Interventions to enhance testing, linkage to care, and treatment initiation for hepatitis C virus infection: a systematic review and meta-analysis

Cunningham, Evan B; Wheeler, Alice; Hajarizadeh, Behzad; French, Clare E; Roche, Rachel; Marshall, Alison D.; Fontaine, Guillaume; Conway, Anna; Valencia, Braulio M.; Bajis, Sahar; Presseau, Justin; Ward, John W.; Degenhardt, Louisa; Dore, Gregory J.; Hickman, Matthew; Vickerman, Peter; Grebely, Jason

doi:10.1016/s2468-1253(21)00471-4

Cited by 85 publications

(63 citation statements)

References 144 publications

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“…Peer workers allow participants to discuss HCV testing and treatment without impacting the therapeutic relationship with OAT providers [ 40 ]. This study supports findings that integrated care can be effective at increasing treatment uptake [ 13 ]. In addition, venepuncture is a barrier to testing for people who inject drugs, recognised amongst both practitioners [ 41 ] and patients [ 25 ].…”

Section: Discussionsupporting

confidence: 90%

“…A mobile unit employing a same day ‘test and treat’ model for a cohort in which the majority were experiencing homelessness, reported 77% initiating treatment [ 30 ]. Although there is weak evidence for the effectiveness of financial incentives to broadly increase HCV treatment uptake [ 13 ], high willingness to partake in such studies [ 31 ] indicates the need for further investigation. Less investigated are the additional system level barriers to providing incentives for treatment, such as provider or clinic reluctance.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, venepuncture is a barrier to testing for people who inject drugs, recognised amongst both practitioners [ 41 ] and patients [ 25 ]. The decentralisation of diagnostics and utilisation of innovative diagnostic technology (including point-of-care and dried blood spot testing) is acceptable among people who inject drugs [ 23 ], has been shown to increase testing [ 13 ], and will be key in reducing drop-off along the HCV care cascade. Event-based models of testing and treatment, or the use of campaign days, have been successful in engaging large numbers of people at risk of HCV [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

“…Campaign days, where staff are deployed to screen large numbers of people as part of an event, have been used globally and show promise in improving testing and linkage to care [ 11 , 12 ]. Studies have evaluated HCV treatment uptake among PWID [ 7 , 8 ], but there is a need for research evaluating novel models of care in the DAA era [ 13 ]. Rapid diagnosis and treatment of HCV can reduce onward transmission and prevent progression of liver disease [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

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A Testing Campaign Intervention Consisting of Peer-Facilitated Engagement, Point-of-Care HCV RNA Testing, and Linkage to Nursing Support to Enhance Hepatitis C Treatment Uptake among People Who Inject Drugs: The ETHOS Engage Study

Conway

Valerio

Alavi

et al. 2022

Viruses

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This study evaluated HCV treatment initiation among people who inject drugs (PWID) following an intervention of campaign days involving peer connection, point-of-care HCV RNA testing, and linkage to nursing support. ETHOS Engage is an observational cohort study of PWID attending 25 drug treatment clinics and needle and syringe programs in Australia (May 2018–September 2019). Point-of-care results were provided to the nurse, facilitating confirmatory testing and treatment. The study aimed to evaluate treatment uptake and factors associated with treatment at 24 months post-enrolment. There were 317 people with current HCV infection and eligible for treatment (median age 43, 65% male, 15% homeless, 69% receiving opioid agonist treatment, 70% injected in last month). Overall, 15% (47/317), 27% (85/317), 38% (120/317), and 49% (155/317) of people with current HCV infection had initiated treatment at 3-, 6-, 12-, and 24-months following testing, respectively. Homelessness (adjusted hazard ratio (aHR): 0.40; 95% confidence interval: 0.23, 0.71) and incarceration in the past 12 months (vs. never, aHR:0.46; 0.28, 0.76) were associated with decreased treatment initiation in the 24 months post-enrolment. This testing campaign intervention facilitated HCV treatment uptake among PWID. Further interventions are needed to achieve HCV elimination among people experiencing homelessness or incarceration.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Testing Campaign Intervention Consisting of Peer-Facilitated Engagement, Point-of-Care HCV RNA Testing, and Linkage to Nursing Support to Enhance Hepatitis C Treatment Uptake among People Who Inject Drugs: The ETHOS Engage Study

Conway

Valerio

Alavi

et al. 2022

Viruses

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“…Removing these eligibility restrictions is necessary, but not sufficient. Addressing other barriers, including burdensome preauthorization requirements as well as integrating routine screening and treatment into primary care and other settings where persons with hepatitis C receive services, could also increase coverage (15)(16)(17).…”

Section: Discussionmentioning

confidence: 99%

Vital Signs: Hepatitis C Treatment Among Insured Adults — United States, 2019–2020

Thompson¹,

Symum²,

Sandul³

et al. 2022

MMWR Morb. Mortal. Wkly. Rep.

