HCV Risk Research Articles

Sécurité Transfusionnelle En Milieu Rural En République Démocratique Du Congo: Plaidoyer pour un dépistagesystématique des hépatites virales B, C et pour la fidélisation des donneurs de sang

Introduction: Transfusional safety remains a major concern in our environment where the permanent availability of the screening tests is not always guaranteed. The first aim of this work is to highlight the prevalence of HBV, HCV and HIV infections and to encourage systematic screening for these viruses. The second aim is to identify the risk incurred by the transfused person depending on whether the blood donor is a loyal blood donor or an improvised familialblood donor. Methods:We conducted a multicentric cross-sectional study at health centers and hospitals performing blood transfusion in Uvira, Kiliba and Lemera (Eastern D.R. Congo) between January 2018 and December 2022. Thirteen thousand and sixty-two blood donors were recruited. Statistical analyzes were done using the Epi Info 7.2 software and the corrected Chi-square or exact Fischer test (when recommended) was used to search for an association between the epidemiological variables. Measurement of association strength by Odds Ratios (95% confidence intervals) was used to compare frequencies observed across donor categories based on the presence of infectious markers. The threshold of significance was set at p <0.05. Results:On a total of 13062 donors, 483 (3.7%) were HIV-positive, 837 (6.4%) seropositive to HBV, and 208 (1.6%) HCV-positive. Among these infected donors (n=1528), 68.39 % N=1045) was infected by the viruses of the hepatitis. Compared to loyal donors, paid donors had 14.38 times the risk of having positive HIV serology (OR = 14.38 [5.16-40.06]), 6.53 and 30.89 times the risk for HBV (OR = 6.53 [3.20-13.34]) and HCV (OR = 30.89 [6.95-283.72]). Conclusion:In rural health zones we studied, blood receivers are at high risk of contamination with HIV, hepatitis by blood given by an unreliable blood donor. Transfusion safety measures should be strengthened by obligatory and systematic HBV and HCV research as well as HIV

Hepatitis C risk score as a tool to identify individuals with HCV infection: a demonstration and cross-sectional epidemiological study in Egypt

ObjectivesHepatitis C virus (HCV) infection poses a global health challenge. By the end of 2021, the WHO estimated that less than a quarter of global HCV infections had been diagnosed....

Sex and gender differences in hepatitis C virus risk, prevention, and cascade of care in people who inject drugs: systematic review and meta-analysis

People who inject drugs (PWID) are a priority population in HCV elimination programming. Overcoming sex and gender disparities in HCV risk, prevention, and the cascade of care is likely to be important to achieving this goal, but these have not yet been comprehensively reviewed. Systematic review and meta-analysis. We searched Pubmed, EMBASE and the Cochrane Database of Systematic Reviews 1 January 2012-22 January 2024 for studies of any design reporting sex or gender differences among PWID in at least one of: sharing of needles and/or syringes, incarceration history, injection while incarcerated, participation in opioid agonist treatment or needle and syringe programs, HCV testing, spontaneous HCV clearance, direct-acting antiviral (DAA) treatment initiation or completion, and sustained virological response (SVR). Assessment of study quality was based on selected aspects of study design. Additional data were requested from study authors. Data were extracted in duplicate and meta-analysed using random effects models. PROSPERO registration CRD42022342806. 9533 studies were identified and 92 studies were included. Compared to men, women were at greater risk for receptive needle and syringe sharing (past 6-12 months: risk ratio (RR) 1.12; 95% confidence interval (CI) 1.01-1.23; <6 months: RR 1.38; 95% CI 1.09-1.76), less likely to be incarcerated (lifetime RR 0.64; 95% CI 0.57-0.73) more likely to be tested for HCV infection (lifetime RR 1.07; 95% CI 1.01, 1.14), more likely to spontaneously clear infection (RR1.58; 95% CI 1.40-1.79), less likely to initiate DAA treatment (0.84; 95% CI 0.78-0.90), and more likely to attain SVR after completing DAA treatment (RR 1.02; 95% CI 1.01-1.04). There are important differences in HCV risk and cascade of care indicators among people who inject drugs that may impact the effectiveness of prevention and treatment programming. Developing and assessing the effectiveness of gender-specific and gender-responsive HCV interventions should be a priority in elimination programming. Réseau SIDA-MI du Québec.

