Linkage to care strategy for the micro-elimination of hepatitis C among parenteral drug users on methadone replacement therapy in Gipuzkoa

Castaño, Ylenia Pérez; Pérez, José Manuel Chouza; Largo, Vanesa Sanz; Cortajarena, Edurne Almandoz; García, Alexandra Gómez; González, Francisco Javier Esandi; Eguzkiza, Aitor; Díaz, Sandra Arranz; Lugea, Itxaso Urtasun; Iturri, Maria Jose Sanchez; Fernández, Borja Gil; Bujanda, Luís; Ruiz-Tapiador, Juan Arenas

doi:10.17235/reed.2020.7194/2020

Cited by 9 publications

(5 citation statements)

References 17 publications

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“…To achieve the goal set by the World Health Organization for HCV elimination, a diagnostic rate of 90% and a treatment coverage rate of 80% are required to achieve a 65% reduction in the rate of HCV-related deaths by 2030 [ 4 , 10 , 34 , 35 , 37 ]. A major challenge is determining the HCV genotype before initiating DAA regimens.…”

Section: Discussionmentioning

confidence: 99%

Pan-Genotypic Direct-Acting Antiviral Agents for Undetermined or Mixed-Genotype Hepatitis C Infection: A Real-World Multi-Center Effectiveness Analysis

Yen

Chen

Lai

et al. 2022

JCM

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Although the pan-genotypic direct-acting antiviral regimen was approved for treating chronic hepatitis C infection regardless of the hepatitis C virus (HCV) genotype, real-world data on its effectiveness against mixed-genotype or genotype-undetermined HCV infection are scarce. We evaluated the real-world safety and efficacy of two pan-genotypic regimens (Glecaprevir/Pibrentasvir and Sofosbuvir/Velpatasvir) for HCV-infected patients with mixed or undetermined HCV genotypes from the five hospitals in the Changhua Christian Care System that commenced treatment between August 2018 and December 2020. This retrospective study evaluated the efficacy and safety of pan-genotypic direct-acting antiviral (DAA) treatment in adults with HCV infection. The primary endpoint was the sustained virological response (SVR) observed 12 weeks after completing the treatment. Altogether, 2446 HCV-infected patients received the pan-genotypic DAA regimen, 37 (1.5%) patients had mixed-genotype HCV infections and 110 (4.5%) patients had undetermined HCV genotypes. The mean age was 63 years and 55.8% of our participants were males. Nine (6.1%) patients had end-stage renal disease and three (2%) had co-existing hepatomas. We lost one patient to follow-up during treatment and one more patient after treatment. A total of four patients died. However, none of these losses were due to treatment-related side effects. The rates of SVR12 for mixed-genotype and genotype-undetermined infections were 97.1% and 96.2%, respectively, by per-protocol analyses, and 91.9% and 92.7% respectively, by intention-to-treat population analyses. Laboratory adverse events with grades ≥3 included anemia (2.5%), thrombocytopenia (2.5%), and jaundice (0.7%). Pan-genotypic DAAs are effective and well-tolerated for mixed-genotype or genotype-undetermined HCV infection real-world settings.

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Section: Discussionmentioning

confidence: 99%

Pan-Genotypic Direct-Acting Antiviral Agents for Undetermined or Mixed-Genotype Hepatitis C Infection: A Real-World Multi-Center Effectiveness Analysis

Yen

Chen

Lai

et al. 2022

JCM

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“…The effective identification of high-risk patients for HCV infection is the first step toward HCV elimination, and such a micro-elimination approach is beneficial for clinicians and public health officials due to limited financial support and the shortage of screening manpower [ 23 ]. Several high-risk subpopulations, such as injection drug users [ 8 ], prisoners [ 24 ], HIV-infected patients [ 2 , 9 ], dialysis patients [ 3 ], and baby boomers [ 18 , 25 ] have been reported as the first target for HCV elimination. Despite the DM population being identified as having a higher risk for hepatitis C infection than the general population [ 13 , 26 , 27 , 28 ], these patients have not been elected as a target for HCV micro-elimination in previous literature.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, a micro-elimination approach targeting specific high-risk populations is less complex and less costly than a universal screening and treatment approach [ 6 , 7 ]. Several specific high-risk populations with bloodstream infections have been identified as the first step toward HCV elimination, including injection drug users [ 8 ], HIV-infected patients [ 2 , 9 ], and patients on dialysis [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Strategy for the Micro-Elimination of Hepatitis C among Patients with Diabetes Mellitus—A Hospital-Based Experience

