scholarly journals On-site testing and case management to improve hepatitis C care in drug users: a prospective, longitudinal, multicenter study in the DAA era

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Dana Busschots ◽  
Rob Bielen ◽  
Özgür M. Koc ◽  
Leen Heyens ◽  
Eefje Dercon ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Case Management ◽  
Multicenter Study ◽  
Treatment Initiation ◽  
Care Center ◽  
Linkage To Care ◽  
Hcv Infection ◽  
Care Model ◽  
Care Cascade ◽  
Addiction Care

Abstract Background Screening and treatment of hepatitis C virus (HCV) infection in people who use drugs (PWUD) remains insufficient. Reducing the burden of HCV infection in PWUD requires interventions focusing on the different steps of the HCV care cascade. Methods We performed a prospective, multicenter study, evaluating the impact of an HCV care model on the HCV care cascade among PWUD attending an addiction care center in Belgium between 2015 and 2018. Interventions within the care model consisted of pre-test counseling, on-site HCV screening and case management services. A multiple logistic regression model was performed to identify the independent factors influencing the outcomes. Results During the study period, 441 PWUD were registered at the addiction care center, 90% (395/441) were contacted, 88% (349/395) were screened for HCV infection. PWUD were more likely to be screened if they had ever injected drugs (p < .001; AOR 6.411 95% CI 3.464–11.864). In 45% (157/349), the HCV antibody (Ab) test was positive, and in 27% (94/349) HCV RNA was positive. Within the Belgian reimbursement criteria (fibrosis stage ≥ F2), 44% (41/94) were treated. Specialist evaluation at the hospital was lower for PWUD receiving decentralized opioid agonist therapy (p = .005; AOR 0.430 95% CI 0.005–0.380), PWUD with unstable housing in the past 6 months before inclusion (p = .015; AOR 0.035 95% CI 0.002–0.517) or if they were recently incarcerated (p = .001; AOR 0.010 95% CI 0.001–0.164). Conclusions This HCV care model demonstrated high screening, linkage to care, and treatment initiation among PWUD in Belgium. Using the cascade of care to guide interventions is easy and necessary to monitor results. This population needs guidance, not only for screening and treatment initiation but also for the long-term follow-up since one in six had cirrhosis and could develop hepatocellular carcinoma. Further interventions are necessary to increase linkage to care and treatment initiation. Universal access to direct-acting antiviral therapy from 2019 will contribute to achieving HCV elimination in the PWUD population. Trial registration Clinical trial registration details: www.clinicaltrials.gov (NCT03106194).

scholarly journals 297. Accessible Care Intervention for Engaging People Who Inject Illicit Drugs in Hepatitis C Virus Care: Preliminary Results from a Randomized Clinical Trial

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S161-S161
Author(s):  
Benjamin Eckhardt ◽  
Yesenia Aponte-Meledez ◽  
Chunki Fung ◽  
Shashi Kapadia ◽  
La Davis ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Hepatitis C ◽  
Usual Care ◽  
Randomized Clinical Trial ◽  
Illicit Drugs ◽  
Treatment Initiation ◽  
Linkage To Care ◽  
Hcv Rna ◽  
Service Program ◽  
Care Intervention

Abstract Background To achieve hepatitis C elimination, treatment programs need to be developed to engage, treat, and cure people who are actively injecting drugs. Methods We present preliminary data from the first 65 participants in the Accessible Care intervention for engaging people who inject illicit drugs (PWID) in hepatitis C (HCV) care. The randomized clinical trial compares the effectiveness of Accessible Care (low-threshold care in a syringe service program located in New York City) with Usual Care (referral to existing services) in facilitating linkage, engagement, and retention in HCV care. Eligible participants were HCV RNA positive and had injected drugs in the past 90 days. We compared the percentage of participants in each arm linked to HCV care (defined as one visit with HCV treatment provider), and initiated direct-acting antiviral (DAA) treatment within 6 months of enrollment. Results Among the 65 participants, the mean age is 41.2 years; 28% are females; 73% homeless; 6% black, 51% Latina/o and 39% white. 82% of participants had injected drugs in the last 30 days, with an average of 13.2 injections/month (median 10). Nearly all participants had health insurance, 88% public insurance, 6% uninsured. Thirty-two participants were randomized to the Accessible Care arm. Within 6 months of enrollment 79% of the Accessible Care arm and 25% of the Usual Care arm had linked to HCV care, and 69% and 13% had been started on DAA therapy, respectively. Of the 26 participants in the Accessible Care arm started on DAA therapy, the median time from enrollment to treatment initiation was 87.5 days [range 22–180]. Conclusion Among HCV-infected PWID enrolled at a syringe service program, higher rates of linkage to care and treatment initiation were seen in the Accessible Care arm where stigma- and shame-free treatment was located within a community-based location. Disclosures All authors: No reported disclosures.