Kentucky Outreach Service Kiosk (KyOSK) Study protocol: a community-level, controlled quasi-experimental, type 1 hybrid effectiveness study to assess implementation, effectiveness and cost-effectiveness of a community-tailored harm reduction kiosk on HIV, HCV and overdose risk in rural Appalachia

IntroductionMany rural communities bear a disproportionate share of drug-related harms. Innovative harm reduction service models, such as vending machines or kiosks, can expand access to services that reduce drug-related harms....

“When people who use drugs can’t differentiate between medical care and cops, it’s a problem.” Compounding risks of law Enforcement Harassment & Punitive Healthcare Policies

BackgroundCommunity-based harm reduction programming is widely recognized as an effective strategy for reducing the increased risks for and spread of HIV, HCV, and for reducing the growing rate of overdose deaths among people who use drugs (PWUD). PWUD in the United States (US) are a highly justice-involved population, also at increased risk for law enforcement interaction, arrest, and incarceration. These risks compound and interact in the context of criminalization and law enforcement surveillance. Justice involvement increases risks for overdose and for riskier injecting behavior among PWUD, in turn increasing HCV and HIV risks. In Central and Southern Appalachia specifically, PWUD have identified fear of law enforcement harassment and arrest as a barrier to engaging in harm reduction behavior, and a deterrent to seeking help at the scene of an overdose. Moreover, stigmatizing and punitive treatment in healthcare settings can deter PWUD from seeking care, with life or death consequences. This evaluation research study assessing the successes and impacts of a grant-funded project to increase access to safer drug consumption supplies and overdose prevention education for PWUD, including justice-involved participants of a syringe access program (SAP), in public housing and beyond in a South-Central Appalachian setting used key informant and opportunistic sampling. Mixed-methods data were compiled and collected including secondary program data; primary interview and participant-observation data.ResultsThe evaluation research identified that grant deliverables were largely achieved, despite challenges presented by the COVID-19 pandemic. In addition, SAP participants and staff reported larger themes surrounding grant-funded activities, in which they perceived that widespread local law enforcement harassment of PWUD increased participants’ risks for overdose death and infectious disease risks and that punitive local healthcare settings and policies acted as deterrents to care-seeking for many PWUD.ConclusionsOverall, the evaluation research found that participants’ experiences with and perceptions of local law enforcement harassment combined with their understandings and experiences of local punitive healthcare settings and policies; together compounding and increasing overdose risks and negative health consequences for local justice-involved PWUD.

Incidence of hepatitis C virus infection in the prison setting: The SToP-C study.

People in prison are at high risk of HCV given high injecting drug use prevalence. This study evaluated HCV incidence and associated injecting drug use characteristics in prison. The SToP-C study enrolled people incarcerated in four Australian prisons. Participants were tested for HCV at enrolment and then every 3-6 months (October-2014 to November-2019). Participants eligible for this analysis included those at-risk of HCV primary infection (anti-HCV negative) or re-infection (anti-HCV positive, HCV RNA negative) with follow-up assessment. A total of 1643 eligible participants were included in analyses (82% male; median age 33 years; 30% injected drugs in prison; 1818 person-years of follow-up). Overall HCV incidence was 6.11/100 person-years (95%CI: 5.07-7.35), with higher rate of re-infection (9.34/100 person-years; 95%CI: 7.15-12.19) than primary infection (4.60/100 person-years; 95%CI: 3.56-5.96). In total population (n = 1643), HCV risk was significantly higher among participants injecting drugs in prison [vs. no injecting; adjusted hazard ratio (aHR): 10.55, 95%CI: 5.88-18.92), and those who were released and re-incarcerated during follow-up (vs. remained incarcerated; aHR: 1.60, 95%CI: 1.03-2.49). Among participants who injected recently (during past month, n = 321), HCV risk was reduced among those receiving high-dosage opioid agonist therapy (OAT), i.e. methadone ≥60 mg/day or buprenorphine ≥16 mg/day, (vs. no OAT, aHR: 0.11, 95%CI: 0.02-0.80) and increased among those sharing needles/syringes without consistent use of disinfectant to clean injecting equipment (vs. no sharing, HR: 4.60, 95%CI: 1.35-15.66). This study demonstrated high HCV transmission risk in prison, particularly among people injecting drugs. High-dosage OAT was protective, but improved OAT coverage and needle/syringe programmes to reduce sharing injecting equipment are required.

