HCV Risk Research Articles

A Prospective Multicenter Study of Hepatocellular Carcinoma in Italian Hemophiliacs With Chronic Hepatitis C

AbstractTo assess the risk factors, natural history, and eligibility for curative treatment of early-detected hepatocellular carcinoma (HCC), 385 hemophiliacs who were treated with blood or plasma derivates for at least 10 years and had persistently elevated aminotransferase values underwent an annual screening with an abdominal ultrasound examination and measurement of the serum alpha-fetoprotein (AFP) level. Of these, 355 had serum antibody to hepatitis C virus (anti-HCV), 29 had anti-HCV and hepatitis B surface antigen (HBsAg), and one had HBsAg alone; 141 had serum antibody to human immunodeficiency virus (anti-HIV). During 48 months of follow-up study, six patients developed HCC. All HCC patients had a HCV-related cirrhosis and had been exposed to HCV risk at a median age of 40 years. All patients had a multicentric tumor, which was not eligible for curative treatment. Univariate analysis showed age, cirrhosis, and baseline AFP levels to be significantly associated with an increased risk of HCC. By multivariate analysis, the risk of HCC was infinite in patients with cirrhosis, 31.0 for those with baseline AFP higher than 11 ng/mL, and 17.9 for those more than 45 years of age. In conclusion, the risk of cancer was greater for patients infected later in life, particularly those with cirrhosis and high AFP. Annual screening of hemophiliacs with ultrasound and AFP fails to identify potentially curable tumors because the diagnosis is made at a late stage of the disease.

Look-Back Study of Transfusion-Transmitted Hepatitis C Virus Infection in Iran

Background: With the identification of blood donors with a subsequent positive result in HCV screening and the possibility of HCV transmission via their previous negative donations, the role of look-back investigation has been crucial in enhancing blood safety. A retrospective study was conducted to identify the fate of blood components from donors subsequently found to be confirmed HCV positive cases with previous negative donations. Objectives: This look-back study aimed to determine the transfusion-induced hepatitis C virus infection through previous HCV-negative donations of subsequent HCV positive blood donors in Iran. Methods: In this study, all serologically confirmed HCV positive blood donors across the country from December 2015 to June 2017 were included. A look-back process was conducted by tracing back previous HCV negative donations of subsequent HCV-positive blood donors to specific recipients, according to the IBTO instructions. The HCV RNA testing was carried out using an in-house one-step TaqMan real-time RT-PCR assay. Results: During the study period, 280 serologically confirmed HCV-positive blood donors were included, with 267 as first-time, nine as repeated, and three as regular donors. Of the participants, the first-time donors were excluded, the repeated donors were not eligible, and only the regular donors were selected for the look-back study. The HCV RNA was detected in one regular donor, but HCV infection was not detected in his previous donation recipient. In addition, more than two HCV risk factors were reported by each regular blood donor. Conclusions: According to the results, evidence of HCV transmission via previous blood transfusions and the risk of HCV infection was not observed among recipients. Due to the reporting of some HCV risk factors by the subjects, paying proper attention to the donor selection process is highly recommended.

Impact of test-and-treat and risk reduction strategies on HCV transmission among MSM living with HIV in France: a modelling approach

ObjectiveSince the early 2000s, there has been an epidemic of HCV occurring among men who have sex with men (MSM) living with HIV, mainly associated with high-risk sexual and drug-related...

Hepatotoxicity of anabolic androgenic steroids in sport

Introduction and purpose: Anabolic-androgenic steroids (AAS) abuse is a common practice among professional as well as recreational athletes. The prevalence of this phenomenon seems to be continuously escalating, too. Even though AAS abuse may provide a desirable haematopoietic and musculotrophic effect, it causes a wide variety of local and systemic side effects. This review aims to demonstrate the AAS induced hepatotoxicity, it is based on the medical literature from the last 10 years. Brief description of the state of knowledge: Orally administered 17-α-alkylated steroids are considered to be the most hepatotoxic. They increase the number of reactive oxygen species (ROS) which directly injure the liver tissue. It may be manifested as an elevation of liver enzymes, peliosis hepatis or distinctive acute cholestasis. Furthermore, ASS abuse for a prolonged period of time may induce the growth of hepatocellular adenoma and hepatocellular cancer. Moreover, AAS intake can lead to liver enlargement, development of toxicant-associated fatty liver disease (TAFLD) and increase the risk of HCV and HBV infection. Conclusions: The collaboration of scientists, doctors, sports associations and governments is substantial. Introduction of innovative AAS detection methods and enforcement of stricter anti doping law may contribute to prevention of health consequences resulting from AAS abuse among athletes.

