HCV Testing Research Articles

Integrated care model and point of care diagnostics facilitate Hepatitis C treatment among patients receiving opioid agonist therapy: a retrospective review of medical records

BackgroundHepatitis C virus (HCV) is common among individuals in opioid agonist therapy (OAT). HCV treatment has previously been unavailable for most HCV positive OAT patients in Finland. The removal of treatment restrictions and attempts to reach HCV elimination goals have increased the number of OAT patients needing HCV treatment. The objectives of this study were 1) to characterize Finnish HCV positive OAT patients and evaluate their eligibility for HCV treatment at addiction service units, and 2) to retrospectively review the outcomes of treated patients.MethodsThe study focused on HCV positive OAT patients (n = 235). Demographics and clinical parameters were retrospectively reviewed using the patients’ medical records. The eligibility of providing HCV treatment to patients at addiction service units were evaluated based on patients’ clinical characteristics, such as liver function and patterns of substance use. The outcomes of patients receiving HCV treatment were reviewed.ResultsOf HCV antibody positive OAT patients, 75% had chronic HCV. Of 103 HCV patients screened for liver fibrosis either with Fibroscan or APRI (aspartate aminotransferase to platelet ratio index), 83 patients (81%) had no indication of severe liver damage. Point of care (POC) HCV tests were used for 46 patients to lower the threshold of attending laboratory testing. All patients preferred POC testing to conventional blood testing.Twenty patients had received HCV treatment, 19 completed the treatment and achieved sustained virologic response (SVR) at the end of the treatment. Of the 18 patients available for evaluation of SVR at 12 weeks after the treatment (SVR12), 17 achieved SVR12.ConclusionsThe integrated model consisting of HCV diagnostics and treatment at the addiction service unit was successfully implemented within normal OAT practice.

HCV Self-Testing to Expand Testing: A Pilot Among Men Who Have Sex With Men in China.

BackgroundHepatitis C virus self-testing (HCVST) may increase test uptake especially among marginalized key populations such as men who have sex with men (MSM). We conducted an observational study to assess the usability, acceptability and feasibility of HCVST among MSM in China.MethodsAn observational study with convenience sampling was performed among MSM in Guangzhou, China in 2019. The OraQuick® HCV Rapid Antibody Test kits were used in this study. Participants performed all 12 HCVST steps and interpreted the results in the presence of a trained observer. Usability was defined as the number and percentage of participants who completed all testing steps correctly without assistance and interpreted the results correctly. Inter-reader concordance was calculated as the percentage agreement between the results interpreted by the participant and those interpreted by a trained staff member. The same process was used to estimate inter-operator agreement between the self-testing and professional use test results. Acceptability was assessed using an interviewer-administered semi-structured questionnaire.ResultsAmong 100 participants with median age 27 (interquartile range 23–30) years, 4% reported prior history of HCV testing, 41% reported using blood-based HIV self-testing in the past, 54% (95%CI: 43.7–64.0%) completed all self-testing steps correctly without assistance and interpreted the results correctly. Both the inter-reader and inter-operator concordance were excellent at 97% (95%CI: 91.5–99.4%) and 98% (95%CI: 93.0–99.8%), respectively. The majority rated the HCVST process as very easy (52%, 95%CI: 41.8–62.1%) or easy (41%, 95%CI: 31.3–51.3%), 76% (95%CI: 66.4–84.0%) were willing to use HCVST again, and 75% (95%CI: 65.3–83.1%) would recommend it to their family and friends.ConclusionsOur findings demonstrate that oral fluid HCVST has high usability and acceptability among Chinese MSM. More implementation research is needed to plan how best to position and scale-up HCVST alongside other facility-and community-based testing approaches and ensure data linkage into health systems.

Usability and acceptability of oral-based HCV self-testing among key populations: a mixed-methods evaluation in Tbilisi, Georgia

