Early Successes in an Open Access, Provincially Funded Hepatitis C Treatment Program in Prince Edward Island

Francheville, Jordan W.; Rankin, Robin; Beck, Jeremy; Hoare, Connie; Materniak, Stefanie; German, Greg; Barrett, Lisa; Bunimov-Wall, Natalie; Smyth, Daniel

doi:10.5604/01.3001.0010.2757

Cited by 10 publications

(5 citation statements)

References 20 publications

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“…The outcomes in our cohort strengthen the case for taskshifting elements of care which can be completed in the community into the community for PWID. [33][34][35] Our data augments the literature suggesting re-treatment following re-infection should be offered without stigma or discrimination. 36,37 Despite the high re-infection rate among the subset with follow-up-which aligns with national re-infection estimates-recent data demonstrated a reduction in chronic HCV among PWID in Tayside, consistent with the rapid sale-up.…”

Section: Discussionsupporting

confidence: 69%

“…Similarly, in the pharmacy pathway, diagnosis and treatment can be wholly facilitated by the pharmacist through the use of simplified DAA prescribing algorithms and the use of dried blood spot sampling. The outcomes in our cohort strengthen the case for task‐shifting elements of care which can be completed in the community into the community for PWID 33‐35 …”

Section: Discussionsupporting

confidence: 60%

“…The outcomes in our cohort strengthen the case for task‐shifting elements of care which can be completed in the community into the community for PWID. 33 , 34 , 35 …”

Section: Discussionmentioning

confidence: 99%

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Real‐world outcomes of rapid regional hepatitis C virus treatment scale‐up among people who inject drugs in Tayside, Scotland

Byrne

Beer

Inglis

et al. 2021

Aliment Pharmacol Ther

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Summary Background In 2017, Tayside, a region in the East of Scotland, rapidly scaled‐up Hepatitis C Virus (HCV) outreach and treatment among People Who Inject Drugs (PWID) using novel community care pathways. Aims We aimed to determine treatment outcomes for PWID during the scale‐up against pre‐determined targets; and assess re‐infection, mortality, and post‐treatment follow up. Methods HCV treatment was delivered in community pharmacies, drug treatment centres, nurse‐led outreach clinics, prisons, and needle exchanges, alongside conventional hospital care. We retrospectively analysed clinical outcomes and compared pathways using logistic regression models. Results Of 800 estimated HCV‐infected PWID, 718 (90%) were diagnosed. 713 treatments commenced among 662 (92%) PWID, delivering 577 (81%) Sustained Virologic Responses (SVR). SVR was 91% among those who attended for testing. Forty‐six individuals were treated more than once. Needle exchanges and community pharmacies initiated 49% of all treatments. Regression analyses implied pharmacies had superior follow‐up, but there was no difference in likelihood of achieving SVR in community pathways relative to hospital care. Re‐infection occurred 39 times over 256.57 person years (PY), yielding a rate of 15.20 per 100 PY (95% CI 10.81‐20.78). 54 deaths occurred (29 drug related) over 1,553.04 PY, yielding a mortality rate of 3.48 per 100 PY (95% CI 2.61‐4.54). Drug‐related mortality was 1.87 per 100 PY (95% CI 1.25‐2.68). Conclusions Rapid HCV treatment scale‐up to PWID in community settings, whilst maintaining high SVR, is achievable. However, other interventions are required to minimise re‐infection; reduce drug‐related deaths; and improve post‐SVR follow‐up testing regionally.

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Section: Discussionsupporting

confidence: 69%

Section: Discussionsupporting

confidence: 60%

See 1 more Smart Citation

Real‐world outcomes of rapid regional hepatitis C virus treatment scale‐up among people who inject drugs in Tayside, Scotland

Byrne

Beer

Inglis

et al. 2021

Aliment Pharmacol Ther

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“…Eventually, 89% of them had their HIV status ever ascertained [87], demonstrating that, in this context, offering testing at home considerably decreased the cost of testing. Testand-treat strategies have also been employed in smaller trials, for specific demographic subgroups, defined by social status (e.g., incarcerated individuals) [88-91], geographical area [92][93][94], sexual behavior (e.g., MSM, sex workers) [95,96], or risk of infection (e.g., drug users) [97] with the goal to achieve local elimination, so-called micro-elimination [98,99]. Some of these trials achieved very high participation and testing rates from the eligible populations, much larger than those reported in the studies of the general population.…”