“Transfusion Associated Diseases and Complications of Blood Transfusion in Thalassaemia Patients”

Background: Transfusion Transmitted Infections (TTIs) are going to hit as a major risk factor in overpopulated regions of the world comprising thalassaemia as a main concern. The variety of infectious diseases that transfer from blood donors to thalassaemia patients leading complications which result in delay hemolytic transfusion reactions and different types of infections whose causative agents may be HBV, HCV, HIV and Syphilis etc. Epidemiology: The thalassaemia affects almost 4.4 of every 10000 births worldwide although its rate in Pakistan is 5000 to 10000 births per year with 5-7 % estimated carrier rate. The blood transfusion and transmissible infections ratio in low income countries is as, HIV presence is from 0.33% to 1.66%, HBV presence is from 2.00% to 4.50%, HCV presence is from 0.50% to2.23% and Syphilis presence is from 0.60% to 1.81%.Diagnostics: The Immuno-chromatographic tests are affordable and can be valid to be used for blood screening throughout world. Blood samples should be processed for a counter check via ELISA/ CLIA and NAT technique to eliminate risk of HBV, HCV, HIV and syphilis deadly infections.Management: Patients must be provided regular blood transfusion to keep average hemoglobin level at 10-12 g/dl. Other treatments include Iron Chelation therapy which is mandatory for better life expectancy as well as splenectomy, stem cell transplant and gene therapy.Conclusion: The blood transfusion infections based on ICT (Immuno-chromatographic technique) prove unreliable while CLIA (ChemiluminescenceImmunoassay) is reliable comparatively due to capturing weak positive and low titer infectious agents. In order to avoid the delayed hemolytic transfusion reactions it is enforced to detect the subgroups of blood like A (A1 and A2) and AB (A1B and A2B).

Associations between polymorphisms in IL-10 gene and the risk of viral hepatitis: a meta-analysis

BackgroundThe relationships between polymorphisms in interleukin-10 (IL-10) gene and the risk of viral hepatitis remain inconclusive. Therefore, the authors conducted so far the very first meta-analysis to robustly assess the relationships between polymorphisms in IL-10 gene and the risk of viral hepatitis by integrating the results of previous works.MethodsMedline, Embase, Wanfang, VIP and CNKI were searched throughly for eligible studies, and 76 genetic association studies were finally included in this meta-analysis.ResultsWe noticed that rs1800871 (− 819 C/T), rs1800872 (− 592 C/A) and rs1800896 (− 1082 G/A) polymorphisms were all significantly associated with the risk of viral hepatitis in Asians, whereas only rs1800896 (− 1082 G/A) polymorphism was significantly associated with the risk of viral hepatitis in Caucasians. In further analyses by disease subtypes, we noticed that the three investigated polymorphisms were all significantly associated with the risk of both HBV and HCV.ConclusionsThis meta-analysis demonstrates that rs1800871 (− 819 C/T), rs1800872 (− 592 C/A) and rs1800896 (− 1082 G/A) polymorphisms may influence the risk of viral hepatitis in Asians, while only rs1800896 (− 1082 G/A) polymorphism may influence the risk of viral hepatitis in Caucasians. In further analyses by disease subtypes, we noticed that the three investigated polymorphisms may influence the risk of both HBV and HCV.

Identification of Risk Factors for Testing of Hepatitis C in Non-Birth Cohort Patients: Is Universal Screening Necessary?