BackgroundHepatitis C virus self-testing (HCVST) is an additional approach that may expand access to HCV testing. We conducted a mixed-methods cross-sectional observational study to assess the usability and acceptability of HCVST among people who inject drugs (PWID), men who have sex with men (MSM) and transgender (TG) people in Tbilisi, Georgia.MethodsThe study was conducted from December 2019 to June 2020 among PWID at one harm reduction site and among MSM/TG at one community-based organization. We used a convergent parallel mixed-methods design. Usability was assessed by observing errors made and difficulties faced by participants. Acceptability was assessed using an interviewer-administered semi-structured questionnaire. A subset of participants participated in cognitive and in-depth interviews.ResultsA total of 90 PWID, 84 MSM and 6 TG were observed performing HCVST. PWID were older (median age 35 vs 24) and had a lower level of education compared to MSM/TG (27% vs 59%). The proportion of participants who completed all steps successfully without assistance was 60% among PWID and 80% among MSM/TG. The most common error was in sample collection and this was observed more often among PWID than MSM/TG (21% vs 6%; p = 0.002). More PWID requested assistance during HCVST compared to MSM/TG (22% vs 8%; p = 0.011). Acceptability was high in both groups (98% vs 96%; p = 0.407). Inter-reader agreement was 97% among PWID and 99% among MSM/TG. Qualitative data from cognitive (n = 20) and in-depth interviews (n = 20) was consistent with the quantitative data confirming a high usability and acceptability.ConclusionsHCVST was highly acceptable among key populations in Georgia of relatively high educational level, and most participants performed HCVST correctly. A significant difference in usability was observed among PWID compared to MSM/TG, indicating that PWID may benefit from improved messaging and education as well as options to receive direct assistance when self-testing for HCV.

Thrombocytopenia in Cases Presenting with Chronic Liver Disease Due to Hepatitis C Virus

Objectives: record the rate of thrombocytopenia in cases presenting with chronic liver disease(CLD) due to Hepatitis C virus. Methodology: A total of 300 patients who were diagnosed with CLD caused by HCV and were over the age of 18 were part of this trial. The enroleld cases were admitted from Deptt. of Medicine, Rawalpindi Medical University. All patients diagnosed using AST, ALT levels of liver function test and reported by the radiologist was labeled as havign CLD. A thrombocyte count and an ELISA test for HCV were performed on the blood sample that was supplied to the laboratory from patients who had been diagnosed with CLD to determine presence/absence of thrombocytopenia. Results: Patients were in majority in age group 41-60 yrs i.e. 62%(n=186), mean age 42.63+8.57 yrs, 60 percent males (n=180) and there are 40 percent female subjects (n=120). Thrombocytopenia was found in 26 percent of CLD patients (n=78), while 74 percent of CLD patients (n=222) did not have any signs of thrombocytopenia. Conclusion: Higher rate of thrombocytopenia was observed in CLD cases due to hepatitis C virus. It needs attention for its early detection and management. Keywords: Chronic liver disease, hepatitis C virus, thrombocytopenia, HCV, CLD

Treating people where they are: Nurse-led micro-elimination of hepatitis C in supported housing sites for networks of people who inject drugs in Victoria, Canada.

To achieve the World Health Organization's goal of eliminating hepatitis C (HCV) by 2030 requires enhanced HCV testing and treatment among people who use drugs (PWUD). Micro-elimination of HCV is a strategy to target HCV testing and treatment efforts to specific segments of the population. From February to December 2018 nurses initiated a "seek & treat" micro-elimination approach, increasing outreach and removing barriers to accessing HCV treatment in a clinic setting by testing and treating individuals, including PWUD, where they live. The aim of this study was to evaluate the proportion of clients with HCV antibodies and HCV RNA and the response to direct acting agent (DAA therapy) among people who live at or have social connections to local supportive housing sites through this nurse-led micro-elimination project in Victoria, Canada. A chart review of electronic medical records and case management documentation was used to collect relevant data of participants treated with DAA therapy, identified through specific housing site testing and outreach interventions. In total, 180 people were tested for HCV antibodies, 72 (40%) were antibody positive: 51 (28%) were RNA positive, 13 (7%) had spontaneously cleared and 8 (4%) had been previously treated. Of the 51 that were currently living with HCV, 43 people were started on treatment, 39 have achieved sustained virologic response (SVR). By providing treatment to clients in their homes and with their friends, clinicians have been able to treat clients, including those with limited contact with the health care system.

