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Araujo GC, Ribeiro CB, Costa MCM, Evangelista MLP, Lima MF, De Paula MC, Ferreira VL, Araujo FAGDR. Evidence-Based Periodic Health Examinations for Adults: A Practical Guide. Cureus 2025; 17:e79963. [PMID: 40177455 PMCID: PMC11964159 DOI: 10.7759/cureus.79963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2025] [Indexed: 04/05/2025] Open
Abstract
Periodic health examinations, or annual clinical checkups, are a primary reason for seeking medical care. The objective is to identify hidden problems or diseases in their early stages and to promote behaviors that prevent or minimize the consequences of these conditions. However, the practice of conducting annual reviews with clinical, laboratory, and imaging examinations indiscriminately is not associated with outcomes that matter to the patient (such as reducing morbidity and mortality) and may result in harm, including overdiagnosis and overtreatment. The objective of the present work is to review and summarize the measures currently recommended and supported by scientific evidence from the main regulatory authorities of the United States (United States Preventive Services Task Force (USPSTF)) and Canada (Canadian Task Force on Preventive Health Care (CTFPHC)), in order to create a practical guide for evidence-based checkups.
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Affiliation(s)
| | - Caio B Ribeiro
- Internal Medicine, Universidade Federal da Bahia, Salvador, BRA
| | | | | | - Mariana F Lima
- Internal Medicine, Escola Bahiana de Medicina, Salvador, BRA
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2
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Torre P, Festa M, Sarcina T, Masarone M, Persico M. Elimination of HCV Infection: Recent Epidemiological Findings, Barriers, and Strategies for the Coming Years. Viruses 2024; 16:1792. [PMID: 39599906 PMCID: PMC11598908 DOI: 10.3390/v16111792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2024] [Revised: 11/04/2024] [Accepted: 11/14/2024] [Indexed: 11/29/2024] Open
Abstract
Hepatitis C is a disease for which in approximately 30 years we have gone from the discovery of the causative agent in 1989, to the introduction of direct-acting antiviral (DAAs) therapies starting from 2011, and to a proposal for its elimination in 2016, with some countries being on track for this goal. Elimination efforts, in the absence of a vaccine, rely on prevention measures and antiviral therapies. However, treatment rates have declined in recent years and are not considered adequate to achieve this goal at a global level. This poses a great epidemiological challenge, as HCV in many countries still causes a significant burden and most infected people are not yet diagnosed. Consequently, efforts are needed at different levels with common purposes: to facilitate access to screening and diagnosis and to improve linkage to care pathways. In this review, we discuss the latest epidemiological findings on HCV infection, the obstacles to its elimination, and strategies that are believed to be useful to overcome these obstacles but are applied unevenly across the world.
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Affiliation(s)
| | | | | | | | - Marcello Persico
- Internal Medicine and Hepatology Unit, Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Largo Città d’Ippocrate, 84131 Salerno, Italy; (P.T.); (M.F.); (T.S.); (M.M.)
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O'Brien SF, Ehsani-Moghaddam B, Osmond L, Fan W, Goldman M, Drews SJ. Epidemiology of Hepatitis C over 28 years of monitoring Canadian blood donors: Insight into a low-risk undiagnosed population. BMC Public Health 2024; 24:2319. [PMID: 39192303 PMCID: PMC11348590 DOI: 10.1186/s12889-024-19790-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 08/13/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND Hepatitis C is a blood-borne infection with the hepatitis C virus (HCV) that can progress to cirrhosis and liver cancer. About 70% (50-80%) of infections become chronic and exhibit anti-HCV and HCV nucleic acid (NAT) positivity. Direct acting oral pan genotypic antiviral treatment became available in 2014 and was free for most Canadians in 2018. Clinical screening for HCV infection is risk-based. About 1% of Canadians have been infected with HCV, with 0.5% chronically infected (about 25% unaware) disproportionately impacting marginalized groups. Blood donors are in good health, are deferred for risks such as injection drug use and can provide insight into the low-risk undiagnosed population. Here we describe HCV epidemiology in first-time blood donors over 28 years of monitoring. METHODS All first-time blood donors in all Canadian provinces except Quebec (1993 to 2021) were analyzed. All blood donations were tested for HCV antibodies (anti-HCV) and since late 1999 also HCV NAT. A case-control study was also included. All HCV positive donors (cases) since 2005 and HCV negative donors (1:4 ratio controls) matched for age, sex and location were invited to complete a risk factor interview. Separate logistic regression models for anti-HCV positivity and chronic HCV assessed the association between age cohort, sex, region and neighbourhood material deprivation and ethnocultural concentration. CASE control data were analysed by logistic regression. RESULTS There were 2,334,238 donors from 1993 to 2021 included. Prevalence for anti-HCV was 0.33% (0.30,0.37) in 1993 and 0.07% (0.05,0.09) in 2021 (p < 0.0001). In 2021 0.03% (0.01,0.04) had chronic HCV. Predictors for both anti-HCV positivity and chronic HCV were similar, for chronic HCV were male sex (OR 1.8, 1.6,2.1), birth between 1945 and 1975 (OR 7.1, 5.9,8.5), living in the western provinces (OR 1.4, 1.2,1.7) and living in material deprived (OR 2.7, 2.1,3.5) and more ethnocultural concentrated neighbourhoods (OR 1.8, 1.3,2.5). There were 318 (35.4%) of chronic HCV positive and 1272 (39.6%) of controls who participated in case control interviews. The strongest risks for acquisition were injection drug use (OR 96.9, 22.3,420.3) and birth in a high prevalence country (OR 24.5, 11.2,53.6). CONCLUSIONS Blood donors have 16 times lower HCV prevalence then the general population. Donors largely mirror population trends and highlight the ongoing prevalence of untreated infections in groups without obvious risks for acquisition missed by risk-based patient screening.
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Affiliation(s)
- Sheila F O'Brien
- Epidemiology & Surveillance, Canadian Blood Services, 1800 Alta Vista Drive, Ottawa, ON, K1G 4J5, Canada.
- School of Epidemiology & Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 4J5, Canada.
| | - Behrouz Ehsani-Moghaddam
- Epidemiology & Surveillance, Canadian Blood Services, 1800 Alta Vista Drive, Ottawa, ON, K1G 4J5, Canada
- Centre for Studies in Primary Care, Department of Family Medicine, Queens University, 220 Bagot Street, Kingston, ON, K7L 3G2, Canada
| | - Lori Osmond
- Epidemiology & Surveillance, Canadian Blood Services, 1800 Alta Vista Drive, Ottawa, ON, K1G 4J5, Canada
| | - Wenli Fan
- Epidemiology & Surveillance, Canadian Blood Services, 1800 Alta Vista Drive, Ottawa, ON, K1G 4J5, Canada
| | - Mindy Goldman
- Donation and Policy Studies, Canadian Blood Services, 1800 Alta Vista Drive, Ottawa, ON, K1G 4J5, Canada
- Department of Pathology & Laboratory Medicine, Faculty of Medicine, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
| | - Steven J Drews
- Microbiology, Canadian Blood Services, 8249-114 Street, Edmonton, AB, T6G 2R8, Canada
- Department of Laboratory Medicine & Pathology, Faculty of Medicine & Dentistry, University of Alberta, 118 Street & 86 Avenue, Edmonton, AB, T6G 2R3, Canada
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Kamga Wouambo R, Panka Tchinda G, Kagoue Simeni LA, Djouela Djoulako PD, Yateu Wouambo CI, Tamko Mella GF, Tchoumi Leuwat EP, Bello D, Fokam J. Anti-hepatitis C antibody carriage and risk of liver impairment in rural-Cameroon: adapting the control of hepatocellular carcinoma for resource-limited settings. BMC Infect Dis 2023; 23:875. [PMID: 38093205 PMCID: PMC10717920 DOI: 10.1186/s12879-023-08880-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 12/07/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND The Viral hepatitis elimination by 2030 is uncertain in resource-limited settings (RLS), due to high burdens and poor diagnostic coverage. This sounds more challenging for hepatitis C virus (HCV) given that antibody (HCVAb) sero-positivity still lacks wide access to HCV RNA molecular testing. This warrants context-specific strategies for appropriate management of liver impairment in RLS. We herein determine the association between anti-HCV positivity and liver impairment in an African RLS. METHODS A facility-based observational study was conducted from July-August 2021 among individuals attending the "St Monique" Health Center at Ottou, a rural community of Yaounde,Cameroon. Following a consecutive sampling, consenting individuals were tested for anti-HCV antibodies, hepatitis B surface antigen (HBsAg) and HIV antibodies (HIVAb) as per the national guidelines. After excluding positive cases for HBsAg and/or HIVAb, liver function tests (ALT/AST) were performed on eligible participants (HBsAg and HIVAb negative) and outcomes were compared according to HCVAb status; with p < 0.05 considered statistically significant. RESULTS Out of 306 eligible participants (negative for HBsAg and HIVAb) enrolled, the mean age was 34.35 ± 3.67 years. 252(82.35%) were female and 129 (42.17%) were single. The overall HCVAb sero-positivity was 15.68%(48/306), with 17.86% (45/252) among women vs. 5.55%(3/54) among men [OR (95%CI) = 3.69(2.11-9.29),p = 0.04]. HCVAb Carriage was greater among participants aged > 50 years compared to younger ones [38.46%(15/39) versus 12.36% (33/267) respectively, OR(95%CI) = 4.43(2.11-9.29), p < 0.000] and in multipartnership [26.67%(12/45)vs.13.79%(36/261) monopartnership, OR (95%CI) = 2.27(1.07-4.80),p = 0.03]. The liver impairment rate (abnormal ALT+AST levels) was 30.39%(93/306), with 40.19%(123/306) of abnormal ALT alone. Moreover, the burden of Liver impairment was significantly with aged> 50 versus younger ones [69.23% (27/39) versus 24.72%(66/267) respectively, p < 0.000). Interestingly, the burden of liver impairment (abnormal AST + ALAT) was significantly higher in HCVAb positive (62.5%, 30/48) versus HCVAb negative (24.42%, 63/258) participants, OR: 3.90 [1.96; 7.79], p = 0.0001. CONCLUSIONS In this rural health facility, HCVAb is highly endemic and the burden of liver impairment is concerning. Interestingly, HCVAb carriage is associated with abnormal liver levels of enzyme (ALT/AST), especially among the elderly populations. Hence, in the absence of nuclei acid testing, ALT/AST are relevant sentinel markers to screen HCVAb carriers who require monitoring/care for HCV-associated hepatocellular carcinoma in RLS.
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Affiliation(s)
- Rodrigue Kamga Wouambo
- Faculty of Science, Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon.
- American Society for Microbiology (ASM), ASM Cameroon, Bangangte, Cameroon.
| | - Gaelle Panka Tchinda
- American Society for Microbiology (ASM), ASM Cameroon, Bangangte, Cameroon
- Ecole de Santé Publique, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Luc Aime Kagoue Simeni
- American Society for Microbiology (ASM), ASM Cameroon, Bangangte, Cameroon
- Department of Microbiology, Faculty of Health Science, University of Buea, Buea, Cameroon
| | - Paule Dana Djouela Djoulako
- American Society for Microbiology (ASM), ASM Cameroon, Bangangte, Cameroon
- Faculty of Medicine, Sorbonne University, Paris, France
| | | | - Ghislaine Flore Tamko Mella
- Laboratory of Fundamental Virology, Centre for Research on Emerging and Reemerging Diseases (CREMER), Yaounde, Cameroon
| | | | - Djoda Bello
- Faculty of Science, Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
| | - Joseph Fokam
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
- Virology Laboratory, Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaounde, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
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Wong WWL, Haines A, Wong J, Hamadeh A, Krahn MD. A province-by-province cost-effectiveness analysis and budget impact analysis of one-time birth cohort screening of hepatitis C virus (HCV) infection in Canada. Sci Rep 2023; 13:13484. [PMID: 37596309 PMCID: PMC10439170 DOI: 10.1038/s41598-023-39521-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/26/2023] [Indexed: 08/20/2023] Open
Abstract
Managing chronic hepatitis C is challenging, as the majority of those infected are asymptomatic. Therefore, to ensure treatments are administered before the onset of severe complications, screening is important. In Canada, uncertainty regarding the cost-effectiveness and budget impact of screening has led to conflicting recommendations. The objective of this study is to estimate the cost-effectiveness and budget-impact of one-time HCV screening. A state-transition model was developed to evaluate the cost-effectiveness and budget-impact between a risk-based screening strategy (current-practice) and a one-time screening strategy on three different birth-cohorts. Cost and prevalence data were obtained from administrative data. Progression and utility data were based on recent systematic reviews. We used a provincial payer-perspective, life-time time-horizon and a 1.5% discount rate for the cost-effectiveness analysis, and used a 10-year time-horizon and no discounting for the budget-impact analysis. One-time screening strategy would cost more and provide more health benefits than the risk-based screening for all birth cohorts. For those born after 1964, the incremental-cost-effectiveness-ratio (ICER) per quality-adjusted-life-year (QALY) of screening versus current-practice varied from $27,422/QALY to $42,191/QALY across different provinces. One-time screening of the cohort would cost an additional $2 million to $236 million across different provinces. For those born 1945-1964, the ICER of screening versus current-practice varied from $35,217/QALY to $48,197/QALY across different provinces. For the cohort born before 1945, the ICER of screening versus current-practice was not cost-effective at a willingness-to-pay threshold of $50,000/QALY across all provinces. Our cost-effectiveness analysis suggests that a one-time HCV screening program for those born after 1945 is cost-effective. Considering the budget impact relative to other funded recommended health services and technologies, HCV screening could be considered affordable.
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Affiliation(s)
- William W L Wong
- School of Pharmacy, Faculty of Science, University of Waterloo, PHR4011, 10A Victoria Street S, Kitchener, ON, N2G1C5, Canada.
- Toronto Health Economics and Technology Assessment Collaborative (THETA), University Health Network, Toronto, ON, Canada.
- ICES, Toronto, ON, Canada.
| | - Alex Haines
- Toronto Health Economics and Technology Assessment Collaborative (THETA), University Health Network, Toronto, ON, Canada
| | - Josephine Wong
- Toronto Health Economics and Technology Assessment Collaborative (THETA), University Health Network, Toronto, ON, Canada
| | - Abdullah Hamadeh
- School of Pharmacy, Faculty of Science, University of Waterloo, PHR4011, 10A Victoria Street S, Kitchener, ON, N2G1C5, Canada
| | - Murray D Krahn
- Toronto Health Economics and Technology Assessment Collaborative (THETA), University Health Network, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
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6
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Fahim C, Prashad AJ, Silveira K, Chandraraj A, Thombs BD, Tonelli M, Thériault G, Grad R, Riva J, Colquhoun H, Rodin R, Subnath M, Rolland-Harris E, Barnhardt K, Straus SE. Dissemination and implementation of clinical practice guidelines: a longitudinal, mixed-methods evaluation of the Canadian Task Force on Preventive Health Care's knowledge translation efforts. CMAJ Open 2023; 11:E684-E695. [PMID: 37553226 PMCID: PMC10414974 DOI: 10.9778/cmajo.20220121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND The Canadian Task Force on Preventive Health Care (task force) develops evidence-based preventive health care guidelines and knowledge translation (KT) tools to facilitate guideline dissemination and implementation. We aimed to determine practitioners' awareness of task force guidelines and KT tools and explore barriers and facilitators to their use. METHODS The task force's KT team completed annual evaluations using surveys and interviews with primary care providers in Canada from 2014 to 2020, to assess practitioners' awareness and determinants of use of task force guidelines and tools. We transcribed interviews verbatim and double-coded them using a framework analysis approach. RESULTS A total of 1284 primary care practitioners completed surveys and 183 participated in interviews. On average, 79.9% of participants were aware of the task force's 7 cancer screening guidelines, 36.2% were aware of the other 6 screening guidelines and 18.6% were aware of the 3 lifestyle or prevention guidelines. Participants identified 13 barriers and 7 facilitators to guideline and KT tool implementation; these were consistent over time. Participants identified strategies at the public and patient, provider and health systems levels to improve uptake of guidelines. INTERPRETATION Canadian primary care practitioners were more aware of task force cancer screening guidelines than its other preventive health guidelines. Over the 6-year period, participants consistently reported barriers to guideline uptake, including misalignment with patient preferences and other provincial or specialty guideline organizations. Further evaluations will assess tailored strategies to address the barriers identified.
