scholarly journals People who inject drugs in metropolitan Chicago: A meta-analysis of data from 1997-2017 to inform interventions and computational modeling toward hepatitis C microelimination

PLoS ONE ◽  
2022 ◽  
Vol 17 (1) ◽  
pp. e0248850
Author(s):  
Basmattee Boodram ◽  
Mary Ellen Mackesy-Amiti ◽  
Aditya Khanna ◽  
Bryan Brickman ◽  
Harel Dahari ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Computational Models ◽  
People Who Inject Drugs ◽  
Meta Analysis ◽  
Graph Model ◽  
The United States ◽  
World Health ◽  
Structural Level ◽  
Random Graph Model ◽  
Synthetic Population

Progress toward hepatitis C virus (HCV) elimination in the United States is not on track to meet targets set by the World Health Organization, as the opioid crisis continues to drive both injection drug use and increasing HCV incidence. A pragmatic approach to achieving this is using a microelimination approach of focusing on high-risk populations such as people who inject drugs (PWID). Computational models are useful in understanding the complex interplay of individual, social, and structural level factors that might alter HCV incidence, prevalence, transmission, and treatment uptake to achieve HCV microelimination. However, these models need to be informed with realistic sociodemographic, risk behavior and network estimates on PWID. We conducted a meta-analysis of research studies spanning 20 years of research and interventions with PWID in metropolitan Chicago to produce parameters for a synthetic population for realistic computational models (e.g., agent-based models). We then fit an exponential random graph model (ERGM) using the network estimates from the meta-analysis in order to develop the network component of the synthetic population.

scholarly journals A meta-analysis of 20 years of data on people who inject drugs in metropolitan Chicago to inform computational modeling

2021 ◽  
Author(s):  
Basmattee Boodram ◽  
Mary Ellen Mackesy-Amiti ◽  
Aditya Khanna ◽  
Bryan Brickman ◽  
Harel Dahari ◽  
...  
Keyword(s):  
Computational Models ◽  
People Who Inject Drugs ◽  
Meta Analysis ◽  
Graph Model ◽  
The United States ◽  
Structural Level ◽  
Dynamic Component ◽  
Random Graph Model ◽  
Agent Based ◽  
Exponential Random Graph

Progress toward hepatitis C virus (HCV) elimination in the United States is not on track to meet targets, as injection drug use continues to drive increasing HCV incidence. Computational models are useful in understanding the complex interplay of individual, social, and structural level factors that might alter HCV incidence, prevalence, transmission, and disease progression. However, these models need to be informed with real socio-behavioral data. We conducted a meta-analysis of research studies spanning 20 years of research and interventions with people who inject drugs in metropolitan Chicago to produce parameters for a synthetic population for a computational model. We then fit an exponential random graph model (ERGM) using the network estimates from the meta-analysis in order to develop the dynamic component of a realistic agent-based model.

scholarly journals 1065. Hepatitis C Virus Care Cascade Assessment–One Step Closer to Micro-Elimination

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S561-S562
Author(s):  
Jehan F Chowdhury ◽  
Anna Winston ◽  
Tanya Zeina ◽  
Hong Gi Shim ◽  
Tine Vindenes
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Drug Use ◽  
Sustained Viral Response ◽  
The United States ◽  
World Health ◽  
Viral Response ◽  
Care Cascade ◽  
Care Gaps ◽  
Hcv Antibody

Abstract Background Hepatitis C virus (HCV) is a leading cause of advanced liver disease and death. In the United States about 3.5 million people are living with HCV, but only 50% are aware of the infection, 16% are prescribed treatment, and only 9% achieve sustained viral response. The World Health Organization published an HCV elimination goal for 2030 that strives to achieve a 65% reduction in HCV-related deaths and 90% reduction in transmission. An important step toward this goal is micro-elimination at local hospitals by addressing care gaps in the HCV care cascade. Figure 1 Methods We created a retrospective cohort of patients who tested positive for HCV antibody (HCV Ab+) between 2016 and 2018 at Tufts Medical Center in Boston, Massachusetts. We assessed achievement of care cascade steps including HCV viral load (VL) testing, linkage to care, treatment initiation, and sustained viral response (SVR). We also assessed patient demographics, clinical factors and HCV risk factors. We used STATA/IC 14.1 to conduct bivariate analysis to identify factors associated with loss to follow-up across each care cascade step. Results A total of 24,308 HCV antibody tests were done during this timeframe, of which 5% (n=1,222) were HCV Ab+. After excluding duplicate tests, 1,041 unique patients with HCV Ab+ were included. This cohort had a mean age of 47 years and were 61% male, 66% white, 72% on public insurance, 12% HIV-positive, 13% HCV treatment-experienced. The most frequent HCV risk factor was injection drug use, occurring in 64% of patients. Of patients with HCV Ab+, 76% (n=791) were tested for an HCV VL, of which 50% (n=393) had detectable VL and 50% (n=398) had undetectable VL. Of the patients with a detectable VL, 58% (n=226) were linked with care. Following care linkage, 69% (n=155) initiated treatment, of which 90% (n=139) completed treatment, of which 97% (n=135) achieved SVR (Figure 1). Factors that were significantly associated with getting a VL test and linking to care included private insurance, HIV co-infection, absence of intravenous drug use and cirrhosis; however, these factors were not significantly associated with achieving subsequent steps. Conclusion Assessment of the HCV care cascade at our hospital allowed us to identify clear care gaps and areas needing improvement towards a local micro-elimination. Disclosures All Authors: No reported disclosures

