Direct-acting antiviral treatment for hepatitis C, reinfection and mortality among people attending an inner-city community health centre in Victoria, Canada

Selfridge, Marion; Cunningham, Evan B; Milne, Rozalyn; Drost, Anne; Barnett, Tamara; Lundgren, Karen; Guarasci, Kellie; Grebely, Jason; Fraser, Chris

doi:10.1016/j.drugpo.2019.03.001

Cited by 19 publications

(12 citation statements)

References 28 publications

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“…In BC, many care providers who provide HCV treatment to PWID incorporate a more comprehensive model including social support and addiction care. 35,36 On the other hand, engagement in HCV care and treatment could also be related to overall life stability and readiness for treatment, which may be contributing to decreased drug-related mortality. 37 Further studies are needed to understand the role of specific behavioural, pharmacological and care related factors associated with reduce drug-related mortality.…”

Section: Discussionmentioning

confidence: 99%

Impact of direct-acting antivirals for HCV on mortality in a large population-based cohort study

Janjua

Wong

Abdia

et al. 2021

Journal of Hepatology

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Section: Discussionmentioning

confidence: 99%

Impact of direct-acting antivirals for HCV on mortality in a large population-based cohort study

Janjua

Wong

Abdia

et al. 2021

Journal of Hepatology

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“…Pharmacotherapy for HCV infection is administered for shorter periods of time ( i.e ., 8-12 wk) and sustained virological responses (SVR) are achieved in over 90% of patients, irrespective of the HCV genotype. Several studies have revealed that DAAs showed efficacy in difficult-to-treat populations, including individuals with SUD[ 3 - 8 ].…”

Section: Introductionmentioning

confidence: 99%

Monitoring hepatitis C virus treatment rates in an Opioid Treatment Program: A longitudinal study

Sanvisens¹,

Rivas²,

Faure³

et al. 2020

WJG

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BACKGROUND Direct-acting antivirals (DAAs) are recommended for the treatment of hepatitis C virus (HCV) infection in patients treated with methadone or buprenorphine. AIM To assess HCV treatment rates in an Opioid Treatment Program (OTP). METHODS This longitudinal study included 501 patients (81.4% men, median age: 45 years; interquartile range: 39-50 years) enrolled in an OTP between October 2015 and September 2017. Patients were followed until September 2019. Data on socio-demographics, substance use, HCV infection, human immunodeficiency virus (HIV) infection and laboratory parameters were collected at entry. We analyzed medical records to evaluate HCV treatment. Kaplan-Meier methods and Cox regression models were used to analyze the DAA treatment uptake and to identify treatment predictors. RESULTS Prevalence of HCV and HIV infection was 70% and 34%, respectively. Among anti-HCV-positive ( n = 336) patients, 47.2%, 41.3%, and 31.9% used alcohol, cannabis, and cocaine, respectively. HCV-RNA tests were positive in 233 (69.3%) patients. Twentyeight patients (8.3%) cleared the infection, and 59/308 (19.1%) had received interferon-based treatment regimens before 2015. Among 249 patients eligible, 111 (44.6%) received DAAs. Treatment rates significantly increased over time from 7.8/100 person-years (p-y) (95%CI: 5.0-12.3) in 2015 to 18.9/100 p-y (95%CI: 11.7-30.3) in 2019. In a multivariate analysis, patients with HIV co-infection were twice as likely to receive DAAs (HR = 1.94, 95%CI: 1.21-3.12) than patients with HCV mono-infection. Current drug use was an independent risk factor for not receiving treatment against infection (HR = 0.48, 95%CI: 0.29-0.80). CONCLUSION HCV treatment is evolving in patients with HCV-HIV co-infection. Ongoing drug use while in an OTP might negatively impact the readiness to treat infection.

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“…Eight studies provided social services in addition to medical care including social case management [ 26 , 31 , 33 , 39 , 45 , 47 , 52 , 58 ]. Two studies offered housing support in addition to income assistance [ 53 ] or legal support [ 32 ]. Two studies offered special housing support for homeless, or at risk of homelessness, patients [ 38 , 44 ].…”

Section: Resultsmentioning

confidence: 99%

“…Seventeen studies modified clinical practices to integrate HCV treatment. Integration was implemented in primary care facilities [31,33,[50][51][52][53][54], SAM services [28,29,34,35,55], syringe exchange programs [56], HIV clinics [57,58], community pharmacies [25], and prisons [30].…”

Section: Integrationmentioning

confidence: 99%

“…Clinical Visits Follow-up support to ensure adherence was the most addressed component within this dimension (19 studies). This follow-up was offered by providers [31,33,37,39,40,42,43,45,46,48,[50][51][52]58] as well as peer support groups [26,53,56]. One study triaged the patients into different levels of support according to their risk of non-adherence and patients who did not complete treatment were offered intensive follow-up home visits by peers [57].…”

Section: Follow-up and Adherence Support For Requiredmentioning

confidence: 99%

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Patient Centeredness in Hepatitis C Direct-Acting Antiviral Treatment Delivery to People Who Inject Drugs: A Scoping Review

Abdelwadoud

Mattingly

Seguí

et al. 2020

Patient

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Background and Objective Patient-centered care (PCC) is crucial for value-based care. We aimed to assess PCC dimensions addressed in hepatitis C virus direct-acting antiviral treatment delivery to people who inject drugs. Methods We conducted a scoping review to identify the studies that described hepatitis C virus treatment delivery to people who inject drugs in the direct-acting antiviral treatment era. We analyzed the included studies against eight PCC dimensions: (1) access to care; (2) coordination and integration of care; (3) continuity and translation; (4) physical comfort; (5) information, education, and communication; (6) emotional support; (7) involvement of family and friends; and (8) respect for individual patient preferences, perceived needs, and values. Additionally, we assessed the use of patient-centered terminology and the recognition of PCC importance and its relevance to treatment outcomes. Results None of the identified 36 studies addressed all PCC dimensions (highest seven, lowest two). Our findings revealed that PCC dimensions are prioritized differently and addressed using different approaches and strategies. Studies that used PCC terminology referred to personalized activities, which does not imply comprehensive PCC. About one-third of the studies acknowledged the importance of patient centeredness and two-thirds recognized its relevance to treatment outcomes. Conclusions Our findings suggest more engagement of people who inject drugs and comprehensive involvement of their families and friends in hepatitis C virus treatment journey, decisions, and outcomes. The recognition of PCC importance and its relevance to treatment outcomes in the analyzed studies emphasizes the need for more patient-centered hepatitis C virus treatment for people who inject drugs. Supplementary Information The online version contains supplementary material available at 10.1007/s40271-020-00489-6.

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Direct-acting antiviral treatment for hepatitis C, reinfection and mortality among people attending an inner-city community health centre in Victoria, Canada

Cited by 19 publications

References 28 publications

Impact of direct-acting antivirals for HCV on mortality in a large population-based cohort study

Impact of direct-acting antivirals for HCV on mortality in a large population-based cohort study

Monitoring hepatitis C virus treatment rates in an Opioid Treatment Program: A longitudinal study

Patient Centeredness in Hepatitis C Direct-Acting Antiviral Treatment Delivery to People Who Inject Drugs: A Scoping Review

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