Impact of an Accelerated Pretreatment Evaluation on Linkage-to-Care for Hepatitis C-infected Persons Who Inject Drugs

Valérie Martel-Laferrière, Suzanne Brissette, Claire Wartelle-Bladou, Louis-Christophe Juteau, Maria Popa, Marie-Ève Goyer, Julie Bruneau, Valérie Martel-Laferrière, Suzanne Brissette, Claire Wartelle-Bladou, Louis-Christophe Juteau, Maria Popa, Marie-Ève Goyer, Julie Bruneau

Abstract

Background: Historically, hepatitis C virus (HCV) pretreatment evaluation has required multiple visits, frequently resulting in loss to follow-up and a delayed initiation of treatment. New technologies can accelerate this process. We investigated the feasibility of a single-day evaluation program and its impact on evaluation completion, treatment eligibility awareness, and treatment initiation among people who inject drugs (PWIDs).

Methods: HCV-infected PWID who were unaware if they were eligible for treatment were recruited in a prospective evaluation of an accelerated model of care between 2017 and 2019 and compared to a historical cohort. The patients underwent a medical evaluation, rapid HCV viral load testing, and transient elastography during a single visit, at the end of which they were informed whether they were eligible for treatment. A historical cohort of patients fulfilling the same inclusion criteria and evaluated with the usual standard of care spanning several visits who were examined at the addiction medicine clinic from 2014 to 2016 served as the comparison group.

Results: The accelerated and historical cohorts included 99 and 76 patients, respectively. The cohorts did not differ significantly by age and gender, but more patients in the historical cohort were undergoing opioid agonist therapy, while more patients in the accelerated cohort injected drugs in the last month. An accelerated evaluation resulted in a higher rate of evaluation completion (100% vs 67.1%; P < .001). Among those eligible for treatment, the proportion of those initiating treatment was similar between the groups (51/64 (79.7%) vs. 26/37 (70.3%); P = .28). The delay in the initiation of treatment was shorter in the accelerated cohort than in the historical cohort (69 (IQR: 49-106) days vs. 219 (IQR: 141-416) days; P < .001).

Conclusions: Accelerated evaluation enhanced the awareness of eligibility and reduced the time to initiation among eligible patients.

Trial registration: This study is registered on www.clinicaltrials.gov (NCT02755402).

Keywords: Hepatitis C; evaluation; person who use drugs; treatment.

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: VML is reporting having received advisor fees from AbbVie and research grants from Gilead Sciences and Merck, outside of the current work. JB is reporting having received advisor fees from Gilead Sciences and AbbVie and a research grant from Gilead Sciences, outside of the current work. SB, CWB, LCJ, MP and MEG have no conflicts of interest to report.

© The Author(s) 2022.

Figures

Figure 1.
Figure 1.
Study flow chart. ¶*Initially not eligible. Patients became eligible once treatment access became universal in March 2018.
Figure 2.
Figure 2.
Treatment initiation among the different groups.

