Integrated models of care for people who inject drugs and live with hepatitis C virus: A systematic review

Socías, M. Eugenia; Karamouzian, Mohammad; Parent, Stéphanie; Barletta, José; Bird, Kathleen A.; Ti, Lianping

doi:10.1016/j.drugpo.2019.05.023

Cited by 54 publications

(56 citation statements)

References 68 publications

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“…27 Thus, the elimination of HCV infection in the PWUD population is crucial in global HCV control. [15][16][17]28 Not surprisingly, both European 14 and US 13,28 However, our study has some limitations. This was a single-centre study with an enrolment of a relatively small sample of PWUD.…”

Section: Close Interaction Between the Personnel Of The Infectious DImentioning

confidence: 79%

Innovative procedures for micro‐elimination of HCV infection in persons who use drugs

Messina

Russo²,

Parente³

et al. 2020

Journal of Viral Hepatitis

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Section: Close Interaction Between the Personnel Of The Infectious DImentioning

confidence: 79%

Innovative procedures for micro‐elimination of HCV infection in persons who use drugs

Messina

Russo²,

Parente³

et al. 2020

Journal of Viral Hepatitis

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“…A recent systematic review of integrated models of care for people who inject drugs and have chronic hepatitis C infection suggests that a one‐stop shop model of care that integrates HCV care in addiction‐treatment programs or community settings may facilitate engagement along the continuum of HCV care for this population. ( 30 ) Additionally, community‐based HCV treatment by primary care providers may offer a promising strategy to reach people experiencing homelessness. ( 12 ) However, in shelters where multidisciplinary resources are lacking, health care providers, shelter staff, and social service outreach workers must advocate for patients in ways that can move the patient toward treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Based on previous research on integrated models of care for at‐risk populations with HCV ( 30 ) and our formative work reported herein, we are currently evaluating scaling up HCV testing and a flexible model of integrated HCV care and treatment. In this model, a designated provider (a nurse in San Francisco and a pharmacist or physician assistant in Minneapolis) performs incentivized HCV point‐of‐care testing and confirmation of active infection, formal patient group education, assessment of treatment readiness, and links the patient to HCV therapy.…”

Section: Discussionmentioning

confidence: 99%

Recommendations for Implementing Hepatitis C Virus Care in Homeless Shelters: The Stakeholder Perspective

et al. 2020

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Compared with the general population, homeless individuals are at higher risk of hepatitis C infection (HCV) and may face unique barriers in receipt of HCV care. This study sought the perspectives of key stakeholders toward establishing a universal HCV screening, testing, and treatment protocol for individuals accessing homeless shelters. Four focus groups were conducted with homeless shelter staff, practice providers, and social service outreach workers (n = 27) in San Francisco, California, and Minneapolis, Minnesota. Focus groups evaluated key societal, system, and individuallevel facilitators and barriers to HCV testing and management. Interviews were transcribed and analyzed thematically. The societal-level barriers identified were lack of insurance, high-out-of-pocket expenses, restriction of access to HCV treatment due to active drug and/or alcohol use, and excessive paperwork required for HCV treatment authorization from payers. System-level barriers included workforce constraints and limited health care infrastructure, HCV stigma, low knowledge of HCV treatment, and existing shelter policies. At the individual level, client barriers included competing priorities, behavioral health concerns, and health attitudes. Facilitators at the system level for HCV care service integration in the shelter setting included high acceptability and buy in, and linkage with social service providers. Conclusion: Despite societal, system, and individual-level barriers identified with respect to the scale-up of HCV services in homeless shelters, there was broad support from key stakeholders for increasing capacity for the provision of HCV services in shelter settings. Recommendations for the scale-up of HCV services in homeless shelter settings are discussed. (Hepatology Communications 2020;4:646-656).H epatitis C virus (HCV) prevalence is underestimated in underserved populations, including people experiencing homelessness who are at increased risk of HCV infection. (1) According to a recent systematic review of infectious disease prevalence studies, the prevalence of HCV among homeless adults ranges from 9.8% to 52.5%. (2) Among people experiencing homelessness, substance use and mental health disorders are common, and are risk factors for HCV infection. (3,4) Moreover, homelessness has consistently been associated with injection drug use, (5) and engaging in unsafe injection drug-use practices likely drives the high rates of HCV infection documented among this population.

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“…This population is both at risk for HCV transmission in the setting of ongoing drug use and also under direct observation of a healthcare provider, underscoring a missed opportunity to engage OAT recipients in curing HCV through integrated substance use and HCV treatment programmes . Both integrating HCV treatment into substance use treatment programmes and integrating addiction services into HCV care have improved linkage to care and treatment success among people living with HCV and substance use disorder in developed countries …”

Section: Discussionmentioning

confidence: 99%

Nurse case management to improve the hepatitis C care continuum in HIV co‐infection: Results of a randomized controlled trial

Starbird

Budhathoki

Han

et al. 2019

Journal of Viral Hepatitis

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The opportunity to eliminate hepatitis C virus (HCV) is at hand, but challenges remain that negatively influence progress through the care continuum, particularly for persons co‐infected with HIV who are not well engaged in care. We conducted a randomized controlled trial to test the effect of nurse case management (NCM) on the HCV continuum among adults co‐infected with HIV compared to usual care (UC). Primary outcomes included linkage to HCV care (attendance at an HCV practice appointment within 60 days) and time to direct‐acting antiviral (DAA) initiation (censored at 6 months). Sixty‐eight participants were enrolled (NCM n = 35; UC n = 33). Participants were 81% Black/African American, 85% received Medicaid, 46% reported illicit drug use, 41% alcohol use, and 43% had an undetectable HIV viral load. At day 60, 47% of NCM participants linked to HCV care compared to 25% of UC participants (P = .031; 95% confidence bound for difference, 3.2%‐40.9%). Few participants initiated DAAs (12% NCM; 25% UC). There was no significant difference in mean time to treatment initiation (NCM = 86 days; UC = 110 days; P = .192). Engagement in HCV care across the continuum was associated with drinking alcohol, knowing someone who cured HCV and having a higher CD4 cell count (P < .05). Our results support provision of NCM as a successful strategy to link persons co‐infected with HIV to HCV care, but interventions should persist beyond linkage to care. Capitalizing on social networks, treatment pathways for patients who drink alcohol, and integrated substance use services may help improve the HCV care continuum.

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Integrated models of care for people who inject drugs and live with hepatitis C virus: A systematic review

Cited by 54 publications

References 68 publications

Innovative procedures for micro‐elimination of HCV infection in persons who use drugs

Innovative procedures for micro‐elimination of HCV infection in persons who use drugs

Recommendations for Implementing Hepatitis C Virus Care in Homeless Shelters: The Stakeholder Perspective

Nurse case management to improve the hepatitis C care continuum in HIV co‐infection: Results of a randomized controlled trial

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