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Affiliation(s)
- Christine Fahim
- Knowledge Translation Program (Fahim, Prashad, Silveira, Chandraraj, Straus), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Faculty of Medicine (Thombs, Theriault), McGill University; Lady Davis Institute for Medical Research (Thombs), Jewish General Hospital, Montréal, Que.; Cumming School of Medicine (Tonelli), University of Calgary, Calgary, Alta.; Department of Medicine (Grad), McGill University, Montréal, Que.; Department of Family Medicine (Riva), McMaster University, Hamilton, Ont.; Department of Occupational Science and Occupational Therapy (Colquhoun), University of Toronto, Toronto, Ont.; Public Health Agency of Canada (Rodin, Subnath, Rolland-Harris); Canadian Medical Association Journal (Barnhardt), Ottawa, Ont.; Department of Medicine, Faculty of Medicine (Straus), University of Toronto, Toronto, Ont.
| | - Anupa Jyoti Prashad
- Knowledge Translation Program (Fahim, Prashad, Silveira, Chandraraj, Straus), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Faculty of Medicine (Thombs, Theriault), McGill University; Lady Davis Institute for Medical Research (Thombs), Jewish General Hospital, Montréal, Que.; Cumming School of Medicine (Tonelli), University of Calgary, Calgary, Alta.; Department of Medicine (Grad), McGill University, Montréal, Que.; Department of Family Medicine (Riva), McMaster University, Hamilton, Ont.; Department of Occupational Science and Occupational Therapy (Colquhoun), University of Toronto, Toronto, Ont.; Public Health Agency of Canada (Rodin, Subnath, Rolland-Harris); Canadian Medical Association Journal (Barnhardt), Ottawa, Ont.; Department of Medicine, Faculty of Medicine (Straus), University of Toronto, Toronto, Ont
| | - Kyle Silveira
- Knowledge Translation Program (Fahim, Prashad, Silveira, Chandraraj, Straus), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Faculty of Medicine (Thombs, Theriault), McGill University; Lady Davis Institute for Medical Research (Thombs), Jewish General Hospital, Montréal, Que.; Cumming School of Medicine (Tonelli), University of Calgary, Calgary, Alta.; Department of Medicine (Grad), McGill University, Montréal, Que.; Department of Family Medicine (Riva), McMaster University, Hamilton, Ont.; Department of Occupational Science and Occupational Therapy (Colquhoun), University of Toronto, Toronto, Ont.; Public Health Agency of Canada (Rodin, Subnath, Rolland-Harris); Canadian Medical Association Journal (Barnhardt), Ottawa, Ont.; Department of Medicine, Faculty of Medicine (Straus), University of Toronto, Toronto, Ont
| | - Arthana Chandraraj
- Knowledge Translation Program (Fahim, Prashad, Silveira, Chandraraj, Straus), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Faculty of Medicine (Thombs, Theriault), McGill University; Lady Davis Institute for Medical Research (Thombs), Jewish General Hospital, Montréal, Que.; Cumming School of Medicine (Tonelli), University of Calgary, Calgary, Alta.; Department of Medicine (Grad), McGill University, Montréal, Que.; Department of Family Medicine (Riva), McMaster University, Hamilton, Ont.; Department of Occupational Science and Occupational Therapy (Colquhoun), University of Toronto, Toronto, Ont.; Public Health Agency of Canada (Rodin, Subnath, Rolland-Harris); Canadian Medical Association Journal (Barnhardt), Ottawa, Ont.; Department of Medicine, Faculty of Medicine (Straus), University of Toronto, Toronto, Ont
| | - Brett D Thombs
- Knowledge Translation Program (Fahim, Prashad, Silveira, Chandraraj, Straus), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Faculty of Medicine (Thombs, Theriault), McGill University; Lady Davis Institute for Medical Research (Thombs), Jewish General Hospital, Montréal, Que.; Cumming School of Medicine (Tonelli), University of Calgary, Calgary, Alta.; Department of Medicine (Grad), McGill University, Montréal, Que.; Department of Family Medicine (Riva), McMaster University, Hamilton, Ont.; Department of Occupational Science and Occupational Therapy (Colquhoun), University of Toronto, Toronto, Ont.; Public Health Agency of Canada (Rodin, Subnath, Rolland-Harris); Canadian Medical Association Journal (Barnhardt), Ottawa, Ont.; Department of Medicine, Faculty of Medicine (Straus), University of Toronto, Toronto, Ont
| | - Marcello Tonelli
- Knowledge Translation Program (Fahim, Prashad, Silveira, Chandraraj, Straus), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Faculty of Medicine (Thombs, Theriault), McGill University; Lady Davis Institute for Medical Research (Thombs), Jewish General Hospital, Montréal, Que.; Cumming School of Medicine (Tonelli), University of Calgary, Calgary, Alta.; Department of Medicine (Grad), McGill University, Montréal, Que.; Department of Family Medicine (Riva), McMaster University, Hamilton, Ont.; Department of Occupational Science and Occupational Therapy (Colquhoun), University of Toronto, Toronto, Ont.; Public Health Agency of Canada (Rodin, Subnath, Rolland-Harris); Canadian Medical Association Journal (Barnhardt), Ottawa, Ont.; Department of Medicine, Faculty of Medicine (Straus), University of Toronto, Toronto, Ont
| | - Guylène Thériault
- Knowledge Translation Program (Fahim, Prashad, Silveira, Chandraraj, Straus), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Faculty of Medicine (Thombs, Theriault), McGill University; Lady Davis Institute for Medical Research (Thombs), Jewish General Hospital, Montréal, Que.; Cumming School of Medicine (Tonelli), University of Calgary, Calgary, Alta.; Department of Medicine (Grad), McGill University, Montréal, Que.; Department of Family Medicine (Riva), McMaster University, Hamilton, Ont.; Department of Occupational Science and Occupational Therapy (Colquhoun), University of Toronto, Toronto, Ont.; Public Health Agency of Canada (Rodin, Subnath, Rolland-Harris); Canadian Medical Association Journal (Barnhardt), Ottawa, Ont.; Department of Medicine, Faculty of Medicine (Straus), University of Toronto, Toronto, Ont
| | - Roland Grad
- Knowledge Translation Program (Fahim, Prashad, Silveira, Chandraraj, Straus), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Faculty of Medicine (Thombs, Theriault), McGill University; Lady Davis Institute for Medical Research (Thombs), Jewish General Hospital, Montréal, Que.; Cumming School of Medicine (Tonelli), University of Calgary, Calgary, Alta.; Department of Medicine (Grad), McGill University, Montréal, Que.; Department of Family Medicine (Riva), McMaster University, Hamilton, Ont.; Department of Occupational Science and Occupational Therapy (Colquhoun), University of Toronto, Toronto, Ont.; Public Health Agency of Canada (Rodin, Subnath, Rolland-Harris); Canadian Medical Association Journal (Barnhardt), Ottawa, Ont.; Department of Medicine, Faculty of Medicine (Straus), University of Toronto, Toronto, Ont
| | - John Riva
- Knowledge Translation Program (Fahim, Prashad, Silveira, Chandraraj, Straus), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Faculty of Medicine (Thombs, Theriault), McGill University; Lady Davis Institute for Medical Research (Thombs), Jewish General Hospital, Montréal, Que.; Cumming School of Medicine (Tonelli), University of Calgary, Calgary, Alta.; Department of Medicine (Grad), McGill University, Montréal, Que.; Department of Family Medicine (Riva), McMaster University, Hamilton, Ont.; Department of Occupational Science and Occupational Therapy (Colquhoun), University of Toronto, Toronto, Ont.; Public Health Agency of Canada (Rodin, Subnath, Rolland-Harris); Canadian Medical Association Journal (Barnhardt), Ottawa, Ont.; Department of Medicine, Faculty of Medicine (Straus), University of Toronto, Toronto, Ont
| | - Heather Colquhoun
- Knowledge Translation Program (Fahim, Prashad, Silveira, Chandraraj, Straus), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Faculty of Medicine (Thombs, Theriault), McGill University; Lady Davis Institute for Medical Research (Thombs), Jewish General Hospital, Montréal, Que.; Cumming School of Medicine (Tonelli), University of Calgary, Calgary, Alta.; Department of Medicine (Grad), McGill University, Montréal, Que.; Department of Family Medicine (Riva), McMaster University, Hamilton, Ont.; Department of Occupational Science and Occupational Therapy (Colquhoun), University of Toronto, Toronto, Ont.; Public Health Agency of Canada (Rodin, Subnath, Rolland-Harris); Canadian Medical Association Journal (Barnhardt), Ottawa, Ont.; Department of Medicine, Faculty of Medicine (Straus), University of Toronto, Toronto, Ont
| | - Rachel Rodin
- Knowledge Translation Program (Fahim, Prashad, Silveira, Chandraraj, Straus), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Faculty of Medicine (Thombs, Theriault), McGill University; Lady Davis Institute for Medical Research (Thombs), Jewish General Hospital, Montréal, Que.; Cumming School of Medicine (Tonelli), University of Calgary, Calgary, Alta.; Department of Medicine (Grad), McGill University, Montréal, Que.; Department of Family Medicine (Riva), McMaster University, Hamilton, Ont.; Department of Occupational Science and Occupational Therapy (Colquhoun), University of Toronto, Toronto, Ont.; Public Health Agency of Canada (Rodin, Subnath, Rolland-Harris); Canadian Medical Association Journal (Barnhardt), Ottawa, Ont.; Department of Medicine, Faculty of Medicine (Straus), University of Toronto, Toronto, Ont
| | - Melissa Subnath
- Knowledge Translation Program (Fahim, Prashad, Silveira, Chandraraj, Straus), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Faculty of Medicine (Thombs, Theriault), McGill University; Lady Davis Institute for Medical Research (Thombs), Jewish General Hospital, Montréal, Que.; Cumming School of Medicine (Tonelli), University of Calgary, Calgary, Alta.; Department of Medicine (Grad), McGill University, Montréal, Que.; Department of Family Medicine (Riva), McMaster University, Hamilton, Ont.; Department of Occupational Science and Occupational Therapy (Colquhoun), University of Toronto, Toronto, Ont.; Public Health Agency of Canada (Rodin, Subnath, Rolland-Harris); Canadian Medical Association Journal (Barnhardt), Ottawa, Ont.; Department of Medicine, Faculty of Medicine (Straus), University of Toronto, Toronto, Ont
| | - Elizabeth Rolland-Harris
- Knowledge Translation Program (Fahim, Prashad, Silveira, Chandraraj, Straus), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Faculty of Medicine (Thombs, Theriault), McGill University; Lady Davis Institute for Medical Research (Thombs), Jewish General Hospital, Montréal, Que.; Cumming School of Medicine (Tonelli), University of Calgary, Calgary, Alta.; Department of Medicine (Grad), McGill University, Montréal, Que.; Department of Family Medicine (Riva), McMaster University, Hamilton, Ont.; Department of Occupational Science and Occupational Therapy (Colquhoun), University of Toronto, Toronto, Ont.; Public Health Agency of Canada (Rodin, Subnath, Rolland-Harris); Canadian Medical Association Journal (Barnhardt), Ottawa, Ont.; Department of Medicine, Faculty of Medicine (Straus), University of Toronto, Toronto, Ont
| | - Kim Barnhardt
- Knowledge Translation Program (Fahim, Prashad, Silveira, Chandraraj, Straus), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Faculty of Medicine (Thombs, Theriault), McGill University; Lady Davis Institute for Medical Research (Thombs), Jewish General Hospital, Montréal, Que.; Cumming School of Medicine (Tonelli), University of Calgary, Calgary, Alta.; Department of Medicine (Grad), McGill University, Montréal, Que.; Department of Family Medicine (Riva), McMaster University, Hamilton, Ont.; Department of Occupational Science and Occupational Therapy (Colquhoun), University of Toronto, Toronto, Ont.; Public Health Agency of Canada (Rodin, Subnath, Rolland-Harris); Canadian Medical Association Journal (Barnhardt), Ottawa, Ont.; Department of Medicine, Faculty of Medicine (Straus), University of Toronto, Toronto, Ont
| | - Sharon E Straus
- Knowledge Translation Program (Fahim, Prashad, Silveira, Chandraraj, Straus), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Faculty of Medicine (Thombs, Theriault), McGill University; Lady Davis Institute for Medical Research (Thombs), Jewish General Hospital, Montréal, Que.; Cumming School of Medicine (Tonelli), University of Calgary, Calgary, Alta.; Department of Medicine (Grad), McGill University, Montréal, Que.; Department of Family Medicine (Riva), McMaster University, Hamilton, Ont.; Department of Occupational Science and Occupational Therapy (Colquhoun), University of Toronto, Toronto, Ont.; Public Health Agency of Canada (Rodin, Subnath, Rolland-Harris); Canadian Medical Association Journal (Barnhardt), Ottawa, Ont.; Department of Medicine, Faculty of Medicine (Straus), University of Toronto, Toronto, Ont
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Balsom CR, Farrell A, Kelly DV. Barriers and enablers to testing for hepatitis C virus infection in people who inject drugs - a scoping review of the qualitative evidence. BMC Public Health 2023; 23:1038. [PMID: 37259073 PMCID: PMC10234098 DOI: 10.1186/s12889-023-16017-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/30/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Injection drug use is the primary mode of transmission of hepatitis C virus (HCV) infection in the developed world and guidelines recommend screening individuals with current or history of injection drug use for HCV; however, the majority of those living with HCV in Canada are not aware of their positive status. This low level of HCV status awareness suggests that screening is not effective with current testing strategies. The aim of this review is to determine what barriers and enablers people who inject drugs (PWID) experience surrounding testing for HCV to help inform the development of an engaging testing strategy. METHODS Comprehensive literature searches were conducted using Medline, Embase and CINAHL in February 2021. Included studies investigated the barriers and enablers to testing for HCV in PWID and the experiences of PWID in testing for HCV. Studies were included if they were qualitative or mixed-methods design, involved people with current injection drug use or those with a history of injecting drugs, and were written in the English language. Studies were compared and common themes were coded and analyzed. RESULTS The literature search resulted in 1554 citations and ultimately nine studies were included. Common barriers included self-perception of low risk for HCV, fear of diagnosis, stigma associated with IV drug use and HCV, antipathy in relation to mainstream health care services, limited knowledge about HCV, lack of rapport with provider, lack of motivation or competing priority of drug use, and limited awareness of new treatment options. Common enablers to testing included increasing awareness of HCV testing and treatment and providing positive narratives around HCV care, positive rapport with provider, accessible testing options and individualized care. CONCLUSION While there has been some qualitative research on barriers and enablers to testing for HCV in PWID more research is needed to focus on this research question as a primary objective in order to provide more understanding from the participant's perspective.
