Integrating hepatitis C care for at-risk groups (HepLink): baseline data from a multicentre feasibility study in primary and community care

Abstract

Objectives To examine HCV prevalence and management among people who inject drugs (PWID) attending primary care and community-based health services at four European sites using baseline data from a multicentre feasibility study of a complex intervention (HepLink). Methods Primary care and community-based health services in Dublin, London, Bucharest and Seville were recruited from the professional networks of the HepLink consortium. Patients were eligible to participate if aged ≥18 years, on opioid substitution treatment or at risk of HCV (i.e. injecting drug use, homeless or incarcerated), and attended the service. Data on patient demographics and prior HCV management were collected on participants at baseline. Results Twenty-nine primary care and community-based health services and 530 patients were recruited. Baseline data were collected on all participants. Participants’ mean age ranged from 35 (Bucharest) to 51 years (London), with 71%–89% male. Prior lifetime HCV antibody testing ranged from 65% (Bucharest) to 95% (Dublin) and HCV antibody positivity among those who had been tested ranged from 78% (Dublin) to 95% (Bucharest). Prior lifetime HCV RNA testing among HCV antibody-positive participants ranged from 17% (Bucharest) to 84% (London). Among HCV antibody- or RNA-positive participants, prior lifetime attendance at a hepatology/infectious disease service ranged from 6% (London) to 50% (Dublin) and prior lifetime HCV treatment initiation from 3% (London) to 33% (Seville). Conclusions Baseline assessment of the HCV cascade of care among PWID attending primary care and community-based health services at four European sites identified key aspects of the care cascade at each site that need to be improved.

WITHDRAWN: What is the clinical course of patients hospitalised for COVID-19 treatment Ireland: a retrospective cohort study in Dublin’s North Inner City (the ‘Mater 100’)

“…Re ecting this demographic, infectious diseases care locally has involved addressing communicable diseases such as HIV and hepatitis C in partnership with local communities. Most recently this has involved initiatives involving prisoners 12 , homeless populations 13 and patients attending General Practice 14 .…”

Cost-effectiveness of mass screening for Hepatitis C virus among all inmates in an Irish prison

“…This calibration produced estimates for the unknown HCV transmission risk among never incarcerated PWID, while assuming HCV transmission risk is elevated among recently released PWID [8] and negligible in prison, based on no new infections being identified in HCV retesting (99 individuals retested after 2 years) undertaken in Mountjoy prison in 2019 (Personal communication Dr Desmond Crowley). The baseline modelled HCV testing rate was also estimated, such that the model projected 63% (55-71%) of chronically infected PWID were currently diagnosed [16]. We assumed 70% (61-79%) of diagnosed individuals were engaged with hospital care, of which 39% (26-53%) commenced treatment within 2 years [16].…”

“…The baseline modelled HCV testing rate was also estimated, such that the model projected 63% (55-71%) of chronically infected PWID were currently diagnosed [16]. We assumed 70% (61-79%) of diagnosed individuals were engaged with hospital care, of which 39% (26-53%) commenced treatment within 2 years [16]. Testing and engagement rates were assumed same regardless of injecting and incarceration status, but only nonincarcerated ex-injectors were treated before 2015 [17].…”

“…Referral rate from diagnosis for standard-ofcare pathway in all compartments Mean 1.21 (0.94-1.56) 70% per year (61-79%) (data from HepLink study [16]). Assume this percentage referral is all within the last year to obtain engagement rate [16]…”

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“…As such, PWID are a priority population for enhancing prevention, testing, linkage to care, treatment and follow-up care in order to meet WHO hepatitis C elimination goals by 2030. In this research project HCV prevalence and management among PWID attending primary care and community-based services at four European sites (Dublin, London, Seville and Bucharest) are described 12 . Lifetime RNA testing among HCV antibody-positive patients ranged from 13.2% to 87.1%, with rates of RNA positivity among those tested ranging from 60% to 89%.…”