Progressive Scale‐up of HBV AND HCV Testing for Hepatitis Elimination in Vietnam

Background. HCV testing is an important first step for treatment and prevention, particularly for those who are highly vulnerable to HCV infection such as people who inject drugs (PWID). In settings where direct-acting antiretroviral medicines are becoming more available, limited information exists about who and where to target to increase the prevalence of HCV testing among PWID. This study is aimed at understanding the prevalence of HCV testing uptake and its determinants of medical services and risk behaviors. Methods. From February 2016 to April 2017, a sample of 509 PWID was interviewed using a structured questionnaire on their history of HCV testing, confirmation, services using in the previous year as well as HCV-related knowledge, and risk behaviors. Multiple logistic regression identified factors associated with ever being tested for HCV before enrollment in the program. Results. Approximately 33% reported ever testing for HCV. Most cited sources of testing are public hospitals and general clinics (68.9%) and outpatient clinics (18.9%). Having ever tested for HCV was positively associated with accessing health services within the prior 12 months ( aOR = 2.25 ; 95% CI 1.11-4.58), being currently enrolled in a methadone treatment program ( aOR = 2.35 ; 95% CI 1.34-4.08), and/or on ART treatment ( aOR = 2.30 ; 95% CI 1.30-4.08). Those who ever delayed in seeking healthcare services for any reason were less likely to get tested for HCV ( aOR = 0.54 ; 95% CI 0.35-0.84). Conclusion. HCV testing prevalence is low among PWID in Hanoi despite a very high prevalence of HCV infection. To improve the cascade of HCV testing, it is critical that intervention programs scale up linkages among methadone, outpatient clinics, and HCV services, take steps to reduce stigma and discrimination in both community and, especially, in health care settings, and increase awareness of HCV for PWID by integrating HCV into routine counseling at health care services.

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HBV/HCV testing/treatment scale-up across WHO regions cost effective

PharmacoEconomics & Outcomes News ◽

10.1007/s40274-020-7241-3 ◽

2020 ◽

Vol 865 (1) ◽

pp. 17-17

Keyword(s):

Scale Up ◽

Cost Effective ◽

Hcv Testing

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Assessing the impact of simplified HCV care on linkage to care amongst high-risk patients at primary healthcare clinics in Malaysia: a prospective observational study

BMJ Open ◽

10.1136/bmjopen-2021-055142 ◽

2021 ◽

Vol 11 (12) ◽

pp. e055142

Author(s):

Jessica Markby ◽

Sonjelle Shilton ◽

Xiaohui Sem ◽

Huan Keat Chan ◽

Rosaida Md Said ◽

...

Keyword(s):

Viral Load ◽

High Risk ◽

Observational Study ◽

Primary Healthcare ◽

Scale Up ◽

Load Test ◽

Cirrhotic Patients ◽

Primary Healthcare Clinics ◽

The Impact ◽

Hcv Testing

IntroductionTo achieve the elimination of hepatitis C virus (HCV), substantial scale-up in access to testing and treatment is needed. This will require innovation and simplification of the care pathway, through decentralisation of testing and treatment to primary care settings and task-shifting to non-specialists. The objective of this study was to evaluate the feasibility and effectiveness of decentralisation of HCV testing and treatment using rapid diagnostic tests (RDTs) in primary healthcare clinics (PHCs) among high-risk populations, with referral of seropositive patients for confirmatory viral load testing and treatment.MethodsThis observational study was conducted between December 2018 and October 2019 at 25 PHCs in three regions in Malaysia. Each PHC was linked to one or more hospitals, for referral of seropositive participants for confirmatory testing and pretreatment evaluation. Treatment was provided in PHCs for non-cirrhotic patients and at hospitals for cirrhotic patients.ResultsDuring the study period, a total of 15 366 adults were screened at the 25 PHCs, using RDTs for HCV antibodies. Of the 2020 (13.2%) HCV antibody-positive participants, 1481/2020 (73.3%) had a confirmatory viral load test, 1241/1481 (83.8%) were HCV RNA-positive, 991/1241 (79.9%) completed pretreatment assessment, 632/991 (63.8%) initiated treatment, 518/632 (82.0%) completed treatment, 352/518 (68.0%) were eligible for a sustained virological response (SVR) cure assessment, 209/352 (59.4%) had an SVR cure assessment, and SVR was achieved in 202/209 (96.7%) patients. A significantly higher proportion of patients referred to PHCs initiated treatment compared with those who had treatment initiated at hospitals (71.0% vs 48.8%, p<0.001).ConclusionsThis study demonstrated the effectiveness and feasibility of a simplified decentralised HCV testing and treatment model in primary healthcare settings, targeting high-risk groups in Malaysia. There were good outcomes across most steps of the cascade of care when treatment was provided at PHCs compared with hospitals.