Knowledge Attitude and Practice about Hepatitis C Virus and Associated Factors among Waste Handlers at Public Hospitals of Sidama Region, Ethiopia: Facility Based Cross Sectional Study

Background: Hepatitis C (HCV) is worldwide community health problem that gives rise to liver cancer. Even though prevalence of HCV is higher and waste handlers being at high risk for HCV, there is scarcity of information on knowledge, attitude and practice (KAP) concerning HCV among waste handlers. Methods: Quantitative cross-sectional study from Oct 2021 to 30 July 2022 in different public Hospitals of Sidama Region aimed to evaluate KAP of HCV among randomly selected waste handlers was undertaken amongst 282 respondents. KAP regarding HCV were assessed using standardized structured questionnaire. Descriptive summary measures were done. Multivariate logistic regression was accompanied with 95% confidence interval and P-value &lt; 0.05 was confirmed statistically significant. To assess the association between the KAP, Spearman’s rho correlation were used. Results: Mean scores for KAP were 22.24±8.15, 46.75±10 and 4.19±1.72 respectively. Educational level (OR = 2.427; 95% CI = [1.116 –37.89], P = 0.042), monthly income (OR = 1.001; 95% CI = [1.000–10.002], P = 0.029), use of media (OR = 2.461; 95% CI = [2.688–8.799], P = 0.006), marital status (OR = 22.961; 95% CI = [1.203–38.157], P = 0.037) and residence (OR = 6.332; 95% CI = [1.703–23.544], P = 0.006) contributed significantly to the prediction of knowledge. Spearman rank correlation revealed significant positive correlations between knowledge-attitude (r = 0.57, P &lt; 0.037), knowledge-practice (r = 0.265, P = 0.00) and attitude-practice (r = 0.72, P = 0.02). Conclusions: Although the study highlighted optimal KAP with regards to several aspects of HCV, educational campaigns should emphasize the necessity of continued education about HCV in order to more improve attitudes, knowledge and practices of waste handlers regarding HCV

Hepatitis C screening and linkage to care with a mobile clinic in Southern Denmark

BackgroundKnowing the prevalence of hepatitis C (HCV) in risk groups is essential for elimination. The aim of the study was to assess HCV prevalence among people with different risk profiles and the feasibility of linking people with HCV to care. MethodsIn Southern Denmark we tested people who were using shelters, cafés, and facilities for marginalized populations and the general population. We established a mobile clinic for HCV testing offering point-of-care HCV-antibody (HCV-Ab), point-of-care HCV RNA testing, and dried blood spot (DBS) testing. People with HCV infection were linked to care. ResultsAmong 802 tested persons, we found an HCV-Ab /HCV RNA prevalence of 13% (n = 101) /3% (n = 24). We found a prevalence of 20% (n = 97)/5% (n = 24) among 475 persons tested at locations attended by people who inject drugs but 0%/0% when testing the general population. Of 24 people who were HCV RNA positive, 83% (n = 20) initiated treatment, 13% (n = 3) spontaneously cleared their infection, and one was lost to follow-up. ConclusionGeneral population testing has limited utility while focus on settings attended by people with increased HCV risk is more feasible. Linkage of people with a current HCV infection to care is feasible.

The impact of border crossing and imprisonment on injection practices and risk of HIV and hepatitis C infection among men who inject drugs in Nepal.

