Interventions to enhance testing and linkage to treatment for hepatitis C infection for people who inject drugs: A systematic review and meta-analysis

Cunningham, Evan B; Wheeler, Alice; Hajarizadeh, Behzad; French, Clare E; Roche, Rachel; Marshall, Alison D.; Fontaine, Guillaume; Conway, Anna; Bajis, Sahar; Valencia, Braulio M.; Presseau, Justin; Ward, John W.; Degenhardt, Louisa; Dore, Gregory J.; Hickman, Matthew; Vickerman, Peter; Grebely, Jason

doi:10.1016/j.drugpo.2022.103917

Cited by 23 publications

(19 citation statements)

References 69 publications

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“…Of the 503 participants (males 100%; age median [IQR] 27 [23][24][25][26][27][28][29][30][31][32] was 25 [22][23][24][25][26][27][28].…”

Section: Resultsmentioning

confidence: 99%

Decentralised same day test and treatment of hepatitis C levering existing peer support networks among people who inject drugs: Feasibility and effectiveness

Nalinikanta,

Singh,

Dhabali

et al. 2024

Preprint

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Background Prevalence of hepatitis C virus (HCV) infection among people who inject drugs in the state of Manipur, India, is 43%; however, access to care is poor. We piloted a Community-led and comprehensive hepatitis care model that included same-day HCV treatment at drug treatment centres. Methods Screening was conducted using HCV antibody (HCV Ab) and hepatitis B virus (HBV) surface antigen (HBsAg) rapid diagnostic tests. Positive HCV Ab samples were tested using a point-of-care HCV RNA. Eligible HCV RNA-positive participants were treated on the same day using direct-acting antivirals and followed for sustained virologic response (SVR). HBsAg-negative participants received rapid HBV vaccination regimen while positive samples were tested for DNA and referred for treatment. Results Between November 2021 and August 2022, 643 individuals were approached and 503 consented and were screened. All screened were males with history of injection drug use, and a median age of 27 years (IQR 23–32). Of the 241 (47.9%) HCV Ab positive all underwent RNA testing and 156 (64.7%) were RNA detectable. Of those with viraemia, 155 (99.4%) were initiated on treatment with 153 (98.1%) on same day. Among those 153, median time from screening to treatment was 6 hours 38 minutes (IQR 5 hours 42 minutes – 8 hours 23 minutes). In total 155 (100%) completed HCV treatment, of those 148 (95.5%) completed SVR testing and 130 (87.8%) achieved SVR12.

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“…Of the 503 participants (males 100%; age median [IQR] 27 [23][24][25][26][27][28][29][30][31][32] was 25 [22][23][24][25][26][27][28].…”

Section: Resultsmentioning

confidence: 99%

Decentralised same day test and treatment of hepatitis C levering existing peer support networks among people who inject drugs: Feasibility and effectiveness

Nalinikanta,

Singh,

Dhabali

et al. 2024

Preprint

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“…40 Patient education can improve their knowledge about the medical impacts of HCV and address the barriers caused by outdated knowledge about HCV treatment. 40 It will be more useful if this can be performed by the specialists who have the closest contact and best relationship with the patients, such as OST case managers and OST specialists. 41 Patient navigation, peer support, and patient reminders are also reported to improve linkage to care and HCV treatment.…”

Section: Barriers and Interventions For Hcv Micro-elimination In Pwidmentioning

confidence: 99%

“…It is necessary to remove barriers and promote access to HCV screening and treatment for PWID. Interventions from different levels can be adopted to overcome the barriers existing in the care cascade 40 . Patient education can improve their knowledge about the medical impacts of HCV and address the barriers caused by outdated knowledge about HCV treatment 40 .…”

Section: Barriers and Interventions For Hcv Micro‐elimination In Pwidmentioning

confidence: 99%

“…Interventions from different levels can be adopted to overcome the barriers existing in the care cascade 40 . Patient education can improve their knowledge about the medical impacts of HCV and address the barriers caused by outdated knowledge about HCV treatment 40 . It will be more useful if this can be performed by the specialists who have the closest contact and best relationship with the patients, such as OST case managers and OST specialists 41 .…”

Section: Barriers and Interventions For Hcv Micro‐elimination In Pwidmentioning

confidence: 99%

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Hepatitis C virus micro‐elimination in people who inject drugs: Challenges and chance in Taiwan and worldwide

Tai,

2023

The Kaohsiung J of Med Scie

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With the introduction of direct‐acting antivirals, elimination of hepatitis C virus (HCV) infection is becoming possible. People who inject drugs (PWID) represent a population with a high risk for HCV infection, which has been reported as high as 90% in Taiwanese PWID. To reach the goal of HCV elimination, PWID is a key population deserving special attention. Barriers in HCV care cascade still exist in PWID, and interventions to promote access to HCV diagnosis, link‐to‐care, treatment, and prevention for PWID are warranted. Although HCV micro‐elimination can be achieved in some prisons and opioid substitution therapy (OST) centers by a multidisciplinary team and integrated care in Taiwan, there are still several unmet needs for HCV elimination in PWID. Continuous efforts, such as the participation of OST specialists and the continuum of care for HCV among PWID, are needed to achieve HCV elimination in Taiwan. In addition, the combination of harm reduction services, treatment as prevention and regular posttreatment HCV surveillance is critical to substantially reduce HCV transmission and prevalence in PWID.