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Affiliation(s)
- Cathy R. Balsom
- School of Pharmacy, Memorial University of Newfoundland, St. John’s, Canada
| | - Alison Farrell
- Health Sciences Library, Memorial University of Newfoundland, St. John’s, Canada
| | - Deborah V. Kelly
- School of Pharmacy, Memorial University of Newfoundland, St. John’s, Canada
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8
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Dickinson JA, Thériault G, Grad R, Bell NR, Szafran O. Évaluer les nouveaux tests de dépistage. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2022; 68:e310-e317. [PMID: 36376045 PMCID: PMC9833176 DOI: 10.46747/cfp.6811e310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- James A Dickinson
- Professeur au Département de médecine familiale et au Département des sciences de la santé communautaire à l'Université de Calgary (Alberta).
| | - Guylène Thériault
- Directrice du volet Rôle du médecin et directrice de la Pédagogie au Campus Outaouais de la Faculté de médecine de l'Université McGill à Montréal (Québec)
| | - Roland Grad
- Professeur agrégé au Département de médecine de famille de l'Université McGill
| | - Neil R Bell
- Professeur au Département de médecine familiale de l'Université de l'Alberta à Edmonton
| | - Olga Szafran
- Directrice associée de la recherche au Département de médecine familiale de l'Université de l'Alberta
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9
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Uzair Khalid M, Khan S, Koerber D, Ashok Shah H. Educational interventions to improve hepatitis C testing or treatment in South Asian communities: A systematic review. CANADIAN LIVER JOURNAL 2022; 5:513-529. [PMID: 38144401 PMCID: PMC10735205 DOI: 10.3138/canlivj-2022-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 06/02/2022] [Accepted: 06/05/2022] [Indexed: 12/26/2023]
Abstract
BACKGROUND: Hepatitis C (HCV) places a disproportionately higher burden on the South Asian community in comparison to the general population, despite the availability of effective antiviral therapies. This study seeks to characterize the effectiveness of health promotion initiatives aimed at South Asians to improve HCV prevention, education, screening, and treatment adherence. METHODS: A systematic review (PROSPERO: CRD42021253796) was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Ovid MEDLINE, CINAHL Plus, Web of Science, ERIC, Ovid Embase, Cochrane Library, and PsycINFO were searched from inception to 15 April 2022 for original studies that reported on any health promotion initiative directed at improving HCV outcomes in the South Asian community. Risk of bias was assessed via a quality score. RESULTS: A total of 15 studies (6 uncontrolled interventional, 3 before-after interventional, 3 randomized controlled, 2 prospective cohort, and 1 historically controlled interventional study designs) involving 69,958 participants were included. The most studied interventions were formal HCV teaching (n = 12), community outreach (n = 6), and coupling screening/testing with existing programs (n = 3). Ninety-two percent (14/15) of interventions were concluded to be successful, and 71% (10/14) of those were concluded to be feasible and/or cost-effective. CONCLUSIONS: Interventions that aim to improve HCV education and accessibility to screening/treatment can substantially reduce barriers to care in South Asian communities. Further research, of higher quality RCT evidence, is needed to study the long-term reduction in HCV prevalence from these proposed interventions, and their associated feasibility profiles.
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Affiliation(s)
- Muhammad Uzair Khalid
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Shawn Khan
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Koerber
- Department of Internal Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Hemant Ashok Shah
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Gastroenterology and Hepatology, University Health Network, Toronto, Ontario, Canada
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10
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Dickinson JA, Thériault G, Grad R, Bell NR, Szafran O. Assessing new screening tests: Panacea or profligate? CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2022; 68:815-822. [PMID: 36376046 PMCID: PMC9833156 DOI: 10.46747/cfp.6811815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- James A. Dickinson
- Professor in the Department of Family Medicine and the Department of Community Health Sciences at the University of Calgary in Alberta.,Correspondence Dr James A. Dickinson; e-mail
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11
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Biondi MJ, Hirode G, Capraru C, Vanderhoff A, Karkada J, Wolfson-Stofko B, Smookler D, Friedman SM, Bates K, Mazzulli T, Juan JV, Shah H, Hansen BE, Feld JJ, Janssen HLA. Birth cohort hepatitis C antibody prevalence in real-world screening settings in Ontario. CANADIAN LIVER JOURNAL 2022; 5:362-371. [PMID: 36133900 PMCID: PMC9473558 DOI: 10.3138/canlivj-2021-0036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/11/2021] [Indexed: 07/29/2023]
Abstract
BACKGROUND Widespread screening and treatment of hepatitis C virus (HCV) is required to decrease late-stage liver disease and liver cancer. Clinical practice guidelines and Canadian Task Force on Preventative Health Care recommendations differ on the value of one-time birth cohort (1945-75) HCV screening in Canada. To assess the utility of this approach, we conducted a real-world analysis of HCV antibody (Ab) prevalence among birth cohort individuals seen in different clinical contexts. METHODS Cross-sectional study of individuals born between 1945 and 1975 who completed HCV Ab testing at multiple participating centres in Ontario, Canada between January 2016 and December 2020. Differences in prevalence were compared by year of birth, gender, and setting. RESULTS Among 16,672 birth cohort individuals tested, HCV Ab prevalence was 3.2%. Prevalence was higher among younger individuals which increased from 0.9% among those born between 1945 and 1956 to 4.6% among those born between 1966 and 1975. Prevalence was higher among males (4.4%) compared with females (2.0%) and differed by test site. In primary care, the prevalence was 0.5%, whereas the prevalence was highest among those tested at drug treatment centres (28.7%) and through community outreach (14.0%). CONCLUSIONS HCV Ab prevalence remains high in the 1945-1975 birth cohort. These data highlight the need to re-evaluate existing Canadian Preventative Task Force recommendations, to consider incorporating one-time birth cohort and/or other population-based approaches to HCV screening into the clinical workflow as a preventative health measure, and to increase training among community providers to screen for and treat HCV.
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Affiliation(s)
- Mia J Biondi
- These first authors contributed equally to this work
- Toronto Centre for Liver Disease/Viral Hepatitis Care Network (VIRCAN), University Health Network, Toronto, Ontario, Canada
| | - Grishma Hirode
- These first authors contributed equally to this work
- Toronto Centre for Liver Disease/Viral Hepatitis Care Network (VIRCAN), University Health Network, Toronto, Ontario, Canada
| | - Camelia Capraru
- Toronto Centre for Liver Disease/Viral Hepatitis Care Network (VIRCAN), University Health Network, Toronto, Ontario, Canada
| | - Aaron Vanderhoff
- Toronto Centre for Liver Disease/Viral Hepatitis Care Network (VIRCAN), University Health Network, Toronto, Ontario, Canada
| | - Joel Karkada
- Toronto Centre for Liver Disease/Viral Hepatitis Care Network (VIRCAN), University Health Network, Toronto, Ontario, Canada
| | - Brett Wolfson-Stofko
- Toronto Centre for Liver Disease/Viral Hepatitis Care Network (VIRCAN), University Health Network, Toronto, Ontario, Canada
| | - David Smookler
- Toronto Centre for Liver Disease/Viral Hepatitis Care Network (VIRCAN), University Health Network, Toronto, Ontario, Canada
| | - Steven M Friedman
- Department of Emergency Medicine, University Health Network, Toronto, Ontario, Canada
| | - Kathy Bates
- Emergency Department, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Tony Mazzulli
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Department of Microbiology, University Health Network/Sinai Health System, Toronto, Ontario, Canada
| | | | - Hemant Shah
- Toronto Centre for Liver Disease/Viral Hepatitis Care Network (VIRCAN), University Health Network, Toronto, Ontario, Canada
| | - Bettina E Hansen
- Toronto Centre for Liver Disease/Viral Hepatitis Care Network (VIRCAN), University Health Network, Toronto, Ontario, Canada
| | - Jordan J Feld
- These senior authors contributed equally to this work
- Toronto Centre for Liver Disease/Viral Hepatitis Care Network (VIRCAN), University Health Network, Toronto, Ontario, Canada
| | - Harry LA Janssen
- These senior authors contributed equally to this work
- Toronto Centre for Liver Disease/Viral Hepatitis Care Network (VIRCAN), University Health Network, Toronto, Ontario, Canada
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Appavoo S. How Did CNBSS Influence Guidelines for So Long and What Can That Teach Us? Curr Oncol 2022; 29:3922-3932. [PMID: 35735422 PMCID: PMC9221595 DOI: 10.3390/curroncol29060313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/23/2022] [Accepted: 05/25/2022] [Indexed: 11/17/2022] Open
Abstract
The biased randomization and other quality concerns about the Canadian National Breast Screening Studies (CNBSS) were documented and criticized for decades, even by several individuals very close to the research. CNBSS were the outlier studies among several RCTs of the era and yet were given equal weighting and occasionally higher importance than the remainder of the canon of mammography RCTs. These studies have had an ongoing influence on subsequent evidence review, guideline formation, and, ultimately, patient access to screening. This article explores possible reasons for the ongoing inclusion of CNBSS in the body of mammography screening evidence, discusses the lack of expertise in critical healthcare guideline processes, and, ultimately, suggests several actions and reforms.
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Affiliation(s)
- Shushiela Appavoo
- Department of Radiology and Diagnostic Imaging, University of Alberta, 2A2.41 WMC 8440-112 Street, Edmonton, Alberta, AB T6G 2B7, Canada
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13
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Barter L, Cooper CL. The impact of electronic medical record system implementation on HCV screening and continuum of care: a systematic review. Ann Hepatol 2022; 24:100322. [PMID: 33549734 DOI: 10.1016/j.aohep.2021.100322] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 01/26/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND OBJECTIVES Hepatitis C (HCV) screening is imperative to meet WHO elimination targets including increased detection and reduced mortality. An electronic medical record (EMR) system can be utilized in health care centers to indicate if a patient should be targeted for HCV screening, thus increasing the number of those offered testing. MATERIALS AND METHODS We examined English language publications reporting on the impact of EMR system utilization on HCV screening and the HCV continuum of care. Relevant papers were identified using multiple search engines to search key terms. Clinical outcomes considered included any or no change in HCV screening rates following EMR system introduction, as well as any or no change in rates of patients progressing along the HCV cascade of care after diagnosis once an EMR system was implemented. RESULTS From a search pool of 18 studies, 11 meet inclusion criteria and reported on the selected clinical outcomes. Each outcome assessed indicated that use of an EMR system increased the proportion of patients offered and/or receiving HCV testing. We were unable to conclude if an EMR system had an impact on the number of patients progressing along the HCV cascade of care following a positive test result. Overall, all methods of implementation of an EMR system had the same outcome of increasing screening rates. CONCLUSIONS EMR system utilization had a positive impact on increasing HCV screening. However, the clinical effectiveness of utilizing an EMR system to help eliminate transmission and increase HCV treatment cure rates requires further study.
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Affiliation(s)
- Lauren Barter
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; St. Francis Xavier University, Antigonish, Nova Scotia, Canada
| | - Curtis L Cooper
- St. Francis Xavier University, Antigonish, Nova Scotia, Canada; University of Ottawa, Ottawa, Ontario, Canada.
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14
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Martel-Laferriere V, Baril JG, Alarie I, Leblanc J, Côté J, Jourdenais E, Horth D, Lambert G, Tremblay C. Opt-out universal HCV and HIV screening in a Canadian emergency room: a cross-sectional study. BMJ Open 2022; 12:e048748. [PMID: 35042704 PMCID: PMC8768931 DOI: 10.1136/bmjopen-2021-048748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To determine the prevalence of undiagnosed hepatitis C virus (HCV) and HIV cases in a population sample tested in the emergency room (ER) and to evaluate linkage-to-care. SETTING Canadian university hospital. PARTICIPANTS Adults born after 1945 who consulted at ER for any condition and on any shift were included. Patients unable to opt-out were excluded. INTERVENTIONS ER nurse confirmed patients' eligibility and provided them with the option to opt-out. A physician met patients with a new diagnosis. Linkage-to-care was assessed 3 months postdiagnosis. Patients newly diagnosed with HCV were considered linked if they had an HCV RNA test, genotype, liver fibrosis evaluation, and if indicated, treatment prescription. Patients newly diagnosed with HIV were considered linked to care if they had an HIV serology confirmation test, viral load, CD4 cell count and started antiretroviral therapy. PRIMARY AND SECONDARY OUTCOME MEASURES Primary objective: to determine the prevalence (overall and undiagnosed cases) of HIV and HCV among the patients who consult the ER. Secondary objectives: to determine the proportion of patients who opt-out, assess the adherence of emergency staff to the offer of testing, determine the proportion of patients linked to care at 3 months. RESULTS Among 6350 eligible patients informed of the screening programme, 62.1% of patients were tested for at least one virus (HIV: 3905; HCV: 3910). 25% patients opted-out, 12% were not tested for organisational reasons, 0.3% (18) patients were HCV-HIV coinfected. Overall prevalence of HCV and HIV cases were 1.9% and 1.2%, respectively. Prevalence of new cases was 0.23% (95% CI 0.12% 0.45%) for HCV and 0.05% (95% CI 0.01% to 0.20%) for HIV. Among the new cases, only two HCV-infected and one HIV-infected patients were linked-to-care 3 months postdiagnosis. CONCLUSIONS Identification of new cases of HCV and HIV through universal screening at the ER and linkage-to-care were both low. TRIAL REGISTRATION NUMBER NCT03595527; Results.
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Affiliation(s)
- Valerie Martel-Laferriere
- CRCHUM, Montreal, Québec, Canada
- CHUM, Montreal, Québec, Canada
- Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Jean-Guy Baril
- CHUM, Montreal, Québec, Canada
- Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Clinique médicale urbaine du Quartier-Latin, Montreal, Québec, Canada
| | - Isabelle Alarie
- Faculty of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Department of Medicine, CHUS, Sherbrooke, Québec, Canada
| | - Judith Leblanc
- AP-HP Greater Paris University Hospital, AP-HP.Sorbonne Université, Clinical Research Platform of East of Paris, Paris, France
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, SUMO, Paris, France
| | - José Côté
- CRCHUM, Montreal, Québec, Canada
- Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Emmanuelle Jourdenais
- CHUM, Montreal, Québec, Canada
- Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Damy Horth
- Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Gilles Lambert
- Institut national de santé publique du Québec, Quebec, Quebec, Canada
- Direction régionale de santé publique de Montréal, Montréal, Quebec, Canada
| | - Cécile Tremblay
- CRCHUM, Montreal, Québec, Canada
- CHUM, Montreal, Québec, Canada
- Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
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15
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Gruner D. Prevalence of chronic conditions in Syrian refugees to Ottawa. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2022; 68:e10-e15. [PMID: 35063993 PMCID: PMC9810065 DOI: 10.46747/cfp.6801e10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To study the prevalence of chronic conditions (ie, anemia, glucose-6-phosphate dehydrogenase [G6PD] deficiency, hepatitis B virus (HBV) and hepatitis C virus (HCV) infection, and tobacco use) in Syrian refugees. DESIGN Cross-sectional study. Four primary care health clinics received Syrian refugees from December 2015 to April 2016, and each followed a standard protocol for refugee health assessments. SETTING Ottawa, Ont. PARTICIPANTS Arabic-speaking Syrian refugees were invited for early primary care health assessment. Most participants arrived in Ottawa from temporary refugee encampments in Lebanon and Jordan between December 2015 and April 2016. MAIN OUTCOME MEASURES Following a protocol, family physicians and nurse practitioners systematically documented age, sex, education, hemoglobin level, G6PD status, HBV and HCV infection, and tobacco use. RESULTS The study included 669 of the 916 government-assisted refugees, which represents most of the 1087 Syrian refugees to Ottawa: 373 male and 296 female participants. Overall, 28.5% of women and adolescent girls had anemia, and 2.0% of men had G6PD deficiency. The seroprevalence of HBV and HCV infection in the overall population was 0.9% and 0.7%, respectively. Tobacco use was reported in 60.3% of men and 11.7% of women. Overall, alcohol use (3.7%) and other substance use (0.5%) were uncommon. CONCLUSION Anemia was a common health problem in women of reproductive age, while the prevalence of chronic HBV and HCV infection was lower than the prevalence in the general Canadian population. Results showed substantial sex differences in tobacco use, with Syrian men using it at a rate much higher than Canadian men and Syrian women. The health assessment did not document chronic conditions affecting dental or mental health.