In Nepal, personal drug use is criminalized and among people who inject drugs (PWID), the majority of whom are men, movement across the border with India for drug procurement and use is common. Using a risk environment approach, this study examined associations between border crossing and imprisonment with respect to HIV, HCV and injection risk behavior among men who inject drugs in Nepal. This cross-sectional study analyzed data from 1345 participants from 14 districts across Nepal. Explanatory variables were prior imprisonment and past-month border crossing to procure or use drugs. We used multivariable logistic regression to evaluate associations between these variables and HIV, HCV, HIV/HCV co-infection and past-month injection risk behavior among PWID. Over half of participants reported prior imprisonment (34.6% prior to past year, 21.6% within past year) and Indo-Nepal border crossing in the past year to use or buy drugs (31.2% sometimes, 20.8% often); over one quarter of participants (29.6%) reported both. Imprisonment prior to the past year was associated with higher odds of all outcome variables: HIV (adjusted odds ratio (aOR) 2.44, 95% confidence interval (CI) 1.29-4.59), HCV (aOR 1.51, 95% CI 1.08-2.09), HIV/HCV co-infection (aOR 3.12, 95% CI 1.58-6.14) and injection risk behavior (aOR 1.64, 95% CI 1.20-2.25). Past-year border crossing to procure or use drugs was associated with HCV (aOR 2.06, 95% CI 1.42-2.98) and injection risk behavior (aOR 1.47, 95% CI 1.04-2.10), with larger effect sizes among PWID who reported both border crossing as well as history of imprisonment. Imprisonment and border crossing were associated with injection risk behavior and disease outcomes. These findings indicate a need to implement cross-border disease surveillance and harm reduction initiatives in the Indo-Nepal border region and in Nepali prisons.

Intrafamilial transmission risk factors and preventive measures followed by household contacts of hepatitis C patients

Background Hepatitis C virus (HCV) infection is the most challenging public health problem in Egypt where the prevalence is the highest in the world. Intrafamilial transmission of hepatitis C occurring between patients infected with HCV and their household members sharing the same house and living conditions. Preventive measures of hepatitis C are considered the first line of defense against HCV infection. Aim assess the intrafamilial transmission risk factors and preventive measures followed by household contacts of hepatitis C patients. Design A descriptive cross sectional research design was utilized. Setting The study was conducted at outpatient clinics of Liver Institute at Kafer-Elsheikh Governorate. Sample A simple random sample of 365 household contacts of hepatitis C patients was recruited for the current study. Tool Data was collected through one tool: A structured Interviewing Questionnaire for household contacts of hepatitis C patients which included three parts; part I-(a) Demographic data, (b) Medical history of household contacts, Part II (a) Household contacts knowledge about HCV (b) Hepatitis C risk factors, Part III: Preventive measures followed by household contact of hepatitis C patient: This part is self-reported practices. Results The study revealed that;56.7% of household contacts were males, 72.1% of them were living in rural areas, 75.60% were married, with a mean age ±SD 36.73±9.18 years old.44.1% obtained secondary education, 30.7% were employees, among this group hypertension and diabetes were the main chronic illness. 49.90% had moderate level of general knowledge about HCV infection, 71.50% had low level of knowledge about hepatitis C risk factors and 90.00% had a low level of preventive measures (self-reported practices) regarding HCV. There was no correlation between household contacts knowledge about HCV risk factors and their preventive measures(r=0.031 and P=0.549). Conclusion Almost half of household contacts mentioned that they knew intrafamilial risk factors while about half of this group have a misconception about intrafamilial risk factors, while majority of them stated that they knew sharing scissors and clippers as the main intrafamilial risk factors and less than one-fourth of them knew direct contact with infected blood and sharing of special equitoothbrushesth brushes. Household contacts applied some preventive measures such as; Cover the wound with a piece of cloth or gauze, disinfect the site with alcohol or antiseptic solution and frequent and proper hand washing. Recommendations Routine health assessment of household contacts knowledge regarding intrafamilial risk factors and preventive measures therefore health education sessions should be conducted to raise their awareness regarding HCV infection and further research should be conducted on larger samples of contacts.

Hepatitis C screening and detection program in a large population: Epidemiological transition and characterization of the disease.