The Role the Type of Vascular Access Plays in the Transmission of Hepatitis C Virus in a High Prevalence Hemodialysis Unit

2002 ◽  
Vol 3 (4) ◽  
pp. 158-163 ◽  
Author(s):  
A.K. Saxena ◽  
B.R. Panhotra ◽  
D.S. Sundaram
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Vascular Access ◽  
Blood Circulation ◽  
Reference Group ◽  
Care Center ◽  
Seroconversion Rate ◽  
Tertiary Care ◽  
Hcv Infection ◽  
Hcv Prevalence

Background The necessity of having a vascular access site as well as extracorporeal blood circulation, may add to the risk for patients being dialyzed in units with high HCV prevalence of acquiring hepatitis C virus (HCV) infection. This study endeavors to determine the role the type of vascular access plays in the transmission of HCV infection in the hemodialysis (HD) unit of a Middle Eastern country. Methods The records of 198 patients with end-stage renal disease (ESRD) enrolled on maintenance HD from November 1995 to November 2000 at this tertiary care center, were retrospectively reviewed to match the HCV prevalence and seroconversion rates among patients groups being dialyzed through various types of vascular accesses. Factors such as, number of units of blood transfused and dialytic age (time-span since the initiation of the HD treatment), implicated in transmission of HCV infection in HD units, were also recorded, and compared among these cohorts. Results The overall, high HCV seroprevalence of 43.4% (86/198) and annual seroconversion rate of 8.6% per year were recorded. Patients with arteriovenous fistula (AVF) documented peak anti-HCV prevalence [61.7% (63/102)] and annual seroconversion rates (12.3%) as compared to lowest prevalence of 12.9% (4/34) and seroconversion rate of 2.5%, observed among patients with permanent Catheters (PC). Patients dialyzed through polytetrafluoroethylene (PTFE) grafts recorded the next highest HCV prevalence of 47.8% (11/23) with seroconversion rate of 9.5% but temporary catheter (TC) group had HCV prevalence of 19% (8/42) and seroconversion rate of 3.8% [Odd Ratio (OR)-1.58, 95% Confidence Interval (CI) (0.37–7.12), p-NS]. Conclusions Considerably higher annual seroconversion rates in AVF [OR-10.90, 95% CI (3.2–40.0), p<0.0001] and PTFE [OR-5.71, 95% CI (1.31–26.79), p<0.016)] groups, appear to suggest that the patients being dialyzed through AVF and PTFE, carried significantly higher risk of acquisition of HCV infection compared to those dialyzed through TC and PC (reference group). This could possibly be attributed to likely accessibility of HCV to blood circulation due to possible breakdown of standard infection control precautions during repeated punctures and cannulations of AVF and PTFE to perform a HD, in a unit with high baseline HCV prevalence.

scholarly journals Comorbidities and concomitant medications in patients with chronic hepatitis C virus infection receiving second-generation direct-acting antiviral regimens in Belgium : an observational study

2021 ◽  
Vol 84 (1) ◽  
pp. 33-41
Author(s):  
S Bourgeois ◽  
JP Mulkay ◽  
M Cool ◽  
X Verhelst ◽  
G Robaeys ◽  
...  
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Concomitant Medication ◽  
Second Generation ◽  
Treatment Initiation ◽  
Primary Objective ◽  
Hcv Infection ◽  
Direct Acting Antiviral ◽  
Concomitant Medications ◽  
Direct Acting

