scholarly journals Integrated Hepatitis C Care for People Who Inject Drugs (Heplink): Protocol for a Feasibility Study in Primary Care (Preprint)

2017 ◽  
Author(s):  
Geoff McCombe ◽  
Davina Swan ◽  
Eileen O’Connor ◽  
Gordana Avramovic ◽  
Peter Vickerman ◽  
...  
Keyword(s):  
Primary Care ◽  
European Union ◽  
General Practice ◽  
Hepatitis C ◽  
People Who Inject Drugs ◽  
Integrated Model ◽  
The European Union ◽  
Direct Acting Antiviral ◽  
Opiate Substitution Therapy ◽  
Clinical Records

BACKGROUND Hepatitis C virus (HCV) infection is a major cause of chronic liver disease and death. Drug use remains the significant cause of new infections in the European Union, with estimates of HCV antibody prevalence among people who inject drugs ranging from 5% to 90% in 29 European countries. In Ireland and the European Union, primary care is a key area to focus efforts to enhance HCV diagnosis and treatment among people who inject drugs. OBJECTIVE The Heplink study aims to improve HCV care outcomes among opiate substitution therapy (OST) patients in general practice by developing an integrated model of HCV care and evaluating its feasibility, acceptability, and likely efficacy. METHODS The integrated model of care comprises education of community practitioners, outreach of an HCV-trained nurse into general practitioner (GP) practices, and enhanced access of patients to community-based evaluation of their HCV disease (including a novel approach to diagnosis, that is, Echosens FibroScan Mini 430). A total of 24 OST-prescribing GP practices were recruited from the professional networks and databases of members of the research consortium. Patients were eligible if they are aged ≥18 years, on OST, and attend the practice for any reason during the recruitment period. Baseline data on HCV care processes and outcomes were extracted from the clinical records of participating patients. RESULTS This study is ongoing and has the potential to make an important impact on patient care and provide high-quality evidence to help GPs make important decisions on HCV testing and onward referral. CONCLUSIONS A substantial proportion of HCV-positive patients on OST in general practice are not engaged with specialist hospital services but qualify for direct-acting antiviral drugs treatment. The Heplink model has the potential to reduce HCV-related morbidity and mortality. REGISTERED REPORT IDENTIFIER RR1-10.2196/9043

A survey of Australian general practitioners’ hepatitis C knowledge and management 2 years after subsidised direct-acting antiviral therapy became available

Sexual Health ◽  
2020 ◽  
Vol 17 (4) ◽  
pp. 387
Author(s):  
Michelle Gooey ◽  
Evelyn Wong ◽  
Alisa Pedrana ◽  
Nicole Allard ◽  
Joseph Doyle ◽  
...  
Keyword(s):  
Primary Care ◽  
Hepatitis C ◽  
General Practitioners ◽  
People Who Inject Drugs ◽  
Knowledge Score ◽  
Direct Acting Antivirals ◽  
Direct Acting Antiviral ◽  
Additional Support ◽  
Direct Acting

In 2016, hepatitis C direct-acting antivirals (DAAs) became available in Australia. A group of general practitioners (GPs) were surveyed twice to assess hepatitis C knowledge and management; 191/1000 (19.1%) responded at baseline, 164/938 (17.5%) at follow up. Participants’ mean Knowledge score increased: baseline 5.75 (95% CI 5.61–5.91), follow up 6.09 (95% CI 5.95–6.22; P <0.01). At follow up, 36/163 (22%) had prescribed DAAs compared with 23/187 (12%) at baseline (χ2(1) = 5.95, P = 0.02); however, 67/150 (45%) were unsure of treatment eligibility for people who inject drugs. Additional support for GPs is warranted to ensure optimal hepatitis C management in primary care.