Chronic hepatitis C (CHC) is considered an important public health challenge. Traditionally identified risk factors have undergone an epidemiological transition where other risk factors have become the main cause of new infections. To describe risk factors associated to hepatitis C positivity through the evaluation of the epidemiological profile in hepatitis-C high-risk populations. Cross-sectional study was conducted as part of an HCV screening program in Mexican population. All participants answered an HCV risk-factor questionnaire and took a rapid test (RT). All patients reactive to the test were subject to HCV PCR (polymerase chain reaction) confirmation. A logistic regression model was used to examine associations between HCV infection and risk factors. The study included 297 631 participants that completed a risk factor questionnaire and underwent an HCV rapid test (RT). In total, 12 840 (4.5%) were reactive to RT and 9257 (3.2% of participants) were confirmed as positives by PCR test. Of these, 72.9% had at least one risk factor and 10.8% were in prison. Most common risk factors were history of acupuncture/tattooing/piercing (21%), intravenous drug use (15%) and high-risk sexual practices (12%). Logistic regressions found that having at least one risk factor increased the probability of having an HCV-positive result by 20% (OR = 1.20, 95% CI: 1.15-1.26), compared to the population without risk factors. We identified 3.2% of HCV-viremic subjects, all associated with risk factors and older age. Screening and diagnosis of HCV in high-risk populations (including underserved populations) should be more efficient.

HCV universal EHR prompt successfully increases screening, highlights potential disparities.

Screening for hepatitis C virus is the first critical decision point for preventing morbidity and mortality from HCV cirrhosis and hepatocellular carcinoma and will ultimately contribute to global elimination of a curable disease. This study aims to portray the changes over time in HCV screening rates and the screened population characteristics following the 2020 implementation of an electronic health record (EHR) alert for universal screening in the outpatient setting in a large healthcare system in the US mid-Atlantic region. Data was abstracted from the EHR on all outpatients from 1/1/2017 through 10/31/2021, including individual demographics and their HCV antibody (Ab) screening dates. For a limited period centered on the implementation of the HCV alert, mixed effects multivariable regression analyses were performed to compare the timeline and characteristics of those screened and un-screened. The final models included socio-demographic covariates of interest, time period (pre/post) and an interaction term between time period and sex. We also examined a model with time as a monthly variable to look at the potential impact of COVID-19 on screening for HCV. Absolute number of screens and screening rate increased by 103% and 62%, respectively, after adopting the universal EHR alert. Patients with Medicaid were more likely to be screened than private insurance (ORadj 1.10, 95% CI: 1.05, 1.15), while those with Medicare were less likely (ORadj 0.62, 95% CI: 0.62, 0.65); and Black (ORadj 1.59, 95% CI: 1.53, 1.64) race more than White. Implementation of universal EHR alerts could prove to be a critical next step in HCV elimination. Those with Medicare and Medicaid insurance were not screened proportionately to the national prevalence of HCV in these populations. Our findings support increased screening and re-testing efforts for those at high risk of HCV.

HEPATITIS B, HEPATITIS C AND HIV AMONG DRUG USERS IN METHADONE MAINTENANCE TREATMENT: PREVALENCE, DOSES, TREATMENT COMPLIANCE

TheUsersofopioidsubstances,especiallyinjectingdrugs,areathighriskofinfection with blood- borne viruses,such as hepatitis B,C and human immunodeficiency virus, due to the sharing of needles and injection equipment. Methadone substitution treatment is approven device in the risk reduction strategy of hepatitis B,C and HIV infection.The aim of this studyis to determine: the socio-demographic and medical psychiatric characteristics of patients with hepatitis B,C and HIV under methadone,the prevalence of hepatitis C,B and HIV,the dose of methadone and compliance with treatment in this population. Materials and methods: This is a retrospective descriptive study of patients admitted to the center of addictology at the hospital Ar-razi of Sale in Morocco , specifically in methadone unit. Results: The prevalence of hepatitis C, B and HIV were respectively 80%, 13% and 4% in patients with positive serology, the average dose of methadone was higher than the dose of all patients enrolled in the methadone program. 80% of patients under methadone with positive serology to HCV, HBV and HIV had a polyconsumption of psychoactive substances (cannabis, cocaine, alcohol, benzodiazepine). 72% of our patients with hepatitis C received treatment for their infection while all the patients with HIV were put on antiretroviral drugs with good therapeutic compliance. Conclusion:Methadone substitution therapy has proven to be a successful strategy to reduce the risk of HIV, HCV and HBV infection in opioid-dependent patients. However, the adjustment of methadone doses and systematic screening for HIV, HCV and HBV is essential in this vulnerable population.

