CI: 1.04, 7.83). CONCLUSIONS Among individuals with acute HCV, a spectrum of HCV RNA patterns is evident. IFNL3 CC genotype is associated with initial viral control, while female sex is associated with ultimate spontaneous clearance.
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Affiliation(s)
- Behzad Hajarizadeh
- The Kirby Institute, UNSW Australia (University of New South Wales), Sydney, NSW, Australia
| | - Bart Grady
- Cluster Infectious Diseases, GGD Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Kimberly Page
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, United States of America
| | - Arthur Y. Kim
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Barbara H. McGovern
- Tufts Medical School, Boston, Massachusetts, United States of America
- Abbvie, Chicago, Illinois, United States of America
| | - Andrea L. Cox
- Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland, United States of America
| | - Thomas M. Rice
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, United States of America
| | - Rachel Sacks-Davis
- Burnet Institute, Melbourne, VIC, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Julie Bruneau
- CRCHUM, Université de Montréal, Montreal, QC, Canada
| | - Meghan Morris
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, United States of America
| | - Janaki Amin
- The Kirby Institute, UNSW Australia (University of New South Wales), Sydney, NSW, Australia
| | | | - Tanya Applegate
- The Kirby Institute, UNSW Australia (University of New South Wales), Sydney, NSW, Australia
| | - Lisa Maher
- The Kirby Institute, UNSW Australia (University of New South Wales), Sydney, NSW, Australia
| | - Margaret Hellard
- Burnet Institute, Melbourne, VIC, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Andrew R. Lloyd
- Inflammation and Infection Research Centre, School of Medical Sciences, UNSW Australia, Sydney, NSW, Australia
| | - Maria Prins
- Cluster Infectious Diseases, GGD Public Health Service of Amsterdam, Amsterdam, The Netherlands
- Academic Medical Center, Amsterdam, The Netherlands
| | - Gregory J. Dore
- The Kirby Institute, UNSW Australia (University of New South Wales), Sydney, NSW, Australia
| | - Jason Grebely
- The Kirby Institute, UNSW Australia (University of New South Wales), Sydney, NSW, Australia
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50
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Veale HJ, Sacks-Davis R, Weaver ER, Pedrana AE, Stoové MA, Hellard ME. The use of social networking platforms for sexual health promotion: identifying key strategies for successful user engagement. BMC Public Health 2015; 15:85. [PMID: 25884461 PMCID: PMC4340797 DOI: 10.1186/s12889-015-1396-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 01/12/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Online social networking platforms such as Facebook and Twitter have grown rapidly in popularity, with opportunities for interaction enhancing their health promotion potential. Such platforms are being used for sexual health promotion but with varying success in reaching and engaging users. We aimed to identify Facebook and Twitter profiles that were able to engage large numbers of users, and to identify strategies used to successfully attract and engage users in sexual health promotion on these platforms. METHODS We identified active Facebook (n = 60) and Twitter (n = 40) profiles undertaking sexual health promotion through a previous systematic review, and assessed profile activity over a one-month period. Quantitative measures of numbers of friends and followers (reach) and social media interactions were assessed, and composite scores used to give profiles an 'engagement success' ranking. Associations between host activity, reach and interaction metrics were explored. Content of the top ten ranked Facebook and Twitter profiles was analysed using a thematic framework and compared with five poorly performing profiles to identify strategies for successful user engagement. RESULTS Profiles that were able to successfully engage large numbers of users were more active and had higher levels of interaction per user than lower-ranked profiles. Strategies used by the top ten ranked profiles included: making regular posts/tweets (median 46 posts or 124 tweets/month for top-ranked profiles versus six posts or six tweets for poorly-performing profiles); individualised interaction with users (85% of top-ranked profiles versus 0% for poorly-performing profiles); and encouraging interaction and conversation by posing questions (100% versus 40%). Uploading multimedia material (80% versus 30%) and highlighting celebrity involvement (70% versus 10%) were also key strategies. CONCLUSION Successful online engagement on social networking platforms can be measured through quantitative (user numbers and interactions) and basic qualitative content analysis. We identified the amount and type of host activity as key strategies for success, and in particular, regular individualised interaction with users, encouraging conversation, uploading multimedia and relevant links, and highlighting celebrity involvement. These findings provide valuable insight for achieving a high level of online engagement through social networking platforms to support successful health promotion initiatives.
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Affiliation(s)
- Hilary J Veale
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia.
| | - Rachel Sacks-Davis
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia. .,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Emma Rn Weaver
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia.
| | - Alisa E Pedrana
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia. .,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Mark A Stoové
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia. .,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Margaret E Hellard
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia. .,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia. .,The Alfred Hospital, Melbourne, VIC, Australia.
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