Reply to: ‘High prevalence of hepatitis C infection among multidrug-resistant tuberculosis patients’

Abstract

We agree with Seung et al.[1]Seung K.J. Frank M.F. Hewison C. Huerga H. Khan U. Mitnick C.D. on behalf of the endTB Study GroupHigh prevalence of hepatitis C infection among multidrug-resistant tuberculosis patients.J Hepatol. 2020; 72: 1028-1029Google Scholar that integrating HCV testing and treatment into existing programs will be critical both for achieving hepatitis C elimination and for the management of other conditions while simultaneously creating efficiencies in the delivery of health care. Our integrated care center (ICC) model for people who inject drugs (PWID) in India was focused on integrating essential infectious disease and harm reduction services in venues tailored to the needs of PWID.[2]Solomon S.S. Solomon S. McFall A.M. Srikrishnan A.K. Anand S. Verma V. et al.Indian National Collaboration on AIDS StudyIntegrated HIV testing, prevention, and treatment intervention for key population in India: a cluster-randomised trial.Lancet HIV. 2019; 6: e283-e296Abstract Full Text Full Text PDF PubMed Scopus (19) Google Scholar While the focus of the results described in the Journal of Hepatology[3]Solomon S.S. Quinn T.C. Solomon S. McFall A.M. Srikrishnan A.K. Verma V. et al.Integrating HCV testing with HIV programs improves hepatitis C outcomes in people who inject drugs.J Hepatol. 2020; 72: 67-74Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar was on integration of HCV testing with existing HIV and harm reduction services, it is important to note that other services were offered at the ICCs including screening for tuberculosis and management of sexually transmitted infections. However, Seung et al. are arguing for models that extend beyond what was described in our paper that essentially reflect a move towards horizontal programming of health service delivery in line with the sustainable development goals. We agree with this approach in general and that tuberculosis (TB) programs would be important venues to identify persons who are infected with HCV that might not be reached by other testing programs. We also agree that this integration provides a dual benefit of both identifying persons with HCV infection and also contributing to the management of TB particularly in settings including India where there is a high burden of multidrug-resistant TB and standard TB treatments are hepatotoxic. Such strategies are also likely to be cost saving. Indeed, we have previously demonstrated that simply adding HCV antibody testing to existing case-finding strategies for HIV would only add an additional median cost of $11 to identify one HCV viremic person compared to $194 if a stand-alone HCV screening program were implemented.[4]Solomon S.S. McFall A.M. Lucas G.M. Srikrishnan A.K. Kumar M.S. Anand S. et al.Respondent-driven sampling for identification of HIV- and HCV-infected people who inject drugs and men who have sex with men in India: a cross-sectional, community-based analysis.PLoS Med. 2017; 14: e1002460Crossref PubMed Scopus (17) Google Scholar Similar to what was suggested by the data provided by Seung et al., the benefit would be greatest in settings where the underlying prevalence of HCV is greatest – perhaps in settings with either high burden of unsafe medical injections or high population prevalence of injection drug use. Beyond infectious diseases, it is also critical that programs address the underlying psychosocial (mental health/drug abuse) and environmental constructs that place these individuals at high risk for HCV, TB and other infectious diseases. Countries should carefully consider this underlying burden and etiology when designing programs for integration of HCV services into existing health systems. Please refer to the accompanying ICMJE disclosure forms for further details. Download .pdf (.17 MB) Help with pdf files disclosures.pdf Integrating HCV testing with HIV programs improves hepatitis C outcomes in people who inject drugs: A cluster-randomized trialJournal of HepatologyVol. 72Issue 1PreviewAn estimated 71 million people are chronically infected with HCV.1 The availability of safe, short duration, curative therapies2–4 prompted the World Health Organization (WHO) to release targets for HCV elimination – 80% reduction in incidence and 65% reduction in mortality by 2030.5 Achieving these targets requires 80% of all people with active infection to be treated. Thus, it is essential that major inroads are made in people who inject drugs (PWID) in low- and middle-income countries (LMICs). Full-Text PDF High prevalence of hepatitis C infection among multidrug-resistant tuberculosis patientsJournal of HepatologyVol. 72Issue 5PreviewIn “Integrating HCV testing with HIV programs improves hepatitis C outcomes in people who inject drugs: A cluster-randomized trial”,1 the authors studied an intervention that integrated HCV testing and education into HIV services across India. In our opinion, many national tuberculosis (TB) programs should also consider integrating HCV testing. TB or the highly resistant variant of the disease, multidrug-resistant (MDR) TB, is generally not considered a risk factor for HBV or HCV infection, except in those who are co-infected with HIV or who are intravenous drug users. Full-Text PDF