Hepatitis C Testing, Status and Treatment among Marginalized People Who Use Drugs in an Inner City Setting: An Observational Cohort Study

Boucher, Lisa M.; Bayoumi, Ahmed M.; Mark, Amy E.; Cooper, Curtis; Martin, Alana; Marshall, Zack; Boyd, Rob; Oickle, Pam; Diliso, Nicola; Pineau, Dave; Renaud, Brad; LeBlanc, Sean; Tyndall, Mark; Lee, Olivia M.; Kendall, Claire

doi:10.1080/10826084.2018.1485699

Cited by 14 publications

(11 citation statements)

References 45 publications

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“…Others in similar settings have also noted this disparity [63]. This finding is of concern given that DAA therapy is reimbursed by our provincial formulary for nearly all patients and that the average age of people with HCV who use drugs in Canada is in the mid to late forties range [63,64]. It is critical to develop policies and strategies that facilitate DAA uptake and completion in those facing barriers to treatment [65,66].…”

Section: Discussionmentioning

confidence: 99%

HCV-infected individuals have higher prevalence of comorbidity and multimorbidity: a retrospective cohort study

et al. 2019

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Background: Almost 1% of Canadians are hepatitis C (HCV)-infected. The liver-specific complications of HCV are established but the extra-hepatic comorbidity, multimorbidity, and its relationship with HCV treatment, is less well known. We describe the morbidity burden for people with HCV and the relationship between multimorbidity and HCV treatment uptake and cure in the pre-and post-direct acting antiviral (DAA) era. Methods: We linked adults with HCV at The Ottawa Hospital Viral Hepatitis Program as of April 1, 2017 to provincial health administrative data and matched on age and sex to 5 Ottawa-area residents for comparison. We used validated algorithms to identify the prevalence of mental and physical health comorbidities, as well as multimorbidity (2+ comorbidities). We calculated direct age-and sex-standardized rates of comorbidity and comparisons were made by interferon-based and interferon-free, DAA HCV treatments. Results: The mean age of the study population was 54.5 years (SD 11.4), 65% were male. Among those with HCV, 4% were HIV co-infected, 26% had liver cirrhosis, 47% received DAA treatment, and 57% were cured of HCV. After accounting for age and sex differences, the HCV group had greater multimorbidity (prevalence ratio (PR) 1.38, 95% confidence interval (CI) 1.20 to 1.58) and physical-mental health multimorbidity (PR 2.71, 95% CI 2.29-3.20) compared to the general population. Specifically, prevalence ratios for people with HCV were significantly higher for diabetes, renal failure, cancer, asthma, chronic obstructive pulmonary disease, substance use disorder, mood and anxiety disorders and liver failure. HCV treatment and cure were not associated with multimorbidity, but treatment prevalence was significantly lower among middle-aged individuals with substance use disorders despite no differences in prevalence of cure among those treated. Conclusion: People with HCV have a higher prevalence of comorbidity and multimorbidity compared to the general population. While HCV treatment was not associated with multimorbidity, people with substance use disorder were less likely to be treated. Our results point to the need for integrated, comprehensive models of care delivery for people with HCV.

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Section: Discussionmentioning

confidence: 99%

HCV-infected individuals have higher prevalence of comorbidity and multimorbidity: a retrospective cohort study

et al. 2019

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“…Historically, there has been a large translational gap in the delivery of treatment to the target population of PWID with HCV: prior studies from the pre-DAA era in the U.S. demonstrate that <10% of PWID have been treated (Carey et al, 2016;Mehta et al, 2008). Data on HCV care continuum among PWID in the DAA-era are emerging from around the globe (Boucher et al, 2018;Iversen et al, 2017;Mohamed et al, 2018;Patel et al, 2018;Young et al, 2018); however, to date U.S. based studies are lacking. The "care continuum" framework, which has been used for overlapping diseases such as HIV (Gardner et al, 2011;Mugavero et al, 2013) and opioid use disorders (Socias et al, 2018), outlines the steps in the care so as to identify where such barriers exist.…”

