The hepatitis C epidemic in Canada: An overview of recent trends in surveillance, injection drug use, harm reduction and treatment

Hepatitis C continues to be a significant public health concern in Canada, with the hepatitis C virus (HCV) responsible for more life-years lost than all other infectious diseases in Canada. An increase in reported hepatitis C infections was observed between 2014 and 2018. Here, we present changing epidemiological trends and discuss risk factors for hepatitis C acquisition in Canada that may have contributed to this increase in reported hepatitis C infections, focusing on injection drug use. We describe a decrease in the use of borrowed needles or syringes coupled with an increase in using other used injection drug use equipment. Also, an increased prevalence of injection drug use and use of prescription opioid and methamphetamine injection by people who inject drugs (PWID) may be increasing the risk of HCV acquisition. At the same time, while harm reduction coverage appears to have increased in Canada in recent years, gaps in access and coverage remain. We also consider how direct-acting antiviral (DAA) eligibility expansion may have affected hepatitis C rates from 2014 to 2018. Finally, we present new surveillance trends observed in 2019 and discuss how the coronavirus disease 2019 (COVID-19) pandemic may affect hepatitis C case counts from 2020 onwards. Continual efforts to i) enhance hepatitis C surveillance and ii) strengthen the reach, effectiveness, and adoption of hepatitis C prevention and treatment services across Canada are vital to reducing HCV transmission among PWID and achieving Canada’s HCV elimination targets by 2030.

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Adherence to Once-daily and Twice-daily Direct-acting Antiviral Therapy for Hepatitis C Infection Among People With Recent Injection Drug Use or Current Opioid Agonist Therapy

Clinical Infectious Diseases ◽

10.1093/cid/ciz1089 ◽

2019 ◽

Vol 71 (7) ◽

pp. e115-e124 ◽

Cited By ~ 6

Author(s):

Evan B Cunningham ◽

Behzad Hajarizadeh ◽

Janaki Amin ◽

Alain H Litwin ◽

Edward Gane ◽

...

Keyword(s):

Hepatitis C ◽

Drug Use ◽

Injection Drug Use ◽

Injection Drug ◽

Agonist Therapy ◽

Opioid Agonist ◽

Once Daily ◽

Direct Acting Antiviral ◽

Opioid Agonist Therapy ◽

Direct Acting

Abstract Background This study investigated adherence and associated factors among people with recent injection drug use (IDU) or current opioid agonist therapy (OAT) and compared once-daily to twice-daily hepatitis C virus (HCV) direct-acting antiviral (DAA) therapy. Methods SIMPLIFY and D3FEAT are international, multicenter studies that recruited participants with recent IDU (previous 6 months; SIMPLIFY, D3FEAT) or current OAT (D3FEAT) between March 2016 and February 2017 in 8 countries. Participants received sofosbuvir/velpatasvir (once daily; SIMPLIFY) or paritaprevir/ritonavir/ombitasvir, dasabuvir (twice daily) ± ribavirin (D3FEAT) for 12 weeks administered in electronic blister packs. We evaluated overall adherence (proportion of prescribed doses taken) and nonadherence (<90% adherent) between dosing patterns. Results Of 190 participants, 184 (97%) completed treatment. Median adherence was 92%, with higher adherence among those receiving once-daily vs twice-daily therapy (94% vs 87%, P = .005). Overall, 40% of participants (n = 76) were nonadherent (<90% adherent). Recent stimulant injecting (odds ratio [OR], 2.48 [95% confidence interval {CI}, 1.28–4.82]), unstable housing (OR, 2.18 [95% CI, 1.01–4.70]), and twice-daily dosing (OR, 2.81 [95% CI, 1.47–5.36]) were associated with nonadherence. Adherence decreased during therapy. Sustained virologic response was high in nonadherent (89%) and adherent populations (95%, P = .174), with no difference in SVR between those who did and did not miss 7 consecutive doses (92% vs 93%, P = .897). Conclusions This study demonstrated high adherence to once- and twice-daily DAA therapy among people with recent IDU or currently receiving OAT. Nonadherence described did not impact treatment outcomes, suggesting forgiveness to nonadherence.

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2895. Threats to Successful Elimination of Viral Hepatitis: Results from the Nationwide Treatment as Prevention for Hepatitis C (TraP HepC) Program in Iceland

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz359.173 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S81-S82

Author(s):

Magnus Gottfredsson ◽

Valgerdur Runarsdottir ◽

Thorvardur J Love ◽

Ragnheidur H Fridriksdottir ◽

Bryndis Sigurdardottir ◽

...