Hepatitis C virus DAA treatment adherence patterns and SVR among people who inject drugs treated in opioid agonist therapy programs

2021 ◽  
Author(s):  
Moonseong Heo ◽  
Irene Pericot-Valverde ◽  
Lior Rennert ◽  
Matthew J Akiyama ◽  
Brianna L Norton ◽  
...  
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Treatment Adherence ◽  
People Who Inject Drugs ◽  
Alcohol Intoxication ◽  
Sustained Viral Response ◽  
Time Frame ◽  
Agonist Therapy ◽  
Opioid Agonist ◽  
Direct Acting Antiviral

Abstract Background Adequate medication adherence is critical for achieving sustained viral response (SVR) of hepatitis C virus (HCV) among people who inject drugs (PWID). However, it is less known which patterns of direct-acting antiviral (DAA) treatment adherence are associated with SVR in this population or what factors are associated with each pattern. Methods The randomized three-arm PREVAIL study utilized electronic blister packs to obtain daily time frame adherence data in opiate agonist therapy program settings. Exact logistic regressions were applied to test the associations between SVR and six types of treatment adherence patterns. Results Of the 113 participants treated with combination DAAs, 109 (96.5%) achieved SVR. SVR was significantly associated with all pattern parameters except for number of switches between adherent and missed days: total adherent daily doses (exact AOR=1.12; 95%CI=1.04-1.22), percent total doses (1.09; 1.03-1.16), days on treatment (1.16; 1.05-1.32), maximum consecutive adherent days (1.34; 1.06-2.04), maximum consecutive non-adherent days (.85; .74-.95=.003). SVR was significantly associated with total adherent doses in the first two months of treatment, it was not in the last month. Compared to White participants (30.7±11.8(se)), Black (18.4±7.8) and Hispanic participants (19.2±6.1) had significantly shorter maximum consecutive adherent days. While alcohol intoxication was significantly associated with frequent switches, drug use was not associated with any adherence pattern. Conclusion Consistent maintenance of adequate total dose adherence over the entire course of HCV treatment is important in achieving SVR among PWID. Additional integrative addiction and medical care may be warranted for treating PWID experiencing alcohol intoxication.

Hepatitis C testing in general practice settings: A cross-sectional study of people who inject drugs in Australia

2017 ◽  
Vol 47 ◽  
pp. 102-106 ◽  
Author(s):  
Kerryn Butler ◽  
Carolyn Day ◽  
Rachel Sutherland ◽  
Joe van Buskirk ◽  
Courtney Breen ◽  
...  
Keyword(s):  
General Practice ◽  
Hepatitis C ◽  
People Who Inject Drugs ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional

scholarly journals Low Hepatitis C Reinfection Following Direct-acting Antiviral Therapy Among People Who Inject Drugs on Opioid Agonist Therapy

2019 ◽  
Vol 70 (12) ◽  
pp. 2695-2702 ◽  
Author(s):  
Matthew J Akiyama ◽  
Daniel Lipsey ◽  
Moonseong Heo ◽  
Linda Agyemang ◽  
Brianna L Norton ◽  
...  
Keyword(s):  
Hepatitis C ◽  
People Who Inject Drugs ◽  
Controlled Trial ◽  
Extension Study ◽  
Agonist Therapy ◽  
Opioid Agonist ◽  
Direct Acting Antiviral ◽  
Opioid Agonist Therapy ◽  
Direct Acting

Abstract Background Direct-acting antiviral (DAA) therapy is highly effective in people who inject drugs (PWID); however, rates, specific injection behaviors, and social determinants associated with hepatitis C virus (HCV) reinfection following DAA therapy among PWID on opioid agonist therapy (OAT) are poorly understood. Methods PREVAIL was a randomized controlled trial that assessed models of HCV care for 150 PWID on OAT. Those who achieved sustained virologic response (SVR) (n = 141; 94%) were eligible for this extension study. Interviews and assessments of recurrent HCV viremia occurred at 6-month intervals for up to 24 months following PREVAIL. We used survival analysis to analyze variables associated with time to reinfection. Results Of 141 who achieved SVR, 114 had a least 1 visit in the extension study (62% male; mean age, 52 years). Injection drug use (IDU) was reported by 19% (n = 22) in the extension study. HCV reinfection was observed in 3 participants. Over 246 person-years of follow-up, the incidence of reinfection was 1.22/100 person-years (95% CI, 0.25–3.57). All reinfections occurred among participants reporting ongoing IDU. The incidence of reinfection in participants reporting ongoing IDU (41 person-years of follow-up) was 7.4/100 person-years (95% CI, 1.5–21.6). Reinfection was associated with reporting ongoing IDU in the follow-up period (P < .001), a lack confidence in the ability to avoid contracting HCV (P < .001), homelessness (P = .002), and living with a PWID (P = .007). Conclusions HCV reinfection was low overall, but more common among people with ongoing IDU following DAA therapy on OAT, as well as those who were not confident in the ability to avoid contracting HCV, homeless, or living with a PWID. Interventions to mediate these risk factors following HCV therapy are warranted.

