From principles to practice: Description of a novel equity-based HCV primary care treatment model for PWID

Milne, Rozalyn; Price, Morgan; Wallace, Bruce; Drost, Anne; Haigh-Gidora, Irene; Nezil, F.A.; Fraser, Chris

doi:10.1016/j.drugpo.2015.07.009

Cited by 28 publications

(16 citation statements)

References 46 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Involving patients in HCV treatment planning, considering patients as a central part of the service, and providing comprehensive services are important for addressing individual patients' care barriers and improving patients' engagement with the services. Providing flexible appointments, appropriate opening hours, and culturally appropriate environments, helps to ensure a more patient‐centric service …”

Section: Discussionmentioning

confidence: 99%

Elements of community‐based models for treating hepatitis C virus in supporting HCV elimination in Australia: A Delphi study

Pourmarzi

Smirnov

Hepworth

et al. 2019

Health Planning & Management

View full text Add to dashboard Cite

Summary Background A key to achieving the goal of hepatitis C virus (HCV) elimination is the provision of its treatment in community settings. This study aimed to identify the important organisational and operational elements of community‐based models for treating HCV and their feasibility in the Australian context. Methods A Delphi study was conducted with 33 experts from Australia. The questionnaire included 13 elements drawn from the literature. Participants rated each element on a five‐point Likert scale for importance and feasibility and suggested additional elements. Consensus was identified when the sum of categories 1 and 2 or 4 and 5 of the five‐point Likert scale reached greater than or equal to 70%. Results Eight elements reached consensus in regard to importance including “Safe and enabling environment,” “Training and support for healthcare providers,” “Open referral policy,” “Linkage with or providing outreach services,” “Person‐centred approach,” “On‐site screening and assessment,” “Linkage or co‐location with harm reduction services,” and “Linkage or co‐location with drug and alcohol services.” At least 65% of participants agreed implementing elements of open referral policy, Training and support for healthcare providers, and Person‐centred approach are usually or always/very feasible. For the other five elements, this was agreed to by a range of 15.2%‐57.6% of participants. Conclusion Successful community‐based models for treating HCV in Australia are dependent on the integration and coordination of care and the support provided for both patients and healthcare providers. Substantial work is required across policy and health service planning to integrate these highly rated elements into Australian primary health care.

show abstract

Section: Discussionmentioning

confidence: 99%

Elements of community‐based models for treating hepatitis C virus in supporting HCV elimination in Australia: A Delphi study

Pourmarzi

Smirnov

Hepworth

et al. 2019

Health Planning & Management

View full text Add to dashboard Cite

show abstract

“…In PWID, treatment of chronic HCV is safe and effective (Alvarez-Uria et al, 2009; Backmund et al, 2001; Bruggmann et al, 2008; Dalgard, 2005; Dimova et al, 2013; Dore et al, 2010; Grebely, Genoway, et al, 2007; Grebely et al, 2010; Grebely, Raffa, et al, 2007; Guadagnino et al, 2007; Hellard et al, 2009; Jack et al, 2009; Jafferbhoy et al, 2012; Jeffrey et al, 2007; Lindenburg et al, 2011; Manolakopoulos et al, 2010; Martinez et al, 2010; Matthews et al, 2005; Mauss et al, 2004; Melin et al, 2010; Neri et al, 2002; Papadopoulos et al, 2010; Robaeys et al, 2006; Sasadeusz et al, 2011; Schaefer et al, 2003, 2007; Sylvestre, 2002; Sylvestre et al, 2005; Van Thiel et al, 1995, 2003; Waizmann & Ackermann, 2010; Wilkinson et al, 2009) (Litwin et al, 2015; Milne et al, 2015; Mason et al, 2015; Keats et al, 2015), and has been recommended for PWID by AASLD/IDSA and EASL guidelines following individualised assessment (AASLD/IDSA, 2015; European Association for Study of Liver, 2014). Therapy has evolved rapidly, with the recent approval of novel interferon-free DAA regimens that are highly effective and much better tolerated than those containing PEG-IFN (AASLD/IDSA, 2015; European Association for Study of Liver, 2014).…”

Section: Peg-ifn and Daa-based Treatment: Treatment Recommendationsmentioning

confidence: 99%

Recommendations for the management of hepatitis C virus infection among people who inject drugs

