Hepatitis C standards of care: A review of good practices since the advent of direct-acting antiviral therapy

Lazarus, Jeffrey V.; Picchio, Camila A; Guy, Danielle; Aleman, Soo; James, Cary; Nava, Felice; Øvrehus, Anne; Turnés, Juan; Ward, John W.; Ustianowski, Andy

doi:10.1016/j.clinre.2020.11.001

Cited by 13 publications

(10 citation statements)

References 43 publications

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“…HIV patients are increasingly aware of their status and are regularly in care, which would suggest that screening for HCV would be done in a timely manner, reducing risk for LP. Integrated care is a reported best practice for increasing screening, management, and treatment monitoring for HCV care 26 and in Spain, elimination of HCV among those who are HIV/HCV is feasible 27 , as is the case in other settings 28 . Of those who had a documented mode of transmission in our study, injecting drug use was the most common route of HCV infection.…”

Section: Discussionmentioning

confidence: 99%

Late presentation of chronic HBV and HCV patients seeking first time specialist care in Spain: a 2-year registry review

Picchio

Lens

Hernandez-Guerra

et al. 2021

Sci Rep

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Chronic viral hepatitis infection affects an estimated 325 million people globally. People who initiate treatment after significant disease progression face increased risk of severe liver complications and death. Data are scarce on the characteristics and risk factors of people who present late to care in Spain and globally. Data were collected from January 2018 to December 2019 to report late presentation (LP) to specialist care at 11 large university hospitals in Spain to assess related risk factors using a multivariable logistic regression model. 2290 (CHB = 505, CHC = 1785) patients were analysed, with 581 (25.2%) presenting late. Hepatitis C patients more frequently reported LP compared to hepatitis B patients (28.1% vs 15.0%; p < 0.001). Older age (p < 0.001), being male (p < 0.001), being Spanish-born (p < 0.001), and having an unknown origin of referral (p = 0.08) were associated with a higher likelihood of LP. Advanced liver disease was identified in 533 (23%) patients and late-stage liver disease in 124 (5.4%). LP, including with irreversible liver damage, to viral hepatitis specialist care is frequent in Spain, despite being a country with unrestricted treatment access. Initiatives to reduce LP should specifically target men, older individuals, foreign-born populations for CHB, and Spanish nationals for CHC.

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Section: Discussionmentioning

confidence: 99%

Late presentation of chronic HBV and HCV patients seeking first time specialist care in Spain: a 2-year registry review

Picchio

Lens

Hernandez-Guerra

et al. 2021

Sci Rep

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“…Furthermore, new models should be implemented to facilitate DAA delivery to enhance adherence while alcohol consumption continues. 42,43 Future research could explore if HCV treatment impacts alcohol consumption and whether the implementation of harm reduction services, specifically for AUD, can increase treatment completion.…”

Section: Discussionmentioning

confidence: 99%

Differences in the hepatitis C virus cascade of care and time to initiation of therapy among vulnerable subpopulations using a mobile unit as point‐of‐care

Valencia

Lazarus

Ceballos

et al. 2021

Liver International

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Background and Aims: People who inject drugs (PWID) and other marginalized populations with high hepatitis C virus (HCV) infection rates represent a unique challenge for treatment initiation due to health, administrative and social barriers. We analysed the HCV cascade of care (CoC) in some vulnerable subpopulations in Madrid, Spain, when using a mobile point-of-care (PoC).Methods: From 2019 to 2021, a mobile unit was used to screen active HCV using a linkage-to-care and two-step PoC-based strategy. Viremic participants were grouped into four subgroups: PWID, homeless individuals and people with a mental health disorder (MHD) and alcohol use disorder (AUD). Logistic regression, and Cox and Aalen's additive models were used to analyse associated factors and differences between groups.Results: A prospectively recruited cohort of 214 HCV-infected individuals (73 PWID, 141 homeless, 57 with a MHD and 91 with AUD) participated in the study. The overall HCV CoC analysis found that 178 (83.1%) attended a hospital, 164 (76.6%) initiated direct-acting antiviral therapy and 141 (65.8%) completed therapy, of which 99 (95.2%) achieved sustained virological response (SVR). PWID were significantly less likely to initiate treatment, whereas individuals with AUD waited longer before starting the treatment. Both people with AUD and PWID were significantly less likely to complete HCV treatment.Conclusions: Overall, SVR was achieved in the majority of the participants treated.However, PWID need better linkage to care and treatment, whereas PWID and AUD need more support for treatment completion. K E Y W O R D S cascade of care, hepatitis C virus, marginalized populations, model of care, point-of-care test How to cite this article: Valencia J, Lazarus JV, Ceballos FC, et al. Differences in the hepatitis C virus cascade of care and time to initiation of therapy among vulnerable subpopulations using a mobile unit as point-of-care.

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“…Particularly affected were community services that provide care for key populations. Community‐based testing services, both fixed‐site and outreach‐based, represent potential sites to target specific population groups and individuals who may be at increased risk of infection and who are not in contact with formal health service 28 , as targeted screening campaigns tailored to the local demographics can better reach high-risk populations 17 .…”

Section: Discussionmentioning

confidence: 99%

“…This underutilization of health services can result in late presentation to hepatitis care 15 , leading to delayed treatment initiation and ensuing liver damage progression, including irreversible liver cancer 16 . Point-of-care (PoC) testing and simplified diagnostic tools can facilitate screening and linkage to care to increase engagement and retainment in care 17 .…”

Section: Introductionmentioning

confidence: 99%

A novel model of care for simplified testing of HBV in African communities during the COVID-19 pandemic in Spain

Picchio

Nomah

Araujo

et al. 2021

Sci Rep

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Chronic hepatitis B virus (HBV) infection is a major public health threat for migrant populations in Spain and efforts to scale up testing are needed to reach the WHO elimination targets. The Hepatitis B Virus Community Screening and Vaccination in Africans (HBV-COMSAVA) study aims to use point-of-care testing and simplified diagnostic tools to identify, link to care, or vaccinate African migrants in Barcelona during the COVID-19 pandemic. From 21/11/20 to 03/07/2021, 314 study participants were offered HBV screening in a community clinic. Rapid tests for HBsAg screening were used and blood samples were collected with plasma separation cards. Patients received results and were offered: linkage to specialist care; post-test counselling; or HBV vaccination in situ. Sociodemographic and clinical history were collected and descriptive statistics were utilized. 274 patients were included and 210 (76.6%) returned to receive results. The HBsAg prevalence was 9.9% and 33.2% of people had evidence of past resolved infection. Overall, 133 required vaccination, followed by post-test counselling (n = 114), and linkage to a specialist (n = 27). Despite the COVID-19 pandemic, by employing a community-based model of care utilizing novel simplified diagnostic tools, HBV-COMSAVA demonstrated that it was possible to diagnose, link to care, and vaccinate African migrants in community-based settings.

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Hepatitis C standards of care: A review of good practices since the advent of direct-acting antiviral therapy

Cited by 13 publications

References 43 publications

Late presentation of chronic HBV and HCV patients seeking first time specialist care in Spain: a 2-year registry review

Late presentation of chronic HBV and HCV patients seeking first time specialist care in Spain: a 2-year registry review

Differences in the hepatitis C virus cascade of care and time to initiation of therapy among vulnerable subpopulations using a mobile unit as point‐of‐care

A novel model of care for simplified testing of HBV in African communities during the COVID-19 pandemic in Spain

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