Hepatitis C Screening: Barriers to Linkage to Care

Saab, Sammy; Challita, Youssef; Najarian, Lisa; Guo, Rong; Saggi, Satvir; Choi, Gina

doi:10.14218/jcth.2018.00063

Cited by 12 publications

(15 citation statements)

References 42 publications

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“…HCV-infected PWID are often unaware of their infection, usually have difficulties in reaching public health services, and only one in ten of those diagnosed enter treatment [15]. Frequently, these kinds of patients are reluctant to accept medical help, and despite being aware that they are HCV-antibody positive, they do not undergo further evaluation or do not keep appointments [16,17]. Furthermore, they do not like to be referred to the hospital but prefer being treated in SerDs.…”

Section: Discussionmentioning

confidence: 99%

Model of Care for Microelimination of Hepatitis C Virus Infection among People Who Inject Drugs

Foschi

Borghi

Grassi

et al. 2021

JCM

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Background: People who inject drugs (PWID) are the largest group at risk for HCV infection. Despite the direct acting antivirals (DAA) advancements, HCV elimination has been hindered by real-life difficulties in PWID. Aims: This study aimed to assess the impact of a multidisciplinary intervention strategy where HCV screening, treatment and follow-up were performed at the same location on efficacy and safety of DAA-therapy in real-life PWID population. Methods: All HCV-infected PWID referred to five specialized outpatient centers for drug addicts (SerDs) in Northern Italy were prospectively enrolled from May 2015 to December 2019. Hepatologists and SerDs healthcare workers collaborated together in the management of PWID inside the SerDs. Sustained virologic response (SVR), safety of treatment, proportion of patients lost to follow-up and reinfection rate were evaluated. Results: A total of 358 PWID started antiviral treatment. About 50% of patients had advanced fibrosis/cirrhosis, 69% received opioid substitution treatment, and 20.7% self-reported recent injecting use. SVR was achieved in 338 (94.4%) patients. Two patients died during treatment; one prematurely discontinued, resulting in a non-responder; twelve were lost during treatment/follow-up; and five relapsed. No serious adverse events were reported. SVR was lower in recent PWID than in former ones (89.2% vs. 95.8%; p = 0.028). Seven reinfections were detected, equating to an incidence of 1.25/100 person-years. Reinfection was associated with recent drug use (OR 11.07, 95%CI 2.10–58.38; p = 0.005). Conclusion: Our embedded treatment model could be appropriate to increase the linkage to care of HCV-infected PWID. In this setting, DAA regimens are well tolerated and highly effective, achieving a lower rate of reinfection.

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Section: Discussionmentioning

confidence: 99%

Model of Care for Microelimination of Hepatitis C Virus Infection among People Who Inject Drugs

Foschi

Borghi

Grassi

et al. 2021

JCM

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“…The disparity between HCV screening and linkage of care were also observed in other countries. A retrospective study of patients screened for HCV within the University of California between February and July 2018 reported that approximately 27% of patients with detectable HCV antibodies were not linked to either further testing or specialty care and specifically young adults and PWID were found as the important predictors of lack of linkage to care [ 24 ]. The rate of referral of anti-HCV positive patients for appropriate specialist care was less than 50%, also in a previous UK study [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Screening, Linkage to Care and Treatment of Hepatitis C Infection in Primary Care Setting in the South of Italy

Citarella¹,

Cammarota²,

Bernardi

et al. 2020

Life

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Hepatitis C virus (HCV) infection remains a pressing public health issue. Our aim is to assess the linkage to care of patients with HCV diagnosis and to support the proactive case-finding of new HCV-infected patients in an Italian primary care setting. This was a retrospective cohort study of 44 general practitioners (GPs) who managed 63,955 inhabitants in the Campania region. Adults with already known HCV diagnosis or those with HCV high-risk profile at June 2019 were identified and reviewed by GPs to identify newly diagnosed of HCV and to assess the linkage to care and treatment for the HCV patients. Overall, 698 HCV patients were identified, 596 with already known HCV diagnosis and 102 identified by testing the high-risk group (2614 subjects). The 38.8% were already treated with direct-acting antivirals, 18.9% were referred to the specialist center and 42.3% were not sent to specialist care for treatment. Similar proportions were found for patients with an already known HCV diagnosis and those newly diagnosed. Given that the HCV infection is often silent, case-finding needs to be proactive and based on risk information. Our findings suggested that there needs to be greater outreach, awareness and education among GPs in order to enhance HCV testing, linkage to care and treatment.

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“…There are various definitions of linkage to care within the HCV literature. Saab et al[ 31 ] defined linkage to care as confirmation of HCV diagnosis by an HVC RNA test and establishment of a follow-up appointment for treatment with a specialist. Others defined linkage to care as confirming HCV by HCV RNA testing[ 32 ] or referral to a specialist and attending the first appointment within six months of diagnosis[ 33 ].…”

Section: Recommendations To Eliminate Hcv Burden In Kuwaitmentioning

confidence: 99%

Accelerating the elimination of hepatitis C in Kuwait: An expert opinion

Hasan

Alfadhli

Al-Gharabally

et al. 2020

WJG

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The hepatitis C virus (HCV) is estimated to affect 71 million people worldwide. In 2016, the World Health Organization adopted the first global health sector strategy to eliminate viral hepatitis as a public health threat by 2030. In December 2018, the European Association for the Study of the Liver, International Liver Foundation convened an expert panel to address the elimination of HCV in Kuwait. Several steps have already been taken to eliminate HCV in Kuwait, including free HCV treatment for Kuwait’s citizens, high blood safety standards, and the implementation of screening and awareness programs. The expert panel made several recommendations aimed at accelerating the elimination of HCV in Kuwait: The development of a national strategy and action plan to guide all HCV elimination activities; the formation of a coordination mechanism to support collaboration between hepatitis working committees; the prioritization of micro-elimination at primary, secondary or tertiary facilities, in prisons and rehabilitation centers; and ensuring the involvement of multiple stakeholders – including relevant civil society groups – in all activities. Enhanced screening and linkage to care should be prioritized in Kuwait, with the expansion of the prescriber base to primary healthcare providers and nurse practitioners to be considered. Raising awareness and educating people about HCV infection also remain essential to achieve the goal of HCV elimination. Lastly, a national HCV registry should be developed to help monitor the implementation of viral hepatitis plans and progress towards achieving national and international targets.

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Hepatitis C Screening: Barriers to Linkage to Care

Cited by 12 publications

References 42 publications

Model of Care for Microelimination of Hepatitis C Virus Infection among People Who Inject Drugs

Model of Care for Microelimination of Hepatitis C Virus Infection among People Who Inject Drugs

Screening, Linkage to Care and Treatment of Hepatitis C Infection in Primary Care Setting in the South of Italy

Accelerating the elimination of hepatitis C in Kuwait: An expert opinion

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