1242. Hepatitis C Treatment as a Complement to Syringe Service Programs: Pilot Progress and Pathways Forward

Abstract Background Hepatitis C (HCV) poses a significant chronic infectious disease threat in the United States, and people who inject drugs (PWID) are at elevated HCV risk. We assessed implementation of a program that provided low-barrier services for high-risk PWID, coupling harm reduction with clinical care, including HCV treatment. Methods In 2018, the University of Illinois at Chicago established a program to deliver comprehensive care to PWID in an underserved Chicago neighborhood, including syringe services (SS) and HCV treatment. We performed chart reviews of SS clients who sought HCV care from 09/2018-01/2021. We assessed patient demographics; the proportions prescribed and initiated on HCV treatment; and the proportions with undetectable HCV RNA at treatment week 4, end of treatment, and 12-weeks post-treatment. Results Among 67 patients, 45 (67%) were male, median age was 45 years (IQR 35-57), 22 (33%) were Black, and 11 (16%) were Hispanic. 66 (99%) reported current or former drug use and 62 (93%) injection drug use, and 3 (4%) sex work. 36 (54%) were undomiciled or lived in unstable housing, 22 (33%) were unemployed, 19 (28%) had been incarcerated within the past year, and 30 (45%) had a history of psychiatric illness. Median pre-treatment HCV RNA was 701,626 IU/L (IQR 39,944-1,979,898). 40 (60%) were prescribed HCV treatment and 31 (46%) initiated treatment (Figure). Of these, 21/31 (68%) completed HCV RNA testing at treatment week 4, of whom 18/21 (86%) had an undetectable viral load; 16/31 (52%) completed end of treatment testing, of whom 16/16 (100%) had an undetectable viral load; and 15/31 (48%) completed 12-week post-treatment testing, of whom 13/15 (87%) had an undetectable viral load. Of the 2 patients who did not achieve sustained viral suppression following treatment, 1 missed four weeks of treatment due to incarceration and 1 reported full adherence to treatment. Numbers and percentages of patients at each step in the treatment cascade Conclusion This comprehensive program offering SS and HCV care successfully reached PWID in an underserved area before and during the pandemic. Losses along the HCV treatment cascade were high: Only 60% were prescribed treatment and less than one-third of those prescribed treatment achieved sustained viral suppression. Among those who remained in care, over 80% achieved sustained viral suppression. Disclosures All Authors: No reported disclosures.

Gender Differences in HIV, HCV risk and Prevention Needs Among People who Inject drug in Vietnam

We examined gender differences among people who inject drug (PWID) in Hai Phong, Vietnam in term of blood-borne infections, risk behaviors, and access to care. Using respondent-driven-sampling surveys, we recruited 3146 PWID from 2016 to 2018. Inclusion criteria included a positive urine test for heroin and recent injection marks. There were 155 female PWID (4,9%), including 82 at RDS-2016, 32 at RDS-2017 and 38 at RDS-2018. The age mean was 36.3 ± 7.2 years. The majority of female PWID had less than high school education (90.9%) and were unemployed (51.3%). There was no difference in the proportion of HIV and HCV positive by gender. However, women had several significant differences in risk behaviors than men in multivariable logistic regression. Being a woman was independently associated with being unemployed, being a sex worker, having unstable housing, having uses drugs for less than 5 years, more use of methamphetamine, having a partner who ever injected drugs, and less access to methadone treatment. Interventions targeting female PWID are needed, possibly through community organizations and peer educators.

The world prevalence, associated risk factors and mortality of hepatitis C virus infection in hemodialysis patients: a meta-analysis.

The worldwide burden of HCV infection among hemodialysis patients has not been systematically examined. A systematic literature search was conducted in MEDLINE and Scopus to determine the worldwide prevalence of HCV infection, risk factors, and clinical outcomes among hemodialysis patients. Random-effect models and meta-regressions were used to generate pooled estimates and assess heterogeneity. Four hundred and seven studies with 1,302,167 participants were analyzed. The pooled prevalence of HCV infection was 21%. The highest prevalence was observed in Africa (28%) and low-income countries (48.5%). A significant prevalence decline was observed following the publication year and was also inversely related to GDP and total population of each country. Factors associated with HCV positivity included younger age, longer dialysis duration, more blood transfusions, and dialyzer reuse. The pooled unadjusted hazard ratio for all-cause mortality was 1.12 (95% CI 1.03-1.22), and the adjusted hazard ratio was 1.21 (95% CI 1.12-1.30) in HCV-infected compared to non-HCV infected patients. HCV infection among hemodialysis patients is a worldwideshared burden and is associated with a higher risk of death. Avoiding unnecessary blood transfusion and dialyzer reuse should be encouraged to prevent HCV transmission in hemodialysis units.

