Expanding access to prevention, care and treatment for hepatitis C virus infection among people who inject drugs

Grebely, Jason; Bruggmann, Philip; Treloar, Carla; Byrne, Jude; Rhodes, Tim; Dore, Gregory J.

doi:10.1016/j.drugpo.2015.07.007

Cited by 35 publications

(35 citation statements)

References 75 publications

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“…Previous data also support the integration of HCV treatment within prevention and treatment services for PWID (Grebely et al, 2015; Sylla, Bruce, Kamarulzaman, & Altice, 2007), which has been crucial for overcoming barriers to HIV treatment.…”

Section: Introductionmentioning

confidence: 70%

Implementing and scaling up HCV treatment services for people who inject drugs and other high risk groups in Ukraine: An evaluation of programmatic and treatment outcomes

Mazhnaya

Meteliuk

Barnard

et al. 2017

International Journal of Drug Policy

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Background HCV prevalence estimates among people who inject drugs (PWID) in Ukraine is high (60%-90%), yet barriers to HCV treatment and care remain substantial including limited access to direct acting antiviral (DAA) medications. A feasibility scale-up project implemented HCV treatment in community-based settings to improve access to DAA treatment for key populations in this context. Methods Using program-level data and verified medical records, we describe the development, implementation processes and outcomes for HCV treatment for PWID and other risks groups. Most participants (76%) received a combination of sofosbuvir, pegylated interferon, and ribavirin for 12 weeks. Treatment enrollment started in June 2015; the first two waves are reported. Data on demographics, HIV characteristics, HCV genotype and RNA levels, including sustained virologic response (SVR) were obtained from verified medical records. We used logistic regression to examine the independent correlates of achieving a SVR. Results The project was implemented in 19 healthcare institutions from 16 regions of Ukraine, mainly within AIDS specialty centers. Our analytical sample included 1,126 participants who were mostly men (73%) and the majority were HIV co-infected (79%). Treatment retention was 97.7% and the proportion of participants who achieved SVR for the 1,029 (91%) with complete data was 94.3% (95% CI 92.8%–95.7%). PWID who were currently injecting had comparable SVR rates (89.2%, 95% CI 81.5–94.5%) to PWID not injecting (94.4%, 95% CI 92.4–96.1), PWID on methadone (94.4%, 95%CI 92.4–96.1), and ‘other’ risk group (95.2%, 95% CI 91.3–97.7). Independent factors associated with achieving a SVR were females sex (AOR: 3.44, 95% CI 1.45–8.14), HCV genotype 3 (AOR: 4.57, 95% CI 1.97 - 10.59) compared to genotype 1. SVR rates in PWID actively injecting did not differ significantly from any other group. Conclusion Both patient-level and structural factors influence HCV treatment scale-up in Ukraine, but patient-level outcomes confirm high levels of achieving SVR in PWID, irrespective of injection and treatment status.

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Section: Introductionmentioning

confidence: 70%

Implementing and scaling up HCV treatment services for people who inject drugs and other high risk groups in Ukraine: An evaluation of programmatic and treatment outcomes

Mazhnaya

Meteliuk

Barnard

et al. 2017

International Journal of Drug Policy

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“…33 Changes in the cost of treatment and developing treatment programmes that reduce the risk of re-infection will be needed to overcome barriers to HCV treatment with DAAs among PWIDs. 34 Recently, studies have demonstrated high efficacy and adherence to DAAs and achievement of sustained virologic response among PWIDs. 35,36 Other studies have demonstrated the feasibility of embedding treatment in harm reduction programmes.…”

Section: Discussionmentioning

confidence: 99%

Shift in disparities in hepatitis C treatment from interferon to DAA era: A population‐based cohort study