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Affiliation(s)
- Douglas Gruner
- Associate Professor in the Department of Family Medicine at the University of Ottawa in Ontario
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16
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Persaud N, Woods H, Workentin A, Adekoya I, Dunn JR, Hwang SW, Maguire J, Pinto AD, O'Campo P, Rourke SB, Werb D. Recommendations for equitable COVID-19 pandemic recovery in Canada. CMAJ 2021; 193:E1878-E1888. [PMID: 37578741 PMCID: PMC8677581 DOI: 10.1503/cmaj.210904] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Nav Persaud
- MAP Centre for Urban Health Solutions (Persaud, Wood, Workentin, Adekoya, Dunn, Hwang, Maguire, Pinto, O'Campo, Rourke, Werb), St. Michael's Hospital, Unity Health Toronto; Faculty of Medicine (Persaud, Hwang, Maguire, Pinto), and Department of Psychiatry (Rourke), Faculty of Medicine, University of Toronto, Toronto, Ont.
| | - Hannah Woods
- MAP Centre for Urban Health Solutions (Persaud, Wood, Workentin, Adekoya, Dunn, Hwang, Maguire, Pinto, O'Campo, Rourke, Werb), St. Michael's Hospital, Unity Health Toronto; Faculty of Medicine (Persaud, Hwang, Maguire, Pinto), and Department of Psychiatry (Rourke), Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Aine Workentin
- MAP Centre for Urban Health Solutions (Persaud, Wood, Workentin, Adekoya, Dunn, Hwang, Maguire, Pinto, O'Campo, Rourke, Werb), St. Michael's Hospital, Unity Health Toronto; Faculty of Medicine (Persaud, Hwang, Maguire, Pinto), and Department of Psychiatry (Rourke), Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Itunu Adekoya
- MAP Centre for Urban Health Solutions (Persaud, Wood, Workentin, Adekoya, Dunn, Hwang, Maguire, Pinto, O'Campo, Rourke, Werb), St. Michael's Hospital, Unity Health Toronto; Faculty of Medicine (Persaud, Hwang, Maguire, Pinto), and Department of Psychiatry (Rourke), Faculty of Medicine, University of Toronto, Toronto, Ont
| | - James R Dunn
- MAP Centre for Urban Health Solutions (Persaud, Wood, Workentin, Adekoya, Dunn, Hwang, Maguire, Pinto, O'Campo, Rourke, Werb), St. Michael's Hospital, Unity Health Toronto; Faculty of Medicine (Persaud, Hwang, Maguire, Pinto), and Department of Psychiatry (Rourke), Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Stephen W Hwang
- MAP Centre for Urban Health Solutions (Persaud, Wood, Workentin, Adekoya, Dunn, Hwang, Maguire, Pinto, O'Campo, Rourke, Werb), St. Michael's Hospital, Unity Health Toronto; Faculty of Medicine (Persaud, Hwang, Maguire, Pinto), and Department of Psychiatry (Rourke), Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Jonathon Maguire
- MAP Centre for Urban Health Solutions (Persaud, Wood, Workentin, Adekoya, Dunn, Hwang, Maguire, Pinto, O'Campo, Rourke, Werb), St. Michael's Hospital, Unity Health Toronto; Faculty of Medicine (Persaud, Hwang, Maguire, Pinto), and Department of Psychiatry (Rourke), Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Andrew D Pinto
- MAP Centre for Urban Health Solutions (Persaud, Wood, Workentin, Adekoya, Dunn, Hwang, Maguire, Pinto, O'Campo, Rourke, Werb), St. Michael's Hospital, Unity Health Toronto; Faculty of Medicine (Persaud, Hwang, Maguire, Pinto), and Department of Psychiatry (Rourke), Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Patricia O'Campo
- MAP Centre for Urban Health Solutions (Persaud, Wood, Workentin, Adekoya, Dunn, Hwang, Maguire, Pinto, O'Campo, Rourke, Werb), St. Michael's Hospital, Unity Health Toronto; Faculty of Medicine (Persaud, Hwang, Maguire, Pinto), and Department of Psychiatry (Rourke), Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Sean B Rourke
- MAP Centre for Urban Health Solutions (Persaud, Wood, Workentin, Adekoya, Dunn, Hwang, Maguire, Pinto, O'Campo, Rourke, Werb), St. Michael's Hospital, Unity Health Toronto; Faculty of Medicine (Persaud, Hwang, Maguire, Pinto), and Department of Psychiatry (Rourke), Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Daniel Werb
- MAP Centre for Urban Health Solutions (Persaud, Wood, Workentin, Adekoya, Dunn, Hwang, Maguire, Pinto, O'Campo, Rourke, Werb), St. Michael's Hospital, Unity Health Toronto; Faculty of Medicine (Persaud, Hwang, Maguire, Pinto), and Department of Psychiatry (Rourke), Faculty of Medicine, University of Toronto, Toronto, Ont
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O'Toole D. [Not Available]. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2021; 67:e326-e328. [PMID: 34906950 PMCID: PMC8670651 DOI: 10.46747/cfp.6712e326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Affiliation(s)
- Danielle O'Toole
- Médecin de famille en pratique à l'Academic Family Medicine et professeure adjointe au département de médecine familiale de l'Université McMaster à Hamilton (Ontario)
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18
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O'Toole D. Rapid recommendations: Updates from 2020 guidelines: part 1. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2021; 67:912-914. [PMID: 34906940 PMCID: PMC8670657 DOI: 10.46747/cfp.6712912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Danielle O'Toole
- Practising family physician in Academic Family Medicine and Assistant Professor in the Department of Family Medicine at McMaster University in Hamilton, Ont
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Kronfli N, Dussault C, Bartlett S, Fuchs D, Kaita K, Harland K, Martin B, Whitten-Nagle C, Cox J. Disparities in hepatitis C care across Canadian provincial prisons: Implications for hepatitis C micro-elimination. CANADIAN LIVER JOURNAL 2021; 4:292-310. [PMID: 35992251 PMCID: PMC9202774 DOI: 10.3138/canlivj-2020-0035] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 11/26/2020] [Indexed: 04/06/2024]
Abstract
Background Delivery of hepatitis C virus (HCV) care to people in prison is essential to HCV elimination. We aimed to describe current HCV care practices across Canada's adult provincial prisons. Methods One representative per provincial prison health care team (except Ontario) was invited to participate in a web-based survey from January to June 2020. The outcomes of interest were HCV screening and treatment, treatment restrictions, and harm reduction services. The government ministry responsible for health care was determined. Non-nominal data were aggregated by province and ministry; descriptive statistical analyses were used to report outcomes. Results The survey was completed by 59/65 (91%) prisons. On-demand, risk-based, opt-in, and opt-out screening are offered by 19 (32%), 10 (17%), 18 (31%), and 9 (15%) prisons, respectively; 3 prisons offer no HCV screening. Liver fibrosis assessments are rare (8 prisons access transient elastography, and 15 use aspartate aminotransferase to platelet ratio or Fibrosis-4); 20 (34%) prisons lack linkage to care programs. Only 32 (54%) prisons have ever initiated HCV treatment on site. Incarceration length and a fibrosis staging of ≥F2 are the most common eligibility restrictions for treatment. Opioid agonist therapy is available in 83% of prisons; needle and syringe programs are not available anywhere. Systematic screening and greater access to treatment and harm reduction services are more common where the Ministry of Health is responsible. Conclusions Tremendous variability exists in HCV screening and care practices across Canada's provincial prisons. To advance HCV care, adopting opt-out screening and removing eligibility restrictions may be important initial strategies.
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Affiliation(s)
- Nadine Kronfli
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University, Montreal, Quebec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Camille Dussault
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Sofia Bartlett
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Dennaye Fuchs
- ID Clinic, Saskatchewan Health Authority, Regina, Saskatchewan, Canada
| | - Kelly Kaita
- Department of Medicine, John Buhler Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kate Harland
- Centre for Research, Education and Clinical Care of At-Risk Populations, Saint John, New Brunswick, Canada
| | - Brandi Martin
- Department of Justice and Public Safety, Community and Correctional Services, Government of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - Cindy Whitten-Nagle
- Department of Justice and Public Safety, Adult Corrections, Government of Newfoundland and Labrador, St. John’s, Newfoundland and Labrador, Canada
| | - Joseph Cox
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University, Montreal, Quebec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
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20
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Yasseen AS, Kwong JC, Feld JJ, Janjua NZ, Greenaway C, Lapointe-Shaw L, Sherman M, Mazzulli T, Kustra R, MacDonald L, Sander B, Crowcroft NS. Viral hepatitis C cascade of care: A population-level comparison of immigrant and long-term residents. Liver Int 2021; 41:1775-1788. [PMID: 33655665 DOI: 10.1111/liv.14840] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/27/2021] [Accepted: 02/18/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Viral hepatitis C represents a major global burden, particularly among immigrant-receiving countries such as Canada, where knowledge of disparities in hepatitis C virus among immigrant groups for micro-elimination efforts is lacking. We quantify the hepatitis C cascades of care among immigrants and long-term residents prior to the introduction of direct-acting antiviral medications. METHODS Using laboratory and health administrative records, we described the hepatitis C virus cascades of care in terms of diagnosis, engagement with care, treatment initiation, and clearance in Ontario, Canada (1997-2014). We stratified the cascade by immigrant and long-term resident groups and identify drivers at each stage using multivariable Poisson regression. RESULTS We included 940 245 individuals in the study with an estimated hepatitis C prevalence of 167 923 (1.4%) overall, 23 759 (0.7%) among all immigrants, and 6019 (1.1%) among immigrants from hepatitis C endemic countries. Overall there were 104 616 individuals with reactive antibody results, 73 861 tested for viral RNA, 52 388 with viral RNA detected, 50 805 genotyped, 13 159 on treatment and 3919 with evidence of viral clearance. Compared to long-term residents, immigrants showed increased nucleic-acid testing (aRR: 1.09 [95%CI: 1.08, 1.10]), treatment initiation (aRR: 1.46 [95%CI: 1.38, 1.54]), and higher clearance rates (aRR: 1.07 [95%CI: 1.03, 1.11]). CONCLUSIONS Hepatitis C virus is more prevalent among long-term residents compared to immigrants overall, however, immigrants from endemic countries are an important subgroup to consider for future screening and linkage to care initiatives. These findings are prior to the introduction of newer medications and provide a population-based benchmark for follow-up studies and evaluation of treatment programs and surveillance activities.
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Affiliation(s)
- Abdool S Yasseen
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,Public Health Ontario, Toronto, ON, Canada
| | - Jeffrey C Kwong
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,Public Health Ontario, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada
| | - Jordan J Feld
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada
| | - Naveed Z Janjua
- BC Centre for Disease Control - Hepatitis Testers Cohort, Vancouver, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Christina Greenaway
- Division of Infectious Diseases, SMBD-Jewish General Hospital, McGill University Montreal, Montreal, Canada.,Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Canada
| | - Lauren Lapointe-Shaw
- ICES, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Tony Mazzulli
- Public Health Ontario, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada.,Mount Sinai Hospital/University Health Network Department of Microbiology, Toronto, ON, Canada
| | - Rafal Kustra
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Liane MacDonald
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Public Health Ontario, Toronto, ON, Canada
| | - Beate Sander
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,Public Health Ontario, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada
| | - Natasha S Crowcroft
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada
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21
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Pandey M, Konrad S, Reed N, Ahenakew V, Isbister P, Isbister T, Gallagher L, Campbell T, Skinner S. Liver health events: an indigenous community-led model to enhance HCV screening and linkage to care. Health Promot Int 2021; 37:6298445. [PMID: 34125199 DOI: 10.1093/heapro/daab074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Despite high prevalence of hepatitis C virus (HCV), linkage to care and treatment for Indigenous people is low. In an Indigenous community in Saskatchewan, Canada a retrospective review identified 200 individuals (∼12% prevalence) had HCV antibodies though majority lacked ribonucleic acid (RNA) testing, and few received treatment despite availability of an effective cure. Following Indigenous oral traditions, focus group discussions were held with key community members and leadership. Participants emphasized the need for a community-based screening and treatment programme. A team of community members, peers and healthcare professionals developed a streamlined screening pathway termed 'liver health event' (LHE) to reduce stigma, reach undiagnosed, re-engage previously diagnosed, and ensure rapid linkage to care/treatment. LHEs began December 2016. Statistics were tracked for each event. As of July 2019, there were 10 LHEs with 540 participants, 227 hepatitis C tests and 346 FibroScans completed. This represented 294 unique individuals, of which 64.3% were tested, and of those, 40.8% were Ab positive. Among those positive for antibodies, 41.7% had active hepatitis C infections, and among these, 90% were linked to care, and 14 new positive individuals were identified. Following the success of LHEs, these were adapted and implemented in 10 other communities in this region, resulting in 17 additional LHEs. This intervention is reaching the undiagnosed and linking clients to care through a low-barrier and de-stigmatizing approach. It has facilitated collaboration, knowledge exchange and mentorship between Indigenous communities, significantly impacting health outcomes of Indigenous people in this region.
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Affiliation(s)
- Mamata Pandey
- Research, Saskatchewan Health Authority, 2180-23 Ave, Wascana Rehabilitation Centre, Regina, SK, S4S 0A5, Canada
| | - Stephanie Konrad
- First Nations Inuit Health Branch-Sask Region, Indigenous Services Canada, Government of Canada, 1783 Hamilton Street, 6th Floor, Alvin Hamilton Building, Regina, SK, S4P 2B6, Canada
| | - Noreen Reed
- Ahtahkakoop Health Centre P.O. Box 64 Mont Nebo, SK, S0J 1X0, Canada
| | - Vanessa Ahenakew
- Ahtahkakoop Health Centre P.O. Box 64 Mont Nebo, SK, S0J 1X0, Canada
| | - Patricia Isbister
- Ahtahkakoop Health Centre P.O. Box 64 Mont Nebo, SK, S0J 1X0, Canada
| | - Tanys Isbister
- Ahtahkakoop Health Centre P.O. Box 64 Mont Nebo, SK, S0J 1X0, Canada
| | - Lesley Gallagher
- Saskatchewan Infectious Disease Care Network, 320 Ave F South, Saskatoon, SK, S7M 1T2, Canada
| | - Trisha Campbell
- Wellness Wheel Regina General Hospital, 2nd Floor Medical Office Wing c/o Infectious Diseases Clinic 1440-14th Avenue, Regina, SK, S4P 0W5, Canada
| | - Stuart Skinner
- Wellness Wheel Regina General Hospital, 2nd Floor Medical Office Wing c/o Infectious Diseases Clinic 1440-14th Avenue, Regina, SK, S4P 0W5, Canada.,University of Saskatchewan, 1440, 14th Avenue, Regina, SK, S4P 0W5, Canada
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22
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Yasseen AS, Kwong JC, Kustra R, Holder L, Chung H, Macdonald L, Janjua NZ, Mazzulli T, Feld J, Crowcroft NS. Validating viral hepatitis B and C diagnosis codes: a retrospective analysis using Ontario's health administrative data. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2021; 112:502-512. [PMID: 33417192 PMCID: PMC8076389 DOI: 10.17269/s41997-020-00435-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 10/11/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE We aimed to determine the criterion validity of using diagnosis codes for hepatitis B virus (HBV) and hepatitis C virus (HCV) to identify infections. METHODS Using linked laboratory and administrative data in Ontario, Canada, from January 2004 to December 2014, we validated HBV/HCV diagnosis codes against laboratory-confirmed infections. Performance measures (sensitivity, specificity, and positive predictive value) were estimated via cross-validated logistic regression and we explored variations by varying time windows from 1 to 5 years before (i.e., prognostic prediction) and after (i.e., diagnostic prediction) the date of laboratory confirmation. Subgroup analyses were performed among immigrants, males, baby boomers, and females to examine the robustness of these measures. RESULTS A total of 1,599,023 individuals were tested for HBV and 840,924 for HCV, with a resulting 41,714 (2.7%) and 58,563 (7.0%) infections identified, respectively. HBV/HCV diagnosis codes ± 3 years of laboratory confirmation showed high specificity (99.9% HBV; 99.8% HCV), moderate positive predictive value (70.3% HBV; 85.8% HCV), and low sensitivity (12.8% HBV; 30.8% HCV). Varying the time window resulted in limited changes to performance measures. Diagnostic models consistently outperformed prognostic models. No major differences were observed among subgroups. CONCLUSION HBV/HCV codes should not be the only source used for monitoring the population burden of these infections, due to low sensitivity and moderate positive predictive values. These results underscore the importance of ongoing laboratory and reportable disease surveillance systems for monitoring viral hepatitis in Ontario.
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Affiliation(s)
- Abdool S Yasseen
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Public Health Ontario, Toronto, Canada
- ICES, Toronto, Canada
| | - Jeffrey C Kwong
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Public Health Ontario, Toronto, Canada
- ICES, Toronto, Canada
- University Health Network, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Rafal Kustra
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | | | - Liane Macdonald
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Public Health Ontario, Toronto, Canada
| | - Naveed Z Janjua
- Hepatitis Testers Cohort, British Columbia Centre for Diseases Control, Vancouver, Canada
| | - Tony Mazzulli
- Public Health Ontario, Toronto, Canada
- Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
- Department of Microbiology, Mount Sinai Hospital/University Health Network, Toronto, Canada
| | - Jordan Feld
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Public Health Ontario, Toronto, Canada
- ICES, Toronto, Canada
- University Health Network, Toronto, Canada
| | - Natasha S Crowcroft
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
- ICES, Toronto, Canada.
- Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.
- Department of Microbiology, Mount Sinai Hospital/University Health Network, Toronto, Canada.
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23
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Sahakyan Y, Lee-Kim V, Bremner KE, Bielecki JM, Krahn MD. Impact of direct-acting antiviral regimens on mortality and morbidity outcomes in patients with chronic hepatitis c: Systematic review and meta-analysis. J Viral Hepat 2021; 28:739-754. [PMID: 33556225 DOI: 10.1111/jvh.13482] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 01/23/2021] [Indexed: 02/06/2023]
Abstract
The long-term effects of direct-acting antiviral therapies (DAAs) for chronic hepatitis C (CHC) remain uncertain. The objective of this systematic review and meta-analysis was to assess the impact of DAAs on CHC progression and mortality. We searched Ovid MEDLINE, Ovid EMBASE and PubMed databases (January 2011 to March 2020) for studies that compared the efficacy of DAAs to a non-DAA control in patients with CHC. Main outcomes were the adjusted hazard ratios (HRs) for mortality, liver decompensation, HCC occurrence and recurrence. Pooled estimates of HRs were determined using random-effects meta-analyses with inverse variance weighting, with sensitivity analyses and meta-regression to explore the effects of clinical factors. We identified 39 articles for the primary analysis. Compared with unexposed individuals, patients treated with DAA had a reduced risk of death (HR; CI = 0.44; 0.38-0.52), decompensation (HR; CI = 0.54; 0.38- 0.76) and HCC occurrence (HR; CI = 0.72; 0.61- 0.86). The protective effect of DAA on HCC recurrence was less clear (HR; CI = 0.72; 0.44-1.16). Sustained virologic response (SVR) attainment was a significant predictor of reduced mortality (HR; CI = 0.33; 0.23-0.46), decompensation (HR; CI = 0.11; 0.05-0.24), HCC occurrence (HR; CI = 0.31; 0.27-0.37) and HCC recurrence (HR; CI = 0.32; 0.20-0.51). Meta-regression showed no evidence of effect modification by patient age, sex, presence of cirrhosis or length of follow-up. In conclusion, our findings show protective effects of DAA treatment and DAA-related SVR on CHC progression and mortality.
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Affiliation(s)
- Yeva Sahakyan
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Victoria Lee-Kim
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.,School of Medicine, Queens University, Kingston, ON, Canada
| | - Karen E Bremner
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Joanna M Bielecki
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Murray D Krahn
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada.,Department of Medicine, University of Toronto and University Health Network, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences (ICES), Toronto, ON, Canada
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24
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Binka M, Butt ZA, McKee G, Darvishian M, Cook D, Wong S, Yu A, Alvarez M, Samji H, Wong J, Krajden M, Janjua NZ. Differences in risk factors for hepatitis B, hepatitis C, and human immunodeficiency virus infection by ethnicity: A large population-based cohort study in British Columbia, Canada. Int J Infect Dis 2021; 106:246-253. [PMID: 33771673 DOI: 10.1016/j.ijid.2021.03.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Addressing the needs of ethnic minorities will be key to finding undiagnosed individuals living with hepatitis B (HBV), hepatitis C (HCV), or human immunodeficiency virus (HIV). To inform screening initiatives in British Columbia (BC), Canada, the factors associated with HBV and/or HCV and/or HIV infection among different ethnic groups within a large population-based cohort were assessed. METHODS Persons diagnosed with HBV, HCV, or HIV in BC between 1990 and 2015 were grouped as East Asian, South Asian, Other Visible Minority (African, Central Asian, Latin American, Pacific Islander, West Asian, unknown ethnicity), and Not a Visible Minority, using a validated name-recognition software. Factors associated with infection within each ethnic group were assessed with multivariable multinomial logistic regression models. RESULTS Participants included 202 521 East Asians, 126 070 South Asians, 65 210 Other Visible Minorities, and 1 291 561 people who were Not a Visible Minority, 14.4%, 3.3%, 4.5%, and 6.3% of whom had HBV and/or HCV and/or HIV infections, respectively. Injection drug use was most prevalent among infection-positive people who were Not a Visible Minority (22.1%), and was strongly associated with HCV monoinfection, HBV/HCV coinfection, and HCV/HIV coinfection, but not with HBV monoinfection among visible ethnic minorities. Extreme material deprivation and social deprivation were more prevalent than injection drug use or problematic alcohol use among visible ethnic minorities. CONCLUSIONS Risk factor distributions varied among persons diagnosed with HBV and/or HCV and/or HIV of differing ethnic backgrounds, with lower substance use prevalence among visible minority populations. This highlights the need for tailored approaches to infection screening among different ethnic groups.
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Affiliation(s)
- Mawuena Binka
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.
| | - Zahid Ahmad Butt
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Geoffrey McKee
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Maryam Darvishian
- British Columbia Cancer Research Centre, Vancouver, British Columbia, Canada
| | - Darrel Cook
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Stanley Wong
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Amanda Yu
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Maria Alvarez
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Hasina Samji
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Jason Wong
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mel Krajden
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Naveed Zafar Janjua
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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25
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Cabezas J, García F, Calleja Panero JL, Buti M, Molero García JM, Blasco AJ, Lázaro de Mercado P, Crespo J. Principles for implementing a population screening strategy for hepatitis C in Spain. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2021; 112:64-70. [PMID: 31880160 DOI: 10.17235/reed.2019.6768/2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND hepatitis C, besides health impairment, results in significant loss of productivity and diminished quality of life, and noticeably contributes to health expenditure increases. Because of all this, the Spanish Ministry of Health (Ministerio de Sanidad, Consumo y Bienestar Social - MSCBS) implemented in 2015 a strategic plan for managing hepatitis C (Plan Estratégico para el Abordaje de la Hepatitis C - PEAHC) within the National Health System. However, the PEAHC includes no screening plan. The MSCBS developed a framework document on population screening (Documento Marco sobre Cribado Poblacional) that defines the criteria a disease must meet in order to consider implementing a screening program. Specifically, it defines 4 criteria related to the health issue, 4 related to the screening test, and 3 criteria dealing with diagnosis confirmation and treatment. OBJECTIVE to identify whether there is scientific evidence to support hepatitis C meeting the criteria to be considered a disease qualifying for a population screening strategy in Spain. METHODS a literature search for scientific evidence concerning each required criterion for implementing a population screening plan for hepatitis C in Spain. RESULTS sufficient scientific evidence was found to support hepatitis C meeting the criteria required by the MSCBS for the implementation of a population screening program. CONCLUSIONS according to the available scientific evidence, hepatitis C in Spain meets the required criteria to qualify for consideration of population screening plan.
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Affiliation(s)
- Joaquín Cabezas
- Aparato Digestivo/Unidad de Hepatología, Hospital Universitario Marqués de Valdecilla, España
| | - Federico García
- Servicio de Microbiología, Hospital Universitario San Cecilio. Instituto de Investigación Ibs
| | - José Luis Calleja Panero
- Servicio de Gastroenterología y Hepatología, Hospital Universitario Puerta de Hierro Majadahonda
| | - María Buti
- Servicio de Aparato Digestivo, Hospital Universitari Vall d´Hebron
| | | | | | | | - Javier Crespo
- Servicio de Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, 39002
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26
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von Aesch Z, Craig-Neil A, Shah H, Antoniou T, Meaney C, Pinto AD. Family medicine-directed hepatitis C care and barriers to treatment: a mixed-methods study. CMAJ Open 2021; 9:E201-E207. [PMID: 33688028 PMCID: PMC8034373 DOI: 10.9778/cmajo.20190194] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Antivirals for the treatment of hepatitis C virus (HCV) infection are effective, but many patients remain untreated and treatment is not yet routine in primary care. We evaluated the characteristics of patients who engaged in HCV treatment, and clinician perspectives on the barriers and facilitators to treatment. METHODS Our mixed-method, parallel-design study was conducted at a multisite primary care centre in downtown Toronto. In a retrospective chart review, we searched records from 2011 to 2017 to collect quantitative data, including HCV infection status and HCV treatment status. To contextualize the data, we conducted in-depth interviews with select physicians between Aug. 1 and Nov. 1, 2017, and analyzed the transcripts using content analysis. RESULTS Of the 40 381 charts reviewed, 727 patients (1.8%, 95% confidence interval [CI] 1.7%-1.9%) were infected with HCV, and 542 (74.6%) had HCV infection requiring treatment. Of those, 255 patients (47.0%) had engaged in treatment. Patients who had engaged in treatment were more likely to be male (odds ratio [OR] 1.63, 95% CI 1.10-2.42), older (OR 1.04 per year increase in age, 95% CI 1.02-1.05) and housed (OR 2.2, 95% CI 1.36-3.75), and they were more likely not to have engaged in injection drug use (OR 1.87, 95% CI 1.33-2.63). Based on interviews with 8 physicians, treatment barriers included a lack of knowledge about HCV treatment, concerns that patients would not adhere to medications and challenges related to medication access. Facilitators of treatment included access to specialist consultation, pharmacist support and primary care treatment guidelines. Common themes that emerged in both quantitative and qualitative components were the roles of unstable housing and intravenous drug use as barriers to engaging in and completing treatment. INTERPRETATION Our study captured provider-identified barriers to HCV care and the key factors related to retention in HCV care, including gender, age, housing status and experience with drug use. Successful primary-care-led HCV treatment programs may incorporate specialist and pharmacy support and focus on younger, female, underhoused populations and people who use drugs.
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Affiliation(s)
- Zoë von Aesch
- Department of Family and Community Medicine (von Aesch, Antoniou, Pinto), St. Michael's Hospital; Department of Family and Community Medicine, Faculty of Medicine (von Aesch, Antoniou, Meaney, Pinto), University of Toronto; Upstream Lab, MAP Centre for Urban Health Solutions (Craig-Neil, Pinto), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Francis Family Liver Clinic, University Health Network, Department of Medicine (Shah); Department of Medicine, Faculty of Medicine (Shah); Li Ka Shing Knowledge Institute (Antoniou), St. Michael's Hospital, Toronto, Ont.
| | - Amy Craig-Neil
- Department of Family and Community Medicine (von Aesch, Antoniou, Pinto), St. Michael's Hospital; Department of Family and Community Medicine, Faculty of Medicine (von Aesch, Antoniou, Meaney, Pinto), University of Toronto; Upstream Lab, MAP Centre for Urban Health Solutions (Craig-Neil, Pinto), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Francis Family Liver Clinic, University Health Network, Department of Medicine (Shah); Department of Medicine, Faculty of Medicine (Shah); Li Ka Shing Knowledge Institute (Antoniou), St. Michael's Hospital, Toronto, Ont
| | - Hemant Shah
- Department of Family and Community Medicine (von Aesch, Antoniou, Pinto), St. Michael's Hospital; Department of Family and Community Medicine, Faculty of Medicine (von Aesch, Antoniou, Meaney, Pinto), University of Toronto; Upstream Lab, MAP Centre for Urban Health Solutions (Craig-Neil, Pinto), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Francis Family Liver Clinic, University Health Network, Department of Medicine (Shah); Department of Medicine, Faculty of Medicine (Shah); Li Ka Shing Knowledge Institute (Antoniou), St. Michael's Hospital, Toronto, Ont
| | - Tony Antoniou
- Department of Family and Community Medicine (von Aesch, Antoniou, Pinto), St. Michael's Hospital; Department of Family and Community Medicine, Faculty of Medicine (von Aesch, Antoniou, Meaney, Pinto), University of Toronto; Upstream Lab, MAP Centre for Urban Health Solutions (Craig-Neil, Pinto), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Francis Family Liver Clinic, University Health Network, Department of Medicine (Shah); Department of Medicine, Faculty of Medicine (Shah); Li Ka Shing Knowledge Institute (Antoniou), St. Michael's Hospital, Toronto, Ont
| | - Christopher Meaney
- Department of Family and Community Medicine (von Aesch, Antoniou, Pinto), St. Michael's Hospital; Department of Family and Community Medicine, Faculty of Medicine (von Aesch, Antoniou, Meaney, Pinto), University of Toronto; Upstream Lab, MAP Centre for Urban Health Solutions (Craig-Neil, Pinto), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Francis Family Liver Clinic, University Health Network, Department of Medicine (Shah); Department of Medicine, Faculty of Medicine (Shah); Li Ka Shing Knowledge Institute (Antoniou), St. Michael's Hospital, Toronto, Ont
| | - Andrew D Pinto
- Department of Family and Community Medicine (von Aesch, Antoniou, Pinto), St. Michael's Hospital; Department of Family and Community Medicine, Faculty of Medicine (von Aesch, Antoniou, Meaney, Pinto), University of Toronto; Upstream Lab, MAP Centre for Urban Health Solutions (Craig-Neil, Pinto), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Francis Family Liver Clinic, University Health Network, Department of Medicine (Shah); Department of Medicine, Faculty of Medicine (Shah); Li Ka Shing Knowledge Institute (Antoniou), St. Michael's Hospital, Toronto, Ont
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González Rubio R, Labrador Cañadas MV, Del Amo J. [Guideline on hepatitis C testing in Spain. An interdisciplinary work with a Public Health approach.]. Rev Esp Salud Publica 2020; 94:e202012180. [PMID: 33331301 PMCID: PMC11583128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 10/26/2020] [Indexed: 06/12/2023] Open
Abstract
Within the framework of the Global health sector strategy on viral hepatitis and the Strategic Plan for tackling hepatitis C in the Spanish National Health System, the Secretariat of the National Plan on HIV and STIs and the Unit for Screening Programs in the Ministry of Health have coordinated the policies around the screening of hepatitis C virus (HCV) in Spain. This paper describes the experience and learnings arisen around it. The key points of the process include interdisciplinary work through a Technical Group made up of experts from the different fields involved; the availability of scientific evidence for decision-making, highlighting the 2nd Seroprevalence Study in the general population; and a public health approach along the entire process. As a result, the recently published Guideline on hepatitis C testing includes the indication for HCV testing for people with risk exposures and situations, as well as the main recommendations to improve screening and linkage to care in the most affected populations. We hope that this Guideline and the continuation of joint work will be a step towards equitable access to the diagnosis and treatment of HCV infection in Spain.
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Affiliation(s)
- Raquel González Rubio
- Secretaría del Plan Nacional sobre el Sida. Dirección General de Salud Pública. Ministerio de Sanidad. Madrid. España
| | | | - Julia Del Amo
- Secretaría del Plan Nacional sobre el Sida. Dirección General de Salud Pública. Ministerio de Sanidad. Madrid. España
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Hamadeh A, Haines A, Feng Z, Thein HH, Janjua NZ, Krahn M, Wong WWL. Estimating chronic hepatitis C prevalence in British Columbia and Ontario, Canada, using population-based cohort studies. J Viral Hepat 2020; 27:1419-1429. [PMID: 32810886 DOI: 10.1111/jvh.13373] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/23/2020] [Accepted: 07/30/2020] [Indexed: 12/19/2022]
Abstract
Patients identified as having chronic hepatitis C (CHC) infection can be effectively and rapidly treated using direct-acting antiviral agents. However, there remains a substantial burden of subclinical undetected infection. This study estimates the prevalence and undiagnosed proportion of CHC in British Columbia (BC) and Ontario, Canada, using a model-based approach, informed by provincial population-level health administrative data. A two-step approach was used: Step 1) Two population-based retrospective analyses of administrative health data for a cohort of British Columbians and a cohort of Ontarians with CHC were conducted to generate population-level statistics of CHC-related health events; Step 2) using a validated natural history model of hepatitis C virus (HCV) infection, the historical prevalence of CHC was back-calculated from the data collected in Step 1. Our retrospective study found that, in BC and Ontario, the number of newly diagnosed CHC cases is declining yearly while the complications of the disease are increasing yearly. BC had a 2014 CHC prevalence of 1.04% (95% CI: 0.84%-1.44%), with 33.3% (95% CI: 25.5%-42.0%) of CHC cases undiagnosed. Ontario had a 2014 CHC prevalence of 0.91% (95% CI: 0.83%-1.02%) with 36.0% (95% CI: 31.2%-38.9%) of CHC cases undiagnosed. Our study offers robust estimates based on the integration of a validated natural history model with population-level health administrative data on HCV-related events, which can provide vital evidence for policymakers to develop appropriate policies to achieve elimination targets. Our approach can also be applied to produce robust region-specific estimates in other countries.