CDC reported that 45% of Hepatitis C (HCV) infected people denied known risk factors. Electronic health record RF-based, non-Birth Cohort (born outside of years 1945-1965) screening is challenging as risk factors are often input as nonsearchable data. Testing non-Birth Cohort patients solely based on risk factors has the potential to miss a substantial number of HCV infected patients. The aim was to determine the HCV antibody positive prevalence who would have been missed had providers only followed risk factor based screening recommendations. A 1:3 case-control retrospective nested chart review was conducted. HCV risk factors and opioid prescriptions were manually abstracted from the Electronic Health Record; other variables were collected using Explorys. In July 2015 HCV screening data was collected on non-Birth Cohort patients who were HCV tested across MedStar Health, as a presumptive marker for high risk. Univariate and multivariate logistic regression models were utilized to determine HCV antibody positive predictors. Eighteen (23%) HCV antibody positive and 123 (49%) HCV antibody negative had no identified risk factors; 6 (33%) HCV antibody positive reported risk factors only after a positive test result. There was a significant interaction between age over 40 and opioid prescription use; these groups were 11× more likely to be HCV antibody positive (CI95 1.6-74.8). HCV testing solely based on presence of risk factors in non-Birth Cohort patients has the potential to miss a significant number of HCV antibody positive patients. Given patient- and provider-level barriers in elucidating risk factors, universal HCV antibody screening may be warranted.

Genetic variants in IL4RA, IL6, and IL12B genes and susceptibility to hepatitis B and C virus infections among Iraqi patients.

Hepatitis B and C viruses (HBV and HCV) are common causative pathogens of viral hepatitis. Progression of both infections is determined by virus- and host-related factors. Cytokines are important host genetic factors that may have a predisposing role in HBV and HCV infections. This case-control study evaluated the genetic association of IL4RA+1902 (rs1801275), IL6-174 (rs1800795), IL6-597 (rs1800797), and IL12B-1188 (rs3212227) variants with chronic HBV and HCV infections among Iraqi patients. A total of 220 viral hepatitis patients were enrolled in the study (113 HBV and 107 HCV), together with 141 healthy subjects. Sequence-specific primer polymerase chain reaction assay was the genotyping method. Results revealed that under a dominant genetic model, IL6-174 variant was significantly associated with HBV infection, whereas no association with the HCV risk was reported. However, the risk for both infections was markedly associated with IL6-597 variant under recessive, dominant, and codominant genetic models. Estimation of IL6-174 -IL6-597 haplotypes depicted that G-A haplotype was significantly associated with an increased risk to develop HBV infection, whereas a significantly decreased risk was associated with G-G and C-G haplotypes. For HCV, G-G and C-A haplotypes were significantly associated with risk of HCV infection. IL4RA+1902 and IL12B-1188 variants showed no association with HBV or HCV risk. Analysis of variance revealed no significant association between genotypes of the four determined single-nucleotide polymorphisms and HBV or HCV viral load. In conclusion, the study supports the concept that IL6-597 variant is associated with susceptibility to HBV and HCV infections among Iraqis. The risk of HBV infection is further associated with IL6-174 variant.

Prevalence of HCV infection in a health area of Madrid (Spain): the first step towards microelimination

Objectiveto estimate the prevalence of HCV infection in the general population of a health area through an intervention in Primary Care, differentiating between new diagnoses and infections previously diagnosed but not treated. Methodsparticipants were selected through a risk assessment questionnaire, with all those who gave at least one affirmative answer and all those over 50 years of age undergoing a rapid test. Positive tests were confirmed in the lab by determination of anti-HCV antibodies by chemiluminescent microparticle immunoassay (CMIA) and determination of viraemia. ResultsOf the 7991 participants, 36.2% presented a positive HCV risk questionnaire. 4717 tests were performed, finding an anti-HCV percentage of 0.65% in the screened population, with 0.46% of active infections. Among the individuals with a positive test result, 51.9% had a known prior diagnosis but had not received treatment, because they were not aware of it or were not linked to the health system, and 19.2% had a positive result for the first time. The prevalence of hidden infection was higher in men, those over 50 years of age and people from Eastern Europe. ConclusionWe found a prevalence of active infections higher than recently described nationwide, and a higher percentage of newly diagnosed infections than recent similar studies in other areas. These differences justify the need to perform local assessments of the prevalence of HCV infection in each of the health areas where it is planned to implement and monitor a microelimination programme.