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Introduction:Over 2 million adults in the United States have hepatitis C virus (HCV) infection, and it contributes to approximately 14,000 deaths a year. Eight to 12 weeks of highly effective direct-acting antiviral (DAA) treatment, which can cure ≥95% of cases, is recommended for persons with hepatitis C. Methods: Data from HealthVerity, an administrative claims and encounters database, were used to construct a cohort of adults aged 18-69 years with HCV infection diagnosed during January 30, 2019-October 31, 2020, who were continuously enrolled in insurance for ≥60 days before and ≥360 days after diagnosis (47,687). Multivariable logistic regression was used to assess the association between initiation of DAA treatment and sex, age, race, payor, and Medicaid restriction status; adjusted odds ratios (aORs) and 95% CIs were calculated. Results:The prevalence of DAA treatment initiation within 360 days of the first positive HCV RNA test result among Medicaid, Medicare, and private insurance recipients was 23%, 28%, and 35%, respectively; among those treated, 75%, 77%, and 84%, respectively, initiated treatment within 180 days of diagnosis. Adjusted odds of treatment initiation were lower among those with Medicaid (aOR = 0.54; 95% CI = 0.51-0.57) and Medicare (aOR = 0.62; 95% CI = 0.56-0.68) than among those with private insurance. After adjusting for insurance type, treatment initiation was lowest among adults aged 18-29 and 30-39 years with Medicaid or private insurance, compared with those aged 50-59 years. Among Medicaid recipients, lower odds of treatment initiation were found among persons in states with Medicaid treatment restrictions (aOR = 0.77; 95% CI = 0.74-0.81) than among those in states without restrictions, and among persons whose race was coded as Black or African American (Black) (aOR = 0.93; 95% CI = 0.88-0.99) or other race (aOR = 0.73; 95% CI = 0.62-0.88) than those whose race was coded as White.Conclusions and Implications for Public Health Practice: Few insured persons with diagnosed hepatitis C receive timely DAA treatment, and disparities in treatment exist. Unrestricted access to timely DAA treatment is critical to reducing viral hepatitis-related mortality, disparities, and transmission. Treatment saves lives, prevents transmission, and is cost saving.

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Integrated Hepatitis C–Opioid Use Disorder Care Through Facilitated Telemedicine

Talal,

Markatou,

Liu

et al. 2024

JAMA

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ImportanceFacilitated telemedicine may promote hepatitis C virus elimination by mitigating geographic and temporal barriers.ObjectiveTo compare sustained virologic responses for hepatitis C virus among persons with opioid use disorder treated through facilitated telemedicine integrated into opioid treatment programs compared with off-site hepatitis specialist referral.Design, Setting, and ParticipantsProspective, cluster randomized clinical trial using a stepped wedge design. Twelve programs throughout New York State included hepatitis C–infected participants (n = 602) enrolled between March 1, 2017, and February 29, 2020. Data were analyzed from December 1, 2022, through September 1, 2023.InterventionHepatitis C treatment with direct-acting antivirals through comanagement with a hepatitis specialist either through facilitated telemedicine integrated into opioid treatment programs (n = 290) or standard-of-care off-site referral (n = 312).Main Outcomes and MeasuresThe primary outcome was hepatitis C virus cure. Twelve programs began with off-site referral, and every 9 months, 4 randomly selected sites transitioned to facilitated telemedicine during 3 steps without participant crossover. Participants completed 2-year follow-up for reinfection assessment. Inclusion criteria required 6-month enrollment in opioid treatment and insurance coverage of hepatitis C medications. Generalized linear mixed-effects models were used to test for the intervention effect, adjusted for time, clustering, and effect modification in individual-based intention-to-treat analysis.ResultsAmong 602 participants, 369 were male (61.3%); 296 (49.2%) were American Indian or Alaska Native, Asian, Black or African American, multiracial, or other (ie, no race category was selected, with race data collected according to the 5 standard National Institutes of Health categories); and 306 (50.8%) were White. The mean (SD) age of the enrolled participants in the telemedicine group was 47.1 (13.1) years; that of the referral group was 48.9 (12.8) years. In telemedicine, 268 of 290 participants (92.4%) initiated treatment compared with 126 of 312 participants (40.4%) in referral. Intention-to-treat cure percentages were 90.3% (262 of 290) in telemedicine and 39.4% (123 of 312) in referral, with an estimated logarithmic odds ratio of the study group effect of 2.9 (95% CI, 2.0-3.5; P &lt; .001) with no effect modification. Observed cure percentages were 246 of 290 participants (84.8%) in telemedicine vs 106 of 312 participants (34.0%) in referral. Subgroup effects were not significant, including fibrosis stage, urban or rural participant residence location, or mental health (anxiety or depression) comorbid conditions. Illicit drug use decreased significantly (referral: 95% CI, 1.2-4.8; P = .001; telemedicine: 95% CI, 0.3-1.0; P &lt; .001) among cured participants. Minimal reinfections (n = 13) occurred, with hepatitis C virus reinfection incidence of 2.5 per 100 person-years. Participants in both groups rated health care delivery satisfaction as high or very high.Conclusions and RelevanceOpioid treatment program–integrated facilitated telemedicine resulted in significantly higher hepatitis C virus cure rates compared with off-site referral, with high participant satisfaction. Illicit drug use declined significantly among cured participants with minimal reinfections.Trial RegistrationClinicalTrials.gov Identifier: NCT02933970

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Interventions to enhance testing, linkage to care, and treatment initiation for hepatitis C virus infection: a systematic review and meta-analysis

Cited by 85 publications

References 144 publications

A Testing Campaign Intervention Consisting of Peer-Facilitated Engagement, Point-of-Care HCV RNA Testing, and Linkage to Nursing Support to Enhance Hepatitis C Treatment Uptake among People Who Inject Drugs: The ETHOS Engage Study

A Testing Campaign Intervention Consisting of Peer-Facilitated Engagement, Point-of-Care HCV RNA Testing, and Linkage to Nursing Support to Enhance Hepatitis C Treatment Uptake among People Who Inject Drugs: The ETHOS Engage Study

Vital Signs: Hepatitis C Treatment Among Insured Adults — United States, 2019–2020

Integrated Hepatitis C–Opioid Use Disorder Care Through Facilitated Telemedicine

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