Objective : To describe comorbidities and concomitant medications in patients initiating treatment for hepatitis C virus (HCV) infection with direct-acting antiviral (DAA) regimens in Belgium. Methods : This was a noninterventional, observational, multi-center study of data from patient charts. Adult patients with HCV infection receiving second-generation DAA therapy were included. Comorbidities were assessed at the time of HCV treatment initiation. Concomitant medications were recorded at the time of diagnosis and at treatment initiation. Potential clinically relevant drug-drug interactions (DDIs) were assessed based on information available at www.hep-druginteractions.org.The primary objective was to describe concomitant medication use ; secondary objectives were to describe modifications in concomitant therapies and comorbidities. Results : 405 patients were included. A total of 956 comorbidities were reported by 362 patients (median, 2 ; range, 0-15). The most common comorbidities were hypertension (27.2%) ; HIV coinfection (22.5%), and type 2 diabetes mellitus (14.3%). Overall, 1455 concomitant medications were being taken by 365 patients (90.1% ; median, 3 ; range 0-16). The most common concomitant medications were psycholeptics (28.6%), antiviral agents (24.2%), and medications for acid-related disorders (21.0%) Overall, 74/365 (20.3%) patients receiving a concomitant medication required an adaptation to their concomitant medication. The medications that most frequently required change were drugs for acid-related disorders (n = 14) and antiviral drugs (n = 5) ; those that were most frequently stopped were lipid-modifying drugs (n = 25) and drugs for acid-related disorders (n = 13). Conclusion : Physicians are aware of the potential for DDIs with DAAs, but improved alignment between clinical practice and theoretical recommendations is required. (Acta gastroenterol. belg., 2021, 84, 33-41).

Pragmatic Experience with Risk-based versus Universal Hepatitis C Screening in Pregnancy: Detection of Infection and Postpartum Linkage to Care

2021 ◽  
Author(s):  
Elisa T. Bushman ◽  
Lakshmi Subramani ◽  
Aalok Sanjanwala ◽  
Jodie Dionne-Odom ◽  
Ricardo Franco ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Pregnant Women ◽  
Universal Screening ◽  
Task Force ◽  
Care Center ◽  
Tertiary Care ◽  
Linkage To Care ◽  
Hcv Rna ◽  
Hcv Screening ◽  
In Pregnancy

Objective Despite the Centers for Disease Control and Prevention (CDC) and U.S. Preventive Services Task Force (USPSTF) recommending universal hepatitis C virus (HCV) screening in pregnancy Society for Maternal-Fetal Medicine (SMFM) and American College of Obstetricians and Gynecologists (ACOG) continue to endorse risk-based screening for HCV in pregnancy. We hypothesized that universal screening is associated with increased HCV diagnosis and postpartum linkage to HCV care compared with risk-based screening. Study Design This retrospective cohort study included pregnant women screened for HCV at a single tertiary-care center. We defined two cohorts: women managed with risk-based (January 2014–October 2016) or universal HCV screening (November 2016–December 2018). Screening was performed with ELISA antibody testing and viremia confirmed with HCV ribonucleic acid (RNA) polymerase chain reaction (PCR). Primary outcomes were the rate of HCV screen positivity and postpartum linkage to care. Results From 2014 to 2018, 16,489 women delivered at our institution, of whom 166 screened positive for HCV. A total of 7,039 pregnant women were screened for HCV: 266 with risk-based and 6,773 with universal screening; 29% (76/266) were positive HCV antibody screening (HCVAb + ) in the risk-based cohort and 1.3% (90/6,773) in the universal cohort. HCVAb+ women in the risk-based cohort were more likely to have a positive drug screen. Only 69% (62/90) of HCVAb+ women in the universal cohort met the criteria for risk-based testing. Of the remaining 28 women, 6 (21%) had active viremia (HCV RNA+). Of the 166 HCVAb+ women, 64% (103/166) were HCV RNA+—51 of 266 (19%) in the risk-based and 52 of 6,773 (0.8%) in the universal cohort. Of HCVAb+ women, 75% (125/166) were referred postpartum for HCV evaluation and 27% (34/125) were linked to care. Only 9% (10/103) of women with viremia initiated treatment within 1 year of delivery. Conclusion Universal HCV screening in pregnancy identified an additional 31% of HCVAb+ women compared with risk-based screening. Given low rates of HCV follow-up and treatment regardless of screening modality, further studies are needed to address barriers to postpartum linkage to care. Key Points

