Detection of active hepatitis C in a single visit and linkage to care among marginalized people using a mobile unit in Madrid, Spain

Ryan, Pablo; Valencia, Jorge; Cuevas, Guillermo; Torres‐Macho, Juan; Troya, Jesús; Pueyo, Ángel Luis Pérez; Muñoz-Gómez, María José; Muñoz‐Rivas, Nuria; Vázquez-Morón, Sonia; Martı́nez, Isidoro; Lazarus, Jeffrey V.; Resino, Salvador

doi:10.1016/j.drugpo.2021.103424

Cited by 12 publications

(23 citation statements)

References 56 publications

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“…Individuals were engaged in a wide variety of locations or hotspots including harm reduction and addiction centres, institutions that provide social assistance, parks and other public areas, homeless shelters and places where street prostitution and mendicity are practiced. In a previous study, 25 we found a high HCV and HIV prevalence at these locations. Periodic screening and consecutive sampling were carried out; that is, the participants were selected consecutively in the order of appearance.…”

Section: Methodssupporting

confidence: 53%

Differences in the hepatitis C virus cascade of care and time to initiation of therapy among vulnerable subpopulations using a mobile unit as point‐of‐care

Valencia

Lazarus

Ceballos

et al. 2021

Liver International

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Background and Aims: People who inject drugs (PWID) and other marginalized populations with high hepatitis C virus (HCV) infection rates represent a unique challenge for treatment initiation due to health, administrative and social barriers. We analysed the HCV cascade of care (CoC) in some vulnerable subpopulations in Madrid, Spain, when using a mobile point-of-care (PoC).Methods: From 2019 to 2021, a mobile unit was used to screen active HCV using a linkage-to-care and two-step PoC-based strategy. Viremic participants were grouped into four subgroups: PWID, homeless individuals and people with a mental health disorder (MHD) and alcohol use disorder (AUD). Logistic regression, and Cox and Aalen's additive models were used to analyse associated factors and differences between groups.Results: A prospectively recruited cohort of 214 HCV-infected individuals (73 PWID, 141 homeless, 57 with a MHD and 91 with AUD) participated in the study. The overall HCV CoC analysis found that 178 (83.1%) attended a hospital, 164 (76.6%) initiated direct-acting antiviral therapy and 141 (65.8%) completed therapy, of which 99 (95.2%) achieved sustained virological response (SVR). PWID were significantly less likely to initiate treatment, whereas individuals with AUD waited longer before starting the treatment. Both people with AUD and PWID were significantly less likely to complete HCV treatment.Conclusions: Overall, SVR was achieved in the majority of the participants treated.However, PWID need better linkage to care and treatment, whereas PWID and AUD need more support for treatment completion. K E Y W O R D S cascade of care, hepatitis C virus, marginalized populations, model of care, point-of-care test How to cite this article: Valencia J, Lazarus JV, Ceballos FC, et al. Differences in the hepatitis C virus cascade of care and time to initiation of therapy among vulnerable subpopulations using a mobile unit as point-of-care.

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Section: Methodssupporting

confidence: 53%

Differences in the hepatitis C virus cascade of care and time to initiation of therapy among vulnerable subpopulations using a mobile unit as point‐of‐care

Valencia

Lazarus

Ceballos

et al. 2021

Liver International

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“…As shown by previous studies (20,26,30), advanced fibrosis was demonstrated in almost 25% of patients with viremic infection and this was also the case in our study. This highlights the difficulty, but also the necessity, in obtaining an early diagnosis of active hepatitis C in this vulnerable population.…”

Section: Discussionsupporting

confidence: 92%

“…Sixty-six percent of the patients included in this study were part of the homeless population, and as such, this study showed a slightly higher rate of treatment initiation (77%) when compared with our results. This is due to the Spanish study including a same-day hospital referral to obtain treatment prescription (26), whereas in our study, treatment prescription was provided remotely, and the delivery was directed to the temporary housing, harm reduction centers, or the streets. In the Spanish study, it is likely that fewer patients were lost to follow-up.…”

