Factors associated with lost to follow-up after hepatitis C treatment delivered by primary care teams in an inner-city multi-site program, Vancouver, Canada

Nouch, Susan; Gallagher, Lesley; Erickson, Margaret; Elbaharia, Rabab; Zhang, Wendy; Wang, Lu; Bacani, Nic; Kason, Deborah; Kleban, Holly; Knebel, Laura; Hall, David S.; Barrios, Rolando; Hull, Mark

doi:10.1016/j.drugpo.2018.06.019

Cited by 22 publications

(30 citation statements)

References 25 publications

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“…High treatment completion and response to HCV therapy has been observed in people receiving OAT and people with recent injecting drug use . The integration and co‐location of care for HCV infection and OAT is associated with improved testing, linkage to treatment and retention in HCV care . The high HCV prevalence among people who inject drugs (PWID) attending OAT clinics makes this an ideal setting for targeted strategies to enhance HCV care.…”

Section: Introductionmentioning

confidence: 99%

Perceived barriers related to testing, management and treatment of HCV infection among physicians prescribing opioid agonist therapy: The C‐SCOPE Study

Litwin

Drolet

Nwankwo

et al. 2019

Journal of Viral Hepatitis

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The aim of this analysis was to evaluate perceived barriers related to HCV testing, management and treatment among physicians practicing in clinics offering opioid agonist treatment (OAT). C‐SCOPE was a study consisting of a self‐administered survey among physicians practicing at clinics providing OAT in Australia, Canada, Europe and the United States between April and May 2017. A 5‐point Likert scale (1 = not a barrier, 3 = moderate barrier, 5 = extreme barrier) was used to measure responses to perceived barriers for HCV testing, evaluation and treatment across the domains of the health system, clinic and patient. Among the 203 physicians enrolled (40% USA, 45% Europe, 14% Australia/Canada), 21% were addiction medicine specialists, 29% psychiatrists and 69% were metro/urban. OAT physicians in this study reported poor access to on‐site venepuncture (35%), point‐of‐care HCV testing (16%), and noninvasive liver disease assessment (25%). Only 30% of OAT physicians reported personally treating HCV infection. Major perceived health system barriers to HCV management included the lack of funding for noninvasive liver disease testing, long wait times to see an HCV specialist, lack of funding for new HCV therapies, and reimbursement restrictions based on drug/alcohol use. Major perceived clinic barriers included the lack of peer support programmes and/or HCV case managers to facilitate linkage to care, the need to refer people off‐site for noninvasive liver disease staging, the lack of support for on‐site phlebotomy and the lack of on‐site delivery of HCV therapy. This study highlights several important modifiable barriers to enhance HCV testing, evaluation and treatment among PWID attending OAT clinics.

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Section: Introductionmentioning

confidence: 99%

Perceived barriers related to testing, management and treatment of HCV infection among physicians prescribing opioid agonist therapy: The C‐SCOPE Study

Litwin

Drolet

Nwankwo

et al. 2019

Journal of Viral Hepatitis

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“…Data extraction on SVR12 rates stratified by absence or presence of cirrhosis was feasible only in three studies using ITT analysis [22,23,25]. The SVR12 rates of patients with and without https://doi.org/10.1371/journal.pone.0229143.g002 https://doi.org/10.1371/journal.pone.0229143.g003 cirrhosis were 85.9% (n = 116/135) and 87.3% (n = 324/371), respectively.…”

Section: Svr Results Of Patients With and Without Cirrhosis Treated Wmentioning

confidence: 99%

“…The literature search resulted in 130 unique studies (S1 Table). After the screening of titles and abstracts by two blinded investigators, 12 studies [7,10,11,[20][21][22][23][24][25][26][27][28] were eligible for full-text analysis. The percent agreement and Cohen's kappa between the two independent reviewers were 95% and 0.69, respectively.…”

