Hepatitis C testing and treatment among active drug users in Amsterdam

Lindenburg, Catharina E. A.; Lambers, Femke A.E.; Urbanus, A.; Schinkel, Janke; Jansen, Petér L. M.; Krol, Anneke; Casteelen, G.; Santen, Gerrit van; Berg, CP; Coutinho, Roel A.; Prins, Maria; Weegink, Christine J.

doi:10.1097/meg.0b013e328340c451

Cited by 79 publications

(35 citation statements)

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“…The 25 studies included one randomised controlled study [16], three cross-sectional studies [17-19], 11 retrospective cohort studies [20-30] and 10 prospective cohort studies [31-40]. Ten of the studies took place at drug treatment clinics, five at hepatitis clinics, and ten in other types of settings.…”

Section: Resultsmentioning

confidence: 99%

“…The HCV antibody-positive treatment uptake level reflects the number of study participants who received treatment as a proportion of the number of study participants known to have antibodies for hepatitis C. Ten studies [19,22,24,26,32,35,36,38-40] reported treatment uptake in relation to HCV antibody-positive status (Table 2). Among groups of study participants who were HCV antibody-positive, treatment uptake ranged from 3% to 64% (median: 17%).…”

Section: Resultsmentioning

confidence: 99%

“…Twenty-one studies [16-18,20-34,37,38,40] yielded 22 datasets with information about HCV RNA-positive treatment uptake levels (Table 3). (One study, by Moussalli et al [17], included an observational phase and an intervention phase that enrolled two separate groups of study participants; for the purpose of calculating treatment uptake levels in this review, the information is regarded as though it represents two studies.)…”

Section: Resultsmentioning

confidence: 99%

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A systematic review of Hepatitis C virus treatment uptake among people who inject drugs in the European Region

et al. 2014

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BackgroundFifteen million adults in the World Health Organization European Region are estimated to have active hepatitis C infection. Intravenous drug use is a major hepatitis C transmission route in this region, and people who inject drugs (PWID) constitute a high-risk and high-prevalence population. A systematic review was conducted to assess levels of hepatitis C treatment uptake among PWID in Europe.MethodsSearches in MEDLINE and EMBASE were carried out for articles in any language published between 1 January 2000 and 31 December 2012. Articles were included in the review if they presented original research findings about hepatitis C treatment uptake levels among people who reported injecting drugs currently or formerly, as well as those who reported using drugs currently or formerly (mode of consumption not specified). Treatment uptake data were extracted if uptake was measurable in relation to the number of patients who either: (a) tested HCV antibody-positive; (b) tested positive for HCV-RNA; or (c) tested positive for HCV-RNA and met additional treatment criteria.ResultsTwenty-five articles from 12 countries were included in the review. Among groups of drug-using study participants who were hepatitis C antibody-positive, the median treatment uptake level was 17%, and among those who were hepatitis C RNA-positive, the median was 30%. In the 11 studies reporting specifically on treatment uptake among current and former injecting drug users, hepatitis C RNA-positive study populations had a median treatment uptake level of 32%. Only one study reported on treatment uptake for current drug users.ConclusionsThis systematic review indicates that hepatitis C treatment uptake is relatively low among drug users in several European countries, and also points to considerable knowledge gaps regarding treatment uptake levels in this population. There was large variability in treatment uptake levels, suggesting that there may be major differences between and within countries in relation to treatment availability, drug-using populations in need of treatment, and the existence of integrated health care services targeting drug users. Stronger national hepatitis C treatment policies are needed, along with efforts to increase knowledge and reduce misconceptions among physicians regarding the feasibility and importance of treating drug users who have hepatitis C.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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A systematic review of Hepatitis C virus treatment uptake among people who inject drugs in the European Region

et al. 2014

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“…Although ever/current drug injectors have treatment efficacy and safety outcomes that are comparable to those for people with no history of drug use [15,66-70], and successful treatment could reduce the likelihood of HCV transmission among PWID by eliminating potential sources of infection [9], international and national treatment guidelines historically have excluded PWID, particularly current injectors, from being treated for hepatitis C [15,70,71]. In 2011, however, the Clinical Practice Guidelines of the European Association for the Study of the Liver (EASL) were revised to endorse the provision of HCV treatment to certain PWID based on an individual approach [72].…”

