Time matters: Point of care screening and streamlined linkage to care dramatically improves hepatitis C treatment uptake in prisoners in England

Mohamed, Zameer; Al‐Kurdi, Deyaa; Nelson, Margaret K.; Shimakawa, Yusuke; Selvapatt, Nowlan; Lacey, Janine; Thursz, Mark; Lemoine, Maud; Brown, Ashley

doi:10.1016/j.drugpo.2019.102608

Cited by 44 publications

(40 citation statements)

References 22 publications

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“…Acceptability of rapid testing for hepatitis B or other blood-borne viruses and sexual transmitted diseases can be varied in different populations. A survey done in a prison setting showed HCV POCs were highly accepted [ 115 ]. Another study showed that people may find it stressful when testing HIV, HCV and syphilis using a POC test [ 116 ].…”

Section: Utility and Acceptability Of Pocs For Hepatitis Bmentioning

confidence: 99%

Point-of-Care Tests for Hepatitis B: An Overview

Xiao

Thompson

Howell

2020

Cells

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Despite the heavy disease burden posed by hepatitis B, around 90% of people living with hepatitis B are not diagnosed globally. Many of the affected populations still have limited or no access to essential blood tests for hepatitis B. Compared to conventional blood tests which heavily rely on centralised laboratory facilities, point-of-care testing for hepatitis B has the potential to broaden testing access in low-resource settings and to engage hard-to-reach populations. Few hepatitis B point-of-care tests have been ratified for clinical use by international and regional regulatory bodies, and countries have been slow to adopt point-of-care testing into hepatitis B programs. This review presents currently available point-of-care tests for hepatitis B and their roles in the care cascade, reviewing evidence for testing performance, utility, acceptability, costs and cost-effectiveness when integrated into hepatitis B diagnosis and monitoring programs. We further discuss challenges and future directions in aspects of technology, implementation, and regulation when adopting point-of-care testing in hepatitis B programs.

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Section: Utility and Acceptability Of Pocs For Hepatitis Bmentioning

confidence: 99%

Point-of-Care Tests for Hepatitis B: An Overview

Xiao

Thompson

Howell

2020

Cells

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“…The Canadian study [29] found that patients with a prison length of stay ≥1 month had a higher HCV screening rate relative to the overall population (17% v. 7%), which is consistent with our data showing higher screening rates in the long stay cohort. Rapid point-of-care (POC) testing can improve the entire cascade of care, as one study at a large prison in the United Kingdom found that use of a POC antibody and RNA testing strategy resulted in a higher frequency of screening and treatment initiation compared to conventional dry blood spot testing [31] . Use of POC testing was also associated with shorter time between the steps of patient admission, testing, clinical assessment, and treatment initiation.…”

Section: Discussionmentioning

confidence: 99%

The hepatitis C virus care cascade in the New York City jail system during the direct acting antiviral treatment era, 2014–2017

et al. 2020

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Background High patient turnover presents challenges and opportunity to provide hepatitis C virus (HCV) care in US jails (remand facilities). This study describes the HCV care cascade in the New York City (NYC) jail system during the direct-acting antiviral (DAA) treatment era. Methods Patients admitted to the NYC jail system from January 2014 through December 2017 were included in this retrospective cohort analysis. We describe rates of screening, diagnosis, linkage to jail-based care, and treatment among the overall cohort, and among subgroups with long jail stays (≥120 days) or frequent stays (≥10 admissions). The study protocol was approved by a third-party institutional review board (BRANY, Lake Success, NY). Findings Among the 121,371 patients in our analysis, HCV screening was performed in 40,219 (33%), 4665 (12%) of whom were viremic, 1813 (39%) seen by an HCV clinician in jail, and 248 (5% of viremic patients) started on treatment in jail. Having a long stay (adjusted risk ratio [aRR] 8·11, 95% confidence interval [CI] 6·98, 9·42) or frequent stays (aRR 1·51, 95% CI 1·04, 2·18) were significantly associated with being seen by an HCV clinician. Patients with long stays had a higher rate of treatment (14% of viremic patients). Sustained virologic response at 12 weeks was achieved in 147/164 (90%) of patients with available virologic data. Interpretation Jail health systems can reach large numbers of HCV-infected individuals. The high burden of HCV argues for universal screening in jail settings. Length of stay was strongly associated with being seen by an HCV clinician in jail. Treatment is feasible among those with longer lengths of stay. Funding None.

