scholarly journals Development and Pilot-testing of a Hepatitis C Reinfection Prevention Intervention for Patients in Treatment for Hepatitis C Infection

2021 ◽  
Author(s):  
Adam Christopher Viera ◽  
Lauretta E. Grau ◽  
Jeffrey D. Fisher ◽  
Scott O. Farnum ◽  
Jeanette M. Tetrault ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Treatment Program ◽  
Self Efficacy ◽  
Antiviral Treatment ◽  
Teachable Moment ◽  
Blood Draw ◽  
Pilot Testing ◽  
Opioid Treatment ◽  
Preliminary Results ◽  
The Impact

Abstract Background: With annual rates of hepatitis C virus (HCV) reinfection among persons who inject drugs ranging from 5% to 22%, the need for behavioral interventions to prevent reinfection following successful treatment is clear. Methods: This report aims to describe the conception and development of an intervention to prevent HCV reinfection and present preliminary results from its pilot testing at an opioid treatment program offering on-site primary medical care, including treatment for HCV infection. We developed a two-session intervention combining a teachable moment followed by a session based on the Information-Motivation-Behavioral Skills (IMB) Model to reinforce learning. The teachable moment occurs in less than ten minutes during the routine blood draw to measure viral load during HCV treatment. The reinforcing IMB session builds knowledge, motivation, and self-efficacy in practicing safer injection skills. Formative exploratory work for the intervention involved a literature review, planning meetings with implementation staff, and development of study materials. Intervention staff were trained and the intervention was pilot tested. Measured outcomes included feasibility and acceptability of the intervention to patients and implementers, study recruitment and retention, and preliminary changes in knowledge, motivation, self-efficacy, and HCV reinfection risk behaviors over the study time period. Results: The study protocol and intervention content are both described, along with the preliminary results of implementation and psychosocial outcomes among 17 patients undergoing direct-acting antiviral treatment for HCV. Baseline data revealed gaps in HCV prevention knowledge that could lead to reinfection. We also report lessons learned related to implementation of such an intervention with this population in integrated care settings. After some minor adjustments, we found high levels of feasibility and acceptability for the intervention at the implementing organization. Intervention implementation was interrupted due to COVID-19 restrictions. Conclusions: It is possible to implement an intervention in an opioid treatment program to improve HCV prevention knowledge with the potential to prevent reinfection. Intervention staff must be attentive to participant needs regarding time and monetary constraints to maximize acceptability. Given the impact of the COVID-19 pandemic, future research should explore the possibility of offering the intervention via phone or video chat.

scholarly journals French hepatitis C care cascade: substantial impact of direct-acting antivirals, but the road to elimination is still long

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Cécile Brouard ◽  
Josiane Pillonel ◽  
Marjorie Boussac ◽  
Victor de Lédinghen ◽  
Antoine Rachas ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Antiviral Treatment ◽  
Hcv Infection ◽  
World Health ◽  
Direct Acting Antivirals ◽  
Substantial Impact ◽  
Chronic Hcv Infection ◽  
Chronic Hcv ◽  
Direct Acting ◽  
The Impact

Abstract Background Hepatitis C virus (HCV) elimination by 2030, as targeted by the World Health Organization (WHO), requires that 90% of people with chronic infection be diagnosed and 80% treated. We estimated the cascade of care (CoC) for chronic HCV infection in mainland France in 2011 and 2016, before and after the introduction of direct-acting antivirals (DAAs). Methods The numbers of people (1) with chronic HCV infection, (2) aware of their infection, (3) receiving care for HCV and (4) on antiviral treatment, were estimated for 2011 and 2016. Estimates for 1) and 2) were based on modelling studies for 2011 and on a virological sub-study nested in a national cross-sectional survey among the general population for 2016. Estimates for 3) and 4) were made using the National Health Data System. Results Between 2011 and 2016, the number of people with chronic HCV infection decreased by 31%, from 192,700 (95% Credibility interval: 150,900-246,100) to 133,500 (95% Confidence interval: 56,900-312,600). The proportion of people aware of their infection rose from 57.7 to 80.6%. The number of people receiving care for HCV increased by 22.5% (representing 25.7% of those infected in 2016), while the number of people on treatment increased by 24.6% (representing 12.1% of those infected in 2016). Conclusions This study suggests that DAAs substantially impact CoC. However, access to care and treatment for infected people remained insufficient in 2016. Updating CoC estimates will help to assess the impact of new measures implemented since 2016 as part of the goal to eliminate HCV.

