scholarly journals Hepatitis C Prevalence and Management Among Patients Receiving Opioid Substitution Treatment in General Practice in Ireland: Baseline Data from a Feasibility Study

10.2196/10313 ◽  
2018 ◽  
Vol 7 (2) ◽  
pp. e10313 ◽  
Author(s):  
Ross Murtagh ◽  
Davina Swan ◽  
Eileen O'Connor ◽  
Geoff McCombe ◽  
John S Lambert ◽  
...  
Keyword(s):  
General Practice ◽  
Hepatitis C ◽  
Feasibility Study ◽  
Baseline Data ◽  
Substitution Treatment ◽  
Opioid Substitution Treatment ◽  
Opioid Substitution

scholarly journals Hepatitis C Prevalence and Management Among Patients Receiving Opioid Substitution Treatment in General Practice in Ireland: Baseline Data from a Feasibility Study (Preprint)

2018 ◽  
Author(s):  
Ross Murtagh ◽  
Davina Swan ◽  
Eileen O'Connor ◽  
Geoff McCombe ◽  
John S. Lambert ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Baseline Data ◽  
Substitution Treatment ◽  
Substitution Therapy ◽  
Opioid Substitution Therapy ◽  
Opioid Substitution Treatment ◽  
Hcv Screening ◽  
Clinical Records ◽  
Opioid Substitution

BACKGROUND Hepatitis C virus (HCV) infection is a major cause of chronic liver disease and death. Injection drug use is now one of the main routes of transmission of HCV in Ireland and globally with an estimated 80% new infections occurring among people who inject drugs (PWID). OBJECTIVE We aimed to examine whether patients receiving opioid substitution therapy in primary care practices in Ireland were receiving guideline-adherent care regarding HCV screening. Ireland has developed a model of care for delivering opioid substitution treatment in the primary care setting. We conducted this study given the shift of providing care for PWID from secondary to primary care settings, in light of current guidelines aimed at scaling up interventions to reduce chronic HCV infection and associated mortality. METHODS We included baseline data from the Dublin site of the Heplink study, a feasibility study focusing on developing complex interventions to enhance community-based HCV treatment and improve the HCV care pathway between primary and secondary care. We recruited 14 opioid substitution treatment-prescribing general practices that employed the administration of opioid substitution therapy from the professional networks and databases of members of the research consortium. A standardized nonprobability sampling framework was used to identify 10 patients from each practice to participate in the study. Patients were eligible if aged ≥18 years, on opioid substitution treatment, and attending the practice for any reason during the recruitment period. The baseline data were collected from the clinical records of participating patients. We collected and analyzed data on demographic characteristics, care processes and outcomes regarding HCV and other blood-borne viruses, urinalysis test results, alcohol use disorders, chronic illness, and health service utilization. We examined whether patients received care concordant with guidelines related to HCV screening and care. RESULTS The baseline data were collected from clinical records of 134 patients; 72.2% (96/134) were males; (mean age 43, SD 7.6; range 27-71 years); 94.8% (127/134) of patients had been tested for anti-HCV antibody in their lifetime; of those, 77.9% (99/127) tested positive. Then, 83.6% (112/134) of patients had received an HIV antibody test in their lifetime; of those, 6.3% (7/112) tested HIV positive. Moreover, 66.4% (89/134) of patients had been tested for hepatitis B virus in their lifetime and 8% (7/89) of those were positive. In the 12 months before the study, 30.6% (41/134) of patients were asked about their alcohol use by their general practitioner, 6.0% (8/134) received a brief intervention, and 2.2% (3/134) were referred to a specialist addiction or alcohol treatment service. CONCLUSIONS With general practice and primary care playing an increased role in HCV care, this study highlights the importance of prioritizing the development and evaluation of real-world clinical solutions that support patients from diagnosis to treatment completion.

Integrating Hepatitis C Care for opioid substitution treatment patients attending general practice: Feasibility, Clinical and Cost Effectiveness (Preprint)

2021 ◽  
Author(s):  
Geoff McCombe ◽  
Davina Swan ◽  
John S Lambert ◽  
Eileen O’Connor ◽  
Zoe Ward ◽  
...  
Keyword(s):  
General Practice ◽  
Cost Effectiveness ◽  
Hepatitis C ◽  
Complex Intervention ◽  
Substitution Treatment ◽  
Hcv Treatment ◽  
Post Intervention ◽  
Opioid Substitution Treatment ◽  
Clinical Support ◽  
Opioid Substitution

