Medical and Behavioral Approaches to Engage People Who Inject Drugs Into Care for Hepatitis C Virus Infection

Gonzalez, Stevan A.; Fierer, Daniel S.; Talal, Andrew H.

doi:10.1097/adt.0000000000000104

Cited by 33 publications

(23 citation statements)

References 151 publications

(174 reference statements)

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“…With the evidence that the management of chronic diseases is most effectively and economically provided in well-supported primary care settings [74,75], our findings call for integrated, comprehensive, community-oriented approaches to HCV care delivery. Specific strategies may include involving peers in care, case management, integration of HCV care with substance use, social service delivery, primary care services [76], use of telehealth services [77], and selfmanagement strategies [78][79][80].…”

Section: Discussionmentioning

confidence: 99%

HCV-infected individuals have higher prevalence of comorbidity and multimorbidity: a retrospective cohort study

et al. 2019

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Background: Almost 1% of Canadians are hepatitis C (HCV)-infected. The liver-specific complications of HCV are established but the extra-hepatic comorbidity, multimorbidity, and its relationship with HCV treatment, is less well known. We describe the morbidity burden for people with HCV and the relationship between multimorbidity and HCV treatment uptake and cure in the pre-and post-direct acting antiviral (DAA) era. Methods: We linked adults with HCV at The Ottawa Hospital Viral Hepatitis Program as of April 1, 2017 to provincial health administrative data and matched on age and sex to 5 Ottawa-area residents for comparison. We used validated algorithms to identify the prevalence of mental and physical health comorbidities, as well as multimorbidity (2+ comorbidities). We calculated direct age-and sex-standardized rates of comorbidity and comparisons were made by interferon-based and interferon-free, DAA HCV treatments. Results: The mean age of the study population was 54.5 years (SD 11.4), 65% were male. Among those with HCV, 4% were HIV co-infected, 26% had liver cirrhosis, 47% received DAA treatment, and 57% were cured of HCV. After accounting for age and sex differences, the HCV group had greater multimorbidity (prevalence ratio (PR) 1.38, 95% confidence interval (CI) 1.20 to 1.58) and physical-mental health multimorbidity (PR 2.71, 95% CI 2.29-3.20) compared to the general population. Specifically, prevalence ratios for people with HCV were significantly higher for diabetes, renal failure, cancer, asthma, chronic obstructive pulmonary disease, substance use disorder, mood and anxiety disorders and liver failure. HCV treatment and cure were not associated with multimorbidity, but treatment prevalence was significantly lower among middle-aged individuals with substance use disorders despite no differences in prevalence of cure among those treated. Conclusion: People with HCV have a higher prevalence of comorbidity and multimorbidity compared to the general population. While HCV treatment was not associated with multimorbidity, people with substance use disorder were less likely to be treated. Our results point to the need for integrated, comprehensive models of care delivery for people with HCV.

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Section: Discussionmentioning

confidence: 99%

HCV-infected individuals have higher prevalence of comorbidity and multimorbidity: a retrospective cohort study

et al. 2019

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“…People who use drugs face multiple barriers to care, including at the provider level (e.g., discrimination), system level (e.g., lack of drug insurance, lack of flexible clinic hours), and structural level (e.g., laws related to drug use); these barriers also interact in dynamic ways within specific contexts (Grebely et al, 2013b;Johnson, Toliver, Mao, & Oramasionwu, 2014;Wagner et al, 2009;Wolfe et al, 2015). Patient-related barriers, such as frequent injecting of drugs, may also be important, although evidence indicates that people who are actively using drugs can also be highly treatment adherent (Gonzalez, Fierer, & Talal, 2017;Grebely et al, 2013a). Obtaining HCV treatment may also serve as a catalyst for some PWID to reduce their drug use or increase other self-care behaviors (Batchelder, Peyser, Nahvi, Arnsten, & Litwin, 2015).…”

Section: Discussionmentioning

confidence: 99%

Hepatitis C Testing, Status and Treatment among Marginalized People Who Use Drugs in an Inner City Setting: An Observational Cohort Study