scholarly journals Factors predicting staging and treatment initiation for patients with chronic hepatitis C infection: insurance a key predictor

2021 ◽  
Author(s):  
Janet Lin ◽  
Cammeo Mauntel-Medici ◽  
Anjana Bairavi Maheswaran ◽  
Sara Baghikar ◽  
Oksana Pugach ◽  
...  
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis C ◽  
Liver Fibrosis ◽  
Chronic Hepatitis C ◽  
Treatment Initiation ◽  
Cox Regression ◽  
Hcv Infection ◽  
Inpatient Setting ◽  
Hepatitis C Infection ◽  
Chronic Hcv

Abstract Background Chronic hepatitis C (HCV) infection affects over 2.4 million Americans and accounts for 18 000 deaths per year. Treatment initiation in this population continues to be low even after introduction of highly effective and shorter duration direct-acting antivirals. This study assesses factors that influence key milestones in the HCV care continuum. Methods Retrospective time-to-event analyses were performed to assess factors influencing liver fibrosis staging and treatment initiation among individuals confirmed with chronic HCV infection at University of Illinois Hospital and Health Sciences System between 1 August 2015 and 24 October 2016 and followed through 28 January 2018. Cox regression models were utilized for multivariable analyses. Results Individuals tested at the liver clinic (hazard ratio [HR] = 2.03; 95% confidence interval [CI]: 1.19–3.46) and at the federally qualified health center (HR = 3.51; 95% CI: 2.19–5.64) had higher instantaneous probability of being staged compared with individuals tested at the emergency department (ED) or inpatient setting. And probability of treatment initiation increased with advancing liver fibrosis especially for Medicaid beneficiaries (HR = 1.64; 95% CI: 1.35–1.99). Conclusions The study demonstrates a need for improving access for patients with early stages of the disease in order to reduce HCV-related morbidity and mortality, especially those tested at nontraditional care locations such as the ED or the inpatient setting.

scholarly journals Hepatitis C virus screening of high-risk patients in a community hospital emergency department: Retrospective review of patient characteristics and future implications

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0252976
Author(s):  
Ji Seok Park ◽  
Judy Wong ◽  
Hillary Cohen
Keyword(s):  
Hepatitis C ◽  
Tobacco Use ◽  
Screening Test ◽  
Linkage To Care ◽  
Hcv Infection ◽  
Hcv Rna ◽  
Spontaneous Clearance ◽  
History Of ◽  
Chronic Hcv Infection ◽  
Chronic Hcv

Background Chronic hepatitis C virus infection (HCV) is a common infectious disease that affects more than 2.7 million people in the US. Because the emergency department (ED) can present an ideal opportunity to screen patients who may not otherwise get routine screening, we implemented a risk-based screening program for ED patients and established a system to facilitate linkage to care. Methods and findings A risk-based screening algorithm for HCV was programmed to trigger an alert in Epic electronic medical record system. Patients identified between August 2018 and April 2020 in the ED were tested for HCV antibody reflex to HCV RNA. Patients with a positive screening test were contacted for the confirmatory test result and to establish medical care for HCV treatment. Patient characteristics including age, sex, self-awareness of HCV infection, history of previous HCV treatment, history of opioids use, history of tobacco use, and types of insurance were obtained. A total of 4,525 patients underwent a screening test, of whom 131 patients (2.90%) were HCV antibody positive and 43 patients (0.95%) were HCV RNA positive, indicating that only 33% of patients with positive screening test had chronic HCV infection. The rate of chronic infection was higher in males as compared to females (1.34% vs 0.60%, p = 0.01). Patients with history of opioid use or history of tobacco use were found to have a lower rate of spontaneous clearance than patients without each history (opioids: 48.6% vs 72.0%, p = 0.02; tobacco: 56.6% vs 80.5%, p = 0.01). Among 43 patients who were diagnosed with chronic hepatitis C, 26 were linked to a clinical setting that can address chronic HCV infection, with linkage to care rate of 60.5%. The most common barrier to this was inability to contact patients after discharge from the ED. Conclusions A streamlined EMR system for HCV screening and subsequent linkage to care from the ED can be successfully implemented. A retrospective review suggests that male sex is related to chronic HCV infection, and history of opioid use or history of tobacco use is related to lower HCV spontaneous clearance.

