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1.
Intern Med J ; 2024 Mar 15.
Article in English | MEDLINE | ID: mdl-38488685

ABSTRACT

BACKGROUND: Australia is struggling to meet its National Hepatitis B Strategy care targets, particularly in nonmetropolitan settings. It is vital to engage priority populations and improve their access to recommended care to reach these targets. AIMS: This retrospective study examined people living with chronic hepatitis B (CHB) in regional North Queensland, Australia, and determined whether their care adhered to current national CHB management guidelines. The analysis aimed to identify gaps in care that might be addressed to improve future outcomes. METHODS: All individuals referred to the gastroenterology clinic at the Townsville University Hospital in regional North Queensland, Australia, for CHB care between January 2015 and December 2020 were identified. Their linkage to care, engagement in care and receipt of guideline-recommended CHB care were determined. RESULTS: Of 255 individuals, 245 (96%) were linked to care; 108 (42%) remained engaged in care and 86 (38%) were receiving guideline-recommended care in 2021. There were 91/255 (36%) who identified as Indigenous Australians. Indigenous status was the only independent predictor of not being linked to care (odds ratio (OR): 0.13 (95% confidence interval (CI): 0.03-0.60), P = 0.01), not being engaged in care (OR: 0.19 (95% CI: 0.10-0.36), P < 0.0001), not receiving guideline-recommended CHB care (OR: 0.16 (95% CI: 0.08-0.31), P < 0.0001) or not being engaged in a hepatocellular carcinoma surveillance programme (OR: 0.08 (95% CI: 0.02-0.27), P < 0.0001). CONCLUSION: Current approaches are failing to deliver optimal CHB care to Indigenous Australians in regional North Queensland. Targeted strategies to ensure that Indigenous Australians in the region receive equitable care are urgently needed.

2.
Clin Liver Dis (Hoboken) ; 23(1): e0118, 2024.
Article in English | MEDLINE | ID: mdl-38283305

ABSTRACT

Screening patients with opioid use disorder (OUD) for HCV can potentially decrease morbidity and mortality if HCV-infected individuals are linked to care. We describe a quality improvement initiative focused on patients with OUD, incorporating an electronic health record decision-support tool for HCV screening across multiple health care venues, and examining the linkage to HCV care. Of 5829 patients with OUD, 4631 were tested for HCV (79.4%), (compared to a baseline of 8%) and 1614 (27.7%) tested positive. Two hundred and thirty patients had died at the study onset. Patients tested in the acute care and emergency department settings were more likely to test positive than those in the ambulatory setting (OR = 2.21 and 2.49, p < 0.001). Before patient outreach, 279 (18.2%) HCV-positive patients were linked to care. After patient outreach, 326 (23.0%) total patients were linked to care. Secondary end points included mortality and the number of patients who were HCV-positive who achieved a cure. The mortality rate in patients who were HCV-positive (12.2%) was higher than that in patients who were HCV-negative (7.4%) (OR = 1.72, p < 0.001) or untested patients (6.2%) (OR = 2.10, p<0.001). Of the 326 with successful linkage to care, 113 (34.7%) had a documented cure. An additional 55 (16.9%) patients had a possible cure, defined as direct acting antiviral ordered but no follow-up documented, known treatment in the absence of documented sustained viral response lab draw, or documentation of cure noted in outside medical records but unavailable laboratory results. A strategy utilizing electronic health record decision-support tools for testing patients with OUD for HCV was highly effective; however, linking patients with HCV to care was less successful.

3.
Washington, D.C.; OPAS; 2023-12-18. (OPAS/BRA_MS/CDE/23-0013).
Non-conventional in Portuguese | PAHO-IRIS | ID: phr2-58953