A cross-sectional study of factors associated with COVID-19 testing among people who inject drugs: missed opportunities for reaching those most at risk

BackgroundPeople who inject drugs (PWID) are vulnerable to SARS-CoV-2 infection. We examined correlates of COVID-19 testing among PWID in the U.S.-Mexico border region and described encounters with services representing potential opportunities (i.e., ‘touchpoints’) where COVID-19 testing could have been offered.MethodsBetween October, 2020 and September, 2021, participants aged ≥18 years from San Diego, California, USA and Tijuana, Baja California, Mexico who injected drugs within the last month completed surveys and SARS-CoV-2, HIV, and HCV serologic testing. Logistic regression identified factors associated with COVID-19 testing including potential touchpoints, comorbidities and COVID-19 related misinformation and disinformation.ResultsOf 583 PWID, 30.5% previously had a COVID-19 test. Of 172 PWID who tested SARS-CoV-2 seropositive (30.1%), 50.3% encountered at least one touchpoint where COVID-19 testing could have been offered within the prior six months. Factors independently associated with at least two fold higher odds of COVID-19 testing were living in San Diego, recent incarceration, receiving substance use treatment, and experiencing ≥1 chronic health condition. Homelessness, having received ≥1 dose of COVID-19 vaccine, and having a HIV or HCV test since the COVID-19 epidemic began were also independently associated with having had a prior COVID-19 test.ConclusionWe identified several factors independently associated with COVID-19 testing and multiple touchpoints where COVID-19 testing could be scaled up for PWID, such as SUD treatment programs and syringe service programs. Integrated health services are needed to improve access to rapid, free COVID-19 testing in this vulnerable population.

Correlates of antiretroviral therapy (ART) initiation among HIV-positive men who have sex with men (MSM) in China

Background Men who have sex with men (MSM) are disproportionately affected by HIV globally and in China. Early antiretroviral therapy (ART) can reduce HIV-related illness, improve quality of life, and decrease HIV incidence rates. Given the high vulnerability of and limited research on ART coverage in China, we describe the ART initiation rate and correlates of ART initiation using Anderson’s health service utilization model. Methods We conducted a cross-sectional survey and collected blood samples for HIV and HCV testing and CD4 count among MSM recruited in Chengdu and Shanghai, China (N= 1,633). Using stepwise logistic regression, we explored factors associated with ART initiation postulated by Anderson’s health service utilization model. Results More than half of the participants had not started ART (53.5%). Older age and Han ethnicity were associated with a higher probability of ART initiation. Being married, higher monthly income (> US$464.35), retirement, depression, and condomless anal sex predicted a lower probability of ART initiation. Conclusions The ART initiation rate among MSM in this study is lower than the national level of ART coverage among all people living with HIV (PLWH) in China. ART initiation is best predicted by demographic characteristics such as age and ethnicity. Participants who are retired, married, reported depressive symptoms, and sexual risk behavior are less likely to have initiated ART. Future studies could examine whether integrating mental health and sexual health services into the current HIV care continuum is beneficial to ART initiation among MSM. Strategies should be developed to promote ART initiation among certain populations such as young MSM and ethnic minorities in China.

The Determining Effective Testing in Emergency Departments and Care Coordination on Treatment Outcomes (DETECT) for Hepatitis C (Hep C) Screening Trial: rationale and design of a multi-center pragmatic randomized clinical trial of hepatitis C screening in emergency departments

BackgroundEarly identification of HCV is a critical health priority, especially now that treatment options are available to limit further transmission and provide cure before long-term sequelae develop. Emergency departments (EDs) are important clinical settings for HCV screening given that EDs serve many at-risk patients who do not access other forms of healthcare. In this article, we describe the rationale and design of The Determining Effective Testing in Emergency Departments and Care Coordination on Treatment Outcomes (DETECT) for Hepatitis C (Hep C) Screening Trial.MethodsThe DETECT Hep C Screening Trial is a multi-center prospective pragmatic randomized two-arm parallel-group superiority trial to test the comparative effectiveness of nontargeted and targeted HCV screening in the ED with a primary hypothesis that nontargeted screening is superior to targeted screening when identifying newly diagnosed HCV. This trial will be performed in the EDs at Denver Health Medical Center (Denver, CO), Johns Hopkins Hospital (Baltimore, MD), and the University of Mississippi Medical Center (Jackson, MS), sites representing approximately 225,000 annual adult visits, and designed using the PRECIS-2 framework for pragmatic trials. When complete, we will have enrolled a minimum of 125,000 randomized patient visits and have performed 13,965 HCV tests. In Denver, the Screening Trial will serve as a conduit for a distinct randomized comparative effectiveness trial to evaluate linkage-to-HCV care strategies. All sites will further contribute to embedded observational studies to assess cost effectiveness, disparities, and social determinants of health in screening, linkage-to-care, and treatment for HCV.DiscussionWhen complete, The DETECT Hep C Screening Trial will represent the largest ED-based pragmatic clinical trial to date and all studies, in aggregate, will significantly inform how to best perform ED-based HCV screening.Trial registrationClinicalTrials.gov ID: NCT04003454. Registered on 1 July 2019.

