Progress and remaining challenges to address hepatitis C, other infectious diseases, and drug-related harms to improve the health of people who use drugs

Grebely, Jason; Collins, Alexandra B.; Artenie, Andreea Adelina; Sutherland, Rachel; Meyer, Jaimie P.; Barocas, Joshua A.; Falade‐Nwulia, Oluwaseun; Cepeda, Javier; Cunningham, Evan B; Hajarizadeh, Behzad; Lafferty, Lise; Lazarus, Jeffrey V.; Bonn, Matthew; Marshall, Alison D.; Treloar, Carla

doi:10.1016/j.drugpo.2021.103469

Cited by 8 publications

(4 citation statements)

References 124 publications

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“…Although an effective HCV treatment is now available, access to treatment has suffered from the same barriers as HRS (lack of coverage, effects of marginalisation and stigma). HCV services (treatment or prevention) were not well adapted to people who inject drugs [ 16 , 17 ]. Other studies identified additional barriers to HCV treatment such as competing priorities and limited healthcare access [ 18 – 21 ].…”

Section: Introductionmentioning

confidence: 99%

Need for integration of hepatitis C (HCV) services in community-based settings for people who inject drugs: results from a global values and preferences survey

Ciaccio¹,

Villes²,

Perfect³

et al. 2023

Harm Reduct J

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Background To inform the development of updated World Health Organization (WHO) guidelines on simplified service delivery for HCV infection, a global survey was undertaken among people affected or infected by HCV. The objective of this analysis is to identify specific needs and preferences among people who inject drugs. Methods A multi-country, anonymous, self-administered online survey conducted in 2021 was developed by Coalition PLUS and the World Hepatitis Alliance in partnership with the WHO. Preferences for test and treat locations and simplifying HCV care were collected among people affected or infected by HCV. Chi-square tests were used to compare respondents who identified with current or former injection drug users through identification with key population to other respondents who did not identify with this key population. Results Among 202 respondents, 62 (30.7%) identified with current/former injection drug users. Compared to other respondents, they were: older [median (IQR): 48 (36–57) vs. 39 (31–51) years, p = 0.003]; more likely to have been tested for HCV (90.2% vs. 64.3%, p = 0.001); more likely to prefer testing in a community-based centre (CBC) (55.4% vs. 33.3%, p = 0.005); or in a support centres for people who use drugs (SCPUD)(50.0% vs. 9.8%, p < 0.001). The most important considerations regarding testing locations among people identified with current/former injection drug users (compared to the other respondents) were: non-judgemental atmosphere (p < 0.001), anonymity (p = 0.018) and community worker (CW) presence (p < 0.001). People identified with current/former injection drug users were more likely to prefer to receive HCV treatment in a CBC (63.0% vs. 44.8%, p = 0.028) or in a SCPUD (46.3% vs. 9.5%, p < 0.001), compared to the other respondents. The most important considerations regarding treatment locations among people identified with current/former injection drug users were the non-stigmatising/non-judgemental approach at the site (p < 0.001) and the presence of community-friendly medical personnel or CW (p = 0.016 and 0.002), compared to the other respondents. Conclusion The preferences of people identified with current/former injection drug users indicated specific needs concerning HCV services. Integration of HCV services in community-based risk reduction centres may be an important element in the development of adapted services to increase uptake and retention in HCV care among this population.

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Section: Introductionmentioning

confidence: 99%

Need for integration of hepatitis C (HCV) services in community-based settings for people who inject drugs: results from a global values and preferences survey

Ciaccio¹,

Villes²,

Perfect³

et al. 2023

Harm Reduct J

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“…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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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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“…Prior to large-scale HCV DAA treatments, it was unclear whether OAT patients were able to complete HCV treatments. Some of the reasons included modest outcomes and attachment to treatment with interferons, negative healthcare experiences and hesitation to focus treating patients with SUD [ 29 , 30 ]. During recent years, many successful experiences have confirmed that patients on OAT have acquired SVR12, which our review further confirms.…”

Section: Discussionmentioning

confidence: 99%

“…During recent years, many successful experiences have confirmed that patients on OAT have acquired SVR12, which our review further confirms. HCV treatments have been shown not be only feasible for patients on OAT, but also among needle and syringe exchange units, mobile services, and other settings [ 29 ]. Many of those studies have focused on the treatment of HCV specifically, without an effort to attach patients to care for treating their SUD, as funding mechanisms for SUD treatment differ in each country.…”

Section: Discussionmentioning

confidence: 99%

Integrated care model and point of care diagnostics facilitate Hepatitis C treatment among patients receiving opioid agonist therapy: a retrospective review of medical records

Häkkinen

Tourunen

Pitkänen

et al. 2022

Subst Abuse Treat Prev Policy

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Background Hepatitis C virus (HCV) is common among individuals in opioid agonist therapy (OAT). HCV treatment has previously been unavailable for most HCV positive OAT patients in Finland. The removal of treatment restrictions and attempts to reach HCV elimination goals have increased the number of OAT patients needing HCV treatment. The objectives of this study were 1) to characterize Finnish HCV positive OAT patients and evaluate their eligibility for HCV treatment at addiction service units, and 2) to retrospectively review the outcomes of treated patients. Methods The study focused on HCV positive OAT patients (n = 235). Demographics and clinical parameters were retrospectively reviewed using the patients’ medical records. The eligibility of providing HCV treatment to patients at addiction service units were evaluated based on patients’ clinical characteristics, such as liver function and patterns of substance use. The outcomes of patients receiving HCV treatment were reviewed. Results Of HCV antibody positive OAT patients, 75% had chronic HCV. Of 103 HCV patients screened for liver fibrosis either with Fibroscan or APRI (aspartate aminotransferase to platelet ratio index), 83 patients (81%) had no indication of severe liver damage. Point of care (POC) HCV tests were used for 46 patients to lower the threshold of attending laboratory testing. All patients preferred POC testing to conventional blood testing. Twenty patients had received HCV treatment, 19 completed the treatment and achieved sustained virologic response (SVR) at the end of the treatment. Of the 18 patients available for evaluation of SVR at 12 weeks after the treatment (SVR12), 17 achieved SVR12. Conclusions The integrated model consisting of HCV diagnostics and treatment at the addiction service unit was successfully implemented within normal OAT practice.

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Progress and remaining challenges to address hepatitis C, other infectious diseases, and drug-related harms to improve the health of people who use drugs

Cited by 8 publications

References 124 publications

Need for integration of hepatitis C (HCV) services in community-based settings for people who inject drugs: results from a global values and preferences survey

Need for integration of hepatitis C (HCV) services in community-based settings for people who inject drugs: results from a global values and preferences survey

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

Integrated care model and point of care diagnostics facilitate Hepatitis C treatment among patients receiving opioid agonist therapy: a retrospective review of medical records

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