Occupational class and risk of hepatitis B and C viral infections: A case-control study-based data from a nationwide hospital group in Japan

BackgroundOccupational class, a proxy for socio-economic status, is a known factor for health disparities. However, no study has reported the association between occupational class and the risk of viral hepatitis B and C (HBV/HCV) infections. We investigated the effects of occupational class on the prevalence of HBV/HCV infections. MethodsThis is an unmatched hospital-based case-control study that included 12,101 patients who were diagnosed with HBV infection (ICD–10, B16.0, B16.1, B16.2, B16.9, B17.0, B18.0, B18.1) or HCV infection (ICD–10, B17.1, B18.2) and 698,168 controls (those with non-HBV/HCV-related diseases) aged ≥ 20 years who were initially hospitalized between 2005 and 2019. Patients were categorized according to occupational class (blue-collar, service, professional, and manager) and industrial sector (blue-collar, service, and white-collar). Managers in the blue-collar industry were set as the reference group, and the odds ratios (ORs) for the risk of HBV and HCV infections were calculated. ResultsOccupational class was significantly associated with only HCV infection risk. Professionals in all industrial sectors showed the lowest risk for HCV (OR (95% confidence intervals [CIs]) = 0.69 [0.58–0.82] in the blue-collar industry, 0.52 [0.38–0.73] in the service industry, and 0.60 [0.52–0.70] in the white-collar industry). Further, after adjusting for sex, age, and region of admitting hospital, all occupational classes in the white-collar industry showed lower risks of HCV than those in the other industries (ORs= 0.58 [0.47–0.71] in blue-collar workers, 0.74 [0.64–0.84] in service workers, 0.60 [0.52–0.70] in professionals, and 0.81 [0.64–1.02] in managers in white-collar industry). ConclusionsOccupational class was closely associated with HCV infection risk only. Considering that blue-collar workers in the white-collar industry also showed a low risk, adequate measures should be taken against hepatitis, possibly because of the screening tests and cure implemented in that population.

The association of gender with receptive and distributive needle sharing among individuals who inject drugs

BackgroundInjection drug use and needle sharing remains a public health concern due to the associated risk of HIV, HCV and skin and soft tissue infections. Studies have shown gendered differences in the risk environment of injection drug use, but data are currently limited to smaller urban cohorts.MethodsTo assess the relationship between gender and needle sharing, we analyzed publicly available data from the 2010–2019 National Survey on Drug Use and Health (NSDUH) datasets. Chi-square tests were conducted for descriptive analyses and multivariable logistic regression models were built adjusting for survey year, age, HIV status, and needle source.ResultsAmong the entire sample, 19.8% reported receptive needle sharing, 18.8% reported distributive sharing of their last needle, and 37.0% reported reuse of their own needle during last injection. In comparison with men, women had 34% increased odds (OR 1.34, 95% CI 1.11–1.55) of receptive needle sharing and 67% increased odds (OR 1.67, 95% CI 1.41–1.98) of distributive needle sharing. Reuse of one's own needle did not differ by gender.ConclusionsIn this nationally representative sample, we found that women are more likely in comparison with men to share needles both through receptive and distributive means. Expansion of interventions, including syringe service programs, to increase access to sterile injection equipment is of great importance.

Universal versus targeted screening for HCV infection in pregnancy in a diverse, multi-ethnic population: Universal screening is more comprehensive.