References

    1. AASLD-IDSA. Recommendations for testing, managing, and treating hepatitis C. Accessed May 20, 2021.
    1. World Health Organization (WHO). Guidelines for the care and treatment of persons diagnosed with chronic hepatitis C virus infection. Accessed May 20th, 2021.
    1. The Canadian Network on Hepatitis C Blueprint Writing Committee and Working Groups. Blueprint to inform hepatitis C elimination efforts in Canada. 2019; Accessed April 20, 2020.
    1. Scott N, McBryde ES, Thompson A, Doyle JS, Hellard ME. Treatment scale-up to achieve global HCV incidence and mortality elimination targets: a cost-effectiveness model. Gut. 2017;66:1507-1515.
    1. Fraser H, Martin NK, Brummer-Korvenkontio H, et al.. Model projections on the impact of HCV treatment in the prevention of HCV transmission among people who inject drugs in Europe. J Hepatol. 2018;68:402-411.
    1. World Health Organization. Global Health Sector Strategy on Viral Hepatitis 2016-2021. Towards Ending Viral Hepatitis. World Health Organization, 2016. Accessed June 25, 2021.
    1. Grebely J, Robaeys G, Bruggmann P, et al.. Recommendations for the management of hepatitis C virus infection among people who inject drugs. Int J Drug Policy. 2015;26:1028-1038.
    1. Dore GJ, Altice F, Litwin AH, et al.. Elbasvir-grazoprevir to treat hepatitis C virus infection in persons receiving opioid agonist therapy: a randomized trial. Ann Intern Med. 2016;165:625-634.
    1. Grebely J, Read P, Cunningham EB, et al.. Elbasvir and grazoprevir for hepatitis C virus genotype 1 infection in people with recent injecting drug use (DARLO-C): an open-label, single-arm, phase 4, multicentre trial. Health Sci Rep. 2020;3:e151.
    1. Grebely J, Dalgard O, Conway B, et al.. Sofosbuvir and velpatasvir for hepatitis C virus infection in people with recent injection drug use (SIMPLIFY): an open-label, single-arm, phase 4, multicentre trial. Lancet Gastroenterol Hepatol. 2018;3:153-161.
    1. van Dijk M, Drenth JPH, Arends JE, et al.. Loss to follow-up in the hepatitis C care cascade: A substantial problem but opportunity for micro-elimination. J Viral Hepat. 2020;27:1270-1283.
    1. Yau AH, Lee T, Ramji A, Ko HH. Rate, delay and predictors of hepatitis C treatment in British Columbia. Can J Gastroenterol Hepatol. 2015;29:315-320.
    1. Kracht PAM, Arends JE, Hoepelman AIM, Vervoort SCJM. The balancing perspective of hard-to-reach hepatitis C patients who were lost to follow-up: a qualitative study. PLoS One. 2020;15:e0230756.
    1. Glaspy S, Avramovic G, McHugh T, et al.. Exploring and understanding HCV patient journeys- HEPCARE Europe project. BMC Infect Dis. 2021;21:239.
    1. Grebely J, Hajarizadeh B, Dore GJ. Direct-acting antiviral agents for HCV infection affecting people who inject drugs. Nat Rev Gastroenterol Hepatol. 2017;14:641-651.
    1. Pawlotsky JM, Ramers CB, Dillon JF, Feld JJ, Lazarus JV. Simplification of care for Chronic Hepatitis C virus infection. Semin Liver Dis. 2020;40:392-402.
    1. Xpert HCV Viral Load Brochure – CE-IVD. 2015; Accessed 28 mai 2015, 2015.
    1. Sterling RK, Lissen E, Clumeck N, et al.. Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection. Hepatology. 2006;43:1317-1325.
    1. Wai CT, Greenson JK, Fontana RJ, et al.. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology. 2003;38:518-526.
    1. Friedrich-Rust M, Ong MF, Martens S, et al.. Performance of transient elastography for the staging of liver fibrosis: a meta-analysis. Gastroenterology. 2008;134:960-974.
    1. Norton BL, Akiyama MJ, Arnsten JH, Agyemang L, Heo M, Litwin AH. High HCV cure rates among people who inject drugs and have suboptimal adherence: A patient-centered approach to HCV models of care. Int J Drug Policy. 2021;93:103135.
    1. Habchi J, Thomas AM, Sprecht-Walsh S, et al.. Optimizing Hepatitis C virus (HCV) treatment in a US colocated HCV/opioid agonist therapy program. Open Forum Infect Dis. 2020;7:ofaa310.
    1. Fadnes LT, Aas CF, Vold JH, et al.. Integrated treatment of hepatitis C virus infection among people who inject drugs: a multicenter randomized controlled trial (INTRO-HCV). PLoS Med. 2021;18:e1003653.
    1. Draper BL, Htay H, Pedrana A, et al.. Outcomes of the CT2 study: a ‘one-stop-shop’ for community-based hepatitis C testing and treatment in Yangon, Myanmar. Liver Int. 2021;41:2578-2589.
    1. Akiyama MJ, Norton BL, Arnsten JH, Agyemang L, Heo M, Litwin AH. Intensive models of hepatitis C care for people who inject drugs receiving opioid agonist therapy: a randomized controlled trial. Ann Intern Med. 2019;170:594-603.
    1. Marshall AD, Pawlotsky JM, Lazarus JV, Aghemo A, Dore GJ, Grebely J. The removal of DAA restrictions in Europe – one step closer to eliminating HCV as a major public health threat. J Hepatol. 2018;69:1188-1196.
    1. Heil J, Soufidi K, Stals F, et al.. Retrieval and re-evaluation of previously diagnosed chronic hepatitis C infections lost to medical follow-up in the Netherlands. Eur J Gastroenterol Hepatol. 2020;32:851-856.
    1. Ford MM, Johnson N, Desai P, Rude E, Laraque F. From Care to Cure: demonstrating a model of clinical patient navigation for hepatitis C care and treatment in high-need patients. Clin Infect Dis. 2017;64:685-691.
    1. Adamson PC, Miceli J, Shiferaw B, Villanueva MS, Canterino JE. A colocalized hepatitis C virus clinic in a primary care practice improves linkage to care in a high prevalence population. Am J Med. 2020;133:705-712.
    1. Beekmans N, Klemt-Kropp M. Re-evaluation of chronic hepatitis B and hepatitis C patients lost to follow-up: results of the Northern Holland hepatitis retrieval project. Hepatol Med Policy. 2018;3:5.
    1. Afdhal N, Reddy KR, Nelson DR, et al.. Ledipasvir and sofosbuvir for previously treated HCV genotype 1 infection. New Engl J Med. 2014;370:1483-1493.
    1. Kowdley KV, Gordon SC, Reddy KR, et al.. Ledipasvir and sofosbuvir for 8 or 12 weeks for chronic HCV without cirrhosis. New Engl J Med. 2014;370:1879-1888.
    1. Feld JJ, Jacobson IM, Hézode C, et al.. Sofosbuvir and velpatasvir for HCV genotype 1, 2, 4, 5, and 6 infection. New Engl J Med. 2015;373:2599-2607.
    1. Foster GR, Afdhal N, Roberts SK, et al.. Sofosbuvir and velpatasvir for HCV genotype 2 and 3 infection. New Engl J Med. 2015;373:2608-2617.
    1. Valerio H, Alavi M, Silk D, et al.. Progress towards elimination of hepatitis C infection among people who inject drugs in Australia: the ETHOS Engage Study. Clin infect dis. 2020;73(1):e69-e78.
    1. Hutton J, Doyle J, Zordan R, et al.. Point-of-care hepatitis C virus testing and linkage to treatment in an Australian inner-city emergency department. Int J Drug Policy. 2019;72:84-90.

Source: PubMed

Sponsorer og samarbejdspartnere

Medicinske tilstande

Narkotikainterventioner

3
Abonner