scholarly journals Hepatitis C Resistance-Associated Variants Among People Who Inject Drugs Treated With Direct-Acting Antiviral-Containing Regimens

2016 ◽  
Vol 3 (suppl_1) ◽  
Author(s):  
Matthew Akiyama ◽  
Jacqueline Reeves ◽  
Yolanda Lie ◽  
Linda Agyemang ◽  
Alain Litwin
Keyword(s):  
Hepatitis C ◽  
People Who Inject Drugs ◽  
Direct Acting Antiviral ◽  
Direct Acting

scholarly journals Availability, Accessibility, and Coverage of Needle and Syringe Programs in Prisons in the European Union: A Multistage Scoping Review

2020 ◽  
Author(s):  
Babak Moazen ◽  
Kate Dolan ◽  
Sahar Saeedi Moghaddam ◽  
Masoud Lotfizadeh ◽  
Karen Duke ◽  
...  
Keyword(s):  
European Union ◽  
People Who Inject Drugs ◽  
Web Of Science ◽  
The European Union ◽  
Pilot Phase ◽  
Infection Transmission ◽  
Eu Countries ◽  
Effective Interventions ◽  
Needle And Syringe Programs ◽  
Meta Analyses

Abstract Needle and syringe programs (NSPs) are among the most effective interventions for controlling the transmission of infection among people who inject drugs in prisons. We evaluated the availability, accessibility, and coverage of NSPs in prisons in European Union (EU) countries. In line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, we systematically searched 4 databases of peer-reviewed publications (MEDLINE (PubMed), ISI Web of Science, EBSCO, and ScienceDirect) and 53 databases containing gray literature to collect data published from January 2008 to August 2018. A total of 23,969 documents (17,297 papers and 6,672 gray documents) were identified, of which 26 were included in the study. In 2018, imprisonment rates in 28 EU countries ranged between 51 per 100,000 population in Finland and 235 per 100,000 population in Lithuania. Only 4 countries were found to have NSPs in prisons: Germany (in 1 prison), Luxembourg (no coverage data were found), Romania (available in more than 50% of prisons), and Spain (in all prisons). Portugal stopped an NSP after a 6-month pilot phase. Despite the protective impact of prison-based NSPs on infection transmission, only 4 EU countries distribute sterile syringes among people who inject drugs in prisons, and coverage of the programs within these countries is very low. Since most prisoners will eventually return to the community, lack of NSPs in EU prisons not only is a threat to the health of prisoners but also endangers public health.

scholarly journals Hepatitis C treatment uptake among people who inject drugs in the oral direct‐acting antiviral era

2020 ◽  
Vol 40 (10) ◽  
pp. 2407-2416
Author(s):  
Oluwaseun Falade‐Nwulia ◽  
Rachel E. Gicquelais ◽  
Jacquie Astemborski ◽  
Sean D. McCormick ◽  
Greg Kirk ◽  
...  
Keyword(s):  
Hepatitis C ◽  
People Who Inject Drugs ◽  
Hepatitis C Treatment ◽  
Direct Acting Antiviral ◽  
Treatment Uptake ◽  
Direct Acting

scholarly journals Cost-effectiveness of different strategies for screening and treatment of Strongyloides stercoralis in migrants from endemic countries to the European Union

2020 ◽  
Vol 5 (5) ◽  
pp. e002321 ◽  
Author(s):  
Philip Erick Wikman-Jorgensen ◽  
Jara Llenas-Garcia ◽  
Jad Shedrawy ◽  
Joaquim Gascon ◽  
Jose Muñoz ◽  
...  
Keyword(s):  
Primary Care ◽  
European Union ◽  
Cost Effectiveness ◽  
Health System ◽  
Cost Savings ◽  
Base Case ◽  
The European Union ◽  
Presumptive Treatment ◽  
Serological Screening ◽  
Life Years