Universal hepatitis C screening in pregnancy is not recommended by NICE due to a lack of effective interventions to prevent mother to child transmission (MTCT) and is only offered to pregnant women at increased risk of infection (intra-venous drug use [IVDU] or with a HCV positive family member). No testing is offered to patients from high endemic areas. However, data regarding true seroprevalence in multi-ethnic inner-city populations in the UK are required. This study aimed to determine test positivity rates of HCV infection in an unselected South East London ethnically diverse population of pregnant women by universal screening during routine antenatal care compared with a "targeted" screening approach. "Targeted" risk-based screening was performed in two eras (2016, n=1002) and subsequently in 2018, after modifying the HCV risk questionnaire (n=1122). Universal opt out screening was similarly performed in two eras in 2017 (n=1012) and again in 2019 (n=1057). During screening for HBV, HIV and syphilis, anti-HCV was tested, followed by an iterative HCV RNA test in those positive for anti-HCV. All anti-HCV-positive women were referred to the specialist hepatology service, and testing was offered to all family members. All HCV RNA-positive patients were followed during pregnancy and post-delivery period and were offered treatment. All infants of HCV RNA-positive mothers were linked to care with paediatric team. In the 2016 "targeted" screening cohort 212/1002 had a risk of BBV (blood borne viral) infection and (0.6%) were anti-HCV positive and HCV RNA positive. 0.3% patients were newly diagnosed. In the 2017 universal screening cohort, 1012/1038 pregnant women consented to testing. 0.96% were anti-HCV positive and 0.86% women were HCV RNA positive with 0.67% newly diagnosed. After modification of the risk-based questionnaire, a second risk-based targeted cohort were tested in 2018: 342/1122 (31%) were assessed as at risk and were offered an anti-HCV test. 0.71% were anti-HCV positive and 0.27% were HCV RNA positive. In the 2019 cohort tested by universal screening, 1049/1057 women were tested and 0.85% tested positive for anti-HCV, 0.28% women were HCV RNA positive. All newly diagnosed patients were born abroad. All patients had mild liver disease and had normal pregnancies. All patients were treated post-delivery and achieved SVR. All patients were negative for other BBV infections. In conclusion, the anti-HCV test positive rate in this ethnically diverse pregnant cohort ranged between 0.96% and 0.6% (whole cohort) but the rate depended upon the era and screening methodology used. Universal screening detected a higher numbers of anti-HCV positive women during pregnancy, including those not previously aware of their hepatitis C. While there was not significant drop in seroprevalence in pregnant women between 2016 and 2019, we observed that the ratio of HCV RNA positive to anti-HCV positive women has declined over time, from 0.86% in 2016 (100% HCV RNA+) to 0.28% in 2019 (33% HCV RNA+) for whole cohort probably due to increased HCV treatment rates from 2016. These data have important implications for hepatitis C testing in pregnancy and the appropriate methodology to use for maximal accuracy.

Real-world treatment patterns, clinical outcomes, and health care resource utilization in advanced unresectable hepatocellular carcinoma.

BACKGROUND: The incidence of advanced unresectable hepatocellular carcinoma (HCC) is increasing in developed countries and the prognosis of advanced HCC remains poor. Real-world evidence of treatment patterns and outcomes can highlight the unmet clinical need. METHODS: We conducted a retrospective population-based cohort study of patients with advanced unresectable HCC diagnosed in Alberta, Canada (2008-2018) using electronic medical records and administrative claims data. A chart review was conducted on patients treated with systemic therapy to capture additional information related to treatment. RESULTS: A total of 1,297 advanced HCC patients were included of whom 555 (42.8%) were recurrent cases and the remainder were unresectable at diagnosis. Median age at diagnosis was 64 (range 21-94) years and 82.1% were men. Only 274 patients (21.1%) received first-line systemic therapy and, of those, 32 patients (11.7%) initiated second-line therapy. Nearly all of the patients received sorafenib (>96.4%) in first-line, and these patients had considerably higher median survival (12.23 months; 95% CI 10.72-14.10) compared with patients not treated with systemic therapy (2.66 months; 95% CI 2.33-3.12; log-rank p <0.001). Among patients treated with systemic therapy, overall survival was higher for recurrent cases, patients with Child-Pugh A functional status, and patients with HCV or multiple known HCC risk factors (p <0.05). CONCLUSIONS: In a Canadian real-world setting, patients who received systemic therapy had greater survival than those who did not, but outcomes were universally poor. These results underscore the need for effective front-line therapeutic options.