Dataset Information

Aiming at the Global Elimination of Viral Hepatitis: Challenges Along the Care Continuum.

ABSTRACT: A recent international workshop, organized by the authors, analyzed the obstacles facing the ambitious goal of eliminating viral hepatitis globally. We identified several policy areas critical to reaching elimination targets. These include providing hepatitis B birth-dose vaccination to all infants within 24 hours of birth, preventing the transmission of blood-borne viruses through the expansion of national hemovigilance schemes, implementing the lessons learned from the HIV epidemic regarding safe medical practices to eliminate iatrogenic infection, adopting point-of-care testing to improve coverage of diagnosis, and providing free or affordable hepatitis C treatment to all. We introduce Egypt as a case study for rapid testing and treatment scale-up: this country offers valuable insights to policy makers internationally, not only regarding how hepatitis C interventions can be expeditiously scaled-up, but also as a guide for how to tackle the problems encountered with such ambitious testing and treatment programs.

SUBMITTER: Heffernan A

PROVIDER: S-EPMC5767952 | biostudies-literature | 2018 Jan

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Aiming at the Global Elimination of Viral Hepatitis: Challenges Along the Care Continuum.

Heffernan Alastair A Barber Ella E Cook Nicola A NA Gomaa Asmaa I AI Harley Yolande X YX Jones Christopher R CR Lim Aaron G AG Mohamed Zameer Z Nayagam Shevanthi S Ndow Gibril G Shah Rajiv R Sonderup Mark W MW Spearman C Wendy CW Waked Imam I Wilkinson Robert J RJ Taylor-Robinson Simon D SD

Open forum infectious diseases 20171117 1

A recent international workshop, organized by the authors, analyzed the obstacles facing the ambitious goal of eliminating viral hepatitis globally. We identified several policy areas critical to reaching elimination targets. These include providing hepatitis B birth-dose vaccination to all infants within 24 hours of birth, preventing the transmission of blood-borne viruses through the expansion of national hemovigilance schemes, implementing the lessons learned from the HIV epidemic regarding s ...[more]

PMID: 29354656

Similar Datasets

Project description:BACKGROUND:Birth cohort screening is recommended for hepatitis C virus (HCV) and underserved populations are disproportionally affected by HCV. Little is known about the influence of race on the HCV care continuum in this population. OBJECTIVE:To assess the cascade of HCV care in a large racially diverse and underserved birth cohort. DESIGN:Retrospective cohort study using electronic medical record data abstracted until August 31, 2017. PATIENTS:34,810 patients born between 1945 and 1965 engaged in primary care between October 1, 2014, and October 31, 2016, within the safety-net clinics of the San Francisco Health Network. MAIN MEASURES:Rate of hepatitis C testing, hepatitis C treatment, and response to therapy. RESULTS:Cohort characteristics were as follows: median age 59 years, 57.6% male, 25.5% White (20.6% Black, 17.7% Latino, 33.0% Asian/Pacific Islander (API), 2% other), and 32.6% preferred a non-English language. 99.7% had an HCV test (95.4% HCV antibody, 4.3% HCVRNA alone). Among HCV antibody-positive patients (N?=?4587), 22.9% were not tested for confirmatory HCVRNA. Among viremic patients (N?=?3673), 20.8% initiated HCV therapy, 90.6% achieved sustained virologic response (SVR) and 8.1% did not have a SVR test. HCV screening and treatment were highest in APIs (98.7 and 34.7% respectively; p?<?0.001). Blacks had the highest chronic HCV rate (22.2%; p?<?0.001). Latinos had the lowest SVR rate (81.3%; p?=?0.01). On multivariable analysis, API race (vs White, OR 1.20; p?=?0.001), presence of HIV co-infection (OR 1.58; p?=?0.02), presence of chronic kidney disease (OR 0.47; p?<?0.001), English (vs non-English) as preferred language (OR 0.54; p?=?0.002), ALT (OR 0.39 per doubling; p?<?0.001), and HCVRNA (OR 0.83 per 10-fold increase; p?<?0.001) were associated with HCV treatment. CONCLUSIONS:Despite near-universal screening, gaps in active HCV confirmation, treatment, and verification of cure were identified and influenced by race. Tailored interventions to engage and treat diverse and underserved populations with HCV infection are needed.

Project description:BackgroundThe HIV care continuum (diagnosis, linkage to care, retention in care, receipt of antiretroviral therapy (ART), viral suppression) has been used to identify opportunities for improving the delivery of HIV care. Continuum steps are typically calculated in a conditional manner, with the number of persons completing the prior step serving as the base population for the next step. This approach may underestimate the prevalence of viral suppression by excluding patients who are suppressed but do not meet standard definitions of retention in care. Understanding how retention in care and viral suppression interact and change over time may improve our ability to intervene on these steps in the continuum.MethodsWe followed 17,140 patients at 11 U.S. HIV clinics between 2010-2012. For each calendar year, patients were classified into one of five categories: (1) retained/suppressed, (2) retained/not-suppressed, (3) not-retained/suppressed, (4) not-retained/not-suppressed, and (5) lost to follow-up (for calendar years 2011 and 2012 only). Retained individuals were those completing ? 2 HIV medical visits separated by ? 90 days in the year. Persons not retained completed ? 1 HIV medical visit during the year, but did not meet the retention definition. Persons lost to follow-up had no HIV medical visits in the year. HIV viral suppression was defined as HIV-1 RNA ? 200 copies/mL at the last measure in the year. Multinomial logistic regression was used to determine the probability of patients' transitioning between retention/suppression categories from 2010 to 2011 and 2010 to 2012, adjusting for age, sex, race/ethnicity, HIV risk factor, insurance status, CD4 count, and use of ART.ResultsOverall, 65.8% of patients were retained/suppressed, 17.4% retained/not-suppressed, 10.0% not-retained/suppressed, and 6.8% not-retained/not-suppressed in 2010. 59.5% of patients maintained the same status in 2011 (kappa=0.458) and 53.3% maintained the same status in 2012 (kappa=0.437).ConclusionsNot counting patients not-retained/suppressed as virally suppressed, as is commonly done in the HIV care continuum, underestimated the proportion suppressed by 13%. Applying the care continuum in a longitudinal manner will enhance its utility.

Dataset Information

Aiming at the Global Elimination of Viral Hepatitis: Challenges Along the Care Continuum.

Publications

Aiming at the Global Elimination of Viral Hepatitis: Challenges Along the Care Continuum.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets