Are the testing needs of key European populations affected by hepatitis B and hepatitis C being addressed? A scoping review of testing studies in Europe

Lazarus, Jeffrey V.; Sperle, Ida; Spina, Alexander; Rockstroh, Jürgen K.

doi:10.3325/cmj.2016.57.442

Cited by 15 publications

(11 citation statements)

References 125 publications

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Section: Interventions To Enhance Hepatitis C Prevention Testing Andmentioning

confidence: 99%

“…Globally, hepatitis C testing and diagnosis remain inadequate, both in terms of numbers (<20% diagnosed) and in terms of completeness of tests offered (even fewer have been HCV RNA tested), in particular for PWID. [35][36][37][38] In a systematic review of the effectiveness of interventions to improve hepatitis C testing among PWID, on-site testing with pre-test discussion and education and dried blood spot (DBS) testing were demonstrated to be effective in increasing hepatitis C testing among PWID when compared to control interventions. 39 Other strategies that have been evaluated (without any comparator intervention) include physical and electronic medical chart reminders to prompt targeted risk-based assessment and testing, [40][41][42][43][44] peerdelivered outreach hepatitis C testing and hepatitis C education, 45 prison-based outreach testing, 46 that is respectful of individual choice and priorities.…”

Section: Hepatitis C Testingmentioning

confidence: 99%

See 1 more Smart Citation

Hepatitis C elimination among people who inject drugs: Challenges and recommendations for action within a health systems framework

Day

Hellard

Treloar

et al. 2018

Liver International

105

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The burden of hepatitis C infection is considerable among people who inject drugs (PWID), with an estimated prevalence of greater than 40%, representing an estimated 5.6 million people who have recently injected drugs living with hepatitis C infection. As such, PWID are a priority population for enhancing prevention, testing, linkage to care, treatment and follow-up care in order to meet World Health Organization (WHO) hepatitis C elimination goals by 2030. There are many barriers to enhancing hepatitis C prevention and care among PWID including; poor global coverage of harm reduction services, restrictive drug policies and criminalization of drug use, poor access to health services, low hepatitis C testing, linkage to care and treatment, restrictions for accessing DAA therapy, and the lack of national strategies and government investment to support WHO elimination goals. On 5 September 2017, the International Network of Hepatitis in Substance Users (INHSU) held a roundtable panel of international experts to discuss remaining challenges and future priorities for action from a health systems perspective. The WHO health systems framework comprises six core components; service delivery, health workforce, health information systems, medical procurement, health systems financing, and leadership and governance. Communication has been proposed as a seventh key element which promotes the central role of affected community engagement. This review paper presents recommended strategies for eliminating hepatitis C as a major public health threat among PWID and outlines future priorities for action within a health systems framework. This article is protected by copyright. All rights reserved.

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Section: Interventions To Enhance Hepatitis C Prevention Testing Andmentioning

confidence: 99%

Section: Hepatitis C Testingmentioning

confidence: 99%

Hepatitis C elimination among people who inject drugs: Challenges and recommendations for action within a health systems framework

Day

Hellard

Treloar

et al. 2018

Liver International

105

View full text Add to dashboard Cite

show abstract

“…Low HCV testing, linkage to care and treatment among PWID Globally, HCV testing/diagnosis remains inadequate, including among PWID [9][10][11][12]. Simplified models of HCV care (including integration into existing HIV and drug health services) across a range of settings facilitates improved engagement in HCV care [112].…”

Section: Restrictive Drug Policies and Criminalization Of Drug Usementioning

confidence: 99%

“…In the interferon-era, diagnosis and treatment for HCV infection remained low [9][10][11][12], including among PWID [13,14], due to patient, provider, health system, and societal barriers. The availability of simple and tolerable directacting antiviral (DAA) therapies for HCV infection with cure rates >95% is one of the greatest medical advances in decades [15,16].…”

Section: Introductionmentioning

confidence: 99%

Elimination of HCV as a public health concern among people who inject drugs by 2030 – What will it take to get there?