Detection of Hepatitis C Virus Antibodies among Healthy Blood Donors at a Tertiary Hospital in Nigeria

Background: Most blood transfusion centres in Nigeria including the University of Abuja Teaching Hospital (UATH), Gwagwalada, Abuja use rapid test kit for screening blood donors. Though it is simple, robust with speedy results, it has some limits. This cross-sectional study determined the prevalence of HCV antibodies by the currently used rapid detection assay among blood donors tested positive by ELISA, describe the HCV risk factors and socio-demographic characters among the blood donor participants. Methods: Blood samples collected from 365 blood donors attending UATH blood bank were screened for HCV antibodies using Enzyme-linked Immunosorbent Assay (ELISA) kit (CTK Biotech, USA). Positive samples were retested using Aria rapid test kit. Structured questionnaires were used to collate subjects’ socio-demographic data and risk factors of infection. Results: Out of 365 blood donors tested, 55 (15.1%) were positive for HCV antibodies. Of the 55 ELISA positive samples, 9 (16.4%) samples were negative by Aria rapid test kit. Sociodemographic data showed that female had a higher prevalence (16.3%) than the male (14.9%) p= 0.81. The age group with the highest rate of infection was 31-45 years p. Conclusion: The study revealed the superiority of ELISA over Aria rapid test kit in the detection of HCV antibodies. The missed positive cases by the currently used rapid test could pose a risk to blood transfusion safety and necessitates for preventive measures to be intensified, as blood donors with high risk factors be deferred from blood donation to reduce HCV transfusion risk in Nigeria.

Abstract PR13: Geospatial analytics and sensitivity/specificity assessments to inform liver cancer prevention

Abstract Background: Liver cancer rates are rising, particularly in minority populations. Risk factors for liver cancer, such as alcohol/drug use, metabolic disorders, and viral hepatitis B/C (HBV/HCV), are generally modifiable through lifestyle interventions, vaccinations, and treatments. However, resources are often limited and strategies to prioritize geographic areas most in need of cancer prevention are needed. Recommendations exist to focus prevention efforts on groups with the highest rates of liver cancer, namely Hispanics, Blacks, and individuals born 1950-1959 who are at high risk for HCV. We compare the sensitivity/specificity of this approach to a dual approach that couples liver cancer disease cluster statistics with neighborhood-level demographic data to inform liver cancer prevention. Methods: Pennsylvania (PA) Liver Cancer Registry data from 2007-2014 were linked to the 2010 U.S. Census data via a geocode at the census tract level with ArcGIS software. Using the space-time scan statistic in SaTScan and relative risk estimates from BayesX, we also identified high-risk clusters or geographic areas with significantly elevated rates of incident liver cancer, adjusted for age, gender, and diagnosis year. Analyses were conducted using elliptical spatial windows and Poisson models. Census tracts in the top 80th percentile for percentage of Hispanics, Blacks or those born between 1950-1959 were also identified. The sensitivity, specificity, and positive predictive value (PPV) of a census tract being located in a high-risk cluster and/or testing positive or negative for at least one of three neighborhood variables (higher % Black, % Hispanic, 1950-1959 birth cohort) were calculated. Results: There were 9,460 cases of liver cancer diagnosed in PA. Five high-risk clusters were identified (relative risks ranged from 1.83-3.73, all p<0.05). Of 3,217 census tracts in PA, 412 were located in one of the 5 high-risk clusters, whereas 1,596 were positive for at least one of 3 neighborhood demographic variables. Within high-risk clusters, 365 census tracts also had a higher percentage of the birth cohort, Blacks or Hispanics. While sensitivity was relatively high (88.66%), specificity (56.1%) and PPV (22.8%; i.e., the chance a census tract with at least one demographic variable truly was located in a high-risk cluster) were low. Conclusions: Coupling disease cluster statistics with neighborhood demographic data refines the identification of areas that carry a greater than expected burden of liver cancer and reduces intervention targets more than neighborhood demographics alone. However, additional analyses are needed to improve the sensitivity/specificity of this combined geospatial approach. Consideration of other patient and neighborhood level socioeconomic data is also being explored and will be presented to further inform the prioritization of liver cancer prevention efforts. This abstract is also being presented as Poster C014. Citation Format: Shannon M. Lynch, Daniel Wiese, Kristen Sorice, Minhhuyen Nguyen, Evelyn Gonzalez, Kevin Henry. Geospatial analytics and sensitivity/specificity assessments to inform liver cancer prevention [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr PR13.