Section: Study Characteristicsmentioning

confidence: 99%

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Effectiveness of implementing a decentralized delivery of hepatitis C virus treatment with direct-acting antivirals: A systematic review with meta-analysis

et al. 2020

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Direct-acting agents (DAAs) for hepatitis C virus (HCV) treatment are safe and highly effective. Few studies described the sustained virologic response rates of treatment conducted by non-specialists. We performed a systematic review and meta-analysis to evaluate the effectiveness of decentralized strategies of HCV treatment with DAAs. PubMed, Embase, Scopus and LILACS were searched until March-2019. Studies were screened by two researchers according to the following inclusion criteria: HCV treatment using DAAs on reallife cohort studies or clinical trials conducted by non-specialized health personnel. The primary endpoint was the sustained virologic response rate at week 12 after the end-of-treatment (SVR12), which is binary at the patient level. Data were extracted in duplicate using electronic-forms and quality appraisal was performed with the NIH Quality Assessment Tool. Heterogeneity was assessed by I 2 statistics. Random-effects meta-analysis models were used for pooling SVR12 rates. Publication bias was assessed using funnel plots. Among the 130 selected studies, nine papers were included for quantitative synthesis. The quality-appraisal was good for two, fair for three and poor for four studies. The pooled relative risk (RR) of SVR12 was not statistically different between decentralized strategy and treatment by specialists [RR = 1.05; 95% confidence interval (95% CI): 0.98-1.1; I 2 = 45% (95% CI: 0-84%), p = 0.145]. SVR12 rate for decentralized HCV treatment was 81% [SVR12 95% CI: 72-89%; I 2 = 93% (95% CI: 88-96%)] and 95% [SVR12 95%CI: 92-98%; I 2 = 77% (95% CI: 52-89%)] with intention to treat analysis and per-protocol analysis, respectively. SVR12 rates using DAAs managed by non-specialized health personnel were satisfactory and similar to those obtained by specialists. This new delivery strategy can improve access to HCV treatment, especially in resource-limited settings. PROSPERO #: CRD42019122609.

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“…Another success of this “real-world” cohort was the low proportion loss to follow-up and patients evaluable for SVR (8.8% of the ITT population). Engagement following DAA therapy is necessary for determining SVR, managing cirrhosis, ongoing HR, routine testing for reinfection, and prompt retreatment [ 23 ]. Colocated OAT can improve retention in HCV care [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Optimizing Hepatitis C Virus (HCV) Treatment in a US Colocated HCV/Opioid Agonist Therapy Program

Habchi

Thomas

Sprecht-Walsh

et al. 2020

Open Forum Infectious Diseases

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Background A minority of patients with opioid use disorder are treated for hepatitis C virus infection (HCV). While colocated HCV and opioid agonist therapy (OAT) along with harm reduction can facilitate prevention and cascade to cure, there are few real-world examples of such embedded care models in the United States in the direct-acting antiviral (DAA) era. Methods We conducted a retrospective chart review to determine sustained virologic response (SVR) and reinfection rates during the first 5-year period of DAA availability among individuals tested and treated on-site at Rhode Island’s only nonprofit methadone maintenance program. Results Of 275 who initiated DAAs, the mean age (range) was 43 (22–71) years, 34.5% were female, 57.5% had genotype 1a, 23.3% had cirrhosis, and 92% were Medicaid recipients. SVR was 85.0% (232/273), while modified intent-to-treat SVR was 93.2% (232/249); 17 patients did not achieve SVR, 2 awaited SVR 12 weeks post-end-of-treatment, and 24 were lost to follow-up. Thirty reinfections were identified over 375.5 person-years of follow-up (rate, 7.99/100 person-years). The median time to first reinfection (interquartile range) was 128 (85.25–202.5) days. Before July 1, 2018, 72 patients accessed DAAs over 3.7 years; after Medicaid DAA restrictions were lifted, 109 patients accessed DAAs over 1.3 years. The Prior Authorization (PA) process requires many steps, differing across 11 RI insurers, taking 45–120 minutes per patient. Conclusions DAA treatment was effective among a marginalized population in an urban colocated OAT/HCV program. Removing DAA restrictions facilitates treatment initiation. The PA process remains a modifiable barrier to expanding capacity in the United States.

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Factors associated with lost to follow-up after hepatitis C treatment delivered by primary care teams in an inner-city multi-site program, Vancouver, Canada

Cited by 22 publications

References 25 publications

Perceived barriers related to testing, management and treatment of HCV infection among physicians prescribing opioid agonist therapy: The C‐SCOPE Study

Perceived barriers related to testing, management and treatment of HCV infection among physicians prescribing opioid agonist therapy: The C‐SCOPE Study

Effectiveness of implementing a decentralized delivery of hepatitis C virus treatment with direct-acting antivirals: A systematic review with meta-analysis

Optimizing Hepatitis C Virus (HCV) Treatment in a US Colocated HCV/Opioid Agonist Therapy Program

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