Grebely

Dore

Morin

et al. 2017

Journal of the International AIDS Society

141

107

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Introduction: Globally, there is a considerable burden of HCV and HIV infections among people who inject drugs (PWID) and transmission of both infections continues. Needle and syringe programme (NSP) and opioid substitution therapy (OST) coverage remains low, despite evidence demonstrating their prevention benefit. Direct-acting antiviral therapies (DAA) with HCV cure >95% among PWID provide an opportunity to reverse rising trends in HCV-related morbidity and mortality and reduce incidence. However, HCV testing, linkage to care, and treatment remain low due to health system, provider, societal, and patient barriers. Between 2015 and 2030, WHO targets include reducing new HCV infections by 80% and HCV deaths by 65%, and increasing HCV diagnoses from <5% to 90% and number of eligible persons receiving HCV treatment from <1% to 80%. This commentary discusses why PWID should be considered as a priority population in these efforts, reasons why this goal could be attainable among PWID, challenges that need to be overcome, and key recommendations for action.Discussion: Challenges to HCV elimination as a global health concern among PWID include poor global coverage of harm reduction services, restrictive drug policies and criminalization of drug use, poor access to health services, low HCV testing, linkage to care and treatment, restrictions for accessing DAA therapy, and the lack of national strategies and government investment to support WHO elimination goals. Key recommendations for action include reforming drug policies (decriminalization of drug use and/or possession, or providing alternatives to imprisonment for PWID; decriminalization of the use and provision of sterile needles-syringes; and legalization of OST for people who are opioid dependent), scaling up and improving funding for harm reduction services, making health services accessible for PWID, supporting community empowerment and community-based programmes, improving access to affordable diagnostics and medicines, and eliminating stigma, discrimination, and violence against PWID.Conclusions: The ambitious targets for HCV elimination set by WHO are achievable in many countries, but will require researchers, healthcare providers, policy makers, affected communities, advocates, the pharmaceutical and diagnostics industries, and governments around the world to work together to make this happen.

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“…Globally, HCV testing and diagnosis remains inadequate (Bruggmann et al, 2014; Lazarus, Sperle, Spina, & Rockstroh, 2016; Liakina et al, 2015; Saraswat et al, 2015). Potential strategies to improve HCV testing include education and counseling by health professionals with on-site HCV testing (Cullen et al, 2006; Lacey, Ellen, Devlin, Wright, & Mijch, 2007; Meyer et al, 2015; Rosenberg et al, 2010; Sahajian et al, 2011; Zhou et al, 2016), physical and electronic medical chart reminders to prompt targeted risk-based assessment and testing (Drainoni et al, 2012; Krauskopf et al, 2014; Litwin et al, 2012; Meyer et al, 2015; Zhou et al, 2016), and simplified testing, including dried blood spot testing (Abou-Saleh, Rice, & Foley, 2013; Coats & Dillon, 2015; Craine, O'Toole, D'Arcy, & Lyons, 2009; Hickman et al, 2008; McLeod et al, 2014; Meyer et al, 2015; Tait, Stephens, McIntyre, Evans, & Dillon, 2013; Zhou et al, 2016), and point-of-care HCV testing (Beckwith et al, 2016; Bottero et al, 2015; Morano et al, 2014).…”

Section: Hcv Testingmentioning

confidence: 99%

Research priorities to achieve universal access to hepatitis C prevention, management and direct-acting antiviral treatment among people who inject drugs

Grebely

Bruneau

Lazarus

et al. 2017

International Journal of Drug Policy

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Globally, it is estimated that 71.1 million people have chronic hepatitis C virus (HCV) infection, including an estimated 7. 5 million people who have recently injected drugs (PWID). There is an additional large, but unquantified, burden among those PWID who have ceased injecting. The incidence of HCV infection among current PWID also remains high in many settings. Morbidity and mortality due to liver disease among PWID with HCV infection continues to increase, despite the advent of well-tolerated, simple interferon-free direct-acting antiviral (DAA) HCV regimens with cure rates >95%. As a result of this important clinical breakthrough, there is potential to reverse the rising burden of advanced liver disease with increased treatment and strive for HCV elimination among PWID. Unfortunately, there are many gaps in knowledge that represent barriers to effective prevention and management of HCV among PWID. The Kirby Institute, UNSW Sydney and the International Network on Hepatitis in Substance Users (INHSU) established an expert round table panel to assess current research gaps and establish future research priorities for the prevention and management of HCV among PWID. This round table consisted of a one-day workshop held on 6 September, 2016, in Oslo, Norway, prior to the International Symposium on Hepatitis in Substance Users (INHSU 2016). International experts in drug and alcohol, infectious diseases, and hepatology were brought together to discuss the available scientific evidence, gaps in research, and develop research priorities. Topics for discussion included the epidemiology of injecting drug use, HCV, and HIV among PWID, HCV prevention, HCV testing, linkage to HCV care and treatment, DAA treatment for HCV infection, and reinfection following successful treatment. This paper highlights the outcomes of the roundtable discussion focused on future research priorities for enhancing HCV prevention, testing, linkage to care and DAA treatment for PWID as we strive for global elimination of HCV infection.

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Are the testing needs of key European populations affected by hepatitis B and hepatitis C being addressed? A scoping review of testing studies in Europe

Cited by 15 publications

References 125 publications

Hepatitis C elimination among people who inject drugs: Challenges and recommendations for action within a health systems framework

Hepatitis C elimination among people who inject drugs: Challenges and recommendations for action within a health systems framework

Elimination of HCV as a public health concern among people who inject drugs by 2030 – What will it take to get there?

Research priorities to achieve universal access to hepatitis C prevention, management and direct-acting antiviral treatment among people who inject drugs

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