ABSTRACT

Este documento apresenta a avaliação final do Termo de Cooperação nº 66 “Ações de Implementação das Políticas Públicas de Controle de DST/HIV/AIDS e Hepatites Virais Fortalecidas no Contexo dos Princípios Diretrizes do SUS e da Cooperação Sul-Sul, desenvolvido entre o Departamento de Doenças de Condições Crônicas e Infecções Sexualmente Transmissíveis da Secretaria de Vigilância em Saúde do Ministério da Saúde e a Organização Pan Americana da Saúde/Organização Mundial da Saúde no Brasil, com vigência de dez anos, no período entre 2011-2021. Neste relatório são abordados, prioritariamente, os processos e resultados acordados nos instrumentos de cooperação do TC 66. A cooperação técnica internacional impulsiona o intercâmbio de conhecimentos, tecnologias e de especialistas em diversos temas, ampliando os horizontes de resposta aos desafios com que se defronta a saúde pública. O relatório final de avaliação é uma oportunidade de divulgar sinteticamente os principais resultados alcançados e destaca os processos técnicos e gerenciais para a realização da cooperação técnica. Os conteúdos abordados neste documento são fruto de uma análise coletiva das múltiplas vozes de gestores e de profissionais das duas instituições parceiras que estiveram à frente das ações e que desenharam o formato e as estratégias metodológicas que nortearam a elaboração deste relatório.


Subject(s)
Sexually Transmitted Diseases , Sexually Transmitted Diseases , HIV , Acquired Immunodeficiency Syndrome , Hepatitis, Viral, Human , Unified Health System , South-South Cooperation , Technical Cooperation , Brazil
5.
J Infect Dis ; 228(Suppl 3): S180-S188, 2023 09 13.
Article in English | MEDLINE | ID: mdl-37703347

ABSTRACT

The estimated prevalence of anti-HCV was 3.1% in Taiwan. Studies have shown iatrogenic behavior was the major transmission route. It is highest in specific populations including patients with end stage renal disease (ESRD), human immunodeficiency virus infection, who inject drug (PWID), and under opioid substitution treatment. Approximately 405,160 patients were seropositive for HCV RNA and in need of treatment. Taiwan government claims to reach WHO's 2030 goal of HCV elimination by 2025 and works hard to resolve several barriers of HCV elimination including political commitment, sustainable financing, minimize reimbursement restrictions, instituted monitoring, and perform micro-elimination of specific populations. The last stage of HCV elimination is to accelerate the universal HCV screening program of populations aged 45-79 years and resolve the unawareness issue of HCV infection. Hopefully, we can achieve the targets of HCV elimination set by WHO and reach the goal earlier in 2025.


Subject(s)
Hepacivirus , Hepatitis C , Humans , Hepacivirus/genetics , Taiwan/epidemiology , Hepatitis C/epidemiology , Hepatitis C/prevention & control , Policy , Government
6.
JMIR Res Protoc ; 12: e38521, 2023 Sep 25.
Article in English | MEDLINE | ID: mdl-37747764

ABSTRACT

BACKGROUND: Hepatitis C is a disease with a strong social component, as its main transmission route is via blood, making it associated with lifestyle. Therefore, it is suitable to be worked on from the perspective of public health policy, which still has a lot of room to explore and improve, contrary to diagnoses and treatments, which are already very refined and effective. OBJECTIVE: An interactive gamified policy tool, designated as Let's End HepC (LEHC), was created to understand the impact of policies related to hepatitis C on the disease's epidemiology on a yearly basis until 2030. METHODS: To this end, an innovative epidemiological model was developed, integrating Markov chains to model the natural history of the disease and adaptive conjoint analysis to reflect the degree of application of each of the 24 public health policies included in the model. This double imputation model makes it possible to assess a set of indicators such as liver transplant, incidence, and deaths year by year until 2030 in different risk groups. Populations at a higher risk were integrated into the model to understand the specific epidemiological dynamics within the total population of each country and within segments that comprise people who have received blood products, prisoners, people who inject drugs, people infected through vertical transmission, and the remaining population. RESULTS: The model has already been applied to a group of countries, and studies in 5 of these countries have already been concluded, showing results very close to those obtained through other forms of evaluation. CONCLUSIONS: The LEHC model allows the simulation of different degrees of implementation of each policy and thus the verification of its epidemiological impact on each studied population. The gamification feature allows assessing the adequate fulfillment of the World Health Organization goals for the elimination of hepatitis C by 2030. LEHC supports health decision makers and people who practice patient advocacy in making decisions based on science, and because LEHC is democratically shared, it ends up contributing to the increase of citizenship in health. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/38521.