scholarly journals A comparative analysis of world health systems and Covid-19

2021 ◽  
Vol 38 (2) ◽  
pp. 115-120
Author(s):  
Ayşe İKİNCİ KELEŞ ◽  
Gökhan KELEŞ
Keyword(s):  
Health Systems ◽  
Social Life ◽  
Meta Analysis ◽  
Good Health ◽  
The United States ◽  
World Health ◽  
The Face ◽  
The Usa ◽  
Health Organization ◽  
Second Wave

Coronavirus disease 2019 (COVID-19), which causes severe airway problems, first emerged in the Chinese city of Wuhan. The virus led to a pandemic that affected the entire world. COVID-19 affects not only health, but also economic and social life. The emergence of this pandemic has led to health systems across the world being questioned. The aim of this study was to assess the adequacy of world health systems in the face of this pandemic. Twelve countries were selected and analyzed in the study. The choice of these countries was determined by the number of COVID-19 cases and deaths. Information concerning health systems and COVID-19 was obtained from Organization for Economic Co-operation and Development 2018, World Health Organization 2020 and Deep Knowledge Group data and was subjected to statistical analysis. According to the analysis, the country with the highest investment in health expenditures is the United States (10586 US dollars/capita), and Germany stands out as the best in health services. Another finding is the first and second wave of COVID-19 was identified as the USA with the highest case and death rate (First wave cases 1.942.363 and deaths 110.514; second wave cases at 7.419.230 and deaths 2.09.450). As a result of the meta-analysis, it is revealed that only socio-economic power is not enough, countries with good health systems are more successful in the pandemic. In addition, the analysis once again reveal how important health systems are in the face of such a pandemic.

Outcomes of Treatment for Hepatitis C in Primary Care, Compared to Hospital-based Care: A Randomized, Controlled Trial in People Who Inject Drugs

2019 ◽  
Vol 70 (9) ◽  
pp. 1900-1906 ◽  
Author(s):  
Amanda J Wade ◽  
Joseph S Doyle ◽  
Edward Gane ◽  
Catherine Stedman ◽  
Bridget Draper ◽  
...  
Keyword(s):  
Primary Care ◽  
Hepatitis C ◽  
People Who Inject Drugs ◽  
Controlled Trial ◽  
Standard Of Care ◽  
Virologic Response ◽  
World Health ◽  
Specialist Care ◽  
Treatment Uptake ◽  
Historical Controls

Abstract Background To achieve the World Health Organization hepatitis C virus (HCV) elimination targets, it is essential to increase access to direct-acting antivirals (DAAs), especially among people who inject drugs (PWID). We aimed to determine the effectiveness of providing DAAs in primary care, compared with hospital-based specialist care. Methods We randomized PWID with HCV attending primary care sites in Australia or New Zealand to receive DAAs at their primary care site or local hospital (standard of care [SOC]). The primary outcome was to determine whether people treated in primary care had a noninferior rate of sustained virologic response at Week 12 (SVR12), compared to historical controls (consistent with DAA trials at the time of the study design); secondary outcomes included comparisons of treatment initiation, SVR12 rates, and the care cascade by study arm. Results We recruited 140 participants and randomized 136: 70 to the primary care arm and 66 to the SOC arm. The SVR12 rate (100%, 95% confidence interval [CI] 87.7–100) of people treated in primary care was noninferior when compared to historical controls (85% assumed). An intention-to-treat analysis revealed that the proportion of participants commencing treatment in the primary care arm (75%, 43/57) was significantly higher than in the SOC arm (34%, 18/53; P < .001; relative risk [RR] 2.48, 95% CI 1.54–3.95), and the proportion of participants with SVR12 was significantly higher in the primary care arm, compared to in the SOC arm (49% [28/57] and 30% [16/53], respectively; P = .043; RR 1.63, 95% CI 1.0–2.65). Conclusions Providing HCV treatment in primary care increases treatment uptake and cure rates. Approaches that increase treatment uptake among PWID will accelerate elimination strategies. Clinical Trials Registration NCT02555475.

scholarly journals Estimating the Number of Persons Who Inject Drugs in the United States by Meta-Analysis to Calculate National Rates of HIV and Hepatitis C Virus Infections