Study protocol of a randomized controlled trial comparing two linkage models for HIV prevention and treatment in justice-involved persons

BackgroundPersons involved in the justice system are at high risk for HIV and drug overdose upon release to the community. This manuscript describes a randomized controlled trial of two evidence-based linkage interventions for provision of HIV prevention and treatment and substance use disorder (SUD) services in four high risk communities to assess which is more effective at addressing these needs upon reentry to the community from the justice system.MethodsThis is a 5-year hybrid type 1 effectiveness-implementation randomized controlled trial that compares two models (Patient Navigation [PN] or Mobile Health Unit [MHU] service delivery) of linking justice-involved individuals to the continuum of community-based HIV and SUD prevention and treatment service cascades of care. A total of 864 justice-involved individuals in four US communities with pre-arrest histories of opioid and/or stimulant use who are living with or at-risk of HIV will be randomized to receive either: (a) PN, wherein patient navigators will link study participants to community-based service providers; or (b) services delivered via an MHU, wherein study participants will be provided integrated HIV prevention/ treatment services and SUD services. The six-month post-release intervention will focus on access to pre-exposure prophylaxis (PrEP) for those without HIV and antiretroviral treatment (ART) for people living with HIV (PLH). Secondary outcomes will examine the continuum of PrEP and HIV care, including: HIV viral load, PrEP/ ART adherence; HIV risk behaviors; HCV testing and linkage to treatment; and sexually transmitted infection incidence and treatment. Additionally, opioid and other substance use disorder diagnoses, prescription, receipt, and retention on medication for opioid use disorder; opioid and stimulant use; and overdose will also be assessed. Primary implementation outcomes include feasibility, acceptability, sustainability, and costs required to implement and sustain the approaches as well as to scale-up in additional communities.DiscussionResults from this project will help inform future methods of delivery of prevention, testing, and treatment of HIV, HCV, substance use disorders (particularly for opioids and stimulants), and sexually transmitted infections for justice-involved individuals in the community.Trial registration: Clincialtrials.gov NCT05286879 March 18, 2022.

Hepatitis C antibody prevalence, correlates and barriers to care among people who inject drugs in Central California.

Hepatitis C (HCV) infection among people who inject drugs (PWID) is a major public health concern. We examined correlates of HCV antibody (anti-HCV) seropositivity and characteristics of prior HCV testing and treatment among PWID in Fresno, California, which has among the highest prevalence of injection drug use (IDU) in the United States. We surveyed 494 peer-recruited PWID (≥18years of age) in 2016 about their experiences with HCV testing and treatment, and conducted HCV and HIV antibody testing for all participants. Bivariate analyses and multivariable logistic regressions were used to identify correlates of anti-HCV seropositivity. A majority (65%) tested positive for anti-HCV, with 32% of those being unaware of their HCV status. Anti-HCV seroprevalence was independently and positively associated with older age (AOR = 1.11 per year, 95% CI = 1.06, 1.17), years injecting (AOR = 1.08 per year, 95% CI = 1.03, 1.13), distributive syringe sharing (AOR = 2.76, 95% CI = 1.29, 5.94), having syringes confiscated by police (AOR = 2.65, 95% CI = 1.22, 5.74), ever trading sex (AOR = 3.51, 95% CI = 1.40, 8.81) and negatively associated with being Black/African American (non-Hispanic) (AOR = 0.06, 95% CI = 0.01, 0.47). Prior HCV testing was associated with older age, ever getting syringes from a syringe services program, and having interactions with police. For those aware of their anti-HCV seropositivity, only 11% had initiated treatment; reasons for not seeing a physician regarding diagnosis included not feeling sick (23%), currently using drugs/alcohol (19%) and not knowing where to go for HCV medical care (19%). Our findings highlight the importance of expanding community-based access to sterile syringes alongside HCV testing and treatment services, particularly at syringe service programs where PWID may be more comfortable seeking testing and treatment.

The impact of point-of-care hepatitis C testing in needle and syringe exchange programs on linkage to care and treatment uptake among people who inject drugs: An Australian pilot study.