8.
Can Liver J ; 6(2): 190-200, 2023 Jul.
Article in English | MEDLINE | ID: mdl-37503523

ABSTRACT

Background: Direct-acting antiviral (DAA) therapies have simplified HCV treatment, and publicly funded Canadian drug plans have eliminated disease-stage restrictions for reimbursement of DAA therapies. However other policies which complicate, delay, or prevent treatment initiation still persist. We aim to describe these plans' existing reimbursement criteria and appraise whether they hinder treatment access. Methods: We reviewed DAA reimbursement policies of 16 publicly funded drug plans published online and provided by contacts with in-depth knowledge of prescribing criteria. Data were collected from May to July 2022. Primary outcomes were: (1) if plans have arranged to accept point-of-care HCV RNA testing for diagnosis; testing requirements for (2) HCV genotype, (3) fibrosis stage, and (4) chronic infection; (5) time taken and method used to approve reimbursement requests; (6) providers eligible to prescribe DAAs; and (7) restrictions on re-treatment. Results: Fifteen (94%) plans have at least one policy in place which limits simplified HCV treatment. Many plans continue to require results of genotype or fibrosis staging, limit eligible prescribers, and take longer than 1 day to approve coverage requests. One plan discourages treatment for re-infection. Conclusion: Reimbursement criteria set by publicly funded Canadian drug plans continue to limit timely, equitable access to HCV treatment. Eliminating clinically irrelevant pre-authorization testing, expanding eligible prescribers, expediting claims processing, and broadening coverage of treatment for reinfection will improve access to DAAs. The federal government could further enhance efforts by introducing a federal HCV elimination strategy or federal high-cost drug PharmaCare program.

9.
S Afr Med J ; 113(5): 39-45, 2023 05 05.
Article in English | MEDLINE | ID: mdl-37170608

ABSTRACT

BACKGROUND: Hepatitis B virus (HBV) infection causes nearly 300 million chronic infections globally. Healthcare workers face up to four times the risk of HBV infection through occupational exposure to contaminated blood and bodily fluids. Health sciences students (HSSs) are regarded as at an even greater risk as they embark on their clinical training journey. While chronic hepatitis B is incurable, it can be prevented by the safe and effective hepatitis B vaccine (HepB). The South African National Department of Health recommends at least three doses of vaccine (HepB3) for HSSs before patient contact. However, data on policy implementation at training institutions, vaccine coverage and HBV immunity in HSSs are lacking or limited. OBJECTIVES: To investigate knowledge, attitudes and practices of HSSs at the University of the Witwatersrand (Wits) in relation to international guidelines and institutional HepB programmes included in the Wits vaccination policy. Sociodemographic factors predicting HepB uptake were also investigated. METHODS: A cross-sectional study was conducted between February and June 2021. An electronic, self-administered survey was emailed to all current HSSs (N=3 785). The survey included questions on sociodemographic characteristics, knowledge of and attitudes towards HepB- related international guidelines and Wits policies, and HepB uptake and vaccine practices at Wits. Descriptive statistical analyses, followed by multivariable regression modelling, were used to identify factors associated with HepB uptake. RESULTS: A response rate of only 7.1% yielded 269 returned surveys, of which 221 were adequate for analysis. Most respondents were female (69.2%), with a mean (standard deviation) age of 22.5 (3.5) years, and were studying a Bachelor of Medicine and Surgery (MB BCh) degree (76.9%). Only 78% of those students who reported a history of vaccination (89.1% of study sample) reported a completed vaccine series. The only significant predictor, when adjusted for interactions, was being enrolled in MB BCh compared with other courses (odds ratio 4.69; p=0.026). Students displayed higher levels of knowledge around institutional (Wits) vaccine recommendations (94.1%) compared with international recommendations (75.6%). Most students were in favour of mandatory vaccination (91.4%), but not of serological testing following vaccination (42.5%). Half of our students received vaccinations in private facilities, but no follow-up or record was made of this by the designated Wits Campus Health and Wellness Centre. CONCLUSION: Institutional HepB policies are suboptimal, with no centralised co-ordination or implementation strategy. Urgent efforts are required to create awareness around policy and management, ensure vaccination coverage in this high-risk group, and foster positive practices with adequate monitoring.