Section: Discussionmentioning

confidence: 99%

Are there national strategies, plans and guidelines for the treatment of hepatitis C in people who inject drugs? A survey of 33 European countries

et al. 2014

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BackgroundHepatitis C virus (HCV) infection represents a major global health problem, which in high-income countries now mostly affects people who inject drugs (PWID). Many studies show that the treatment of HCV infection is as successful among PWID as among other populations and recently PWID have been included in the international guidelines for the treatment of HCV infection. The aim of this survey was to collect data from European countries on the existence of national strategies, action plans and clinical guidelines for HCV treatment in the general population and PWID in particular.MethodsThirty-three European countries were invited to participate. Data on available national strategies, action plans and guidelines for HCV treatment in general population and in PWID specifically were collected prospectively by means of a structured electronic questionnaire and analyzed accordingly.ResultsAll of the 33 invited European countries participated in the survey. Twenty-two responses came from non-governmental organizations, six from public health institutions, four from university institutions and one was an independent consultant. Fourteen (42.4%) of the countries reported having a national strategy and/or national action plan for HCV treatment, from which ten of them also reported having a national strategy and/or national action plan for treatment of HCV infection in PWID. Nearly three-quarters reported having national HCV treatment guidelines. PWID were included in the majority (66.7%) of the guidelines. Fourteen (42.4%) countries reported having separate guidelines for the treatment of HCV infection in PWID.ConclusionsGiven the high burden of HCV-related morbidity and mortality in PWID in Europe, the management of HCV infection should become a healthcare priority in all European countries, starting with developing or using already-existing national strategies, action plans and guidelines for this population.

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“…3 The experience of some European countries has shown that access of PWID to HCV therapy (including DAA) and scaling up HCV treatment is feasible using an integrated multidisciplinary approach. [17][18][19] The need for psychiatric evaluation is enforced by most of the Medicaid providers. This requirement is implemented for anyone who has used illicit drugs, or any psychotropic medication in their lifetime.…”

Section: Discussionmentioning

confidence: 99%

The Prescribers’ Dilemma: Treatment of Hepatitis C Infection for Medicaid Insured Patients in United States

Khallafi¹,

George²,

Qureshi³

2015

Liver Res Open J

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Introduction of Direct Acting Antivirals (DAA) to Hepatitis C Virus (HCV) treatment armamentarium has offered a great boost to the providers' confidence to safely and effectively treat HCV infection in the majority of patients. However, the cost of these medications is high and thus access is poor. Medicaid insurance providers have devised stringent eligibility criteria to approve the cost of DAA for its members. We reviewed the criteria among various Medicaid agencies from States of Ohio and Pennsylvania and noticed similarities and differences among them. The prerequisite process demanding clinical, laboratory, radiologic or histologic documentation is quite cumbersome and sometimes confusing. In certain aspects the eligibility requirements for DAA are not in concordance with the clinical evidence provided by the recently updated guidelines. We have addressed the dilemma most of the providers face while planning HCV treatment for the Medicaid insured patients in regards to the needed testing, clinical documentation and liver fibrosis assessment, along with the clinical implications of such requirements. While HCV remains a major public health issue, variable State Medicaid policies may lead to disparity in access to the emerging DAA with subsequent healthcare outcomes. These gaps may compromise long term efforts of the public health HCV initiatives.

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Hepatitis C testing and treatment among active drug users in Amsterdam

Abstract: In a multidisciplinary setting, HIV-negative drug users with chronic HCV infection can be treated successfully despite active drug or alcohol use and psychiatric diseases. Therefore, access to HCV therapy using an integrated approach should be increased for this population.

Cited by 79 publications

References 50 publications

A systematic review of Hepatitis C virus treatment uptake among people who inject drugs in the European Region

A systematic review of Hepatitis C virus treatment uptake among people who inject drugs in the European Region

Are there national strategies, plans and guidelines for the treatment of hepatitis C in people who inject drugs? A survey of 33 European countries

The Prescribers’ Dilemma: Treatment of Hepatitis C Infection for Medicaid Insured Patients in United States

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