Chen

Yen

et al. 2021

JCM

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Hepatitis C virus (HCV) infection can induce insulin resistance, and patients with diabetes mellitus (DM) have a higher prevalence of HCV infection. Patient outcomes improve after HCV eradication in DM patients. However, HCV micro-elimination targeting this population has not been approached. Little is known about using electronic alert systems for HCV screening among patients with DM in a hospital-based setting. We implemented an electronic reminder system for HCV antibody screening and RNA testing in outpatient departments among patients with DM. The screening rates and treatment rates at different departments before and after system implementation were compared. The results indicated that the total HCV screening rate increased from 49.3% (9505/19,272) to 78.2% (15,073/19,272), and the HCV-RNA testing rate increased from 73.4% to 94.2%. The anti-HCV antibody seropositive rate was 5.7%, and the HCV viremia rate was 62.7% in our patient population. The rate of positive anti-HCV antibodies and HCV viremia increased with patient age. This study demonstrates the feasibility and usefulness of an electronic alert system for HCV screening and treatment among DM patients in a hospital-based setting.

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“…DOT has been the public health standard of care for tuberculosis treatment since the early 1990s and is a standard practice for people receiving methadone in OTP settings [15]. DOT for HCV treatment has been studied in OTP settings [16][17][18]. However, DOT is not common in community health settings, due to the heavy burden of daily visits on patients and staff.…”

Section: Introductionmentioning

confidence: 99%

A Video-Observed Treatment Strategy to Improve Adherence to Treatment Among Persons Who Inject Drugs Infected With Hepatitis C Virus: Qualitative Study of Stakeholder Perceptions and Experiences

Karasz¹,

Merchant²,

Arnstein³

et al. 2023

J Med Internet Res

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Background Direct-acting antiviral medications have the potential to eliminate the hepatitis C virus (HCV) epidemic among people who inject drugs; yet, suboptimal adherence remains a barrier. Directly observed treatment (DOT), an effective strategy for optimizing adherence, has been frequently implemented in opioid treatment programs but less commonly in community health settings due to the heavy burden of daily visits. An alternative is video-observed therapy (VOT), which uses mobile health technology to monitor adherence. VOT has not been widely studied among people who inject drugs with HCV. Objective This qualitative study, part of a larger implementation evaluation, investigates stakeholder perceptions and experiences with VOT in Project HERO (Hepatitis C Real Outcomes), a multisite pragmatic trial testing treatment delivery models for people who inject drugs with HCV. Our goal was to understand the potential barriers and facilitators to the implementation of the VOT technology. Methods Qualitative interviews were conducted with 27 Project HERO study staff and 7 patients. Interviews focused on perceptions and experiences with the VOT app and barriers and facilitators to implementation. Team meeting minutes over the first 2 years of the project were transcribed. A coding system was developed and applied to the data. We summarized thematic data and compared participant perceptions to generate a close understanding of the data. Results Frequent barriers to VOT included mechanical failure, stolen or lost phones, and a steep learning curve for participants and study staff. In sites with older and less technically skilled participants, staff found it difficult to implement the VOT app. Research staff found that the routine monitoring of app use led to closer engagement with participants. This was both a benefit and a potential threat to the validity of this pragmatic trial. Patient participants reported mixed experiences. Conclusions VOT may be a useful alternative to DOT for some patients, but it may not be feasible for all. Significant staff involvement may be required.

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Linkage to care strategy for the micro-elimination of hepatitis C among parenteral drug users on methadone replacement therapy in Gipuzkoa

Cited by 9 publications

References 17 publications

Pan-Genotypic Direct-Acting Antiviral Agents for Undetermined or Mixed-Genotype Hepatitis C Infection: A Real-World Multi-Center Effectiveness Analysis

Pan-Genotypic Direct-Acting Antiviral Agents for Undetermined or Mixed-Genotype Hepatitis C Infection: A Real-World Multi-Center Effectiveness Analysis

Strategy for the Micro-Elimination of Hepatitis C among Patients with Diabetes Mellitus—A Hospital-Based Experience

A Video-Observed Treatment Strategy to Improve Adherence to Treatment Among Persons Who Inject Drugs Infected With Hepatitis C Virus: Qualitative Study of Stakeholder Perceptions and Experiences

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