Keyword(s):

Hepatitis C ◽

Drug Use ◽

Injection Drug Use ◽

Addiction Treatment ◽

Antiviral Agents ◽

Injection Drug ◽

Treatment As Prevention ◽

Direct Acting Antiviral ◽

Unrestricted Access ◽

History Of

Abstract Background The main driver of the Hepatitis C virus (HCV) epidemic in most western countries is injection drug use (IDU) among people who inject drugs (PWID). Iceland has provided unrestricted access to direct-acting antiviral agents (DAA) to all HCV-infected patients in the country covered by national health insurance, by a program entitled Treatment as Prevention for Hepatitis C (TraP HepC) from 2016 and is on track to become among the first to achieve the WHO goals of eliminating HCV as a public health threat. Methods We analyzed data regarding testing for HCV, incidence of IDU, prevalence of HCV viremia among PWID, drug use in the community and trends in homelessness prior to and during the first 24 months of TraP HepC to monitor outcomes and identify new or persistent challenges. Results Intensity of nationwide testing for HCV increased by 22% in 2016, 60% in 2017, and 81% in 2018 compared with previous years (P < 0.001). During 2016–2018 the incidence of new injection drug use, as surveyed among those admitted for addiction treatment increased by 48%. The total number of PWID admitted annually with HCV viremia however remained relatively stable during the entire period (2010–2018). The prevalence of HCV viremia among people recently injecting drugs admitted for addiction treatment however dropped from 48.7% to 16.2% in 2017, and to 10.2% in 2018 (P < 0.001). Analysis of data regarding stimulant use, as measured by drug levels in wastewater shows an almost threefold increase of amphetamine and an eightfold increase in cocaine levels during 2016–2018 compared with 2015. Concurrently, the number of homeless has doubled. Two years into TraP HepC > 80% of the estimated total HCV-infected population were started on their first course of DAAs. By intention to treat analysis, the cure rate was 92.4% among patients without history of IDU in the past 6 months, compared with 82.9% among active IDU (P = 0.0006); those with history of recent IDU were more likely to discontinue (P < 0.0001). Homelessness carried the highest relative risk (RR) of treatment failure (RR = 2.4, P = 0.008), mostly due to discontinuation. Conclusion Iceland is on track to eliminate HCV, but challenges such as increasing drug use in the community and homelessness need to continuously monitored and addressed; they may jeopardize the success of elimination efforts. Disclosures All Authors: No reported Disclosures.

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Injection drug use and hepatitis C infection

PsycEXTRA Dataset ◽

10.1037/e414072008-001 ◽

2003 ◽

Author(s):

Kathryn Macomber ◽

Garry Goza

Keyword(s):

Hepatitis C ◽

Drug Use ◽

Injection Drug Use ◽

Injection Drug ◽

Hepatitis C Infection

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Harm reduction via online platforms for people who use drugs in Russia: a qualitative analysis of web outreach work

Harm Reduction Journal ◽

10.1186/s12954-020-00452-6 ◽

2020 ◽

Vol 17 (1) ◽

Author(s):

Arsen Davitadze ◽

Peter Meylakhs ◽

Aleksey Lakhov ◽

Elizabeth J. King

Keyword(s):

Drug Use ◽

Harm Reduction ◽

Injection Drug Use ◽

Injection Drug ◽

People Who Use Drugs ◽

Structured Interviews ◽

Advantages And Disadvantages ◽

Online Platforms ◽

Outreach Work ◽

Outreach Workers

Abstract Background Harm reduction services to people who use drugs (PWUD) in Russia are insufficient in terms of quantity, government endorsement, and accessibility. The situation has recently deteriorated even further because of social distancing measures of the COVID-19 pandemic. Several organizations have started to provide some harm reduction services via online platforms by web outreach. However, little is known on how online outreach services are organized and implemented. Drawing on the example of St. Petersburg-based NGO “Humanitarian Action,” we explored web outreach work in Telegram instant messenger. Methods Our data were comprised of 4 semi-structured interviews with the NGO staff and 301 cases of web outreach work with PWUD. We used thematic analysis to study the process of web outreach, harm reduction service provision, and needs of PWUD. Results Three stages of the process of web outreach work were identified: clients initiating communication, NGO workers addressing clients’ needs, and NGO workers receiving clients’ feedback. Communication proceeded in group chat or direct messages. Challenges in addressing clients’ needs happened when clients turned for help after hours, sent recorded voice messages, sent unclear messages, and/or were unwilling to transition to telephone communication. All web outreach workers reported receiving only positive feedback on their work. The needs of PWUD were categorized into two major themes, depending on whether they can be addressed fully or partially online. In cases of online only provision of services, web outreach workers helped PWUD treat minor injection drug use complications, obtain verified harm reduction information and receive general psychological support. In instances of partial online services provision, PWUD were assisted in getting treatment of severe injection drug use complications, overdoses, and in accessing offline medical, psychological, social, legal and harm reduction services. Conclusions Our research demonstrated that web outreach work is a convenient tool for delivering some harm reduction services to PWUD either partially or completely online and for recruiting new clients (including hard-to-reach PWUD that avoid attending brick-and-mortar facilities). Harm reduction organizations should consider incorporating online harm reduction services into their activities. However, further research is needed to explore relative advantages and disadvantages of online harm reduction services.

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