Point-of-care (POC) diagnostics overcome barriers to conventional hepatitis C (HCV) testing in people who inject drugs. This study assessed impact on hepatitis C treatment uptake of POC HCV testing in needle and syringe exchange programs (NSPs). Rapid EC was a single-arm interventional pilot study of HCV POC testing conducted in three inner-city community clinics with NSPs. Twelve months after the POC testing, a retrospective medical record and Pharmaceutical Benefits Scheme audit was performed to determine the number of HCV RNA-positive participants who were prescribed HCV treatment. 70 HCV RNA-positive Rapid EC study participants were included. 44 (63%) were prescribed DAAs; 26 (59%) completed treatment and 15 (34%) had SVR testing, all of whom were cured. Age≥40years (aOR 3.45, 95% CI 1.10-11.05, p=.03) and secondary school education (aOR 5.8, 95% CI 1.54-21.80, p=.009) had higher likelihood of being prescribed DAAs, whereas homelessness was inversely associated with prescription of DAAs (aOR 0.30, 95% CI 0.09-1.04, p=.057). Median time to receive a DAA script from date of diagnosis was seven days (IQR 0 to 14days), and time to filling the DAA prescription was 2days (IQR 0-12days). In conclusion, provision of POC testing through NSPs was effective for linking new clients to HCV treatment and reduced the time to treatment. Further studies are needed to define the most cost-effective use of POC testing in models of care for people who inject drugs to increase HCV treatment uptake.

Retrospective Analysis of Hepatitis B and Hepatitis C Viruses and HIV Infections in Patients Presenting to the General Surgery Clinic and Evaluated Preoperatively

Aim: Hepatitis B(HBV), Hepatitis C(HCV) and HIV infections are important parenterally transmitted infections. The aim of this study is to determine the seroprevalence of HBsAg, anti-HBs, anti-HCV and anti-HIV in patients with preoperative preparation.
 Materials and MethodS: Anti-HBs, HBsAg, anti-HCV, anti-HIV tests with chemiluminescent enzyme immune-assay method in a total of 900 patients applied to the General Surgery Clinic and were evaluated preoperatively by Abbott Architect i1000 immunoassay analyzer (Abbott Diagnostics, Illinois, USA) operated according to the manufacturer's instructions. Anti-HBs titer above 10 IU/mL, serum optical density/”cut-off” control optical density (S/Co) ≥1 in HBsAg, anti HCV and anti-HIV tests were accepted as positive. HBV-DNA and HCV RNA tests were performed with real-time PCR method.
 Results: Anti-HBs test was found to be reactive in 34.11% and nonreactive in 65.89%. HBsAg positivity was 1.0% (9/900), and anti-HCV positivity was 0.33% (3/900). Anti-HIV positivity and HBsAg-anti-HCV association were not detected. Six patients with HBsAg positivity and one patient with anti-HCV positivity were found incidentally during preoperative examinations.
 Conclusion:As a result of these data, it can be concluded that cost-effective serological tests for HBV and HCV infections performed in the preoperative period are extremely important in the detection of asymptomatic patients. Preoperative screening is important in terms of early diagnosis of patients before complications such as cirrhosis and HCC develop, enabling treatment, as well as enabling healthcare professionals to increase infection control measures while intervening with infected patients, to be more careful in terms of percutaneous injuries, and to reduce the risk of transmission.

Cost-Effectiveness of a Core Antigen–Based Rapid Diagnostic Test for Hepatitis C

ObjectivesHepatitis C virus (HCV) affects 58 million worldwide and > 79% of people remain undiagnosed. Rapid diagnostic tests (RDTs) for HCV can help improve diagnosis and treatment rates. Nevertheless, the high price and infrastructure needed to use current molecular HCV RDT options present a barrier to widespread use—particularly in low- and middle-income countries. We evaluated the performance and cost-effectiveness of a theoretical core antigen (cAg) RDT for HCV viremia confirmation, which requires fewer resources. MethodsWe adapted a previously validated microsimulation model to simulate HCV disease progression and outcomes under different HCV testing algorithms in Georgia and Malaysia. We compared standard of care testing with laboratory-based ribonucleic acid HCV to a cAg-based RDT for HCV confirmation. We simulated a cohort of 10 000 adults in each country, with an HCV-ribonucleic acid prevalence of 5.40% in Georgia and 1.54% in Malaysia. We projected the cumulative healthcare costs, quality-adjusted life-years, and diagnosis coverage rates over a lifetime horizon. ResultsCompared with the standard of care testing, the cAg-based RDT would increase quality-adjusted life-years by 270 in Georgia and 259 in Malaysia per 10 000 people. The high diagnosis rate and treatment rate of the cAg-based RDT result in substantial cost savings because of averted HCV sequelae management costs. Cost savings are $281 000 for Georgia and $781 000 for Malaysia. ConclusionsWe found that a cAg-based RDT for HCV could improve the diagnosis rate and result in cost savings. Such a test could have a substantial impact on the feasibility and cost of HCV elimination.