Section: Introductionmentioning

confidence: 99%

Hepatitis C continuum of care and utilization of healthcare and harm reduction services among persons who inject drugs in Seattle

Tsui

Miller

Scott

et al. 2019

Drug and Alcohol Dependence

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Background: To describe the "continuum of care" for hepatitis C virus (HCV) and related health service utilization among persons who inject drugs (PWID) in the Seattle metropolitan area. Methods: The study analyzed data from the 2015 National HIV Behavioral Surveillance system focused on PWID, which included local questions on HCV treatment and testing. We calculated respondent driven sampling (RDS)-adjusted percentages of participants who had completed each step of the care continuum and compared healthcare harm reduction services among participants who were HCV+ vs. HCV-using bivariate analyses. Results: 513 PWID were screened for HCV antibodies (Ab). Of those, 59.7% were HCV Ab+. Among those HCV Ab+, 86.4% had been tested for HCV at least once; 69.9% reported a previous diagnosis. Of those diagnosed, 55.9% had received a confirmatory test, 17.2% had ever received any medications for HCV, and 7.2% had completed treatment. The majority of HCV Ab+ participants had seen a health care provider in the past 12 months (85.6%). Conclusions: There is a large gap between HCV screening and treatment among Seattle area PWID.

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“…However, the model relied on subsequent engagement with specialist services to translate this into improved treatment numbers. This cavity in the care cascade has also been demonstrated in other studies, 27,28 and an expansion of GP practice to initiate HCV therapy could help facilitate its closure 29 …”

Section: Discussionmentioning

confidence: 53%

Provider‐related barriers and enablers to the provision of hepatitis C treatment by general practitioners in Scotland: A behaviour change analysis

Whiteley

Speakman

Elliott

et al. 2020

Journal of Viral Hepatitis

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The ease of direct‐acting antiviral (DAA) medications for hepatitis C virus (HCV) has provided an opportunity to decentralize HCV treatment into community settings. However, the role of non‐specialist clinicians in community‐based pathways has received scant attention to date. This study examined barriers and enablers to expanding the role of general practitioners (GPs) in HCV treatment provision, using simple behaviour change theory as a conceptual framework. A maximum variation sample of 22 HCV treatment providers, GPs and HCV support workers participated in semi‐structured interviews. Data were inductively coded, and the resulting codes deductively mapped into three principal components of behaviour change: capability, opportunity and motivation (COM‐B). By this process, a number of provider‐ and systemic‐level barriers and enablers were identified. Key barriers included the pre‐treatment assessment of liver fibrosis, GP capacity and the ‘speciality’ of HCV care. Enablers included the simplicity of the drugs, existing GP/patient relationships and the provision of holistic care. In addition to these specific factors, the data also exposed an overarching provider understanding of ‘HCV treatment’ as triumvirate in nature, incorporating the assessment of liver fibrosis, the provision of holistic support and the treatment of disease. This understanding imposes a further fundamental barrier to GP‐led treatment as each of these three components needs to be individually addressed. To enable sustainable models of HCV treatment provision by GPs, a pragmatic re‐examination of the ‘HCV treatment triumvirate’ is required, and a paradigm shift from the ‘refer and treat’ status quo.

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Hepatitis C Testing, Status and Treatment among Marginalized People Who Use Drugs in an Inner City Setting: An Observational Cohort Study

Cited by 14 publications

References 45 publications

HCV-infected individuals have higher prevalence of comorbidity and multimorbidity: a retrospective cohort study

HCV-infected individuals have higher prevalence of comorbidity and multimorbidity: a retrospective cohort study

Hepatitis C continuum of care and utilization of healthcare and harm reduction services among persons who inject drugs in Seattle

Provider‐related barriers and enablers to the provision of hepatitis C treatment by general practitioners in Scotland: A behaviour change analysis

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