Gaps in the Hepatitis C Continuum of Care among Sex Workers in Vancouver, British Columbia: Implications for Voluntary Hepatitis C Virus Testing, Treatment and Care

Socías, María Eugenia; Shannon, Kate; Montaner, Julio S. G.; Guillemi, Silvia; Dobrer, Sabina; Nguyen, Paul; Goldenberg, Shira M.; Deering, Kathleen

doi:10.1155/2015/381870

Cited by 31 publications

(35 citation statements)

References 56 publications

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“…Health care providers included general practitioners, clinical representatives from hospitals, newly qualified doctors, medical students, resident physicians and nurses (8)(9)(10)(11)(12)(13)(14). Patient groups included adults born between 1945 and 1965; patients attending sexually transmitted infections (STI) clinics, outpatient clinics or primary care facilities; youth and adults working in HIV/HCV prevention; immigrant and migrant populations; and sex workers (10,12,13,(15)(16)(17)(18)(19)(20)(21)(22)(23).…”

Section: Resultsmentioning

confidence: 99%

Barriers to and facilitators of hepatitis C virus screening and testing: A scoping review

Shehata

Austin

et al. 2018

CCDR

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Background: As part of the global effort to eliminate hepatitis C virus (HCV), it is important to understand the barriers to and facilitators of HCV screening and testing. Objective: To examine the barriers and facilitators experienced by health care providers offering HCV screening and testing and patients seeking HCV testing. Methods: A literature search was conducted using Embase, Medline and Scopus databases to collect studies published between January 2012 and July 2017. We extracted the following data: author, year of publication, study design, population, setting, country, method of data collection, and knowledge and awareness outcomes. Results: A total of 16 articles were identified. Barriers to HCV screening and testing among patients included low self-perceived risk of acquiring HCV, perceived stigma and fear of a positive result. Facilitators of HCV screening and testing, as reported by patients, included increased knowledge of transmission and manifestations of HCV infection and having HCV testing included as part of routine care with or without HIV testing. Barriers to offering HCV screening and testing included time constraints, lack of specific knowledge about HCV and discomfort in asking about risk behaviours. Facilitators of offering HCV screening and testing included testing reminders and working in locations with a higher HCV caseload. Conclusion: Lack of knowledge and fear of stigma and discrimination remain barriers to HCV testing at the patient level and lack of time, knowledge and discomfort in asking about risk behaviours remain barriers to offering HCV testing by health care providers. This identifies potential areas for future public health action.

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Section: Resultsmentioning

confidence: 99%

Barriers to and facilitators of hepatitis C virus screening and testing: A scoping review

Shehata

Austin

et al. 2018

CCDR

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“…To examine bivariable associations between each independent variable and the outcome of interest, we then used the bivariable logistic regression. Next, to determine the independent correlates of willingness to receive DAA‐based regimens, we fitted a multivariable logistic model, using an a priori ‐defined backward stepwise procedure that has been used extensively in several earlier studies . Starting with a full model containing all variables associated with the outcome at P < 0.10 in bivariable analyses, the Akaike information criterion (AIC) of the model is noted, and the variable with the largest P ‐value is dropped to fit a reduced model.…”

Section: Methodsmentioning

confidence: 99%

High prevalence of willingness to use direct‐acting antiviral‐based regimens for hepatitis C virus (HCV) infection among HIV/HCV coinfected people who use drugs