Wirusowe zapalenie wątroby typu C w Polsce w 2019 roku

HCV infection continues to be a significant public health problem in Europe. The aim of the study was to assess the epidemiological situation of hepatitis C in Poland in 2019, based on data collected as part of epidemiological surveillance in 2019, comparing them to data from previous years. The following were analyzed: 1) data from epidemiological surveillance in 2019 2) diagnosis rates from "Infectious Diseases and Poisonings in Poland" bulletins for the years 2013-2019 3) data on deaths due to hepatitis C from the Demographic Surveys and Labour Market Department of the Statistics Poland. In 2019, the HCV diagnosis rate was 8.71 per 100 thousand - a total of 3 343 cases of HCV infection were reported. This was a slight decrease compared to 2018. Still we observe the rate differentiation, territorial (differences in the value of the diagnosis rate are noticeable already at the voivodeship and poviat level) and demographic (higher rates in men than in women, higher rates in urban than in rural areas), which is probably related to HCV testing accessibility. Among acute hepatitis C cases according to the EU definition, indicative of current HCV transmission, exposures related to health care (haemodialysis and nosocomial transmission) were identified, followed by non-medical injection (community needle stick injuries, tattoos, piercings) and sexual contact. A low number of diagnoses (5.9%; 196/3343) among people who inject drugs indicate diagnostic difficulties. For years, the overview of hepatitis C in Poland, observed in epidemiological surveillance, has been determined by the availability of HCV testing. Developing the comfortable testing + treatment system in Poland that reaches people exposed to the current transmission of HCV infection (bearing in mind the possibility of re-infection) is the only possibility of eradication of HCV infections.

Examining the impact of the first wave of COVID-19 and associated control measures on interventions to prevent blood-borne viruses among people who inject drugs in Scotland: an interrupted time series study

BackgroundCOVID-19 has likely affected the delivery of interventions to prevent blood-borne viruses (BBVs) among people who inject drugs (PWID). We examined the impact of the first wave of COVID-19 in Scotland on: 1) needle and syringe provision (NSP), 2) opioid agonist therapy (OAT) and 3) BBV testing. MethodsAn interrupted time series study design; 23rd March 2020 (date of the first ‘lockdown’) was chosen as the key date. ResultsThe number of HIV tests and HCV tests in drug services/prisons, and the number of needles/syringes (N/S) distributed decreased by 94% (RR=0.062, 95% CI 0.041–0.094, p < 0.001), 95% (RR=0.049, 95% CI 0.034–0.069, p < 0.001) and 18% (RR = 0.816, 95% CI 0.750–0.887, p < 0.001), respectively, immediately after lockdown. Post-lockdown, an increasing trend was observed relating to the number of N/S distributed (0.6%; RR = 1.006, 95% CI 1.001–1.012, p = 0.015), HIV tests (12.1%; RR = 1.121, 95% CI 1.092–1.152, p < 0.001) and HCV tests (13.2%; RR = 1.132, 95 CI 1.106–1.158, p < 0.001). Trends relating to the total amount of methadone prescribed remained stable, but a decreasing trend in the number of prescriptions (2.4%; RR = 0.976, 95% CI 0.959–0.993, p = 0.006) and an increasing trend in the quantity prescribed per prescription (2.8%; RR = 1.028, 95% CI 1.013–1.042, p < 0.001) was observed post-lockdown. ConclusionsCOVID-19 impacted the delivery of BBV prevention services for PWID in Scotland. While there is evidence of service recovery; further effort is likely required to return some intervention coverage to pre-pandemic levels in the context of subsequent waves of COVID-19.

Harm reduction and health services provided by syringe services programs in 2019 and subsequent impact of COVID-19 on services in 2020