Subject(s)
Health Knowledge, Attitudes, Practice , Hepatitis B , Humans , Female , Young Adult , Adult , Male , Cross-Sectional Studies , South Africa , Universities , Hepatitis B/prevention & control , Hepatitis B virus , Hepatitis B Vaccines , Vaccination , Students , Policy
10.
Washington, D.C.; OPS; 2023-05-09.
in Spanish | PAHO-IRIS | ID: phr-57449

ABSTRACT

Esta sinopsis de política se centra en las nuevas recomendaciones de la OMS sobre la prestación simplificada de servicios con un enfoque de salud pública respecto a las pruebas, la atención y el tratamiento de la infección por el virus de la hepatitis C. Se abordan la descentralización, la integración y la distribución de tareas; el tratamiento con antivirales de acción directa en la población infantil y adolescente, y el uso de las pruebas de la carga viral de ARN y las pruebas reflejas de la carga viral en el punto de atención. Está dirigida principalmente a los equipos de gerencia de los programas nacionales de hepatitis y otros encargados de formular políticas en los ministerios de salud. También será útil para personal responsable de elaborar algoritmos nacionales de uso de las pruebas y de la compra de los ensayos, el control de calidad y el aseguramiento de la calidad.


Subject(s)
Hepatitis C , Hepatitis C, Chronic , Patient Care , Child Health , Adolescent Health
11.
Washington, D.C.; OPS; 2023-05-09.
in Spanish | PAHO-IRIS | ID: phr-57448

ABSTRACT

Esta sinopsis de política se centra en las nuevas recomendaciones de la OMS sobre el tratamiento de la infección crónica por el virus de la hepatitis C en la población infantil y adolescente de 3 años de edad en adelante. Está dirigida principalmente a los equipos de gerencia de los programas nacionales de hepatitis y otros encargados de formular políticas de los ministerios de salud. También será útil para prestadores de atención de salud y pediatras que ofrezcan y administren las pruebas, la atención y el tratamiento de las hepatitis en la población infantil, adolescente y adulta con infección crónica.


Subject(s)
Hepatitis C , Hepatitis C, Chronic , Patient Care , Adolescent Health , Child Health
13.
PLOS Glob Public Health ; 3(1): e0001165, 2023.
Article in English | MEDLINE | ID: mdl-36963057

ABSTRACT

The aim of this systematic review and meta-analysis is to evaluate available prevalence and viral sequencing data representing chronic hepatitis B (CHB) infection in Kenya. More than 20% of the global disease burden from CHB is in Africa, however there is minimal high quality seroprevalence data from individual countries and little viral sequencing data available to represent the continent. We undertook a systematic review of the prevalence and genetic data available for hepatitis B virus (HBV) in Kenya using the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) 2020 checklist. We identified 23 studies reporting HBV prevalence and 8 studies that included HBV genetic data published in English between January 2000 and December 2021. We assessed study quality using the Joanna Briggs Institute critical appraisal checklist. Due to study heterogeneity, we divided the studies to represent low, moderate, high and very high-risk for HBV infection, identifying 8, 7, 5 and 3 studies in these groups, respectively. We calculated pooled HBV prevalence within each group and evaluated available sequencing data. Pooled HBV prevalence was 3.4% (95% CI 2.7-4.2%), 6.1% (95% CI 5.1-7.4%), 6.2% (95% CI 4.64-8.2) and 29.2% (95% CI 12.2-55.1), respectively. Study quality was overall low; only three studies detailed sample size calculation and 17/23 studies were cross sectional. Eight studies included genetic information on HBV, with two undertaking whole genome sequencing. Genotype A accounted for 92% of infections. Other genotypes included genotype D (6%), D/E recombinants (1%) or mixed populations (1%). Drug resistance mutations were reported by two studies. There is an urgent need for more high quality seroprevalence and genetic data to represent HBV in Kenya to underpin improved HBV screening, treatment and prevention in order to support progress towards elimination targets.

14.
JAMA ; 329(15): 1246-1247, 2023 04 18.
Article in English | MEDLINE | ID: mdl-36892977

ABSTRACT

This Medical News article is an interview with Francis S. Collins, MD, PhD, former National Institutes of Health director, and JAMA Editor in Chief Kirsten Bibbins-Domingo, PhD, MD, MAS, about a historic Biden-Harris administration proposal to cure and prevent all hepatitis C infections in the US.