Grebely

Robaeys

Bruggmann

et al. 2015

International Journal of Drug Policy

166

132

View full text Add to dashboard Cite

In high income countries, the majority of new and existing hepatitis C virus (HCV) infections occur among people who inject drugs (PWID). In many low and middle income countries large HCV epidemics have also emerged among PWID populations. The burden of HCV-related liver disease among PWID is increasing, but treatment uptake remains extremely low. There are a number of barriers to care which should be considered and systematically addressed, but should not exclude PWID from HCV treatment. The rapid development of interferon-free direct-acting antiviral (DAA) therapy for HCV infection has brought considerable optimism to the HCV sector, with the realistic hope that therapeutic intervention will soon provide near optimal efficacy with well-tolerated, short duration, all oral regimens. Further, it has been clearly demonstrated that HCV treatment is safe and effective across a broad range of multidisciplinary healthcare settings. Given the burden of HCV-related disease among PWID, strategies to enhance HCV assessment and treatment in this group are urgently needed. These recommendations demonstrate that treatment among PWID is feasible and provide a framework for HCV assessment and

show abstract

“…Despite evidence that HCV testing and treatment worldwide are increasing (Milne et al, 2015; Smith, Combellick, Jordan, & Hagan, 2015), PWID continue to lack access to effective treatment in low and middle-income settings (LMIC) (Harris, Albers, & Swan, 2015; Milne et al, 2015). Numerous system-level barriers continue to prevent PWID from receiving HCV treatment, including treatment cost, criminalization of drug use, restrictive treatment protocols, and stigma and discrimination in healthcare settings (Wolfe et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

Implementing and scaling up HCV treatment services for people who inject drugs and other high risk groups in Ukraine: An evaluation of programmatic and treatment outcomes

Mazhnaya

Meteliuk

Barnard

et al. 2017

International Journal of Drug Policy

View full text Add to dashboard Cite

Background HCV prevalence estimates among people who inject drugs (PWID) in Ukraine is high (60%-90%), yet barriers to HCV treatment and care remain substantial including limited access to direct acting antiviral (DAA) medications. A feasibility scale-up project implemented HCV treatment in community-based settings to improve access to DAA treatment for key populations in this context. Methods Using program-level data and verified medical records, we describe the development, implementation processes and outcomes for HCV treatment for PWID and other risks groups. Most participants (76%) received a combination of sofosbuvir, pegylated interferon, and ribavirin for 12 weeks. Treatment enrollment started in June 2015; the first two waves are reported. Data on demographics, HIV characteristics, HCV genotype and RNA levels, including sustained virologic response (SVR) were obtained from verified medical records. We used logistic regression to examine the independent correlates of achieving a SVR. Results The project was implemented in 19 healthcare institutions from 16 regions of Ukraine, mainly within AIDS specialty centers. Our analytical sample included 1,126 participants who were mostly men (73%) and the majority were HIV co-infected (79%). Treatment retention was 97.7% and the proportion of participants who achieved SVR for the 1,029 (91%) with complete data was 94.3% (95% CI 92.8%–95.7%). PWID who were currently injecting had comparable SVR rates (89.2%, 95% CI 81.5–94.5%) to PWID not injecting (94.4%, 95% CI 92.4–96.1), PWID on methadone (94.4%, 95%CI 92.4–96.1), and ‘other’ risk group (95.2%, 95% CI 91.3–97.7). Independent factors associated with achieving a SVR were females sex (AOR: 3.44, 95% CI 1.45–8.14), HCV genotype 3 (AOR: 4.57, 95% CI 1.97 - 10.59) compared to genotype 1. SVR rates in PWID actively injecting did not differ significantly from any other group. Conclusion Both patient-level and structural factors influence HCV treatment scale-up in Ukraine, but patient-level outcomes confirm high levels of achieving SVR in PWID, irrespective of injection and treatment status.

show abstract

From principles to practice: Description of a novel equity-based HCV primary care treatment model for PWID

Cited by 28 publications

References 46 publications

Elements of community‐based models for treating hepatitis C virus in supporting HCV elimination in Australia: A Delphi study

Elements of community‐based models for treating hepatitis C virus in supporting HCV elimination in Australia: A Delphi study

Recommendations for the management of hepatitis C virus infection among people who inject drugs

Implementing and scaling up HCV treatment services for people who inject drugs and other high risk groups in Ukraine: An evaluation of programmatic and treatment outcomes

Contact Info

Product

Resources

About