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Affiliation(s)
- Abdullah Hamadeh
- School of Pharmacy, University of Waterloo, Kitchener, ON, Canada
| | - Alex Haines
- Toronto Health Economics and Technology Assessment Collaborative (THETA), University Health Network, Toronto, ON, Canada
| | - Zeny Feng
- Department of Mathematics and Statistics, University of Guelph, Guelph, ON, Canada
| | - Hla-Hla Thein
- Toronto Health Economics and Technology Assessment Collaborative (THETA), University Health Network, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada
| | - Naveed Z Janjua
- BC Centre for Disuse Control, University of British Columbia, Vancouver, BC, Canada
| | - Murray Krahn
- Toronto Health Economics and Technology Assessment Collaborative (THETA), University Health Network, Toronto, ON, Canada.,ICES, Toronto, ON, Canada
| | - William W L Wong
- School of Pharmacy, University of Waterloo, Kitchener, ON, Canada.,Toronto Health Economics and Technology Assessment Collaborative (THETA), University Health Network, Toronto, ON, Canada.,ICES, Toronto, ON, Canada
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GRADE-Leitlinien zu Gerechtigkeit 4. Berücksichtigung der Gerechtigkeit im Gesundheitswesen bei der Entwicklung von GRADE-Leitlinien: von der Evidenz zur Empfehlung. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2020; 156-157:105-112. [PMID: 32863163 DOI: 10.1016/j.zefq.2020.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The aim of this paper is to provide detailed guidance on how to incorporate health equity within the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) evidence to decision process. STUDY DESIGN AND SETTING We developed this guidance based on the GRADE evidence to decision frame-work, iteratively reviewing and modifying draft documents, in person discussion of project group members and input from other GRADE members. This is a German translation of the original paper published in English. RESULTS Considering the impact on health equity may be required, both in general guidelines and guide-lines that focus on disadvantaged populations. We suggest two approaches to incorporate equity considerations: (1) assessing the potential impact of interventions on equity and (2) incorporating equity considerations when judging or weighing each of the evidence to decision criteria. We provide guidance and include illustrative examples. CONCLUSION Guideline panels should consider the impact of recommendations on health equity with attention to remote and underserviced settings and disadvantaged populations. Guideline panels may wish to incorporate equity judgments across the evidence to decision framework. This is the fourth and final paper in a series about considering equity in the GRADE guideline development process. This series is coming from the GRADE equity subgroup.
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Haines AG, Mendlowitz AB, Wong WWL, Krahn M. Strategies to achieve population control of HCV infection: results of a multidisciplinary focus group. CANADIAN LIVER JOURNAL 2020; 3:224-231. [PMID: 35991858 PMCID: PMC9202787 DOI: 10.3138/canlivj-2019-0017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 11/11/2019] [Indexed: 08/20/2023]
Abstract
BACKGROUND To meet the World Health Organization's ambitious target to eradicate hepatitis C virus (HCV) by 2030, a comprehensive strategy is needed in Canada to ensure everyone infected with HCV is identified, diagnosed, and treated. The purpose of this study was to highlight the barriers to any strategy aimed at achieving this goal. METHODS A focus group was formed (N = 11) that consisted of clinicians, patients, drug program budget managers, industry representatives, and individuals from provincial public health and federal agencies in Canada. The group met in person for a half-day focus group session. Two discussions were held: one on future barriers related to HCV treatment and one related to HCV screening. A grounded theory approach was used to elicit key themes from the day's discussion. RESULTS Nine themes were identified. Four themes related to HCV screening: public awareness and engagement, resource infrastructure and capacity, heterogeneity between provinces, and mechanisms of screening. Three themes related to HCV treatment: access to treatment and illicit drug use, linkage to care, and predicting post-treatment outcomes. Two overarching themes that contributed to most discussions were a focus on baby boomers versus persons who inject drugs and the need for further education and training. CONCLUSION The views and findings extracted from this qualitative research complement proposals of national strategies from organizations such as the Canadian Network on Hepatitis C. This work highlights the financial, logistical, and ethical constraints that need to be tackled to make HCV elimination proposals a reality.
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Affiliation(s)
- Alexander G Haines
- Toronto Health Economics and Technology Assessment Collaborative, Toronto, Ontario, Canada
| | - Andrew B Mendlowitz
- Toronto Health Economics and Technology Assessment Collaborative, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - William WL Wong
- School of Pharmacy, University of Waterloo, Kitchener, Ontario, Canada
| | - Murray Krahn
- Toronto Health Economics and Technology Assessment Collaborative, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
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Apau Bediako R. The Ethics of Screening and Treating Persons with Hepatitis C: A Canadian Perspective. CANADIAN JOURNAL OF BIOETHICS 2020. [DOI: 10.7202/1068763ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In this article, I argue that the Canadian government’s position against screening for hepatitis C virus (HCV) and publicly funding HCV treatment is ethically unjustifiable. Cost of medication and likelihood of widening existing health inequality are the government’s argument for not funding HCV treatment and for also not having a screening program. I object to this position and argue in favour of a screening program and public funding of HCV treatment. I argue that these barriers are ethically unjust. Conclusively, being denied screening and early treatment is to be denied the best possible outcome.
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Affiliation(s)
- Ramseyer Apau Bediako
- Centre for Bioethics, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Canada
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Zaltzman A, Dubey V, Iglar K. Update to the Preventive Care Checklist Form ©. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2020; 66:270-272. [PMID: 32273415 PMCID: PMC7145119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Alina Zaltzman
- Family physician in the Department of Family and Community Medicine at St Michael's Hospital in Toronto, Ont
| | - Vinita Dubey
- Associate Medical Officer of Health with Toronto Public Health and Adjunct Professor in the Dalla Lana School of Public Health at the University of Toronto
| | - Karl Iglar
- Associate Professor in the Department of Family and Community Medicine at the University of Toronto and a staff physician at St Michael's Hospital
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Hepatitis C Virus Screening of High-Risk Patients in a Canadian Emergency Department. Can J Gastroenterol Hepatol 2020; 2020:5258289. [PMID: 32211349 PMCID: PMC7049435 DOI: 10.1155/2020/5258289] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 01/04/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Approximately 0.7% of the Canadian population is infected with hepatitis C virus (HCV), and many individuals are unaware of their infection. Our objectives were to utilize an emergency department (ED) based point-of-care (POC) HCV screening test to describe our local population and estimate the proportion of high-risk patients in our population with undiagnosed HCV. METHODS A convenience sample of medically stable patients (≥18 years) presenting to a community ED in Calgary, AB, between April and July 2018 underwent rapid clinical screening for HCV risk factors, including history of injection drug use, healthcare in endemic countries, and other recognized criteria. High-risk patients were offered POC HCV testing. Antibody-positive patients underwent HCV-RNA testing and were linked to hepatology care. The primary outcome was the proportion of new HCV diagnoses in the high-risk population. RESULTS Of the 999 patients screened by survey, 247 patients (24.7%) were high-risk and eligible for testing. Of these, 123 (49.8%) were from HCV-endemic countries, while 63 (25.5%) and 31 (12.6%) patients endorsed a history of incarceration and intravenous drug use (IVDU), respectively. A total of 144 (58.3%) eligible patients agreed to testing. Of these, 6 patients were POC-positive (4.2%, CI 0.9-7.4%); all 6 had antibodies detected on confirmatory lab testing and 4 had detectable HCV-RNA viral loads in follow-up. Notably, 103 (41.7%) patients declined POC testing. Interpretation. Among 144 high-risk patients who agreed to testing, the rate of undiagnosed HCV infection was 4.2%, and the rate of undiagnosed HCV infection with detectable viral load was 2.8%. Many patients with high-risk clinical criteria refused POC testing. It is unknown if tested and untested groups have the same disease prevalence. This study shows that ED HCV screening is feasible and that a small number of previously undiagnosed patients can be identified and linked to potentially life-changing care.
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O'Keefe-Markman C, Lea KD, McCabe C, Hyshka E, Bubela T. Social values for health technology assessment in Canada: a scoping review of hepatitis C screening, diagnosis and treatment. BMC Public Health 2020; 20:89. [PMID: 31959155 PMCID: PMC6971980 DOI: 10.1186/s12889-020-8190-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 01/09/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Health care system decision makers face challenges in allocating resources for screening, diagnosis and treatment of hepatitis C. Approximately 240,000 individuals are infected with the hepatitis C virus (HCV) in Canada. Populations most affected by HCV include Indigenous people, people who inject drugs, immigrants and homeless or incarcerated populations as well as those born between 1946 and 1965. Curative but expensive drug regimens of novel direct acting antivirals (DAAs) are available. We aim to identify social values from academic literature for inclusion in health technology assessments. METHODS We conducted a scoping review of academic literature to identify and analyze the social values and evidence-based recommendations for screening, diagnosis and treatment of HCV in Canada. After applying inclusion/exclusion criteria, we abstracted: type of intervention(s), population(s) affected, study location, screening methods, diagnostics and treatments. We then abstracted and applied qualitative codes for social values. We extracted social value statements and clustered them into one of 4 categories: (1) equity and justice, (2) duty to provide care, (3) maximization of population benefit, and (4) individual versus community interests. RESULTS One hundred and eighteen articles met our inclusion criteria on screening, diagnosis and treatment of HCV in Canada. Of these, 54 (45.8%) discussed screening, 4 (3.4%) discussed diagnosis and 60 (50.8%) discussed treatment options. Most articles discussed the general population and other non-vulnerable populations. Articles that discussed vulnerable populations focused on people who inject drugs. We coded 1243 statements, most of which fell into the social value categories of equity and justice, duty to provide care and maximization of population benefit. CONCLUSION The academic literature identified an expanded set of social values to be taken into account by resource allocation decision makers in financially constrained environments. In the context of hepatitis C, authors called for greater consideration of equity and justice and the duty to provide care in making evidence-based recommendations for screening, diagnosis and treatment for different populations and in different settings that also account for individual and community interests.
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Affiliation(s)
| | - Kristina Dawn Lea
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Christopher McCabe
- Institute of Health Economics, Edmonton, AB, Canada
- Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Elaine Hyshka
- School of Public Health, University of Alberta, Edmonton, AB, Canada
- Inner City Health and Wellness, Royal Alexandra Hospital, Edmonton, AB, Canada
| | - Tania Bubela
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
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Kronfli N, Buxton JA, Jennings L, Kouyoumdjian F, Wong A. Hepatitis C virus (HCV) care in Canadian correctional facilities: Where are we and where do we need to be? CANADIAN LIVER JOURNAL 2019; 2:171-183. [PMID: 35992759 PMCID: PMC9202815 DOI: 10.3138/canlivj.2019-0007] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 03/26/2019] [Indexed: 07/29/2023]
Abstract
Approximately 25% of people in Canadian correctional facilities have been previously exposed to hepatitis C virus (HCV). Despite being a high-prevalence setting, most Canadian prisons have thus far failed to engage the majority of those with chronic HCV infection in care. Several factors, including the lack of systematic screening programs, lack of on-site and trained health care personnel to improve access to care and treatment during incarceration, and the absence of standardized procedures needed to facilitate linkage to care following release likely contribute to poor engagement along the HCV care cascade for people in prison. HCV screening and engagement in care for people in prison can be improved through the implementation of universal opt-out screening upon admission and consideration of multidisciplinary care models for the provision of care. As well, the dissemination of prison-based needle and syringe programs to avert new HCV infections and re-infections should be considered. To meet the World Health Organization (WHO) 2030 HCV elimination goals, engaging researchers, clinicians and other health care providers, policy makers, correctional officials, and members of community in dialogue will be an essential first step going forward.
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Affiliation(s)
- Nadine Kronfli
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University, Montreal, Quebec, Canada
| | - Jane A Buxton
- BC Centre of Disease Control and School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lindsay Jennings
- Prisoners with HIV/AIDS Support Action Network, Toronto, Ontario, Canada
| | - Fiona Kouyoumdjian
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Alexander Wong
- Department of Medicine, University of Saskatchewan, Regina, Saskatchewan, Canada
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Hamadeh A, Feng Z, Krahn M, Wong WWL. A model-based framework for chronic hepatitis C prevalence estimation. PLoS One 2019; 14:e0225366. [PMID: 31751393 PMCID: PMC6874092 DOI: 10.1371/journal.pone.0225366] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 11/04/2019] [Indexed: 01/26/2023] Open
Abstract
Chronic hepatitis C (CHC) continues to be a highly burdensome disease worldwide. The often-asymptomatic nature of early-stage CHC means that the disease often remains undiagnosed, leaving its prevalence highly uncertain. This generates significant uncertainty in the planning of hepatitis C eradication programs to meet WHO targets. The aim of this work is to establish a mathematical framework for the estimation of a geographic locale’s CHC prevalence and the proportion of its CHC population that remains undiagnosed. A Bayesian MCMC approach is taken to infer these populations from the observed occurrence of CHC-related events using a recently published natural history model of the disease. Using the Canadian context as a specific example, this study estimates that in 2013, the CHC prevalence rate in Canada was 0.63% (95% CI: 0.53% - 0.72%), with 27.1% (95% CI: 19.3% - 36.1%) of the infected population undiagnosed.
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Affiliation(s)
- Abdullah Hamadeh
- School of Pharmacy, University of Waterloo, Kitchener, ON, Canada
| | - Zeny Feng
- Department of Mathematics and Statistics, University of Guelph, Guelph, ON, Canada
| | - Murray Krahn
- Toronto Health Economics and Technology Assessment Collaborative, University Health Network, Toronto General Hospital, Toronto, ON, Canada
- Toronto General Research Institute, Toronto, ON, Canada
| | - William W. L. Wong
- School of Pharmacy, University of Waterloo, Kitchener, ON, Canada
- * E-mail:
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O'Toole D. Quick and painless: 2018 Updates on guideline recommendations. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2019; 65:804-806. [PMID: 31722914 PMCID: PMC6853339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Danielle O'Toole
- Practising family physician in Academic Family Medicine and Assistant Professor in the Department of Family Medicine at McMaster University in Hamilton, Ont
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Williams J, Miners A, Harris R, Mandal S, Simmons R, Ireland G, Hickman M, Gore C, Vickerman P. Cost-Effectiveness of One-Time Birth Cohort Screening for Hepatitis C as Part of the National Health Service Health Check Program in England. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:1248-1256. [PMID: 31708061 DOI: 10.1016/j.jval.2019.06.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 05/14/2019] [Accepted: 06/28/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND OBJECTIVES Birth cohort screening for the hepatitis C virus (HCV) has been implemented in the US, but there is little evidence of its cost-effectiveness in England. We aim to evaluate the cost-effectiveness of one-time HCV screening for individuals born between 1950 and 1979 as part of the National Health Service health check in England, a health check for adults aged 40 to 74 years in primary care. METHODS A Markov model was developed to analyze add-on HCV testing to the National Health Service health check for individuals in birth cohorts between 1950 and 1979, versus current background HCV testing only, over a lifetime horizon. The model used data from a back-calculation model of the burden of HCV in England, sentinel surveillance of HCV testing, and published literature. Results are presented from a health service perspective in pounds in 2017, as incremental cost-effectiveness ratios per quality-adjusted life years gained. RESULTS The base-case incremental cost-effectiveness ratios ranged from £7648 to £24 434, and £18 681 to £46 024, across birth cohorts when considering 2 sources of HCV transition probabilities. The intervention is most likely to be cost-effective for those born in the 1970s, and potentially cost-effective for those born from 1955 to 1969. The model results were most sensitive to the source of HCV transition probabilities, the probability of referral and receiving treatment, and the HCV prevalence among testers. The maximum value of future research across all birth cohorts was £11.3 million at £20 000 per quality-adjusted life years gained. CONCLUSION Birth cohort screening is likely to be cost-effective for younger birth cohorts, although considerable uncertainty exists for other birth cohorts. Further studies are warranted to reduce uncertainty in cost-effectiveness and consider the acceptability of the intervention.