Peer outreach point-of-care testing as a bridge to hepatitis C care for people who inject drugs in Toronto, Canada

BackgroundPeople who inject drugs have high rates of hepatitis C (HCV) and yet many remain undiagnosed and untreated. HCV treatment guidelines and elimination strategies recommend task-shifting to expand where, and by whom, HCV testing and care is delivered. MethodsA randomized controlled trial design was used to evaluate if point-of-care (POC) HCV antibody testing by peer outreach workers outside of health and social service spaces would improve engagement in HCV care. People with a lifetime history of injection drug use without prior knowledge of HCV antibody status were randomized to receive HCV outreach plus either POC or referral to community-based HCV program for testing as usual. The study was co-designed by people with lived experience of HCV. Results920 people were approached to participate over 14 weeks. After refusals, withdrawals and removal of duplicates, there were 380 study participants. Outreach took place primarily in public spaces (66%) such as parks, coffee shops and apartment lobbies. Participants reported very high rates of poverty, housing instability and recent injection drug use. Despite being at high risk for HCV, 61% had no history or knowledge of past HCV testing (n = 230). Of those who received a POC test 77/195 (39%) were positive for HCV antibodies. There was no change in rates of engagement in HCV care among those who received the POC (n = 6; 3%) compared to those who did not (n = 5; 3%). ConclusionPeer outreach workers were able to efficiently reach a marginalized group of individuals who had a high HCV antibody prevalence and low rates of prior HCV testing. This improved participants’ knowledge of their HCV antibody status, but that knowledge in itself did not lead to any change in participant's subsequent engagement in HCV care. Future work is required to evaluate strategies such as incentives or peer navigators to improve linkage to HCV care after diagnosis.

The seropervelance of infectious hepatitis viruses (HBV, HCV and HEV) among blood donors and their correlation to risk factors in Qena governorate, Upper Egypt.

This study was performed to determine the prevalence of HBV and HCV infection among blood donors and the occurrence of HEV in hepatitis viruses seropositive blood donors. Also, to investigate the correlation between the occurrence of hepatitis viruses and other risk factors (gender, age, occupation, educational level, residency and donors' types). A total of 11,604 blood samples fromapparently healthy blood donors of age range 18-60years old were collected. The blood donors were categorized as voluntary and replacement donors. Blood samples from donors were tested for the presence of HBsAg, HCV and HEV antibodies by using Enzyme-linked immunosorbent assay. The overall results indicated that 671 out of 11,604 blood donors; 370 persons (3.188%) HCV, 295 persons (2.542%) HBV and 6 persons (0.052%) HCV and HBV; were hepatitis viruses seropositive donors. The prevalence of HEV were 193 (28.76%) among these seropositive blood donors. There is a highly significant correlation among HCV, HBV and other risk factors. Also, the HEV showed high significant with age and educational level and significant with donor types and locations. All investigated virus combinations (HEV/HCV, HEV/HBV and HEV/HCV/HBV) were highly significant with the risk factors except for occupation. In conclusion, the HEV is significantly correlated to HCV and HBV seropositive donors and should be screened among blood donors.

Evaluation of Contamination Risk by the cobas e 602 Serology Module Before Viral Load Testing on the cobas 6800 System

Diagnosis of HCV, HBV, and HIV involves antibody screening followed by confirmation and/or treatment decision using nucleic acid tests. However, minimal data exist evaluating the risk of nucleic acid cross-contamination on serology devices upstream of molecular testing despite the potential clinical and laboratory workflow advantages of single specimen vial testing for both procedures. We conducted a checkerboard study investigating the potential risk of HCV, HBV, and HIV nucleic acid cross-contamination on 480 negative specimens by a serology screening instrument that uses disposable tips for sample transfer, rather than a fixed needle, before molecular testing. Nucleic acid contamination was observed in 0 of 480 negative specimens when processed with alternating high-titer HCV, HBV, or HIV specimens on the serology platform. This study suggests that specimens analyzed by a serology instrument using disposable tips for sample transfer may be suitable for direct primary specimen reflex testing by a sensitive nucleic acid confirmatory test.

