Effectiveness of Interventions for Prevention of Common Infections Among Opioid Users: A Systematic Review of Systematic Reviews

Ponder

European Journal of Gastroenterology &Amp; Hepatology

et al. 2022

Background and aims Hepatitis C virus (HCV) is a prominent liver disease that often presents with mental illness. We stratify the HCV population and review its healthcare burden on the US hospital system. Methods The US National Inpatient Sample was used to select admissions related to HCV between 2016 and 2019. Weights were assigned to discharges, and trend analyses were performed. Strata were formed across demographics, comorbidities, psychiatric and substance use conditions, and other variables. Outcomes of interest included hospitalization incidences, mortality rates, total costs, and mean per-hospitalization costs. Results From 2016 to 2019, there were improvements in mortality and hospitalization incidence for HCV, as well as a decline in aggregate costs across the majority of strata. Exceptions that showed cost growth included admissions with multiple psychiatric, stimulant use, or poly-substance use disorders, and a history of homelessness. Admissions with no psychiatric comorbidities, admissions with no substance use comorbidities, and admissions with housing and without HIV comorbidity showed decreasing total costs. Along with per-capita mean costs, admissions with comorbid opioid use, bipolar, or anxiety disorder showed significant increases. No significant trends in per-capita costs were found in admissions without mental illness diagnoses. Conclusions Most strata demonstrated decreases in hospitalization incidences and total costs surrounding HCV; however, HCV cases with mental illness diagnoses saw expenditure growth. Cost-saving mechanisms for these subgroups are warranted.

Section: Discussionmentioning

confidence: 99%

The nationwide trends in hospital admissions, deaths, and costs related to hepatitis C stratified by psychiatric disorders and substance use: an analysis of US hospitals between 2016 and 2019

Ponder

European Journal of Gastroenterology &Amp; Hepatology

et al. 2022

“…To date, there have only been observational studies in which each of these components, particularly their combination, has been associated with reductions in HIV and/or HCV infection risk [4][5][6]. The traditional criteria for grading quality of evidence in systematic reviews automatically assess evidence from observational studies as low, and therefore, evidence for the effect of comprehensive NSP and OAT participation has been deemed to be of low quality [4,7]. Despite this 'low quality' evidence, the World Health Organization (WHO) strongly recommends a comprehensive package of HRP to reduce transmission of HIV, HCV and hepatitis B virus (HBV) among PWID [8].…”

Section: Introductionmentioning

confidence: 99%

Comprehensive needle and syringe program and opioid agonist therapy reduce HIV and hepatitis c virus acquisition among people who inject drugs in different settings: A pooled analysis of emulated trials

et al. 2023

Background and Aims Although the Netherlands, Canada and Australia were early adopters of harm reduction for people who inject drugs (PWID), their respective HIV and hepatitis C (HCV) epidemics differ. We measured the pooled effect of needle and syringe program (NSP) and opioid agonist therapy (OAT) participation on HIV and HCV incidence in these settings. Design For each cohort, we emulated the design and statistical analysis of a target trial using observational data. Setting and Participants We included PWID at risk of HIV or HCV infection from the Amsterdam Cohort Studies (1985–2013), Vancouver Injection Drug Users Study (1997–2009) and Melbourne Injecting Drug User Cohort Study (SuperMIX) (2010–2021). Measurements Separately for each infection and cohort (only HCV in SuperMIX), marginal structural models were used to compare the effect of comprehensive (on OAT and 100% NSP coverage or on OAT only if no recent injection drug use) versus no/partial NSP/OAT (no OAT and/or <100% NSP coverage) participation. Pooled hazard ratios (HR) and 95% CI were calculated using random‐effects meta‐analysis. Findings We observed 94 HIV seroconversions and 81 HCV seroconversions among 2023 and 430 participants, respectively. Comprehensive NSP/OAT led to a 41% lower risk of HIV acquisition (pooled HR = 0.59, 95% CI = 0.36–0.96) and a 76% lower risk of HCV acquisition (pooled HR = 0.24, 95% CI = 0.11–0.51), compared with no/partial NSP/OAT, with little heterogeneity between studies for both infections (I2 = 0%). Conclusions In the Netherlands, Canada and Australia, comprehensive needle and syringe program and opioid agonist therapy participation appears to substantially reduce HIV and hepatitis C acquisition compared with no or partial needle and syringe program/opioid agonist therapy participation. These findings from an emulated trial design reinforce the critical role of comprehensive access to harm reduction in optimizing infection prevention for people who inject drugs.