scholarly journals Hepatitis C Virus (HCV) Care Continuum Outcomes and HCV Community Viral Loads Among Patients in an Opioid Treatment Program

2020 ◽  
Vol 222 (Supplement_5) ◽  
pp. S335-S345
Author(s):  
Ashly E Jordan ◽  
Charles M Cleland ◽  
Bruce R Schackman ◽  
Katarzyna Wyka ◽  
David C Perlman ◽  
...  
Keyword(s):  
Hepatitis C Virus ◽  
Viral Load ◽  
Hepatitis C ◽  
Treatment Program ◽  
Linkage To Care ◽  
People Who Use Drugs ◽  
Treatment Need ◽  
Care Continuum ◽  
Opioid Treatment ◽  
Unmet Treatment Need

Abstract Background Hepatitis C virus (HCV) remains endemic among people who use drugs (PWUD). Measures of HCV community viral load (CVL) and HCV care continuum outcomes may be valuable for ascertaining unmet treatment need and for HCV surveillance and control. Methods Data from patients in an opioid treatment program during 2013–2016 were used to (1) identify proportions of antibody and viral load (VL) tested, linked-to-care, and treated, in 2013–2014 and 2015–2016, and pre- and postimplementation of qualitative reflex VL testing; (2) calculate engaged-in-care HCV CVL and “documented” and “estimated” unmet treatment need; and (3) examine factors associated with linkage-to-HCV-care. Results Among 11 267 patients, proportions of HCV antibody tested (52.5% in 2013–2014 vs 73.3% in 2015–2016), linked-to-HCV-care (15.7% vs 51.8%), and treated (12.0% vs 44.7%) all increased significantly. Hispanic ethnicity was associated with less linkage-to-care, and Manhattan residence was associated with improved linkage-to-care. The overall engaged-in-care HCV CVL was 4 351 079 copies/mL (standard deviation = 7 149 888); local HCV CVLs varied by subgroup and geography. Documented and estimated unmet treatment need decreased but remained high. Conclusions After qualitative reflex VL testing was implemented, care continuum outcomes improved, but gaps remained. High rates of unmet treatment need suggest that control of the HCV epidemic among PWUD will require expansion of HCV treatment coverage.

Patient Reaction to Telemedicine for Clinical Management of Hepatitis C Virus Integrated into an Opioid Treatment Program

2019 ◽  
Vol 25 (9) ◽  
pp. 791-801 ◽  
Author(s):  
Andrew H. Talal ◽  
Anthony McLeod ◽  
Phyllis Andrews ◽  
Heidi Nieves-McGrath ◽  
Yang Chen ◽  
...  
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Treatment Program ◽  
Clinical Management ◽  
Opioid Treatment

scholarly journals Genetic Variation in theIL-6andHLA-DQB1Genes Is Associated with Spontaneous Clearance of Hepatitis C Virus Infection

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Paul Ravi Waldron ◽  
Ilana Belitskaya-Lévy ◽  
Aarthi Chary ◽  
Johann Won ◽  
Mark Winters ◽  
...  
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Multiple Testing ◽  
Antiviral Treatment ◽  
Small Sample ◽  
Hcv Infection ◽  
Spontaneous Clearance ◽  
Ratio Test ◽  
Permutation Methods ◽  
The Impact

Background. Millions of people are infected with hepatitis C virus (HCV) worldwide and 30% spontaneously clear the infection. Reasons for HCV clearance without antiviral treatment are not well understood.Methods. Blood was collected for DNA analysis from patients with chronic HCV infection or evidence of spontaneous clearance. To overcome anticipated limitations of small sample size, primary analyses consisted of a candidate gene analysis of 12 preselected genes based on known association with host immunologic response to HCV infection. To further reduce the impact of multiple testing on power, a single likelihood ratio test was conducted for each gene using all associated SNPs assayed on the Illumina Quad 610/660W chip. Step-down permutation methods were used to adjust for multiple testing in all analyses.Results. Ninety-five and 62 patients with HCV chronic infection or spontaneous clearance, respectively, were included for analysis.HLA-DQB1(p=1.76⁎10-5) andIL-6(p=0.0007) genes were significantly associated with spontaneous HCV clearance.IL-28Bwas not significantly associated with spontaneous clearance (p=0.17).Conclusion. Our whole-gene analytic strategy identified a previously unreported association of IL-6 with spontaneous clearance of HCV infection. We also confirmed the finding that HLA-DQB1 is associated with spontaneous resolution of HCV infection.

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