Novel Models to Identify Census Tracts for Hepatitis C Screening Interventions.

Increased screening efforts and the development of effective antiviral treatments have led to marked improvement in hepatitis C (HCV) patient outcomes. However, many people in the United States are still believed to have undiagnosed HCV. Geospatial modeling using variables representing at-risk populations in need of screening for HCV and social determinants of health (SDOH) provide opportunities to identify populations at risk of HCV. A literature review was conducted to identify variables associated with patients at risk for HCV infection. Two sets of variables were collected: HCV Transmission Risk and SDOH Level of Need. The variables were combined into indices for each group and then mapped at the census tract level (n = 233). Multiple linear regression analysis and the Pearson correlation coefficient were used to validate the models. A total of 4 HCV Transmission Risk variables and 12 SDOH Level of Need variables were identified. Between the 2 indexes, 21 high-risk census tracts were identified that scored at least 2 standard deviations above the mean. The regression analysis showed a significant relationship with HCV infection rate and prevalence of drug use (B = 0.78, P < .001). A significant relationship also existed with the HCV infection rate for households with no/limited English use (B = -0.24, P = .001), no car use (B = 0.036, P < .001), living below the poverty line (B = 0.014, P = .009), and median household income (B = -0.00, P = .009). Geospatial models identified high-priority census tracts that can be used to map high-risk HCV populations that may otherwise be unrecognized. This will allow future targeted screening and linkage-to-care interventions for patients at high risk of HCV.

From the Editor’s Desk…

From the Editor’s Desk…

HEPATITIS B AND C: FREQUENCY, MODES OF TRANSMISSION AND RISK FACTORS ALONG WITH SOME UNORTHODOX ROUTES OF SPREAD

Background: Pakistan's being a country placed in intermediate endemicity zone of HBV and HCV, with rising population, there is lack scarcity of knowledge about transmission of risk factors specially unorthodox and frequency of this health challenge. Methods: A retrospective case control study where case records of all patients aged from 18 - 70 years from 2012 to 2017 with either gender diagnosed as chronic hepatitis B and C were included. Information about shave from barber-shop, sharing of toothbrush at home, tattooing, cautery, and ear piercing were collected. Information about unorthodox risks for transmission of HBV and HCV, like skin branding, cupping of blood, circumcision by the barber, sharing of tooth brushes and leech therapy was collected. Results: Among 1134 patients of chronic hepatitis B (HBV) and chronic hepatitis C (HCV), Age &gt; 35 years, shave from barber and dental treatment were found to be risk factor for both HCV and HBV transmission. Amongst unorthodox risk factors like skin branding, cupping of blood, circumcision by the barber, sharing of tooth brushes and leech therapy, only cupping of blood (Hijama) was a significant risk for transmission of both HBV and HCV. Conclusion: Viral related chronic hepatitis is frequently reported problem in this part of the world where HCV supersedes HBV. Socieodemographic factor like age &gt; 35 year, shave from barbers and dental treatment were risk factors for transmission of both HCV and HBV. Among orthodox routes of transmission blood cupping (hijama) has shown as a significant transmission risk for both HCV and HBV.

Transmission of hepatitis C virus in HIV-positive and PrEP-using MSM in England.

We sought to characterize risk factors and patterns of HCV transmission amongst men who have sex with men (MSM). MSM with recently acquired HCV (AHCV) were prospectively recruited ('clinic cohort') between January and September 2017. Clinical data and risk behaviours were identified and blood obtained for HCV whole genome sequencing. Phylogenetic analyses were performed, using sequences from this cohort and two other AHCV cohorts, to identify transmission clusters. Sixteen (40.0%) men in the clinic cohort were HIV-negative MSM. HIV-negative MSM were younger than HIV-positive MSM; most (81.3%) had taken HIV PrEP in the preceding year. Eighteen men (45.0%) reported injection drug use; most (34, 85.0%) reported noninjection drug use in the last year. Most in both groups reported condomless anal sex, fisting and sex in a group environment. Few (7, 17.5%) men thought partners may have had HCV. There were 52 sequences in the HCV genotype 1a phylogeny, 18 from the clinic cohort and 34 from other AHCV cohorts; 47 (90.4%) clustered with ≥1 other sequence. There were 7 clusters of 2-27 sequences; 6 clusters contained HIV-negative and HIV-positive MSM and 1 cluster only HIV-positive MSM. Four of these clusters were part of larger clusters first described in 2007. PrEP-using MSM are at risk of HCV, sharing similar risk factors to HIV-positive MSM. Phylogenetics highlights that PrEP-using and HIV-positive MSM are involved in the same HCV transmission networks. Few men demonstrated HCV awareness and risk reduction strategies should be expanded.