“…In contrast to HAV (hepatitis A virus) and HBV, there are currently no effective vaccines against HCV [19,20] and HIV [21]. However, harm reduction programmes including OAT and needle and syringe programmes, which have been established in Switzerland since the early 1990s [22,23], reduce the risk of HCV and HIV infection [24][25][26][27][28]. Besides, since 2012, guidelines recommend antiretroviral treatment (ART) irrespective of CD4 count [29], lowering the community viral load and contributing to reduced HIV transmission (treatment as prevention) [30][31][32][33].…”

Section: Introductionmentioning

confidence: 99%

HCV elimination in a Swiss opioid agonist therapy programme – a cohort study

Bregenzer¹,

Krismer²,

Wendel³

et al. 2022

Swiss Med Wkly

BACKG ROUND: In opioid agonist therapy (OAT) programmes, chronic hepatitis C is highly prevalent and directly observed therapy guarantees optimal adherence. Since 2017, all patients with chronic hepatitis C in Switzerland can be treated with pangenotypic direct-acting antivirals irrespective of liver fibrosis stage. Until the end of 2021, however, prescription was restricted to infectious disease specialists, gastroenterologists and certain addiction specialists. Difficult venous access after long-term intravenous drug use and, in the case of referral to a specialist, difficulties keeping appointments are barriers to HCV diagnosis and treatment. AIMS: To assess whether minimally invasive point-of-care tests and a "test-and-treat / vaccinate on-site" approach can improve human immunodeficiency virus (HIV) / hepatitis C virus (HCV) screening, HCV treatment uptake and immunity against hepatitis A/B. METHODS: Since September 2018, an infectious disease specialist and a study nurse performed 4-weekly visits in the OAT programme "HAG " (heroin dispensation of the canton Aargau), offering HIV/HCV antibody rapid testing (20 min) and HCV RNA quantification (G eneXpert ® , 60 min) from capillary blood, noninvasive liver fibrosis assessment (Fibroscan ® , 5-10 min) and HCV treatment prescription on-site. Recommended venous blood draws for HAV/HBV serology and HAV/HBV vaccinations were performed by the staff of the "HAG". Project performance was assessed by annual cross-sectional chart review. RESULTS: Of the 128 patients registered in April 2018, 79 (62%) were still present in May 2021. With 72 newly registered, a total of 200 patients could be assessed, of whom 129 (65%) were still present in May 2021. Between April 2018 and May 2021, the proportion ever tested for HIV antibodies increased from 79% (101/128) to 91% (117/129), the proportion ever tested for HCV antibodies from 83% (106/128) to 93% (120/129) and the proportion of those HCV antibody positive ever tested for HCV RNA tested from 89% (47/53) to 98% (56/57). The proportion with adequate HCV management (last HCV antibody test ≤1 year ago, if HCV antibody negative or last HCV RNA test ≤1 year ago, if HCV antibody-positive and RNA-negative) improved from 23% ([15 + 15]/128) to 80% ([55 + 48]/129). Overall, HCV treatment uptake in-creased from 60% (21/35) to 92% (55/60) and HCV RNA prevalence among the HCV antibody positives decreased from 38% (18/47) to 7% (6/84). Between 2018 and 2021, 19 non-cirrhotic chronic hepatitis C patients were successfully treated on-site (18 sustained virological responses [SVR] 12, 1 SVR4), with excellent adherence (≥93%) and, so far, no reinfection. The proportion with known HAV/ HBV serostatus increased from 38%/51% to 64%/76%. Immunity against HAV/HBV improved from 19%/23% to 50%/57%. CONCLUSION: Capillary blood point-of-care tests and a "test-and-treat / vaccinate on-site" approach remove crucial barriers to diagnosis and treatment, making hepatitis elimination in OAT programmes achievable. A high fluctuation rate requires HIV/HCV/HA...