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Affiliation(s)
- Jack Williams
- Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, England, UK; The National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London, England, UK.
| | - Alec Miners
- Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, England, UK; The National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London, England, UK
| | - Ross Harris
- National Infection Service, Public Health England, Colindale, England, UK
| | - Sema Mandal
- The National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London, England, UK; National Infection Service, Public Health England, Colindale, England, UK
| | - Ruth Simmons
- The National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London, England, UK; National Infection Service, Public Health England, Colindale, England, UK
| | - Georgina Ireland
- The National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London, England, UK; National Infection Service, Public Health England, Colindale, England, UK
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, England, UK; The National Institute for Health Research Health Protection Research Unit in Evaluation of Interventions, England, UK
| | | | - Peter Vickerman
- The National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London, England, UK; Population Health Sciences, Bristol Medical School, University of Bristol, England, UK; The National Institute for Health Research Health Protection Research Unit in Evaluation of Interventions, England, UK
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Kronfli N, Dussault C, Klein MB, Lebouché B, Sebastiani G, Cox J. The hepatitis C virus cascade of care in a Quebec provincial prison: a retrospective cohort study. CMAJ Open 2019; 7:E674-E679. [PMID: 31796509 PMCID: PMC6890491 DOI: 10.9778/cmajo.20190068] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) microelimination efforts must target people in prison; however, although some inmates may qualify for treatment in provincial prisons, it may not be routinely provided. Our aim was to characterize the cascade of HCV care in Quebec's largest provincial prison. METHODS We conducted a retrospective study of all HCV-related laboratory tests requested at the Établissement de détention de Montréal (men's prison with on-demand screening), between July 1, 2017, and June 30, 2018. We defined 8 HCV care cascade steps: 1) total sentenced inmates, 2) screened for HCV (via HCV antibody [HCV Ab]), 3) HCV Ab positive, 4) tested for HCV RNA, 5) HCV RNA positive, 6) linked to care, 7) HCV treatment initiated and 8) achieved sustained virologic response. We measured proportions of inmates at each step using denominator-numerator linkage. We also calculated the proportion screened among inmates with a sentence duration of at least 1 month, during which time screening should be feasible. RESULTS Of the 4931 sentenced inmates, 344 (7%) were screened for HCV, of whom 38 (11%) were HCV Ab positive. Thirty-five (92%) of the 38 received HCV RNA testing, which showed positivity in 16 (46%). Ten (62%) of the 16 inmates were linked to care; treatment was initiated in 3 (30%), 2 of whom (67%) achieved a sustained virologic response. Among inmates with a sentence duration of at least 1 month (n = 1972), the proportion screened increased to 17%. INTERPRETATION A small proportion (7%) of men at a Canadian provincial prison with on-demand HCV testing were screened, and rates of treatment initiation were low in the absence of formal HCV cure pathways. To eliminate HCV in this subpopulation, opt-out HCV testing should be considered.
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Affiliation(s)
- Nadine Kronfli
- Division of Infectious Diseases (Kronfli, Klein, Lebouché, Sebastiani, Cox), Department of Medicine, McGill University; Chronic Viral Illness Service (Kronfli, Klein, Lebouché, Sebastiani, Cox), McGill University; Research Institute of the McGill University Health Centre (Kronfli, Dussault, Klein, Lebouché, Sebastiani, Cox), Montréal, Que.
| | - Camille Dussault
- Division of Infectious Diseases (Kronfli, Klein, Lebouché, Sebastiani, Cox), Department of Medicine, McGill University; Chronic Viral Illness Service (Kronfli, Klein, Lebouché, Sebastiani, Cox), McGill University; Research Institute of the McGill University Health Centre (Kronfli, Dussault, Klein, Lebouché, Sebastiani, Cox), Montréal, Que
| | - Marina B Klein
- Division of Infectious Diseases (Kronfli, Klein, Lebouché, Sebastiani, Cox), Department of Medicine, McGill University; Chronic Viral Illness Service (Kronfli, Klein, Lebouché, Sebastiani, Cox), McGill University; Research Institute of the McGill University Health Centre (Kronfli, Dussault, Klein, Lebouché, Sebastiani, Cox), Montréal, Que
| | - Bertrand Lebouché
- Division of Infectious Diseases (Kronfli, Klein, Lebouché, Sebastiani, Cox), Department of Medicine, McGill University; Chronic Viral Illness Service (Kronfli, Klein, Lebouché, Sebastiani, Cox), McGill University; Research Institute of the McGill University Health Centre (Kronfli, Dussault, Klein, Lebouché, Sebastiani, Cox), Montréal, Que
| | - Giada Sebastiani
- Division of Infectious Diseases (Kronfli, Klein, Lebouché, Sebastiani, Cox), Department of Medicine, McGill University; Chronic Viral Illness Service (Kronfli, Klein, Lebouché, Sebastiani, Cox), McGill University; Research Institute of the McGill University Health Centre (Kronfli, Dussault, Klein, Lebouché, Sebastiani, Cox), Montréal, Que
| | - Joseph Cox
- Division of Infectious Diseases (Kronfli, Klein, Lebouché, Sebastiani, Cox), Department of Medicine, McGill University; Chronic Viral Illness Service (Kronfli, Klein, Lebouché, Sebastiani, Cox), McGill University; Research Institute of the McGill University Health Centre (Kronfli, Dussault, Klein, Lebouché, Sebastiani, Cox), Montréal, Que
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Shah H, Bilodeau M, Burak KW, Cooper C, Klein M, Ramji A, Smyth D, Feld JJ. The management of chronic hepatitis C: 2018 guideline update from the Canadian Association for the Study of the Liver. CMAJ 2019; 190:E677-E687. [PMID: 29866893 DOI: 10.1503/cmaj.170453] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Hemant Shah
- Toronto Centre for Liver Disease (Shah, Feld), Toronto Western and General Hospital, University Health Network, University of Toronto, Toronto, Ont.; Department of Medicine, Liver Unit (Bilodeau), Centre hospitalier de l'Université de Montréal, Montréal, Que.; Department of Medicine, Liver Unit, Division of Gastroenterology and Hepatology (Burak), University of Calgary, Calgary, Alta.; Division of Infectious diseases (Cooper), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; Division of Infectious Diseases and Chronic Viral Illness Service Glen site (Klein), McGill University Health Centre Montréal, Que.; Department of Medicine, Division of Gastroenterology (Ramji), University of British Columbia, Vancouver, BC; Division of Infectious Disease (Smyth), Dalhousie University, Moncton Hospital, Moncton, NB
| | - Marc Bilodeau
- Toronto Centre for Liver Disease (Shah, Feld), Toronto Western and General Hospital, University Health Network, University of Toronto, Toronto, Ont.; Department of Medicine, Liver Unit (Bilodeau), Centre hospitalier de l'Université de Montréal, Montréal, Que.; Department of Medicine, Liver Unit, Division of Gastroenterology and Hepatology (Burak), University of Calgary, Calgary, Alta.; Division of Infectious diseases (Cooper), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; Division of Infectious Diseases and Chronic Viral Illness Service Glen site (Klein), McGill University Health Centre Montréal, Que.; Department of Medicine, Division of Gastroenterology (Ramji), University of British Columbia, Vancouver, BC; Division of Infectious Disease (Smyth), Dalhousie University, Moncton Hospital, Moncton, NB
| | - Kelly W Burak
- Toronto Centre for Liver Disease (Shah, Feld), Toronto Western and General Hospital, University Health Network, University of Toronto, Toronto, Ont.; Department of Medicine, Liver Unit (Bilodeau), Centre hospitalier de l'Université de Montréal, Montréal, Que.; Department of Medicine, Liver Unit, Division of Gastroenterology and Hepatology (Burak), University of Calgary, Calgary, Alta.; Division of Infectious diseases (Cooper), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; Division of Infectious Diseases and Chronic Viral Illness Service Glen site (Klein), McGill University Health Centre Montréal, Que.; Department of Medicine, Division of Gastroenterology (Ramji), University of British Columbia, Vancouver, BC; Division of Infectious Disease (Smyth), Dalhousie University, Moncton Hospital, Moncton, NB
| | - Curtis Cooper
- Toronto Centre for Liver Disease (Shah, Feld), Toronto Western and General Hospital, University Health Network, University of Toronto, Toronto, Ont.; Department of Medicine, Liver Unit (Bilodeau), Centre hospitalier de l'Université de Montréal, Montréal, Que.; Department of Medicine, Liver Unit, Division of Gastroenterology and Hepatology (Burak), University of Calgary, Calgary, Alta.; Division of Infectious diseases (Cooper), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; Division of Infectious Diseases and Chronic Viral Illness Service Glen site (Klein), McGill University Health Centre Montréal, Que.; Department of Medicine, Division of Gastroenterology (Ramji), University of British Columbia, Vancouver, BC; Division of Infectious Disease (Smyth), Dalhousie University, Moncton Hospital, Moncton, NB
| | - Marina Klein
- Toronto Centre for Liver Disease (Shah, Feld), Toronto Western and General Hospital, University Health Network, University of Toronto, Toronto, Ont.; Department of Medicine, Liver Unit (Bilodeau), Centre hospitalier de l'Université de Montréal, Montréal, Que.; Department of Medicine, Liver Unit, Division of Gastroenterology and Hepatology (Burak), University of Calgary, Calgary, Alta.; Division of Infectious diseases (Cooper), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; Division of Infectious Diseases and Chronic Viral Illness Service Glen site (Klein), McGill University Health Centre Montréal, Que.; Department of Medicine, Division of Gastroenterology (Ramji), University of British Columbia, Vancouver, BC; Division of Infectious Disease (Smyth), Dalhousie University, Moncton Hospital, Moncton, NB
| | - Alnoor Ramji
- Toronto Centre for Liver Disease (Shah, Feld), Toronto Western and General Hospital, University Health Network, University of Toronto, Toronto, Ont.; Department of Medicine, Liver Unit (Bilodeau), Centre hospitalier de l'Université de Montréal, Montréal, Que.; Department of Medicine, Liver Unit, Division of Gastroenterology and Hepatology (Burak), University of Calgary, Calgary, Alta.; Division of Infectious diseases (Cooper), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; Division of Infectious Diseases and Chronic Viral Illness Service Glen site (Klein), McGill University Health Centre Montréal, Que.; Department of Medicine, Division of Gastroenterology (Ramji), University of British Columbia, Vancouver, BC; Division of Infectious Disease (Smyth), Dalhousie University, Moncton Hospital, Moncton, NB
| | - Dan Smyth
- Toronto Centre for Liver Disease (Shah, Feld), Toronto Western and General Hospital, University Health Network, University of Toronto, Toronto, Ont.; Department of Medicine, Liver Unit (Bilodeau), Centre hospitalier de l'Université de Montréal, Montréal, Que.; Department of Medicine, Liver Unit, Division of Gastroenterology and Hepatology (Burak), University of Calgary, Calgary, Alta.; Division of Infectious diseases (Cooper), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; Division of Infectious Diseases and Chronic Viral Illness Service Glen site (Klein), McGill University Health Centre Montréal, Que.; Department of Medicine, Division of Gastroenterology (Ramji), University of British Columbia, Vancouver, BC; Division of Infectious Disease (Smyth), Dalhousie University, Moncton Hospital, Moncton, NB
| | - Jordan J Feld
- Toronto Centre for Liver Disease (Shah, Feld), Toronto Western and General Hospital, University Health Network, University of Toronto, Toronto, Ont.; Department of Medicine, Liver Unit (Bilodeau), Centre hospitalier de l'Université de Montréal, Montréal, Que.; Department of Medicine, Liver Unit, Division of Gastroenterology and Hepatology (Burak), University of Calgary, Calgary, Alta.; Division of Infectious diseases (Cooper), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; Division of Infectious Diseases and Chronic Viral Illness Service Glen site (Klein), McGill University Health Centre Montréal, Que.; Department of Medicine, Division of Gastroenterology (Ramji), University of British Columbia, Vancouver, BC; Division of Infectious Disease (Smyth), Dalhousie University, Moncton Hospital, Moncton, NB
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Makarenko I, Artenie A, Hoj S, Minoyan N, Jacka B, Zang G, Barlett G, Jutras-Aswad D, Martel-Laferriere V, Bruneau J. Transitioning from interferon-based to direct antiviral treatment options: A potential shift in barriers and facilitators of treatment initiation among people who use drugs? THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 72:69-76. [PMID: 31010749 DOI: 10.1016/j.drugpo.2019.04.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/31/2019] [Accepted: 04/04/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Multiple barriers for accessing hepatitis C virus (HCV) treatment were identified during the interferon-based (IFN) treatment era for people who inject drugs (PWID). Whether these barriers persist since the introduction of IFN-free direct-acting antiviral (DAA) agents in Canada remains to be documented. This study examined temporal trends in HCV treatment initiation and associated factors during the transition from INF-based to all-oral DAA regimens. METHODS The study population was drawn from a prospective cohort of PWID in Montreal, Canada. At three-month/one-year intervals between 2011 and 2017, participants with chronic HCV infection completed an interviewer-administered questionnaire on socio-demographic characteristics, drug use and health service utilisation, including HCV treatment. Time-updated Cox multivariate regression models, stratified by DAA + INF (2011-2013) and all-oral DAA (2014-2017) availability periods, were conducted to examine associations between time to HCV treatment initiation and associated barriers and facilitators. RESULTS Of 308 participants (85% male, median age 42 [IQR: 33, 50]), 80 (26%) initiated HCV treatment during 915 person-years (PY). Incidence rates increased from 1.6 /100 PY (95%CI:0.9-2.6) in 2011 to 12.7 (10.6-15.1) in 2017 (p-trend = 0.0012). In multivariate analyses, visiting a primary care physician (2011-2013: aHR = 3.63[1.21-10.9]; 2014-2017: 2.52[1.10-5.77]) and frequent injection (0.23[0.05-0.99] and 0.49[0.24-0.99]) were consistently associated with treatment initiation. Participants aged >40 (2.27[1.24-4.13]), receiving opioid agonist therapy (OAT) (2.17[1.19-3.94]), and reporting prior HCV treatment (3.00[1.75-5.15]) were more likely to initiate treatment in the all-oral DAA period. CONCLUSION Treatment initiation increased between 2011 and 2017, but still remains low among PWID. Primary care visiting was a key facilitator regardless of the period, while engagement in OAT and health services, indicated by prior HCV treatment, increased the likelihood of treatment initiation in the DAA era. These findings suggest that access to health services is essential but not enough to scale up treatment in this population.
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Affiliation(s)
- Iuliia Makarenko
- McGill University, Department of Family Medicine, Montreal, QC, Canada; Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Adelina Artenie
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Stine Hoj
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Nanor Minoyan
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Brendan Jacka
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Geng Zang
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Gillian Barlett
- McGill University, Department of Family Medicine, Montreal, QC, Canada
| | - Didier Jutras-Aswad
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada; Department of Psychiatry and Addiction, Université de Montréal, Montreal, QC, Canada
| | - Valerie Martel-Laferriere
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada; Department of Microbiology, Infectious Diseases and Immunology, Université de Montréal, Montreal, QC, Canada
| | - Julie Bruneau
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada; Department of Family and Emergency Medicine, Université de Montréal, Montreal, QC, Canada.