Examining risk behavior and syringe coverage among people who inject drugs accessing a syringe services program: A latent class analysis

IntroductionInjection drug use (IDU) remains a significant public health problem. IDU has been associated closely with the opioid crisis; driving overdose, HIV, and Hepatitis C (HCV) infection nationwide. Syringe services programs (SSPs) remain pivotal evidence-based interventions to reduce harm and engage subgroups of people who inject drugs (PWID). This study aims to provide policy considerations from the IDEA SSP, the first legal SSP in the state of Florida. MethodsWe performed a latent class analysis on patterns of substance use among participants (N = 982) newly enrolled in a syringe services program (SSP). Associations between classes of substance use and sociodemographic variables, risky injection and sex behaviors, HIV/HCV status and syringe coverage were analyzed using the R3STEP and BCH 3-step procedures in latent class regression. ResultsWe found a three-class solution: Heroin-Dominant class (73.9%), Methamphetamine-Dominant class (9.5%) and Heroin/Cocaine class (16.6%). Compared to Heroin-Dominant class, the Heroin/Cocaine class were more likely to report homelessness, sharing works, unprotected sex, public injection, and to be HCV positive. Compared to both Heroin-Dominant and Heroin/Cocaine classes, the Methamphetamine-Dominant class were more likely to be male, Hispanic, gay or bisexual orientation, HIV positive, to report unprotected sex and sex with PWID. In addition, the lowest and highest syringe coverage were among those in the Heroin/Cocaine and Methamphetamine-Dominant classes, respectively. ConclusionExisting interventions among this population to mitigate infectious disease risk, such as SSPs, can be a used to engage differing PWID populations. However, multi-component, targeted preventive interventions and need-based syringe distribution policies are required to further reduce HIV and HCV risk among various PWID populations.

Increasing uptake of hepatitis C virus infection case-finding, testing, and treatment in primary care: evaluation of the HepCATT (Hepatitis C Assessment Through to Treatment) trial

BackgroundHepatitis C virus (HCV) infection is a key cause of liver disease but can be cured in more than 95% of patients. Around 70 000 people in England may have undiagnosed HCV infection and many more will not have been treated. Interventions to increase case-finding in primary care are likely to be cost-effective; however, evidence of effective interventions is lacking. The Hepatitis C Assessment Through to Treatment (HepCATT) trial assessed whether a complex intervention in primary care could increase case-finding, testing, and treatment of HCV.AimTo investigate the feasibility and acceptability of the HepCATT intervention.Design and settingA qualitative study with primary care practice staff from practices in the south west of England taking part in the HepCATT trial.MethodSemi-structured interviews were carried out with GPs, nurses, and practice staff to ascertain their views of the HepCATT intervention at least 1 month after implementing the intervention in their practice. Normalisation process theory, which outlines the social processes involved in intervention implementation, informed thematic data analysis.ResultsParticipants appreciated the HepCATT intervention for increasing knowledge and awareness of HCV. Although some initial technical difficulties were reported, participants saw the benefits of using the audit tool to systematically identify patients with HCV infection risk factors and found it straightforward to use. Participants valued the opportunity to discuss HCV testing with patients, especially those who may not have been previously aware of HCV risk. Future implementation should consider fully integrating software systems and additional resources to screen patient lists and conduct tests.ConclusionWhen supported by a complex intervention, primary care can play a crucial role in identifying and caring for patients with HCV infection, to help stem the HCV epidemic, and prevent HCV-related illness.