Janjua

Islam

Wong

et al. 2017

Journal of Viral Hepatitis

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We evaluated the shift in the characteristics of people who received interferon-based hepatitis C virus (HCV) treatments and those who received recently introduced direct-acting antivirals (DAAs) in British Columbia (BC), Canada. The BC Hepatitis Testers Cohort includes 1.5 million individuals tested for HCV or HIV, or reported cases of hepatitis B and active tuberculosis in BC from 1990 to 2013 linked to medical visits, hospitalization, cancer, prescription drugs and mortality data. This analysis included all patients who filled at least one prescription for HCV treatment until 31 July 2015. HCV treatments were classified as older interferon-based treatments including pegylated interferon/ribavirin (PegIFN/RBV) with/without boceprevir or telaprevir, DAAs with RBV or PegIFN/RBV, and newer interferon-free DAAs. Of 11 886 people treated for HCV between 2000 and 2015, 1164 (9.8%) received interferon-free DAAs (ledipasvir/sofosbuvir: n=1075; 92.4%), while 452 (3.8%) received a combination of DAAs and RBV or PegIFN/RBV. Compared to those receiving interferon-based treatment, people with HIV co-infection (adjusted odds ratio [aOR]: 2.96, 95% CI: 2.31-3.81), cirrhosis (aOR: 1.77, 95% CI: 1.45-2.15), decompensated cirrhosis (aOR: 1.72, 95% CI: 1.31-2.28), diabetes (aOR: 1.30, 95% CI: 1.10-1.54), a history of injection drug use (aOR: 1.34, 95% CI: 1.09-1.65) and opioid substitution therapy (aOR: 1.30, 95% CI: 1.01-1.67) were more likely to receive interferon-free DAAs. Socio-economically marginalized individuals were significantly less likely (most deprived vs most privileged: aOR: 0.71, 95% CI: 0.58-0.87) to receive DAAs. In conclusion, there is a shift in prescription of new HCV treatments to previously excluded groups (eg HIV-co-infected), although gaps remain for the socio-economically marginalized populations.

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“…Screening of pregnant women, especially if they have a history of opioid use will inform prenatal health management as well as follow-up of infants born to pregnant women with HCV. Women should be treated for HCV after delivery, including women with opioid-use disorder or on pharmacotherapy (Dore et al, 2016; Grebely et al, 2015), not only for their postnatal health but also to avoid potential transmission in future pregnancies. Clinical trials using direct-acting antivirals in pediatric populations are currently underway, and have potential to further reduce the burden of infection and accompanying morbidity in children (Ohmer & Honegger, 2016).…”

Section: Discussionmentioning

confidence: 99%

Hepatitis C Cascade of Care Among Pregnant Women on Opioid Agonist Pharmacotherapy Attending a Comprehensive Prenatal Program

Page

Leeman

Bishop

et al. 2017

Matern Child Health J

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Background Given the large increases in opioid use among pregnant women and associations with hepatitis C virus (HCV) infection, screening pregnant women who are on (opioid agonist) pharmacotherapy for HCV infection has potential to inform medical care for these mothers as well as their newborns. We investigated the HCV testing cascade among pregnant women on pharmacotherapy in order to describe exposure and infection rates and to identify opportunities that would improve care. Methods Secondary analyses of laboratory results were performed for HCV testing, including anti-HCV, viremia (RNA) and genotype. Information was abstracted from the medical records of women who were followed at a comprehensive prenatal care clinic for women with substance use disorders at the University of New Mexico. Results The sample included 190 pregnant women, of whom 188 were on pharmacotherapy (43.7% on buprenorphine and 55.3% on methadone); the remaining two had tested positive for heroin or prescription opioids. A total of 178 (93.7%) were tested for anti-HCV, 94 (98.9%) of whom were tested for RNA, and 41 (57.7%) were genotyped. Prevalence of exposure to HCV by anti-HCV results was 53.3%, and 37.3% were positive for HCV RNA indicating chronic infection. Conclusions The high prevalence of exposure and infection with HCV in pregnant women who involved in pharmacotherapy for a substance use disorder indicate a need for ongoing surveillance and testing for HCV. Identifying HCV during pregnancy is crucial because this identification would serve to enhance medical care and potentially prevent vertical transmission. Identifying HCS would also facilitate referrals to newly available curative HCV treatments following delivery.

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Expanding access to prevention, care and treatment for hepatitis C virus infection among people who inject drugs

Cited by 35 publications

References 75 publications

Implementing and scaling up HCV treatment services for people who inject drugs and other high risk groups in Ukraine: An evaluation of programmatic and treatment outcomes

Implementing and scaling up HCV treatment services for people who inject drugs and other high risk groups in Ukraine: An evaluation of programmatic and treatment outcomes

Shift in disparities in hepatitis C treatment from interferon to DAA era: A population‐based cohort study

Hepatitis C Cascade of Care Among Pregnant Women on Opioid Agonist Pharmacotherapy Attending a Comprehensive Prenatal Program

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