BACKGROUND Hepatitis C (HCV) infection is common among people who inject drugs (PWID), yet well described barriers mean that a minority have accessed HCV treatment. OBJECTIVE The aim of this study was to examine feasibility, acceptability, clinical and cost effectiveness of an integrated model of HCV care for opioid substitution treatment (OST) patients in general practice. METHODS A pre-and-post intervention design with an embedded economic analysis was used to establish the feasibility, acceptability, clinical and cost effectiveness of a complex intervention to optimise HCV identification and linkage to HCV treatment among patients prescribed methadone in primary care. The ‘complex intervention’ comprised General Practitioner (GP) / practice staff education, nurse-led clinical support, and enhanced community-based HCV assessment of patients. General practices in North Dublin were recruited from the professional networks of the research team and from GPs who attended educational sessions. RESULTS Fourteen practices, 135 patients participated. Follow-up data was collected six-months post-intervention on 131(97.0%) patients. With regards to clinical effectiveness, among HCV antibody-positive patients, there was a significant increase in the proportions of who had a liver fibroscan (17/101(16.8%) vs 52/100 (52.0%); p<0.001), had attended hepatology/infectious diseases services (51/101(50.5%) vs 61/100 (61.0%); p=0.002), and initiated treatment (20/101(19.8%) vs 30/100 (30.0%); p=0.004). The mean incremental cost-effectiveness ratio of the intervention was €13,255 per quality adjusted life year gained at current full drug list price (€39,729 per course), which would be cost saving if these costs are reduced by 88%. CONCLUSIONS The complex intervention involving clinical support, access to assessment and practitioner education has the potential to enhance patient care, improving access to assessment and treatment in a cost effective manner.

scholarly journals Hepatitis C testing and status among opioid substitution treatment clients in New South Wales

2014 ◽  
Vol 38 (2) ◽  
pp. 160-164 ◽  
Author(s):  
Fiona L. Shand ◽  
Carolyn Day ◽  
William Rawlinson ◽  
Louisa Degenhardt ◽  
Nicholas G. Martin ◽  
...  
Keyword(s):  
Hepatitis C ◽  
New South ◽  
New South Wales ◽  
Substitution Treatment ◽  
Opioid Substitution Treatment ◽  
South Wales ◽  
Opioid Substitution

scholarly journals Hepatitis C Treatment Uptake among Patients Who Have Received Opioid Substitution Treatment: A Population-Based Study

PLoS ONE ◽  
2016 ◽  
Vol 11 (11) ◽  
pp. e0166451 ◽  
Author(s):  
Håvard Midgard ◽  
Jørgen G. Bramness ◽  
Svetlana Skurtveit ◽  
John W. Haukeland ◽  
Olav Dalgard
Keyword(s):  
Hepatitis C ◽  
Population Based ◽  
Substitution Treatment ◽  
Opioid Substitution Treatment ◽  
Population Based Study ◽  
Hepatitis C Treatment ◽  
Treatment Uptake ◽  
Opioid Substitution

Hepatitis C Virus Prevalence and Incidence in a Large Nationwide Sample of Patients in Opioid Substitution Treatment in Germany: A Prospective Cohort Study

2019 ◽  
Vol 70 (10) ◽  
pp. 2199-2205 ◽  
Author(s):  
Bernd Schulte ◽  
Christiane Sybille Schmidt ◽  
Lisa Strada ◽  
Moritz Rosenkranz ◽  
Ingo Schäfer ◽  
...  
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
High Risk ◽  
Incidence Rates ◽  
Hcv Rna ◽  
High Risk Population ◽  
Substitution Treatment ◽  
Opioid Substitution Treatment ◽  
Hcv Antibody ◽  
Opioid Substitution

Abstract Background Hepatitis C virus (HCV) infection is highly prevalent among people who inject drugs (PWID). Accurate data on HCV prevalence and incidence rates among patients receiving opioid substitution treatment (OST) are needed to estimate the current and future burden of HCV infections in this high-risk population. Methods Baseline data from routine care were collected between October 2014 and June 2016 from randomly selected OST facilities in Germany. The primary outcome measure was the HCV status (antibody and RNA prevalence). Patients who were HCV antibody–negative at baseline were followed up after 12 months to calculate the HCV incidence rate. Results Sixty-three facilities from 14 German Federal States provided clinical data for a total of 2466 OST patients. HCV antibody and HCV RNA prevalence were 58.8% (95% confidence interval [CI], 56.8%–60.8%) and 27.3% (95% CI, 25.5%–29.2%), respectively. At baseline, a total of 528 patients (21.4%) had previously undergone antiviral treatment. Moreover, lower HCV RNA prevalence was associated with female gender, employment, younger age, and shorter duration of OST and opioid dependence. The HCV incidence rate was 2.5 cases per 100 person-years. Conclusions The low HCV RNA prevalence and HCV incidence rates confirm that OST in Germany is an effective setting both for treating chronic HCV infections and for preventing new infections among PWID. Scaling up the provision of OST, HCV testing, and HCV treatment among OST patients are important public health strategies for reducing HCV infections in this high-risk population.

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