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Routinization of HIV & HCV Testing in the Inpatient Setting: Involvement of Residents and Nurses

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.1072 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S425-S425

Author(s):

Gabriel Buluku ◽

Sally Bjornholm ◽

Travis Brown ◽

Jamie Mignano ◽

Sarah Schmalzle

Keyword(s):

Scale Up ◽

Internal Medicine Resident ◽

Fourth Generation ◽

Hcv Rna ◽

Inpatient Setting ◽

Medicine Resident ◽

Opt Out ◽

Time Of Admission ◽

Hcv Testing ◽

Hiv 1

Abstract Background Approximately 1 in 5 and 1 in 2 of people infected with HIV and HCV respectively in the US are unaware of their infection. Risk based opt-in testing strategies result in missed or delayed diagnoses and may further stigmatize these illnesses. The use of routine opt-out testing increases test uptake and can identify patients with HIV or HCV early, resulting in improved outcomes and decreased transmission. This strategy has not yet been fully accepted or operationalized in many health care settings. Methods We implemented routine opt-out HIV and HCV testing for all inpatients using internal medicine resident and nurse driven screening models. Patients were eligible for each test if they had not been tested within 1 year and were not known to be infected. Residents were educated on rationale and protocols for routine opt out testing via one grand rounds lecture (January 2016) and one residency orientation lecture (August 2016). Between March and November 2016, residents were incentivized with gift cards awarded for most tests ordered. Nurses were educated through targeted forums. Instructions were distributed and placed in high traffic areas and HIV 1/2 fourth-generation Ag-Ab and HCV Ab orders were added to admission order sets. Patients were given a chance to decline after routine opt-out testing was offered and educational brochure provided, in accordance with Maryland law. Positive tests were confirmed using Western Blot initially, later changed to HIV 1/2 differentiation assay; HCV was confirmed with HCV RNA. Those with confirmed infection were linked to care. Results 71% of 3814 and 83% of 2219 eligible patients were tested for HIV and HCV; 54 (2%) and 390 (21%) were diagnosed with HIV and HCV respectively (Figure 1). Testing activity averaged 32 HIV and 28 HCV tests per month from January to March 2016 and increased after the noted interventions to an average of 300 HIV and 247 HCV tests per month from January to March 2017. Conclusion A high disease burden was found within the studied population, highlighting the benefit of routine opt out testing for HIV and HCV. Empowering residents and nurses to offer screening at time of admission is a viable strategy to scale up testing in the inpatient setting. Disclosures All authors: No reported disclosures.

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NiAl precipitation in Fe-12w/o Cr-5w/o Ni-4w/o Al

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s042482010007480x ◽

1983 ◽

Vol 41 ◽

pp. 202-203

Author(s):

L.E. Murr ◽

J.S. Dunning ◽

S. Shankar

Keyword(s):

Solid Solution ◽

Stainless Steel ◽

Stainless Steels ◽

Alloy Composition ◽

Chromium Content ◽

Scale Up ◽

Optical Metallography ◽

Property Evaluation ◽

310 Stainless Steel ◽

Microstructural Studies

Aluminum additions to conventional 18Cr-8Ni austenitic stainless steel compositions impart excellent resistance to high sulfur environments. However, problems are typically encountered with aluminum additions above about 1% due to embrittlement caused by aluminum in solid solution and the precipitation of NiAl. Consequently, little use has been made of aluminum alloy additions to stainless steels for use in sulfur or H2S environments in the chemical industry, energy conversion or generation, and mineral processing, for example.A research program at the Albany Research Center has concentrated on the development of a wrought alloy composition with as low a chromium content as possible, with the idea of developing a low-chromium substitute for 310 stainless steel (25Cr-20Ni) which is often used in high-sulfur environments. On the basis of workability and microstructural studies involving optical metallography on 100g button ingots soaked at 700°C and air-cooled, a low-alloy composition Fe-12Cr-5Ni-4Al (in wt %) was selected for scale up and property evaluation.

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