scholarly journals Initiation of Hepatitis C treatment in two rural Rwandan districts: A mobile clinic approach

2020 ◽  
Author(s):  
Innocent Kamali ◽  
Dale Barnhart ◽  
Francoise Nyirahabihirwe ◽  
Jean de la Paix Gakuru ◽  
Mariam Uwase ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Mass Screening ◽  
Laboratory Tests ◽  
Treatment Initiation ◽  
Linkage To Care ◽  
Standard Of Care ◽  
Health Facilities ◽  
Mobile Clinic ◽  
Primary Level ◽  
The Cost

Abstract Background: To eliminate hepatitis C, Rwanda is conducting national mass screenings and providing hepatitis C patients with free access to Direct Acting Antivirals (DAAs). Until 2020, all prescribers trained and authorized to initiate DAA treatment were based at District Hospitals, and access to DAAs remains expensive and geographically difficult for rural patients. We designed and implemented a mobile hepatitis clinic to provide DAA treatment initiation at primary-level health facilities among hepatitis C patients identified through mass screening campaigns in rural Kirehe and Kayonza districts. Methods: The mobile clinic team was composed of one clinician trained and authorized to manage hepatitis, one lab technician, and one driver. Eligible patients received same-day clinical consultations, counselling, laboratory tests and DAA initiation. Using clinical databases, registers, and program records, we compared the number of patients who initiated DAA treatment before and during the mobile clinic campaign. We assessed linkage to care during the mobile clinical campaign and assessed predictors of linkage to care. We also estimated the cost per patient of providing mobile services and the reduction in out-of-pocket costs associated with accessing DAA treatment through the mobile clinic rather than the standard of care.Results: Prior to the mobile clinic, only 408 patients in Kirehe and Kayonza had been initiated on DAAs over a 25-month period. Between November 2019 and January 2020, out of 661 eligible patients with chronic hepatitis C, 429 (64.9%) were linked to care through the mobile clinic. Having a telephone number and complete address recorded at screening were strongly associated with linkage to care. The cost per patient of the mobile clinic program was 29.36 USD, excluding government-provided DAAs. Providing patients with same-day laboratory tests and clinical consultation at primary-level health facilities reduced out-of-pocket expenses by 9.88 USD. Conclusion: The mobile clinic model was a feasible strategy for providing rapid treatment initiation among hepatitis C patients identified through a mass screening campaign. Compared to the standard of care, mobile clinics reached more patients in a much shorter time. This low-cost strategy also reduced out-of-pocket expenditures among patients. However, long-term, sustainable care would require decentralization to the primary health-center level.

