Low uptake of treatment for hepatitis C virus infection in a large community‐based study of inner city residents

Abstract

Despite the availability of effective therapy for hepatitis C virus (HCV) infection, there are little data on the uptake of treatment. We evaluated factors associated with HCV infection and the uptake of HCV treatment in a large community-based inner city cohort in Vancouver, Canada. The Community Health and Safety Evaluation is a cohort study of inner city residents recruited from January 2003 to June 2004. HIV and HCV status and information on prescriptions for HCV treatment were determined through linkage with provincial databases. HCV prevalence was calculated and factors associated with HCV infection were identified. HCV treatment uptake and incidence of HCV infection from January 2000 to December 2004 were expressed in terms of person-years of observation. Among 2913 individuals, HCV antibody testing was performed in 2118 and the HCV seroprevalence was 64.2% (1360 of 2118). In total, 1.1% of HCV antibody-positive individuals (15 of 1360) initiated treatment for HCV infection from January 2000 to December 2004 [0.28 cases per 100 person-years (95% CI, 0.15-0.46)]. Three of 15 (20.0%) treated individuals achieved a sustained virological response. During the same period, the incidence of HCV infection was 7.26 cases (95% CI, 5.72-8.80) per 100 person-years. Overall, the rate of new HCV seroconversions in this cohort in the study period was about 25 times the rate of HCV treatment uptake. There are extremely low rates of HCV treatment initiation and very limited effectiveness, despite a high prevalence of HCV infection in this large community-based cohort of inner city residents with access to universal healthcare.

High hepatic and extrahepatic mortality and low treatment uptake in HCV-coinfected persons in the Swiss HIV cohort study between 2001 and 2013

“…[16], and in a German and Swedish HIV/HCV cohort treatment rates were 40% and 25%, respectively [17,18]. In a large US cohort of veterans only 12% of monoinfected patients received therapy between 2000 and 2005 [19]; in coinfected populations treatment uptake was even lower [20,21]. Predictors for treatment uptake, including genotype 3, MSM, younger age, no psychiatric disorders and controlled HIV-infection, indicate that therapy was started in the easier-to-treat patients.…”

Hepatitis C virus resistance to interferon therapy: an alarming situation

“…Further it is reported that primary care physicians rarely refer HCV patients for subspecialty assessment and only one-half of HCV infected patients are referred to a specialist for evaluation and management [95]. Boaz and colleagues [96] told that referral of HCV patients with normal liver tests is below 30%. Moreover, for those patients referred for treatment, the accessibility to specialists act as an additional hurdle.…”

Traitement intégré de l’hépatite C auprès des personnes avec des troubles concomitants de santé mentale et de dépendance : promouvoir le changement en milieu urbain

“…taux de traitement oscillant entre 1 et 6 %, alors que plus de 70 % en font la demande (Grebely, 2009 ;Sherman, 2007). De plus, les personnes avec des troubles mentaux sont souvent jugées admissibles au traitement (Freedman, 2009).…”

“…Elle permet aussi de définir certaines conditions préalables au traitement et qui feront l'objet d'un premier plan d'intervention (la stabilisation d'une condition psychiatrique, l'augmentation du contrôle sur certains aspects de la consommation de substances ou l'obtention d'un domicile fixe, par exemple). L'adhésion à ces premiers rendez-vous est reconnue comme un bon indicateur du degré d'engagement du patient (Grebely, 2009) et permet de mettre en évidence les difficultés à envisager à cet égard lors d'un éventuel traitement.…”

“…La participation au groupe leur permet donc de surmonter leur méfiance envers ces derniers et envers les autorités en général, d'apprivoiser leurs craintes face au traitement et d'être entourés par des personnes qui ne les jugent pas. D'autres données de recherche suggèrent que les groupes d'entraide par les pairs ont une incidence positive sur le degré d'adhésion au traitement et sur le taux de réponse (Grebely, 2009 ;.…”