ObjectivesThis study describes harm reduction and health services provided by U.S syringe services programs (SSPs) in 2019 and changes in provision of those services in 2020. MethodsSSPs were invited to participate in the Dave Purchase Memorial survey in August 2020. We collected programmatic data on services provided in 2019 and at the time of the survey in 2020. We conducted descriptive analyses using Chi-square and McNemar’s tests. ResultsAt the time of the survey, > 60% of SSPs reported increased monthly syringe and naloxone distribution and expansion of home-based and mail-based naloxone delivery in Fall 2020 compared to 2019. Approximately three-quarters of SSPs decreased or stopped providing on-site HIV and HCV testing. Nearly half of SSPs offering on-site medications for opioid use disorder (MOUD) in 2019 increased provision of MOUD in 2020. The proportion of SSPs offering on-site mental health care services and primary care services statistically significantly decreased from 2019 to Fall 2020, but telehealth offerings of these services increased. ConclusionsMany SSPs that offered health services in 2019 and remained operational in 2020 increased telehealth provision of mental health and primary care services, increased MOUD provision, and expanded harm reduction services, but most SSPs reduced or stopped on-site HIV and HCV testing. Sustaining SSP growth and innovation is paramount for preventing overdose deaths and HIV/HCV outbreaks after the deadliest year of the opioid epidemic in 2020.

TEST AND CURE Towards hepatitis C Micro Elimination by Increase Outreach Linkage to Care by use of HCV Viral Load Real Time Measure and Same Day Treatment

Introduction and objective: HCV treatment for all was effective in France since 2017. HCV testing, diagnosis and treatment of drugs users and precarious people remain low. Lost follow-up was too important since several stages are necessary. Pangenotypic direct antiviral agents were available. Point-of-care HCV RNA testing offers advantage over antibody testing, enabling diagnosis of active infection with real time measure in a single visit. It is missing link between HCV RDT, liver fibrosis evaluation by FIBROSCAN and treatment. Validated Xpert HCV Viral Load assay CEPHEID, fast training technique, allow developing projects of diagnosis to treatment session. Our objective was to evaluate test to cure session allowing the access in 5 hours to an antiviral treatment to vulnerable and precarious populations (drug users, migrants, psychiatric patients). Materials and methods: Eligible patients had to have known positive serology or risk behavior, an unknown or unchecked viral load after antiviral treatment; 5 to 7 patients were recruited per each session by social or nursing interview. Between 9 am and 2 pm these patients had access to measure of the hepatic fibrosis by FIBROSCAN, HCV viral load in real time by CEPHEID Xpert HCV Viral load finger-stick samples, social interview, shared educational evaluation, collective workshops, especially harm reduction, depiction of results by hepatologist and prescription of DAA (sofosbuvir velpastasvir combination) allowed delivery of 1st month of treatment. Specific social and nursing follow-up was made during and after treatment. Compliance and sustained virological rate were determinate at week 12. Results: From October 2019 to December 2021, 223 sessions were realized on 27 sites: 9 drug units, one prison, 17 social units; 1602 patients with drug using history were screened; 427 patients had HCV positive serology and 24 patients did not come; 403 FIBROSCAN measures and 403 measures of viral load in real time were realized. Mean value of liver stiffness was 8.2 and 29% of patients were F3 or F4: 229 patients were HCV RNA positive (56.8%), 57 declared knew their HCV status; 228 treatments began same day, only 1 was delayed due to default social rights; 120 patients had a negative viral load spontaneously and 54 following prior treatment; 399 social interviews and 405 collective workshops were realized. On 31st January 2022, 207 antiviral treatments were completed and 199 patients were cured; 12 patients interrupted treatment; 3 patients relapsed and 5 reinfections; 89% of patients were satisfied with this program. Conclusions: Despite 3 months interruption by COVID 19 pandemic lockdown and sanitary restrictions, 94% of positive participants were linked to care and cure with this mobile clinic model, by screening and RNA real time measure in unity of place adapted to precarious public, patients distant from system of care had access immediately to treatment.

Sensitivity of Elisa for Hepatitis C Virus Identification in Serum and Comparison of Elisa with ICT

In the developing countries, Immuno Chromatographic Techniques (ICT) are used instead of ELISA which may give false positive and false negative results. But ELISA technique has more than 99% accuracy, sensitivity and specificity regarding the diagnosis of Hepatitis C Virus. A cross sectional study on 200 patients is the part of this study to check sensitivity of ELISA for HCV as well as to compare the sensitivity of ELISA and ICT method for HCV. For investigation of Pakistani patients using these techniques, 50 samples of control group (25 samples of negative control and 25 of positive control) and 150 samples of patients (suspected for HCV) were collected. Their HCV tests were first performed by using ICT kits. Then these samples were tested for anti-HCV antibody through ELISA by fully automated Instrument and their cut off values was determined. Results obtained by ELISA were compared by the results obtained by testing through ICT method. Results revealed that twenty-five patients suffering from hepatitis C were detected by both ELISA and ICT (positive control). Similarly, ELISA and ICT showed the negative results for all twenty-five negative control patients. Both ELISA and ICT showed the same results regarding detection of hepatitis C except two patients in experimental group. ICT showed positive result of a patient who was healthy and also confirmed negative by ELISA technique. Also this patient did not show any sign and symptom of hepatitis C. Further, ICT showed negative result of hepatitis C infected patient who has the sign and symptoms of hepatitis C and also ELISA showed positive result regarding detection of hepatitis C. It can be concluded from this experiment that both ELISA and ICT can be used for the detection of hepatitis C. However, the sensitivity of ELISA is higher as compared to ICT. Therefore, it can be recommended that ELISA is more appropriate method for the detection of hepatitis C.