Subject(s)
Disease Eradication , Health Policy , Hepacivirus , Hepatitis C , Humans , Hepatitis C/prevention & control , National Institutes of Health (U.S.)/organization & administration , United States/epidemiology , Disease Eradication/methods
15.
J Travel Med ; 30(1)2023 02 18.
Article in English | MEDLINE | ID: mdl-36426801

ABSTRACT

BACKGROUND/OBJECTIVE: Refugees and migrants to the World Health Organization (WHO) European Region are disproportionately affected by infections, including tuberculosis (TB), human immunodeficiency virus (HIV) and hepatitis B and C (HBV/HCV) compared with the host population. There are inequities in the accessibility and quality of health services available to refugees and migrants in the Region. This has consequences for health outcomes and will ultimately impact the ability to meet Regional infection elimination targets. METHODS: We reviewed academic and grey literature to identify national policies and guidelines for TB/HIV/HBV/HCV specific to refugees and migrants in the Member States of the WHO European Region and to identify: (i) evidence informing policy and (ii) barriers and facilitators to policy implementation. RESULTS: Relatively few primary national policy/guideline documents were identified which related to refugees and migrants and TB [14 of 53 Member States (26%), HIV (n = 15, 28%) and HBV/HCV (n = 3, 6%)], which often did not align with the WHO recommendations, and for some countries, violated refugees' and migrants' human rights. We found extreme heterogeneity in the implementation of the WHO- and European Centre for Disease Prevention and Control (ECDC)-advocated policies and recommendations on the prevention, diagnosis, treatment and care of TB/HIV/HBV/HCV infection among migrants across the Member States of the WHO European Region.There is great heterogeneity in implementation of WHO- and ECDC-advocated policies on the prevention, diagnosis, treatment and care of TB/HIV/HBV/HCV infection in refugees and migrants across the Member States in the Region. CONCLUSION: More transparent and accessible reporting of national policies and guidelines are required, together with the evidence base upon which these policy decisions are based. Political engagement is essential to drive the changes in national legislation to ensure equitable and universal access to the diagnosis and care for infectious diseases.


Subject(s)
HIV Infections , Hepatitis B , Hepatitis C , Refugees , Transients and Migrants , Tuberculosis , Humans , HIV , Tuberculosis/epidemiology , Policy , World Health Organization
16.
China Pharmacy ; (12): 907-910, 2023.
Article in Chinese | WPRIM (Western Pacific) | ID: wpr-972258

ABSTRACT

OBJECTIVE To provide reference for the prevention and treatment of hepatitis C and the formulation and improvement of medical insurance payment policy for direct-acting antiviral (DAA) drugs. METHODS An questionnaire survey was conducted among the patients who received hepatitis C treatment in a third-grade class-A hospital in Sichuan province from 2019 to 2020 and enjoyed Chengdu medical insurance policy. The patients’ hepatitis C treatment and satisfaction with the medical insurance policy for DAA drugs were compared before and after DAA drugs were included in the medical insurance list. RESULTS A total of 203 patients effectively responded among 644 investigated patients. In terms of treatment plans, although there were significant differences in the treatment plan between patients who saw a doctor in 2019 and 2020 (P<0.05), the vast majority of patients were cured within the course of treatment (200 cases, 98.52%), and there were no obvious adverse reactions (193 cases, 95.07%). In terms of economic burden, the out-of-pocket costs and economic burden of patients treated with DAA drugs in 2020 were significantly lower than those treated with DAA drugs in 2019 (P<0.05); in terms of patient services, 78.82% of patients received expert consultation services from designated medical institutions, but 9.85% of patients still did not receive any patient services provided by the hospital. In terms of satisfaction with outpatient reimbursement policy, the overall satisfaction of patients who saw a doctor in 2020 (95.37%) was significantly higher than those who saw a doctor in 2019 (81.05%)(P<0.05). CONCLUSIONS The surveyed patients with hepatitis C obtain good efficacy after DAA drugs treatment, and are satisfied with the medical insurance policy of DAA drugs, but the standardized management of patient services in designated medical institutions is insufficient.

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