Gaps in hepatitis C virus prevention and care for HIV-hepatitis C virus co-infected people who inject drugs in Canada

Delaunay, Charlotte Lanièce; Maheu‐Giroux, Mathieu; Marathe, Gayatri; Saeed, Sahar; Martel-Laferrière, Valérie; Cooper, Curtis; Walmsley, Sharon; Cox, Joseph; Wong, Alexander; Klein, Marina B.

doi:10.1016/j.drugpo.2022.103627

Cited by 9 publications

(4 citation statements)

References 70 publications

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“…In Canada, studies conducted in Vancouver and Toronto have reported an increase in injection frequency and equipment sharing following the introduction of fentanyl in the unregulated drug supply [ 32 , 33 ]. This finding is consistent with recent data from the Canadian Coinfection Cohort [ 34 ], which points to an increase in injection frequency among people who inject drugs. Finally, it is supported by a recent Canadian study that found a direct association between daily fentanyl injection, equipment sharing (i.e., syringes, cookers, and filters), and injection-related health risks [ 35 ].…”

Section: Introductionsupporting

confidence: 93%

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Impact of safer supply programs on injection practices: client and provider experiences in Ontario, Canada

et al. 2023

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Objectives Fentanyl has contributed to a sharp rise in the toxicity of the unregulated drug supply and fatal overdoses in Canada. It has also changed injection practices. Injection frequency has increased as a result and so has equipment sharing and health-related risks. The aim of this analysis was to explore the impact of safer supply programs on injection practices from the perspective of clients and providers in Ontario, Canada. Methods The data set included qualitative interviews with 52 clients and 21 providers that were conducted between February and October 2021 across four safer supply programs. Interview excerpts discussing injection practices were extracted, screened, coded and then grouped into themes. Results We identified three themes, each theme corresponding to a change in injection practices. The first change was a decrease in the amount of fentanyl used and a decrease in injection frequency. The second change involved switching to injecting hydromorphone tablets instead of fentanyl. Finally, the third change was stopping injecting altogether and taking safer supply medications orally. Conclusion Safer supply programs can contribute to reducing injection-related health risks in addition to overdose risks. More specifically, they have the potential to address disease prevention and health promotion gaps that stand-alone downstream harm reduction interventions cannot address, by working upstream and providing a safer alternative to fentanyl.

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Section: Introductionsupporting

confidence: 93%

“…Our findings suggest that safer supply programs could help address long-standing gaps in prevention, especially in HIV and HCV prevention [ 34 , 37 , 44 , 45 ]. Our analysis was narrowly focused on injection practices, but we were able to identify upstream pathways of risk reduction that should be further explored.…”

Section: Discussionmentioning

confidence: 99%

Impact of safer supply programs on injection practices: client and provider experiences in Ontario, Canada

et al. 2023

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“…Among a PLHIV cohort in Israel, drug use was also found to be associated with reduced access to HCV treatment [46] and active injection drug use was associated with reduced odds of linkage to HCV care among PLHIV in the US [47]. Whilst the association between injecting drug use and reduced odds of HCV treatment initiation or linkage is likely a reflection of the various socio-economic, health system, and policy factors that contribute to reduced access to health services among PWID, it is important to note the substantial research showing that PWID achieve good HCV cascade outcomes, including adherence to treatment, low discontinuation rates, and high SVR rates [48][49][50]. Contrary to finding that HCV treatment initiation was less likely among MSM in our region, Boerekamps et al found HCV treatment uptake to be highest among MSM relative to other populations [45].…”

Section: Plos Onementioning

confidence: 99%

Trends in hepatitis C virus coinfection and its cascade of care among adults living with HIV in Asia between 2010 and 2020

