Hepatitis C elimination among people who inject drugs: Challenges and recommendations for action within a health systems framework

Day, Emma; Hellard, Margaret; Treloar, Carla; Bruneau, Julie; Martin, Natasha K.; Øvrehus, Anne; Dalgård, Olav; Lloyd, Andrew R.; Dillon, John; Hickman, Matthew; Byrne, Jude; Litwin, Alain H.; Matičič, Mojca; Bruggmann, Philip; Midgard, Håvard; Norton, Brianna L.; Trooskin, Stacey; Lazarus, Jeffrey V.; Grebely, Jason

doi:10.1111/liv.13949

Cited by 105 publications

(79 citation statements)

References 115 publications

(223 reference statements)

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“…1 Further, PWID are often socially marginalised and face economic and cultural barriers to health service access, regardless of the country in which they live. 24,31 Consequently, our findings that relate to engagement with these target populations may be especially pertinent.…”

Section: Discussionmentioning

confidence: 98%

“…To eliminate HCV, a “treatment as prevention” strategy has been widely discussed and to some extent has begun to be adopted . In the context of HCV, treatment as prevention involves very active screening and treatment uptake among those actively engaged in injecting drug use . Linkage or colocation of HCV services with harm reduction services can provide opportunities to engage with PWID and reduce the risk of reinfection.…”

Section: Discussionmentioning

confidence: 99%

“…Colocation or linkage of HCV services enables the provision of holistic care especially for PWID. It might be difficult for HCV prescribers to provide specialised advice on harm reduction, thus linkage to dedicated services may ensure that support is provided for prevention of new infections post‐treatment …”

Section: Discussionmentioning

confidence: 99%

“…6,23 In the context of HCV, treatment as prevention involves very active screening and treatment uptake among those actively engaged in injecting drug use. 6,23,24 Linkage or colocation of HCV services with harm reduction services can provide opportunities to engage with PWID and reduce the risk of reinfection. Colocation or linkage of HCV services enables the provision of holistic care especially for PWID.…”

Section: Discussionmentioning

confidence: 99%

“…It might be difficult for HCV prescribers to provide specialised advice on harm reduction, thus linkage to dedicated services may ensure that support is provided for prevention of new infections post-treatment. 6,23,24 In Australia, there is some integration of HCV and drug and alcohol services where HCV services were added to the existing drug and alcohol services. In some of them, harm reduction services were also provided.…”

Section: Discussionmentioning

confidence: 99%

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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

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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.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

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

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All-Cause and Cause-Specific Mortality Among People Using Extramedical Opioids

et al. 2020

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IMPORTANCE Extramedical opioid use has escalated in recent years. A better understanding of cause-specific mortality in this population is needed to inform comprehensive responses. OBJECTIVE To estimate all-cause and cause-specific crude mortality rates (CMRs) and standardized mortality ratios (SMRs) among people using extramedical opioids, including age-and sex-specific estimates when possible. DATA SOURCES For this systematic review and meta-analysis, MEDLINE, PsycINFO, and Embase were searched for studies published from January 1, 2009, to October 3, 2019, and an earlier systematic review on this topic published in 2011. STUDY SELECTION Cohort studies of people using extramedical opioids and reporting mortality outcomes were screened for inclusion independently by 2 team members. DATA EXTRACTION AND SYNTHESIS Data were extracted by a team member and checked by another team member. Study quality was assessed using a custom set of items that examined risk of bias and quality of reporting. Data were pooled using random-effects meta-analysis models. Heterogeneity was assessed using stratified meta-analyses and meta-regression. MAIN OUTCOMES AND MEASURES Outcome measures were all-cause and cause-specific CMRs and SMRs among people using extramedical opioids compared with the general population of the same age and sex. RESULTS Of 8683 identified studies, 124 were included in this analysis (100 primary studies and 24 studies providing additional data for primary studies). The pooled all-cause CMR, based on 99 cohorts of 1 262 592 people, was 1.6 per 100 person-years (95% CI, 1.4-1.8 per 100 person-years), with substantial heterogeneity (I 2 = 99.7%). Heterogeneity was associated with the proportion of the study sample that injected opioids or was living with HIV infection or hepatitis C. The pooled all-cause SMR, based on 43 cohorts, was 10.0 (95% CI, 7.6-13.2). Excess mortality was observed across a range of causes, including overdose, injuries, and infectious and noncommunicable diseases. CONCLUSIONS AND RELEVANCE The findings suggest that people using extramedical opioids experience significant excess mortality, much of which is preventable. The range of causes for which excess mortality was observed highlights the multiplicity of risk exposures experienced by this population and the need for comprehensive responses to address these. Better data on cause-specific mortality in this population in several world regions appear to be needed.

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Initiation of oral hepatitis C virus treatment: Which barriers are pertinent for ambulatory individuals with a history of illicit substance use? A qualitative interview study

Barbati,

Strasser,

Allemann

et al. 2024

Health Science Reports

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Background and AimsThe World Health Organization has set a goal to eradicate hepatitis C virus (HCV) by the year 2030. Nonadherence to HCV treatment has substantial economic implications due to high treatment costs, among others. Barriers to start HCV treatment may be critical. The aim of this study was to assess pertinent barriers to HCV treatment in ambulatory patients with a history of illicit substance use and to compare them to the literature.MethodsBarriers to HCV treatment mentioned by the key risk group (i.e., people who inject drugs) were retrieved from literature through a pragmatic literature search. From 34 published articles, we identified 80 modifiable barriers that were bundled in 23 items within the four topics “Personal difficulties and barriers to treatment,” “Personal motivation to be treated,” “Knowledge about the disease,” and “Received information about the medicine.” In‐depth semistructured interviews were performed face‐to‐face with ambulatory patients from the University Psychiatric Clinics in Basel, Switzerland. Transcripts were coded inductively.ResultsInterviews were performed with seven individuals (mean age: 48.3 years; range: 38–63 years; one woman) treated with oral direct‐acting antivirals between 2014 and 2022. Thirteen barriers to start HCV treatment were mentioned that corresponded to the five categories: information, attitudes, swallowing difficulties, social environment, and unfavorable lifestyle. The barrier “swallowing difficulties” emerged exclusively from the statements provided by the interviewees.ConclusionBarriers to the initiation of HCV treatment indicated by our interviewees clearly differed from the literature. Notably, the challenge of swallowing medicines may be particularly relevant for physicians prescribing and pharmacists dispensing HCV medication.

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Hepatitis C elimination among people who inject drugs: Challenges and recommendations for action within a health systems framework

Cited by 105 publications

References 115 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

All-Cause and Cause-Specific Mortality Among People Using Extramedical Opioids

Initiation of oral hepatitis C virus treatment: Which barriers are pertinent for ambulatory individuals with a history of illicit substance use? A qualitative interview study

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