Boucher

Bayoumi

Mark

et al. 2018

Substance Use & Misuse

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Among 663 participants, 562 (84.8%) reported testing for HCV and 258 (45.9%) reported HCV-positive status. In multivariable analysis, HCV-positive status was associated with female gender (RR 1.27; 95%CI 1.04 to 1.55), advancing age (RR 1.03/year; 95%CI 1.02 to 1.04), receiving disability payments (RR 1.42; 95%CI 1.06 to 1.91), injecting drugs (RR 5.11; 95%CI 2.64 to 9.91), ever injecting with a used needle (RR 1.30; 95%CI 1.12 to 1.52), and ever having taken methadone (RR 1.26; 95%CI 1.05 to 1.52). Of HCV positive participants, 196 (76%) were engaged in primary care but only 23 (8.9%) had received HCV therapy. Conclusions/Importance: Although HCV testing and positive status rates are high among PWID in our study, few have received HCV treatment. Innovative initiatives to increase access to HCV treatment for PWID are urgently needed.

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“…Specific strategies may include involving peers in care, case management, integration of HCV care with substance use, social service delivery, primary care services [62], use of telehealth services [63], and self-management strategies. [64][65][66]…”

Section: Discussionmentioning

confidence: 99%

“…the age-and sex-standardized prevalence rates for the two groups, along with the prevalence rate ratios and 95% confidence intervals. The prevalence in the HCV group was significantly higher for asthma (prevalence ratio (PR) 1.32; 95% confidence interval (CI) 1.06 to 1 64…”

mentioning

confidence: 99%

HCV-Infected Individuals have Higher Prevalence of Comorbidity and Multimorbidity: A retrospective cohort study

Cooper

Galanakis

Donelle

et al. 2019

Preprint

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Background Almost 1% of Canadians are hepatitis C (HCV)-infected. The liver-specific complications of HCV are established but the extra-hepatic comorbidity, multimorbidity, and its relationship with HCV treatment, is less well known. We describe the morbidity burden for people with HCV and the relationship between multimorbidity and HCV treatment in the pre- and post-direct acting antiviral (DAA) era. Methods We linked adults with HCV at The Ottawa Hospital Viral Hepatitis Program as of April 1, 2017 to provincial health administrative data and matched on age and sex to 5 Ottawa-area residents for comparison. We used validated algorithms to identify the prevalence of mental and physical health comorbidities, as well as multimorbidity (2+ comorbidities). We calculated direct age- and sex-standardized rates of comorbidity and comparisons were made by interferon-based and DAA HCV treatments. Results The mean age of the study population was 54.5 years (SD 11.4), 65% were male. Among those with HCV, 4% were HIV co-infected, 26% had liver cirrhosis, 47% received DAA treatment, and 57% were cured of HCV. After accounting for age and sex differences, the HCV group had greater multimorbidity (prevalence ratio (PR) 1.38, 95% confidence interval (CI) 1.20 to 1.58) and physical-mental health multimorbidity (PR 2.71, 95% CI 2.29 – 3.20) compared to the general population. Specifically, prevalence ratios for people with HCV were significantly higher for diabetes, renal failure, cancer, asthma, chronic obstructive pulmonary disease, substance use disorder, mood and anxiety disorders and liver failure. HCV treatment and cure were not associated with multimorbidity, but treatment prevalence was significantly lower among middle-aged individuals with substance use disorders despite no differences in prevalence of cure among those treated. Conclusion People with HCV have a higher prevalence of comorbidity and multimorbidity compared to the general population. While HCV treatment was not associated with multimorbidity, people with substance use disorder were less likely to be treated. Our results point to the need for integrated, comprehensive models of care delivery for people with HCV.

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Medical and Behavioral Approaches to Engage People Who Inject Drugs Into Care for Hepatitis C Virus Infection

Cited by 33 publications

References 151 publications

HCV-infected individuals have higher prevalence of comorbidity and multimorbidity: a retrospective cohort study

HCV-infected individuals have higher prevalence of comorbidity and multimorbidity: a retrospective cohort study

Hepatitis C Testing, Status and Treatment among Marginalized People Who Use Drugs in an Inner City Setting: An Observational Cohort Study

HCV-Infected Individuals have Higher Prevalence of Comorbidity and Multimorbidity: A retrospective cohort study

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