Ross¹,

Rupasinghe²,

Avihingsanon³

et al. 2023

PLoS ONE

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Background Chronic hepatitis C virus (HCV) infection contributes to substantial morbidity and mortality among adults living with HIV. Cascades of HCV care support monitoring of program performance, but data from Asia are limited. We assessed regional HCV coinfection and cascade outcomes among adults living with HIV in care from 2010–2020. Methods Patients ≥18 years old with confirmed HIV infection on antiretroviral therapy (ART) at 11 clinical sites in Cambodia, China, India, Indonesia, South Korea, Thailand and Vietnam were included. HCV- and HIV-related treatment and laboratory data were collected from those with a positive HCV antibody (anti-HCV) test after January 2010. An HCV cascade was evaluated, including proportions positive for anti-HCV, tested for HCV RNA or HCV core antigen (HCVcAg), initiated on HCV treatment, and achieved sustained virologic response (SVR). Factors associated with screening uptake, treatment initiation, and treatment response were analyzed using Fine and Gray’s competing risk regression model. Results Of 24,421 patients, 9169 (38%) had an anti-HCV test, and 971 (11%) had a positive result. The proportion with positive anti-HCV was 12.1% in 2010–2014, 3.9% in 2015–2017, and 3.8% in 2018–2020. From 2010 to 2014, 34% with positive anti-HCV had subsequent HCV RNA or HCVcAg testing, 66% initiated HCV treatment, and 83% achieved SVR. From 2015 to 2017, 69% with positive anti-HCV had subsequent HCV RNA or HCVcAg testing, 59% initiated HCV treatment, and 88% achieved SVR. From 2018 to 2020, 80% had subsequent HCV RNA or HCVcAg testing, 61% initiated HCV treatment, and 96% achieved SVR. Having chronic HCV in later calendar years and in high-income countries were associated with increased screening, treatment initiation or achieving SVR. Older age, injecting drug use HIV exposure, lower CD4 and higher HIV RNA were associated with reduced HCV screening or treatment initiation. Conclusions Our analysis identified persistent gaps in the HCV cascade of care, highlighting the need for focused efforts to strengthen chronic HCV screening, treatment initiation, and monitoring among adult PLHIV in the Asia region.

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“…In addition to stigma, other frequent obstacles to healthcare access for PWUD include competing life and medical priorities, such as unstable housing status and mental health challenges, as well as nancial and geographical barriers [9,10]. These obstacles contribute to signi cant treatment gaps for PWUD leading to their increased morbidity and mortality [11]. A characteristic PWUD treatment gap is observed with two highly prevalent viral infections, hepatitis C virus (HCV) and HIV [12,13].…”

Section: Introductionmentioning

confidence: 99%

Telehealth to increase healthcare access; perspectives of people who use drugs

Papalamprakopoulou,

Ntagianta,

Triantafyllou

et al. 2024

Preprint

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Background: People who use drugs (PWUD) often face restricted healthcare access despite their heightened healthcare needs. Factors such as stigma, mistrust of the healthcare system, competing priorities, and geographical barriers pose significant challenges to accessing healthcare services for PWUD. Telehealth offers an innovative solution to expand healthcare access for better inclusion of underserved populations in healthcare. We aimed to explore PWUDs’ perceptions of telehealth as a healthcare delivery modality. Methods: We utilized purposive sampling to recruit participants (N = 57) for nine focus group discussions (FGDs) in Athens, Greece. Eligibility criteria required participants to be at least 18 years old, with a history of injection drug use, and current internet access. The FGDs followed a semi-structured interview guide, were audio recorded, transcribed verbatim, translated into English, and de-identified. We applied thematic analysis to analyze FGD transcripts. Results: Participants’ mean (standard deviation) age was 47.9 (8.9) years, 89.5% (51/57) were male, 91.2% (52/57) were of Greek origin, and 61.4% (35/57) had attended at least 10 years of school. Three main themes emerged from the FGDs: (1) high internet utilization for healthcare-related purposes among PWUD, (2) highlighting telehealth benefits despite access obstacles and PWUDs’ concerns about diagnostic accuracy, and (3) approaches to overcome access obstacles and build digital trust. Participants extensively used the internet for healthcare-related processes such as accessing healthcare information and scheduling provider appointments. Despite being telehealth-inexperienced, most participants expressed a strong willingness to embrace telehealth due to its perceived convenience, time-saving nature, and trusted digital environment. Some participants perceived the inability to conduct a physical examination during telehealth encounters as limiting its diagnostic accuracy, while others expressed concerns about digital literacy and technological infrastructure accessibility. To build trust in telehealth and promote patient-centeredness, participants recommended an initial in-person visit, virtual eye contact during telehealth encounters, patient education, and partnerships with PWUD-supportive community organizations equipped with appropriate infrastructure. Conclusions: PWUD frequently use the internet for health-related purposes and suggested several approaches to enhance virtual trust. Their insights and suggestions are practical guidance for policymakers seeking to enhance healthcare access for underserved populations through telehealth. Clintrials.gov registration number: NCT05794984

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Gaps in hepatitis C virus prevention and care for HIV-hepatitis C virus co-infected people who inject drugs in Canada

Cited by 9 publications

References 70 publications

Impact of safer supply programs on injection practices: client and provider experiences in Ontario, Canada

Impact of safer supply programs on injection practices: client and provider experiences in Ontario, Canada

Trends in hepatitis C virus coinfection and its cascade of care among adults living with HIV in Asia between 2010 and 2020

Telehealth to increase healthcare access; perspectives of people who use drugs

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