Socías

Dong

et al. 2017

HIV Medicine

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Objectives Despite the high burden of hepatitis C virus (HCV)-related morbidity and mortality among HIV-positive people who use illicit drugs (PWUD), uptake of interferon-based treatments for HCV infection has been negligible among this group. Direct-acting antiviral (DAA) therapies offer an opportunity to expand treatment access among this population. The aim of this study was to explore willingness to use DAA-based regimens among HIV/HCV co-infected PWUD in Vancouver, Canada. Methods Data was drawn from the AIDS Care Cohort to evaluate Exposure to Survival Services (ACCESS), a prospective cohort of HIV-positive PWUD. Using logistic regression analyses we investigated factors associated with willingness to use DAA-based regimens among HIV/HCV co-infected participants. Results Of 418 HIV/HCV co-infected PWUD surveyed between June 2014 and May 2015, 295 (71%) were willing to use DAA-based regimens. In multivariable analysis, participants enrolled in methadone maintenance therapy (Adjusted Odds Ratio [AOR] = 1.61, 95% Confidence Interval [CI]: 1.04–2.51), those with a recent assessment by an HCV specialist (AOR = 2.02, 95% CI: 1.28–3.19), and those who perceived that HCV infection was affecting their health (AOR = 2.49, 95% CI: 1.41–4.37) were more likely to be willing to use DAA-based regimens. Conclusions Overall, this study found high prevalence of willingness to use DAA-based regimens among HIV/HCV co-infected PWUD in Vancouver. Importantly, enrollment in methadone maintenance therapy was positively associated with willingness, suggesting that integrated models of HIV, HCV and addiction care should be explored as a way to address HCV-related morbidity and mortality among HIV/HCV co-infected PWUD.

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“…In Vancouver, we recently demonstrated the severe gaps in HCV testing and treatment faced by sex workers, with fewer than half of HCV-positive women being connected to care and almost none having received treatment 35 . Despite high HCV prevalence and incidence among sex workers, most HCV-related services target PWID, with a lack of sex worker-tailored or women-centred models of care.…”

Section: Public Health Implicationsmentioning

confidence: 99%

Dual sexual and drug-related predictors of hepatitis C incidence among sex workers in a Canadian setting: gaps and opportunities for scale-up of hepatitis C virus prevention, treatment, and care

Goldenberg

Montaner

Braschel

et al. 2017

International Journal of Infectious Diseases

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Background Hepatitis C virus (HCV) represents a significant cause of morbidity and mortality globally. While sex workers (SWs) may face elevated HCV risks through both drug/sexual pathways, incidence data among SWs are severely lacking. We characterized HCV incidence and predictors of HCV seroconversion among women SWs in Vancouver, BC. Methods Questionnaire and serological data were drawn from a community-based cohort of women SWs (2010–2014). Kaplan-Meier methods and Cox regression were used to model HCV incidence and predictors of time to HCV seroconversion. Results Among 759 SWs, HCV prevalence was 42.7%. Among 292 baseline-seronegative SWs, HCV incidence density was 3.84/100 person-years(PY), with higher rates among women using injection drugs (23.30/100 PY) and non-injection crack (6.27/100 PY), and those living with HIV (13.27/100 PY) or acute STIs (5.10/100 PY). In Cox analyses adjusted for injection drug use, age (HR: 0.94, 95%CI: 0.86–1.01), acute STI infection (HR: 2.49, 95%CI: 1.02–6.06), and non-injection crack use (HR: 2.71, 95%CI: 1.18–6.25) predicted time to HCV seroconversion. Discussion While HCV incidence was highest among women who inject drugs, STIs and non-injection stimulant use appear to be pathways to HCV infections, suggesting potential dual sexual/drug transmission. Integrated HCV services within sexual health and HIV/STI programs are recommended.

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Gaps in the Hepatitis C Continuum of Care among Sex Workers in Vancouver, British Columbia: Implications for Voluntary Hepatitis C Virus Testing, Treatment and Care

Cited by 31 publications

References 56 publications

Barriers to and facilitators of hepatitis C virus screening and testing: A scoping review

Barriers to and facilitators of hepatitis C virus screening and testing: A scoping review

High prevalence of willingness to use direct‐acting antiviral‐based regimens for hepatitis C virus (HCV) infection among HIV/HCV coinfected people who use drugs

Dual sexual and drug-related predictors of hepatitis C incidence among sex workers in a Canadian setting: gaps and opportunities for scale-up of hepatitis C virus prevention, treatment, and care

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