Section: Discussionmentioning

confidence: 96%

Results of a Model of Delivering Hepatitis C Care in a Homeless Metropolitan Population in England

et al. 2022

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INTRODUCTION:Given the hepatitis C virus (HCV) burden and despite curative treatments, more efforts focused on scaling-up testing and treatment in homeless populations are needed. This project aimed to implement education and flexible on-site HCV testing, treatment, and follow-up for a homeless population in south London and to evaluate engagement, therapy initiation, and cure rates.METHODS:A mobile unit (van) for on-site HCV education, screening, treatment, and follow-up was placed on the street in a well-known homeless population areas from January 2018 to September 2021. Homeless was defined as living in temporary housing (hostel/hotel-based) or living on the street (street-based). Sociodemographic status, risk factors, comorbidities, concomitant medication, and data related with HCV treatment were recorded. Univariable and multivariable modeling were performed for treatment initiation and sustained virological response (SVR).RESULTS:Nine hundred forty homeless people were identified and 99.3% participated. 56.2% were street-based, 243 (26%) tested positive for HCV antibody, and 162 (17.4%) were viremic. Those with detectable HCV RNA had significantly more frequent psychiatric disorders, active substance use disorders, were on opioid agonist treatment, had advanced fibrosis, and had lower rates of previous treatment in comparison with undetectable HCV RNA. Overall treatment initiation was 70.4% and SVR was 72.8%. In the multivariable analysis, being screened in temporary housing (odds ratio [OR] 3.166; P = 0.002) and having opioid agonist treatment (OR 3.137; P = 0.004) were positively associated with treatment initiation. HCV treatment adherence (OR 26.552; P < 0.001) was the only factor associated with achieving SVR.DISCUSSION:Promoting education and having flexible and reflex mobile on-site testing and treatment for HCV in the homeless population improve engagement with the health care system, meaning higher rates of treatment initiation and SVR. However, street-based homeless population not linked with harm reduction services are less likely to initiate HCV treatment, highlighting an urgent need for a broad health inclusion system.

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“…Some interventions have attempted to mitigate the effects of homelessness with regards to treatment uptake, by providing flexible appointments [ 26 ] or mobile testing and treatment [ 29 ]. A mobile unit employing a same day ‘test and treat’ model for a cohort in which the majority were experiencing homelessness, reported 77% initiating treatment [ 30 ]. Although there is weak evidence for the effectiveness of financial incentives to broadly increase HCV treatment uptake [ 13 ], high willingness to partake in such studies [ 31 ] indicates the need for further investigation.…”

Section: Discussionmentioning

confidence: 99%

A Testing Campaign Intervention Consisting of Peer-Facilitated Engagement, Point-of-Care HCV RNA Testing, and Linkage to Nursing Support to Enhance Hepatitis C Treatment Uptake among People Who Inject Drugs: The ETHOS Engage Study

Conway

Valerio

Alavi

et al. 2022

Viruses

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This study evaluated HCV treatment initiation among people who inject drugs (PWID) following an intervention of campaign days involving peer connection, point-of-care HCV RNA testing, and linkage to nursing support. ETHOS Engage is an observational cohort study of PWID attending 25 drug treatment clinics and needle and syringe programs in Australia (May 2018–September 2019). Point-of-care results were provided to the nurse, facilitating confirmatory testing and treatment. The study aimed to evaluate treatment uptake and factors associated with treatment at 24 months post-enrolment. There were 317 people with current HCV infection and eligible for treatment (median age 43, 65% male, 15% homeless, 69% receiving opioid agonist treatment, 70% injected in last month). Overall, 15% (47/317), 27% (85/317), 38% (120/317), and 49% (155/317) of people with current HCV infection had initiated treatment at 3-, 6-, 12-, and 24-months following testing, respectively. Homelessness (adjusted hazard ratio (aHR): 0.40; 95% confidence interval: 0.23, 0.71) and incarceration in the past 12 months (vs. never, aHR:0.46; 0.28, 0.76) were associated with decreased treatment initiation in the 24 months post-enrolment. This testing campaign intervention facilitated HCV treatment uptake among PWID. Further interventions are needed to achieve HCV elimination among people experiencing homelessness or incarceration.

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Detection of active hepatitis C in a single visit and linkage to care among marginalized people using a mobile unit in Madrid, Spain

Cited by 12 publications

References 56 publications

Differences in the hepatitis C virus cascade of care and time to initiation of therapy among vulnerable subpopulations using a mobile unit as point‐of‐care

Differences in the hepatitis C virus cascade of care and time to initiation of therapy among vulnerable subpopulations using a mobile unit as point‐of‐care

Results of a Model of Delivering Hepatitis C Care in a Homeless Metropolitan Population in England

A Testing Campaign Intervention Consisting of Peer-Facilitated Engagement, Point-of-Care HCV RNA Testing, and Linkage to Nursing Support to Enhance Hepatitis C Treatment Uptake among People Who Inject Drugs: The ETHOS Engage Study

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