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Should we screen people at increased risk of hepatitis C virus infection? CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2019; 65:195-196. [PMID: 30867176 PMCID: PMC6515960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Faudrait-il dépister une infection par le virus de l’hépatite C chez les personnes à risque élevé? CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2019; 65:e110-e112. [PMID: 30867190 PMCID: PMC6515958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Chan J, Young J, Cox J, Nitulescu R, Klein MB. Patterns of practice and barriers to care for hepatitis C in the direct-acting antiviral (DAA) era: A national survey of Canadian infectious diseases physicians. CANADIAN LIVER JOURNAL 2018; 1:231-239. [PMID: 35992622 PMCID: PMC9202762 DOI: 10.3138/canlivj.2018-0012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 04/19/2018] [Indexed: 07/29/2023]
Abstract
BACKGROUND Infectious diseases (ID) physicians are important for hepatitis C virus (HCV) care delivery in Canada. Our study describes their current and intended patterns of practice, attitudes, and barriers to care. METHODS The study population includes 372 practicing ID physicians who are members of the Association of Medical Microbiology and Infectious Disease (AMMI) Canada. A random sample from each province was invited to participate in a web-based survey. Our outcome of interest was level of HCV care provided, and related intentions for the next 12 months. Additional survey domains included attitudes toward treatment and perceived barriers to care. RESULTS Of 205 invitations to complete the survey, 64 (31%) physicians responded to the full survey and 81 to an abbreviated survey on the main outcomes of interest (overall response rate 71%). After adjusting for non-response, we estimate that 38% (95% CI 29% to 46%) are prescribing direct-acting antiviral (DAA) therapy, and 17% (95% CI 9% to 24%) are interested in starting to prescribe. Of full survey respondents, 100% of prescribers and 79% of non-prescribers agreed that people who inject drugs should be offered DAA therapy. Common barriers to care include patients' competing priorities, mental health comorbidities, poor access to harm reduction services, and insufficient physician training. CONCLUSIONS A large proportion of Canadian ID physicians are not currently prescribing DAA therapy for HCV. While some of these physicians are interested in starting to prescribe, we need strategies to improve physician training and address other barriers to care as provincial restrictions on DAA eligibility are being eliminated.
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Affiliation(s)
- Justin Chan
- Correctional Health Services, New York City Health + Hospitals, New York, New York
| | - Jim Young
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
| | - Joseph Cox
- Division of Infectious Diseases, Faculty of Medicine, McGill University, Montreal, Québec
| | - Roy Nitulescu
- Division of Infectious Diseases, Faculty of Medicine, McGill University, Montreal, Québec
| | - Marina B Klein
- Division of Infectious Diseases, Faculty of Medicine, McGill University, Montreal, Québec
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Irvin R, Ward K, Agee T, Nelson NP, Vellozzi C, Thomas DL, Millman AJ. Comparison of hepatitis C virus testing recommendations in high-income countries. World J Hepatol 2018; 10:743-751. [PMID: 30386467 PMCID: PMC6206144 DOI: 10.4254/wjh.v10.i10.743] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 07/02/2018] [Accepted: 07/10/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate hepatitis C virus (HCV) testing recommendations from the United States and other high-income countries.
METHODS A comprehensive search for current HCV testing recommendations from the top quartile of United Nations Human Development Index (HDI) countries (very high HDI) was performed using Google and reviewed from May 1 - October 30, 2014 and re-reviewed April 1 - October 2, 2017.
RESULTS Of the 51 countries identified, 16 had HCV testing recommendations from a government body or recommendations issued collaboratively between a government and a medical organization. Of these 16 countries, 15 had HCV testing recommendations that were primarily risk-based and highlight behaviors, exposures, and conditions that are associated with HCV transmission in that region. In addition to risk-based testing, the HCV Guidance Panel (United States) incorporates recommendations for a one-time test for individuals born during 1945-1965 (the birth cohort) without prior ascertainment of risk into their guidance. In addition to the United States, six other countries either have an age-based testing recommendation or recommend one-time testing for all adults independent of risk factors typical of the region.
CONCLUSION This review affirmed the similarities of the HCV Guidance Panel’s guidance with those of recommendations from very high HDI countries.
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Affiliation(s)
- Risha Irvin
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD 21205, United States
| | - Kathleen Ward
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD 21205, United States
| | - Tracy Agee
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD 21205, United States
| | - Noele P Nelson
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA 30329, United States
| | - Claudia Vellozzi
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA 30329, United States
| | - David L Thomas
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD 21205, United States
| | - Alexander J Millman
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA 30329, United States
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Malebranche M, King D, Leonard J. Descriptive epidemiology of hepatitis C in individuals referred for specialized HCV care in Newfoundland and Labrador, 1996–2014. CANADIAN LIVER JOURNAL 2018; 1:107-114. [DOI: 10.3138/canlivj.2018-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 05/30/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND: Despite growing awareness of the significant burden of disease caused by hepatitis C virus (HCV) infection worldwide, understanding of the epidemiology and demographic distribution of HCV infection in Canada, specifically in Atlantic Canada, is limited. Currently, data on the demographic and clinical profile of HCV-infected individuals in Newfoundland and Labrador is limited. The aim of this study is to address this knowledge gap. Methods: A retrospective cohort study of HCV-positive individuals referred for specialized care in St. John’s, Newfoundland, between 1996 and 2014, was conducted. Descriptive data were obtained through chart review and access to a database consisting of individuals referred for specialized HCV care in St. John’s. Results: During the study period, 767 individuals were referred for specialized HCV care, of whom 714 were included in our analysis. These individuals represent 57.5% of HCV-positive cases identified by the province’s public health department during the same time frame. HCV infection was more common among men (68.2%) and urban dwellers (74.8%). The majority of cases were HCV genotype 1 (52.1%). Intravenous and intranasal drug use were the most common self-reported risk factors for HCV transmission. High loss-to-follow-up rates were found among those referred from the province’s correctional system. Conclusions: This study provides important insights into the demographic and clinical profile of individuals referred for HCV-related care in Newfoundland and Labrador and fills a gap in the current understanding of HCV-positive individuals in this Atlantic province. These findings can help inform future directions for HCV-related health policy, resource allocation, and clinical care initiatives in Newfoundland and Labrador and across Canada.
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Affiliation(s)
- Mary Malebranche
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Dawn King
- Department of Gastroenterology, Eastern Health, St. John’s, Newfoundland and Labrador
| | - Jennifer Leonard
- Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland
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Deuffic-Burban S, Huneau A, Verleene A, Brouard C, Pillonel J, Le Strat Y, Cossais S, Roudot-Thoraval F, Canva V, Mathurin P, Dhumeaux D, Yazdanpanah Y. Assessing the cost-effectiveness of hepatitis C screening strategies in France. J Hepatol 2018; 69:785-792. [PMID: 30227916 DOI: 10.1016/j.jhep.2018.05.027] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 05/09/2018] [Accepted: 05/15/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS In Europe, hepatitis C virus (HCV) screening still targets people at high risk of infection. We aim to determine the cost-effectiveness of expanded HCV screening in France. METHODS A Markov model simulated chronic hepatitis C (CHC) prevalence, incidence of events, quality-adjusted life years (QALYs), costs and incremental cost-effectiveness ratio (ICER) in the French general population, aged 18 to 80 years, undiagnosed for CHC for different strategies: S1 = current strategy targeting the at risk population; S2 = S1 and all men between 18 and 59 years; S3 = S1 and all individuals between 40 and 59 years; S4 = S1 and all individuals between 40 and 80 years; S5 = all individuals between 18 and 80 years (universal screening). Once CHC was diagnosed, treatment was initiated either to patients with fibrosis stage ≥F2 or regardless of fibrosis. Data were extracted from published literature, a national prevalence survey, and a previously published mathematical model. ICER were interpreted based on one or three times French GDP per capita (€32,800). RESULTS Universal screening led to the lowest prevalence of CHC and incidence of events, regardless of treatment initiation. When considering treatment initiation to patients with fibrosis ≥F2, targeting all people aged 40-80 was the only cost-effective strategy at both thresholds (€26,100/QALY). When we considered treatment for all, although universal screening of all individuals aged 18-80 is associated with the highest costs, it is more effective than targeting all people aged 40-80, and cost-effective at both thresholds (€31,100/QALY). CONCLUSIONS In France, universal screening is the most effective screening strategy for HCV. Universal screening is cost-effective when treatment is initiated regardless of fibrosis stage. From an individual and especially from a societal perspective of HCV eradication, this strategy should be implemented. LAY SUMMARY In the context of highly effective and well tolerated therapies for hepatitis C virus that are now recommended for all patients, a reassessment of hepatitis C screening strategies is needed. An effectiveness and cost-effectiveness study of different strategies targeting either the at-risk population, specific ages or all individuals was performed. In France, universal screening is the most effective strategy and is cost-effective when treatment is initiated regardless of fibrosis stage. From an individual and especially from a societal perspective of hepatitis C virus eradication, this strategy should be implemented.
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Affiliation(s)
- Sylvie Deuffic-Burban
- IAME, UMR 1137, Inserm, Université Paris Diderot, Sorbonne Paris Cité, Paris, France; Université Lille, Inserm, CHU Lille, U995 - LIRIC - Lille Inflammation Research International Center, Lille, France.
| | - Alexandre Huneau
- IAME, UMR 1137, Inserm, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Adeline Verleene
- IAME, UMR 1137, Inserm, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | | | | | | | - Sabrina Cossais
- IAME, UMR 1137, Inserm, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | | | - Valérie Canva
- Service des Maladies de l'Appareil Digestif et de la Nutrition, Hôpital Huriez, CHRU Lille, Lille, France
| | - Philippe Mathurin
- Université Lille, Inserm, CHU Lille, U995 - LIRIC - Lille Inflammation Research International Center, Lille, France; Service des Maladies de l'Appareil Digestif et de la Nutrition, Hôpital Huriez, CHRU Lille, Lille, France
| | | | - Yazdan Yazdanpanah
- IAME, UMR 1137, Inserm, Université Paris Diderot, Sorbonne Paris Cité, Paris, France; Service de maladies Infectieuses et tropicales, Hôpital Bichat Claude Bernard, Paris, France
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Wong WWL, Haines A, Farhang Zangneh H, Shah H. Can we afford not to screen and treat hepatitis C virus infection in Canada? CANADIAN LIVER JOURNAL 2018; 1:51-65. [PMID: 35990719 PMCID: PMC9202796 DOI: 10.3138/canlivj.1.2.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 06/12/2018] [Indexed: 08/20/2023]
Abstract
BACKGROUND Screening for hepatitis C virus (HCV) followed by direct-acting antiviral (DAA) treatment in individuals born between 1945 and 1964 has been shown to be both effective and cost-effective, but the question of affordability remains unresolved. We looked at long-term cost and health outcomes of HCV screening for Ontario up to 2030. METHODS We used a validated state-transition model to analyze the budget and health impact of HCV screening followed by DAA treatment in individuals born between 1945 and 1964 versus current practice. We used a payer's perspective, discounting costs at an annual rate of 1.5%. Costs, liver-related deaths, and hepatocellular carcinoma (HCC) and decompensated cirrhosis (DC) cases detected were measured over a 14-year period. RESULTS By 2030, the cost of implementing a HCV screening program for individuals born between 1945 and 1964 will add an additional $845 million to the Ontario health care budget. Sensitivity analyses showed that DAA costs had the largest effect on the budget, and decreasing DAA costs to $16,000 will lead to a significantly lower budget impact of $331 million. Regarding population health, a screen-and-treat strategy will prevent 1,199 cases of HCC, 1,565 cases of DC, and 1,665 liver-related deaths by 2030. CONCLUSIONS Contrasting the budget impact of this HCV screening strategy with other recommended health services and technologies, we conclude that HCV screening should be considered affordable. If Canada is committed to meeting the targets set out by the World Health Organization, then provinces cannot afford to not expand current screening programs.
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Affiliation(s)
- William WL Wong
- School of Pharmacy, Faculty of Science, University of Waterloo, Kitchener, Ontario, Canada
- Toronto Health Economics and Technology Assessment Collaborative (THETA), Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Alex Haines
- Toronto Health Economics and Technology Assessment Collaborative (THETA), Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Hooman Farhang Zangneh
- Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Hemant Shah
- Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Khan S, Bernier A, Dapp D, Fortier E, Krajden M, King A, Grebely J, Sagan SM, Cooper CL, Crawley AM. 6th Canadian Symposium on Hepatitis C Virus: Delivering a cure for hepatitis C infection-What are the remaining gaps? CANADIAN LIVER JOURNAL 2018; 1:94-105. [PMID: 35990718 PMCID: PMC9202794 DOI: 10.3138/canlivj.1.2.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 03/12/2018] [Indexed: 08/31/2024]
Abstract
Estimates are that more than 250,000 people in Canada are chronically infected with hepatitis C virus (HCV), and many more are unaware of their infection status. If untreated, chronic HCV infection can lead to cirrhosis and subsequent complications such as hepatocellular carcinoma. The Canadian Network on Hepatitis C, supported by the Public Health Agency of Canada and the Canadian Institutes of Health Research, has been committed to the scientific study of chronic hepatitis C and to supporting the advocacy work to improve diagnosis and access to HCV care in Canada. Although the treatment of HCV infection has been greatly advanced with direct-acting antivirals, with cure rates as high as 95%, many challenges remain in the implementation of HCV care. These issues include the lack of an effective vaccine, infection screening, treatment failure or resistance, post-cure health issues, limitations of treatment access despite increased provincial subsidization, complex needs of at-risk populations (ie, injection drug users, societal obstacles). At the 6th Canadian Symposium on HCV in March 2017, the theme "Delivering a Cure for Hepatitis C Infection: What Are the Remaining Gaps?" provided a framework in which basic scientists, clinicians, epidemiologists, social scientists, and community members interested in HCV research in Canada could showcase how they are working to address these ongoing challenges.
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Affiliation(s)
- Sarwat Khan
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario, Canada
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Annie Bernier
- Department of Microbiology and Immunology, McGill University, Montreal, Quebec, Canada
| | - Dustin Dapp
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Emmanuel Fortier
- Faculté de Médicine, Université de Montréal, Montreal, Quebec, Canada
| | - Mel Krajden
- British Columbia Center for Disease Control, Vancouver, British Columbia, Canada
| | - Alexandra King
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Jason Grebely
- The Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia;
| | - Selena M Sagan
- Department of Microbiology and Immunology, McGill University, Montreal, Quebec, Canada
| | - Curtis L Cooper
- School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Division of Infectious Diseases, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Angela M Crawley
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario, Canada
- Chronic Diseases Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Biology, Carleton University, Ottawa, Ontario, Canada
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Greenaway C, Makarenko I, Tanveer F, Janjua NZ. Addressing hepatitis C in the foreign-born population: A key to hepatitis C virus elimination in Canada. CANADIAN LIVER JOURNAL 2018; 1:34-50. [PMID: 35990716 PMCID: PMC9202799 DOI: 10.3138/canlivj.1.2.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 03/12/2018] [Indexed: 10/26/2023]
Abstract
Hepatitis C virus (HCV) is the leading cause of death from infectious disease in Canada. Immigrants are an important group who are at increased risk for HCV; they account for a disproportionate number of all HCV cases in Canada (~30%) and have approximately a twofold higher prevalence of HCV (~2%) than those born in Canada. HCV-infected immigrants are more likely to develop cirrhosis and hepatocellular carcinoma and are more likely to have a liver-related death during a hospitalization than HCV-infected non-immigrants. Several factors, including lack of routine HCV screening programs in Canada for immigrants before or after arrival, lack of awareness on the part of health practitioners that immigrants are at increased risk of HCV and could benefit from screening, and several patient- and health system-level barriers that affect access to health care and treatment likely contribute to delayed diagnosis and treatment uptake. HCV screening and engagement in care among immigrants can be improved through reminders in electronic medical records that prompt practitioners to screen for HCV during clinical visits and implementation of decentralized community-based screening strategies that address cultural and language barriers. In conclusion, early screening and linkage to care for immigrants from countries with an intermediate or high prevalence of HCV would not only improve the health of this population but will be key to achieving HCV elimination in Canada. This article describes the unique barriers encountered by the foreign-born population in accessing HCV care and approaches to overcoming these barriers.
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Affiliation(s)
- Christina Greenaway
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montréal, Québec, Canada
- Division of Infectious Diseases, Jewish General Hospital, McGill University, Montréal, Québec, Canada
| | - Iuliia Makarenko
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montréal, Québec, Canada
| | - Fozia Tanveer
- CATIE (Canada’s source for HIV and hepatitis C information), Toronto, Ontario, Canada
| | - Naveed Z Janjua
- Clinical Preventative Services, British Columbia Centers for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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