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“…For example, colocating or coordinating HCV treatment within existing clinical care programs can be effective, but this treatment only reaches those already engaged in the health care system. Colocation within trust-established settings in the community can ease access barriers and reduce stigma and discrimination . However, at each step along the traditional path from HCV diagnosis to treatment initiation, patients may be lost to follow-up.…”

Section: Introductionmentioning

confidence: 99%

Community-Based Point-of-Diagnosis Hepatitis C Treatment for Marginalized Populations

Morris,

McDonell,

Luetkemeyer

et al. 2023

JAMA Netw Open

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ImportanceDisparities persist in testing and treatment for hepatitis C virus (HCV), leaving socially marginalized populations less likely to benefit from curative treatment. Linkage services are often insufficient to overcome barriers to navigating the medical system and contextual factors.ObjectiveTo determine the feasibility, acceptability, and safety of HCV treatment at the point of HCV infection diagnosis disclosure in a nonclinical community setting.Design, Setting, and ParticipantsIn this single-arm nonrandomized controlled trial conducted between July 1, 2020, and October 31, 2021, street-outreach recruitment targeted people experiencing homelessness and injecting drugs in an urban US community who were eligible for simplified HCV treatment.InterventionsStudy procedures were designed to reflect the community environment and services needed to provide HCV testing, disclosure, and treatment in a nonclinical site. The test-and-treat No One Waits (NOW) model of care provided a 2-week starter pack of 400 mg of sofosbuvir and 100 mg of velpatasvir at time of HCV RNA results disclosure. Participants were transitioned to insurance-provided sofosbuvir-velpatasvir when feasible to complete a 12-week treatment course.Main Outcomes and MeasuresThe primary end point was sustained virologic response at posttreatment week 12 or later (SVR12). Acceptability end points were treatment initiation and completion. Safety end points were treatment discontinuation because of a late exclusion criterion and adverse events.ResultsOf the 492 people (median [IQR] age, 48 [37-58] years; 62 [71%] male) who underwent anti-HCV testing, 246 (50%) tested anti-HCV positive, and 111 (23%) tested HCV RNA positive and were eligible for simplified HCV treatment. Eighty-nine of the 111 eligible participants (80%) returned for confirmatory RNA results, and 87 (98%) accepted and initiated HCV treatment. Seventy (80%) were currently injecting drugs, 83 (97%) had an income below the poverty line, and 53 (61%) were currently unsheltered. Most had HCV genotype 1a (45 [52%]) or 3 (20 [23%]). Sixty-nine (79%) completed 12 weeks of sofosbuvir-velpatasvir treatment, 2 stopped treatment because of low adherence, and 16 were lost to follow-up. Of the 66 participants who completed treatment and had a successful blood draw, 61 (92%) had undetectable HCV RNA at treatment completion. Of the 87 treated patients, 58 achieved SVR12, leading to a treatment response of 67% (95% CI, 56%-76%) among the intention-to-treat group and 84% (95% CI, 73%-92%) among the per-protocol group. There were no adverse events, late exclusions, or deaths.Conclusions and RelevanceIn this nonrandomized controlled trial of HCV treatment at the point of diagnosis, the NOW model of care reduced steps between HCV testing and treatment initiation and resulted in high levels of treatment initiation, completion, and cure. The NOW model of care can expand the current HCV test-and-treat toolkit by reaching a broader population of marginalized communities and expediting curative therapy.Trial RegistrationClinicalTrials.gov Identifier: NCT03987503

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Interventions to enhance testing and linkage to treatment for hepatitis C infection for people who inject drugs: A systematic review and meta-analysis

Cited by 23 publications

References 69 publications

Decentralised same day test and treatment of hepatitis C levering existing peer support networks among people who inject drugs: Feasibility and effectiveness

Decentralised same day test and treatment of hepatitis C levering existing peer support networks among people who inject drugs: Feasibility and effectiveness

Hepatitis C virus micro‐elimination in people who inject drugs: Challenges and chance in Taiwan and worldwide

Community-Based Point-of-Diagnosis Hepatitis C Treatment for Marginalized Populations

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