BackgroundThe best strategy for controlling morbidity due to imported strongyloidiasis in migrants is unclear. We evaluate the cost-effectiveness of six possible interventions.MethodsWe developed a stochastic Markov chain model. The target population was adult migrants from endemic countries to the European Union; the time horizon, a lifetime and the perspective, that of the health system. Average and incremental cost-effectiveness ratios (ACER and ICER) were calculated as 2016 EUR/life-year gained (LYG). Health interventions compared were: base case (no programme), primary care-based presumptive treatment (PCPresTr), primary care-based serological screening and treatment (PCSerTr), hospital-based presumptive treatment (HospPresTr), hospital-based serological screening and treatment (HospSerTr), hospital-based presumptive treatment of immunosuppressed (HospPresTrim) and hospital-based serological screening and treatment of the immunosuppressed (HospSerTrim). The willingness to pay threshold (WTP) was €32 126.95/LYG.ResultsThe base case model yielded a loss of 2 486 708.24 life-years and cost EUR 3 238 393. Other interventions showed the following: PCPresTr: 2 488 095.47 life-years (Δ1 387.23LYG), cost: EUR 8 194 563; ACER: EUR 3573/LYG; PCSerTr: 2 488 085.8 life-years (Δ1377.57LYG), cost: EUR 207 679 077, ACER: EUR 148 407/LYG; HospPresTr: 2 488 046.17 life-years (Δ1337.92LYG), cost: EUR 14 559 575; ACER: EUR 8462/LYG; HospSerTr: 2 488 024.33 life-years (Δ1316.08LYG); cost: EUR 207 734 073; ACER: EUR 155 382/LYG; HospPresTrim: 2 488 093.93 life-years, cost: EUR 1 105 483; ACER: EUR −1539/LYG (cost savings); HospSerTrim: 2 488 073.8 life-years (Δ1365.55LYG), cost: EUR 4 274 239; ACER: EUR 759/LYG. One-way and probabilistic sensitivity analyses were undertaken; HospPresTrim remained below WTP for all parameters’ ranges and iterations.ConclusionPresumptively treating all immunosuppressed migrants from areas with endemic Strongyloides would generate cost savings to the health system.

scholarly journals A systematic review and meta-analysis of community and primary-care-based hepatitis C testing and treatment services that employ direct acting antiviral drug treatments

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Andrew Radley ◽  
Emma Robinson ◽  
Esther J. Aspinall ◽  
Kathryn Angus ◽  
Lex Tan ◽  
...  
Keyword(s):  
Primary Care ◽  
Hepatitis C ◽  
Meta Analysis ◽  
Antiviral Drug ◽  
Sustained Viral Response ◽  
Primary Care Providers ◽  
Care Providers ◽  
Hcv Treatment ◽  
Direct Acting Antiviral ◽  
Direct Acting

Abstract Background Direct Acting Antiviral (DAAs) drugs have a much lower burden of treatment and monitoring requirements than regimens containing interferon and ribavirin, and a much higher efficacy in treating hepatitis C (HCV). These characteristics mean that initiating treatment and obtaining a virological cure (Sustained Viral response, SVR) on completion of treatment, in non-specialist environments should be feasible. We investigated the English-language literature evaluating community and primary care-based pathways using DAAs to treat HCV infection. Methods Databases (Cinahl; Embase; Medline; PsycINFO; PubMed) were searched for studies of treatment with DAAs in non-specialist settings to achieve SVR. Relevant studies were identified including those containing a comparison between a community and specialist services where available. A narrative synthesis and linked meta-analysis were performed on suitable studies with a strength of evidence assessment (GRADE). Results Seventeen studies fulfilled the inclusion criteria: five from Australia; two from Canada; two from UK and eight from USA. Seven studies demonstrated use of DAAs in primary care environments; four studies evaluated integrated systems linking specialists with primary care providers; three studies evaluated services in locations providing care to people who inject drugs; two studies evaluated delivery in pharmacies; and one evaluated delivery through telemedicine. Sixteen studies recorded treatment uptake. Patient numbers varied from around 60 participants with pathway studies to several thousand in two large database studies. Most studies recruited less than 500 patients. Five studies reported reduced SVR rates from an intention-to-treat analysis perspective because of loss to follow-up before the final confirmatory SVR test. GRADE assessments were made for uptake of HCV treatment (medium); completion of HCV treatment (low) and achievement of SVR at 12 weeks (medium). Conclusion Services sited in community settings are feasible and can deliver increased uptake of treatment. Such clinics are able to demonstrate similar SVR rates to published studies and real-world clinics in secondary care. Stronger study designs are needed to confirm the precision of effect size seen in current studies. Prospero: CRD42017069873.

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