Section: Plos Onementioning

confidence: 99%

Impact of voluntary testing on infectious disease epidemiology: A game theoretic approach

Pepiot,

Supervie,

Breban

2023

PLoS ONE

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The World Health Organization recommends test-and-treat interventions to curb and even eliminate epidemics of HIV, viral hepatitis, and sexually transmitted infections (e.g., chlamydia, gonorrhea, syphilis and trichomoniasis). Epidemic models show these goals are achievable, provided the participation of individuals in test-and-treat interventions is sufficiently high. We combine epidemic models and game theoretic models to describe individual’s decisions to get tested for infectious diseases within certain epidemiological contexts, and, implicitly, their voluntary participation to test-and-treat interventions. We develop three hybrid models, to discuss interventions against HIV, HCV, and sexually transmitted infections, and the potential behavioral response from the target population. Our findings are similar across diseases. Particularly, individuals use three distinct behavioral patterns relative to testing, based on their perceived costs for testing, besides the payoff for discovering their disease status. Firstly, if the cost of testing is too high, then individuals refrain from voluntary testing and get tested only if they are symptomatic. Secondly, if the cost is moderate, some individuals will test voluntarily, starting treatment if needed. Hence, the spread of the disease declines and the disease epidemiology is mitigated. Thirdly, the most beneficial testing behavior takes place as individuals perceive a per-test payoff that surpasses a certain threshold, every time they get tested. Consequently, individuals achieve high voluntary testing rates, which may result in the elimination of the epidemic, albeit on temporary basis. Trials and studies have attained different levels of participation and testing rates. To increase testing rates, they should provide each eligible individual with a payoff, above a given threshold, each time the individual tests voluntarily.

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“…Dr Barrett emphasized that uncoordinated care delivery by clinicians and public health officials does not work and advocated for greater connectivity between PEI and other provinces alongside industry partners. The lack of access to curative therapies was an initial barrier in the province, where industry played a crucial role before treatment funding was switched over to provincial support (61). Provincial coordinating points now facilitate care delivery and triage to appropriate providers, demonstrating the importance of having dedicated staff to facilitate clinical and public health partnerships.…”

Section: Health Services Research: Blueprint Update and Implementationmentioning

confidence: 99%

The 9th Canadian Symposium on Hepatitis C Virus: Advances in HCV research and treatment towards elimination

Casey

Greenwald

et al. 2021

CanLivJ

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Hepatitis C virus (HCV) elimination has evolved into a coordinated global effort. Canada, with more than 250,000 chronically infected individuals, is among the countries leading this effort. The 9th Canadian Symposium on HCV, held in February 2020, thus established and addressed its theme, ‘advances in HCV research and treatment towards elimination’, by gathering together basic scientists, clinicians, epidemiologists, social scientists, and community members interested in HCV research in Canada. Plenary sessions showcased topical research from prominent international and national researchers, complemented by select abstract presentations. This event was hosted by the Canadian Network on Hepatitis C (CanHepC), with support from the Public Health Agency of Canada and the Canadian Institutes of Health Research and in partnership with the Canadian Liver Meeting. CanHepC has an established record in HCV research by its members and in its advocacy activities to address the care, treatment, diagnosis, and immediate and long-term needs of those affected by HCV infection. Many challenges remain in tackling chronic HCV infection, such as the need for a vaccine; difficult-to-treat populations and unknown aspects of patient subgroups, including pregnant women and children; vulnerable people; and issues distinct to Indigenous peoples. There is also increasing concern about long-term clinical outcomes after successful treatment, with the rise in comorbidities such as diabetes, cardiovascular disease, and fatty liver disease and the remaining risk for hepatocellular carcinoma in cirrhotic individuals. The symposium addressed these topics in highlighting research advances that will collectively play an important role in eliminating HCV and minimizing subsequent health challenges.

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Early Successes in an Open Access, Provincially Funded Hepatitis C Treatment Program in Prince Edward Island

Cited by 10 publications

References 20 publications

Real‐world outcomes of rapid regional hepatitis C virus treatment scale‐up among people who inject drugs in Tayside, Scotland

Real‐world outcomes of rapid regional hepatitis C virus treatment scale‐up among people who inject drugs in Tayside, Scotland

Impact of voluntary testing on infectious disease epidemiology: A game theoretic approach

The 9th Canadian Symposium on Hepatitis C Virus: Advances in HCV research and treatment towards elimination

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