Decentralisation of hepatitis C virus care into community settings: A key approach on the path to elimination

Brennan, Paul; Byrne, Christopher J.; Dillon, John

doi:10.1111/liv.15229

Cited by 2 publications

(3 citation statements)

References 16 publications

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“…33 Decentralisation and personalised care need to be a core tenet of service design to improve overall health and ensure linkage to care. 21,34 The high predominantly drug-related mortality in this study further reinforces the need for an integrated and decentralised service. About 15% of our cohort died before they could receive DAA and of those treated, a further 15% died post-SVR12.…”

Section: Univariate Analysissupporting

confidence: 56%

“…It is essential that PWUDs have easy access to BBV testing, OAT and linkage to care in community settings employing a diverse prescriber base 33 . Decentralisation and personalised care need to be a core tenet of service design to improve overall health and ensure linkage to care 21,34 . The high predominantly drug‐related mortality in this study further reinforces the need for an integrated and decentralised service.…”

Section: Discussionmentioning

confidence: 66%

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Excellent hepatitis C virus cure rates despite increasing complexity of people who use drugs: Integrated‐Test‐stage Treat study final outcomes

O'Sullivan,

Jones,

Mourad

et al. 2023

Journal of Viral Hepatitis

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Achieving hepatitic C virus (HCV) elimination requires linking people who use drugs (PWUD) into care. We report final direct‐acting antivirals (DAAs)‐based outcomes from the Integrated‐Test‐stage ‐Treat (ITTREAT) study. Project ITTREAT (2013–2021), based at an addiction centre, was a ‘one‐stop’ service with innovative linkage to care strategies. Primary outcome was sustained virological response (SVR12) (intention to treat ITT) including whether individuals were recruited in first (period 1) versus last four (period 2 included the COVID‐19 pandemic) years of the study. Number recruited were n = 765, mean age 40.9 ± 10.1 years, 78% males, history of current/past injecting drug use (IDU) and alcohol use being 77% and 90%, respectively. Prevalence of a positive HCV PCR was 84% with 19% having cirrhosis. Comparing those recruited in period 2 versus period 1, there was increasing prevalence of IDU, 90% versus 72% (p < .001); homelessness, 67% versus 50% (p < .001); psychiatric diagnosis, 84% versus 50% (p < .001); overdose history 71% versus 31% (p < .001), receiving opioid agonist treatment (OAT) 75% versus 52% (p < .001) and comorbidity 44% versus 25% (p < .001). Of those treated with DAAs (n = 272), ITT SVR rates were 86% (95% CI: 81%–90%), being similar in period 2 versus period 1. Predictors of non‐SVR were receiving OAT (OR 0.33, 95% CI: 0.12–0.87, p = .025) and ≥80% adherence (OR 0.01, 95% CI: 0.003–0.041, p < .001). Reinfection rates period 2 versus period 1 (per 100 person‐years) were 1.84 versus 1.70, respectively. In the treated cohort, mortality was 15%, being mostly drug‐related. Despite increasing complexity of PWUD, high SVR12 rates are achievable with use of OAT and good adherence.

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Section: Univariate Analysissupporting

confidence: 56%

Section: Discussionmentioning

confidence: 66%

Excellent hepatitis C virus cure rates despite increasing complexity of people who use drugs: Integrated‐Test‐stage Treat study final outcomes

O'Sullivan,

Jones,

Mourad

et al. 2023

Journal of Viral Hepatitis

View full text Add to dashboard Cite

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“…What has now become well appreciated however is that the population infected with HCV is not uniform but rather comprises multiple sub-groups of people each with their own distinct group characteristics [8][9][10][11][12][13]. As a consequence, HCV elimination is best achieved by aiming for micro-elimination in patients within each of the high-risk groups with specific and tailored interventions that promote engagement with the health system [14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Micro‐elimination of chronic hepatitis C virus in mental health settings: A prospective multicentre pragmatic trial

Gofton,

Bondezi,

Kotze

et al. 2024

Drug and Alcohol Review

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IntroductionHepatitis C virus (HCV) prevalence is high in the mental health population. We sought to evaluate testing and treatment uptake for HCV following the implementation of a universal nurse led study in inpatient and outpatient mental health populations.MethodsFrom January 2018 to December 2020, we screened mental health inpatients (n = 322) and community mental health patients (n = 615) for HCV with either specialist hepatology nurses or mental health nurses (mental health nurse).Results75.5% (464/615) of community patients and 100% (322/322) of inpatients consented to screening, with an HCV antibody‐positive prevalence of 12.7% (59/464) in community patients and 19.6% (63/322) in inpatients. RNA detectable prevalence was 4.0% (22/464) and 7.5% (24/322), respectively. Community patients who were screened by specialist hepatology nurses were more likely to consent to screening (94.4% vs. 45.7%, p < 0.001) but had lower proportion of HCV antibody (10.5% vs. 20.3%, p < 0.001) and RNA detectable (4.0% vs. 7.5%, p = 0.018) when compared to mental health nurse screening. Engagement with treatment was 27.0% of community mental health patients and 45.8% of mental health inpatients undergoing treatment. All patients undergoing treatment and underwent sustained viral response (SVR) testing achieved SVR.Discussion and ConclusionsUniversal screening of HCV using a nurse‐led model has high rates of success in mental health patients with high proportions undergoing screening, with no reduction in the rates of SVR achieved with DAA therapy compared to the general population. Further work is needed to bridge the gap between identification of HCV and treatment among mental health patients.

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Decentralisation of hepatitis C virus care into community settings: A key approach on the path to elimination

Cited by 2 publications

References 16 publications

Excellent hepatitis C virus cure rates despite increasing complexity of people who use drugs: Integrated‐Test‐stage Treat study final outcomes

Excellent hepatitis C virus cure rates despite increasing complexity of people who use drugs: Integrated‐Test‐stage Treat study final outcomes

Micro‐elimination of chronic hepatitis C virus in mental health settings: A prospective multicentre pragmatic trial

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