PLoS ONE ◽  
2014 ◽  
Vol 9 (5) ◽  
pp. e97596 ◽  
Author(s):  
Amy Lansky ◽  
Teresa Finlayson ◽  
Christopher Johnson ◽  
Deborah Holtzman ◽  
Cyprian Wejnert ◽  
...  
Keyword(s):  
United States ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Meta Analysis ◽  
The United States ◽  
Virus Infections ◽  
Persons Who Inject Drugs

scholarly journals The global burden of tuberculous meningitis in adults: A modelling study

2021 ◽  
Vol 1 (12) ◽  
pp. e0000069
Author(s):  
Peter J. Dodd ◽  
Muhammad Osman ◽  
Fiona V. Cresswell ◽  
Anna M. Stadelman ◽  
Nguyen Huu Lan ◽  
...  
Keyword(s):  
Tuberculous Meningitis ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Case Fatality ◽  
The United States ◽  
World Health ◽  
People Living With Hiv ◽  
Surveillance Systems ◽  
Incidence And Mortality ◽  
Health Organization

Tuberculous meningitis (TBM) is the most lethal form of tuberculosis. The incidence and mortality of TBM is unknown due to diagnostic challenges and limited disaggregated reporting of treated TBM by existing surveillance systems. We aimed to estimate the incidence and mortality of TBM in adults (15+ years) globally. Using national surveillance data from Brazil, South Africa, the United Kingdom, the United States of America, and Vietnam, we estimated the fraction of reported tuberculosis that is TBM, and the case fatality ratios for treated TBM in each of these countries. We adjusted these estimates according to findings from a systematic review and meta-analysis and applied them to World Health Organization tuberculosis notifications and estimates to model the global TBM incidence and mortality. Assuming the case detection ratio (CDR) for TBM was the same as all TB, we estimated that in 2019, 164,000 (95% UI; 129,000–199,000) adults developed TBM globally; 23% were among people living with HIV. Almost 60% of incident TBM occurred in males and 20% were in adults 25–34 years old. 70% of global TBM incidence occurred in Southeast Asia and Africa. We estimated that 78,200 (95% UI; 52,300–104,000) adults died of TBM in 2019, representing 48% of incident TBM. TBM case fatality in those treated was on average 27%. Sensitivity analysis assuming improved detection of TBM compared to other forms of TB (CDR odds ratio of 2) reduced estimated global mortality to 54,900 (95% UI; 32,200–77,700); assuming instead worse detection for TBM (CDR odds ratio of 0.5) increased estimated mortality to 125,000 (95% UI; 88,800–161,000). Our results highlight the need for improved routine TBM monitoring, especially in high burden countries. Reducing TBM incidence and mortality will be necessary to achieve the End TB Strategy targets.

scholarly journals Cost-effectiveness of Hepatitis C Virus Treatment Models for People Who Inject Drugs in Opioid Agonist Treatment Programs

2019 ◽  
Vol 70 (7) ◽  
pp. 1397-1405 ◽  
Author(s):  
Sarah Gutkind ◽  
Bruce R Schackman ◽  
Jake R Morgan ◽  
Jared A Leff ◽  
Linda Agyemang ◽  
...  
Keyword(s):  
Hepatitis C Virus ◽  
Cost Effectiveness ◽  
Hepatitis C ◽  
People Who Inject Drugs ◽  
Lifetime Cost ◽  
The United States ◽  
Healthcare Sector ◽  
Individual Treatment ◽  
Hcv Treatment ◽  
Treatment Models

AbstractBackgroundMany people who inject drugs in the United States have chronic hepatitis C virus (HCV). On-site treatment in opiate agonist treatment (OAT) programs addresses HCV treatment barriers, but few evidence-based models exist.MethodsWe evaluated the cost-effectiveness of HCV treatment models for OAT patients using data from a randomized trial conducted in Bronx, New York. We used a decision analytic model to compare self-administered individual treatment (SIT), group treatment (GT), directly observed therapy (DOT), and no intervention for a simulated cohort with the same demographic characteristics of trial participants. We projected long-term outcomes using an established model of HCV disease progression and treatment (hepatitis C cost-effectiveness model: HEP-CE). Incremental cost-effectiveness ratios (ICERs) are reported in 2016 US$/quality-adjusted life years (QALY), discounted 3% annually, from the healthcare sector and societal perspectives.ResultsFor those assigned to SIT, we projected 89% would ever achieve a sustained viral response (SVR), with 7.21 QALYs and a $245 500 lifetime cost, compared to 22% achieving SVR, with 5.49 QALYs and a $161 300 lifetime cost, with no intervention. GT was more efficient than SIT, resulting in 0.33 additional QALYs and a $14 100 lower lifetime cost per person, with an ICER of $34 300/QALY, compared to no intervention. DOT was slightly more effective and costly than GT, with an ICER > $100 000/QALY, compared to GT. In probabilistic sensitivity analyses, GT and DOT were preferred in 91% of simulations at a threshold of <$100 000/QALY; conclusions were similar from the societal perspective.ConclusionsAll models were associated with high rates of achieving SVR, compared to standard care. GT and DOT treatment models should be considered as cost-effective alternatives to SIT.

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