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“…Figure 2 summarises the model natural history. Liver disease progression from mild (F0/F1) and moderate (F2/3) disease to compensated cirrhosis (F4) and its associated complications (decompensation (DC) and hepatocellular carcinoma (HCC) was included in the model, parameterised from existing literature 15‐17 . Given the high‐risk status of the population, it is assumed that the transmission of disease has occurred as a result of injecting drug use.…”

Section: Methodsmentioning

confidence: 99%

“…Where possible, empirical data from both opt‐out universal HCV DBS general prison population screening and a pilot simplified screen‐and‐treat algorithm at HMP Wormwood Scrubs have been used to generate epidemiolocal, screening and costs parameters 15 . A review of the relevant literature was used to derive all other necessary parameters.…”

Section: Methodsmentioning

confidence: 99%

“…Between September 2017 and December 2018 at (Her Majesty's Prison) HMP Wormwood Scrubs universal opt‐out DBS general prison population screening was combined with an in‐reach Hepatology clinic and treatment in line with the NHS England approved DAA therapy for patients with a sentence long enough to complete treatment, while those with shorter sentences were provided with contact information for community linkage‐to‐care. In addition, between September and December 2018 we evaluated a simplified pathway involving point‐of‐care screening (Oraquick® anti‐HCV (Orasure®, Bethlehem, PA) screening followed by Xpert® HCV fingerstick viral load (Xpert® HCV FS VL) (Cepheid®, Sunnyvale, CA) confirmation), fast‐track treatment approval and initiation irrespective of sentence duration 15 . A flow diagram summarising both interventions can be found in Figure 1.…”

Section: Introductionmentioning

confidence: 99%

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Cost‐effectiveness of strategies to improve HCV screening, linkage‐to‐care and treatment in remand prison settings in England

Mohamed

Scott

Al‐Kurdi

et al. 2020

Liver International

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Background A simplified cascade‐of‐care may improve screening and treatment uptake among incarcerated individuals. We assessed the cost‐effectiveness of traditional and simplified screening and treatment in a London remand prison. Methods Using empirical data from Her Majesty's Prison (HMP) Wormwood Scrubs, London, we designed a decision tree and Markov transition state model using national average data for HCV screening and treatment for the base‐case scenario. This compared two alternative strategies; (a) general prison population screening and treatment and (b) prioritising screening and treatment among people who inject drugs (PWID) combined with general prison population screening and treatment. Strategies varied the rates of screening (47%‐90%), linkage‐to‐care (60%‐86%) and treatment (21%‐85%). Cost, utility and disease transition rates were obtained from existing literature. Outcome measures were as follows: screening, treatment and disease‐related costs per admitted individual, quality‐adjusted life years (QALYs). Incremental cost‐effectiveness ratios (ICERs) were calculated for each intervention. All costs and utilities were discounted at a rate of 3.5% per annum. Both univariate and probabilistic sensitivity analyses have been conducted. Results In our cohort of 5239 incarcerated individuals with an estimated chronic HCV prevalence of 2.6%, all strategy ICER values (£3565‐10 300) fell below the national willingness to pay threshold (£30 000). Increased successful treatment (7%‐54%) was observed by an optimising cascade‐of‐care. A robust sensitivity analysis identified treatment cost of, QALY for mild liver disease and probability of completing treatment as important factors that impact the ICER value. Conclusion In our remand setting, optimising adherence to the cascade‐of‐care is cost‐effective. Where universal screening is not practical, a stratified approach focused on intensive screening and treatment of PWID also results in increased treatment uptake and is highly cost‐effective.

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Time matters: Point of care screening and streamlined linkage to care dramatically improves hepatitis C treatment uptake in prisoners in England

Cited by 44 publications

References 22 publications

Point-of-Care Tests for Hepatitis B: An Overview

Point-of-Care Tests for Hepatitis B: An Overview

The hepatitis C virus care cascade in the New York City jail system during the direct acting antiviral treatment era, 2014–2017

Cost‐effectiveness of strategies to improve HCV screening, linkage‐to‐care and treatment in remand prison settings in England

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