Interventions to increase testing, linkage to care and treatment of hepatitis C virus (HCV) infection among people in prisons: A systematic review

2018 ◽  
Vol 57 ◽  
pp. 95-103 ◽  
Author(s):  
Nadine Kronfli ◽  
Blake Linthwaite ◽  
Fiona Kouyoumdjian ◽  
Marina B. Klein ◽  
Bertrand Lebouché ◽  
...  
Keyword(s):  
Systematic Review ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Linkage To Care ◽  
Hcv Infection ◽  
Care And Treatment

scholarly journals 2899. Decreased Hepatitis C Virus-Associated Mortality in the US 2014–2017 After New Oral Direct-Acting Antiviral Era

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S82-S83
Author(s):  
Zainab Wasti ◽  
Dagan Coppock ◽  
Edgar Chou ◽  
Dong Heun Lee
Keyword(s):  
United States ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Linkage To Care ◽  
The United States ◽  
Ease Of Use ◽  
Hcv Infection ◽  
Race And Gender ◽  
Direct Acting Antiviral ◽  
Direct Acting

Abstract Background Due to the ease of use and low side effect profile of new direct-acting antivirals (DAA), cure rates for hepatitis C virus (HCV) infection have increased in recent years. However, limited data exist addressing the mortality associated with HCV infection since the advent of DAAs. This study examines multiple-cause-of-death (MCOD) data from 2014 to 2017 to describe changes in HCV-associated mortality in the United States. Methods We examined death certificate information from public use MCOD data obtained from the National Center for Health Statistics. All-cause mortality associated with HCV, as defined by ICD-10 codes (B17.1 and B18.2), was evaluated. The age-adjusted crude mortality rate was calculated. Overall HCV-associated mortality, stratified by race and gender, was analyzed. Results From 2014 to 2017, the number of deaths associated with HCV, as listed in death certificates decreased from 19,613 to 17,253. This represents an average of 4% decrease in mortality each year. Crude age-adjusted mortality decreased from 5.01 (95% CI 4.93–5.08) deaths per 100,000 people in 2014 to 4.13 (95% CI 4.07–4.20) deaths per 100,000 people in 2017. Males had age-adjusted mortality of 6.82 (95% CI 6.76–6.88) and females had age-adjusted mortality of 2.59 (95% CI 2.55–2.63). African Americans had age-adjusted mortality of 7.50 (95% CI 7.37–7.63), and whites had age-adjusted mortality of 4.39 (95% CI 4.35–4.42) during the three-year period. Conclusion After the introduction of DAAs in 2014, mortality associated with HCV significantly decreased in the United States. There were differences in mortality rates by gender and race, which may reflect differences in HCV seroprevalence. With the availability of effective, well-tolerated HCV treatment, aggressive HCV screening and linkage to care is warranted, especially in high-risk populations. Disclosures All Authors: No reported Disclosures.

scholarly journals Screening, Linkage to Care and Treatment of Hepatitis C Infection in Primary Care Setting in the South of Italy

Life ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. 359
Author(s):  
Anna Citarella ◽  
Simona Cammarota ◽  
Francesca F. Bernardi ◽  
Carmine Coppola ◽  
Maria D’Antò ◽  
...  
Keyword(s):  
Primary Care ◽  
Hepatitis C ◽  
High Risk ◽  
Care Setting ◽  
Primary Care Setting ◽  
Linkage To Care ◽  
Case Finding ◽  
Hcv Infection ◽  
Newly Diagnosed ◽  
Care And Treatment

Hepatitis C virus (HCV) infection remains a pressing public health issue. Our aim is to assess the linkage to care of patients with HCV diagnosis and to support the proactive case-finding of new HCV-infected patients in an Italian primary care setting. This was a retrospective cohort study of 44 general practitioners (GPs) who managed 63,955 inhabitants in the Campania region. Adults with already known HCV diagnosis or those with HCV high-risk profile at June 2019 were identified and reviewed by GPs to identify newly diagnosed of HCV and to assess the linkage to care and treatment for the HCV patients. Overall, 698 HCV patients were identified, 596 with already known HCV diagnosis and 102 identified by testing the high-risk group (2614 subjects). The 38.8% were already treated with direct-acting antivirals, 18.9% were referred to the specialist center and 42.3% were not sent to specialist care for treatment. Similar proportions were found for patients with an already known HCV diagnosis and those newly diagnosed. Given that the HCV infection is often silent, case-finding needs to be proactive and based on risk information. Our findings suggested that there needs to be greater outreach, awareness and education among GPs in order to enhance HCV testing, linkage to care and treatment.

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