IMPACT OF RISK FACTORS IN THE SCRUTINY AND DIAGNOSIS OF HEPATITIS C

Chronic hepatitis C is considered a public health problem. Risk factors for infection traditionally identified as blood transfusion, major surgeries, organ donation, hemodialysis, vertical transmission have undergone an epidemiological transition. Other risk factors have become the main causes of new infections, such as intravenous drug use, sexual intercourse, prison, and tattoos. To describe the risk factors associated with the positivity of Hepatitis C by analyzing the epidemiological profile of populations at high risk for Hepatitis C. A cross-sectional study was carried out in the Mexican population as part of an HCV 2-years screening program implemented from December 2017 to December 2019. People were invited to participate in the program mainly in public health institutions, or through special campaigns in state and federal social rehabilitation centers and prisons. Adults (> 18 years) with informed consent were included for the study. Participants received a multiple-choice questionnaire to identify sociodemographic variables and the existence of any risk factor for HCV. A rapid test for HCV was performed and those participants whose results were reactive were applied a PCR test to determine quantification of HCV RNA. For the statistical analysis, the population was classified according to risk, as a general population with at least one risk factor and a high-risk population. A logistic regression model adjusted for sociodemographic variables and risk factors for the general population was developed to analyze the factors that may be associated with HCV positivity. This national cross-sectional cohort included 297,397 eligible subjects with a rapid test performed. Of the total number of rapid tests carried out, 13,085 subjects were reactive (4.4%) and 9,426 subjects (3.2% of the total population) were confirmed as positive by PCR test. The prevalence of viremia in the general population was 2.5%, while in the population with HIV was 3.1% and in persons deprived of their liberty (CERESO) was 18.5%. (Table) The median age in the total population was 43 years. Jalisco (10.1%) and Colima (7.7%) were the states with the highest percentage of positive results, followed by Baja California (7.4%). The percentage of people with viremia increases with age, going from 1.1% in the group of 18-29 years to more than 4.7% in those older than 60 years. In this cohort, the most common risk factors were history of acupuncture/ tattooing/piercings (21%), intravenous drug use (15%), and high-risk sexual practices (12%). From the logistic regression by risk population, we found that having at least one risk factor increased the odds of being HCV positive by 62% (OR = 1.62, IC 95% 1.54-1.69), compared with the population without risk factors. When conducted the analysis by type of specific population, the results showed that incarcerated people were 55 times more likely to be positive for Hepatitis C and 14 times more likely to be positive to HCV, compared to the HIV positive population. In this cross-sectional study with different high-risk populations for detecting hepatitis C, we identified 3.2% of viremic patients who were linearly related to older age and the existence of risk factors. Based on the results for this analysis, screening and diagnosis in high-risk populations, even those that are routinely marginalized, could be more effective. The authors declare that there is no conflict of interest.

Sero-Prevalence of Hepatitis B and C Antibody among the Residence of Island Communities of Lake Chad Basin, Borno State, Nigeria

Aim: The study sought to determine the prevalence of hepatitis B (HBV) and hepatitis C (HCV) among the people of Lake Chad Basin of Borno State Nigeria.&#x0D; Study Design: A cross sectional quantitative survey that derived information on the behavioral characteristics, vulnerability of the population and prevalence of HBV and HCV.&#x0D; Place and Duration of Study: Testing for HBV and HCV antibodies was carried out among the people of urban and rural communities of Lake Chad Basin of Borno State Nigeria in 2017.&#x0D; Methodology: 1790 samples were collected on dried sample blot card, dried and transported to National Institute for Pharmaceutical Research and Development Abuja where the samples were tested using HBsAg ELISA rapid test kit (ACON, USA) and confirmed with HBsAg ELISA test kit (ABON, ABON Biopharm Hangzhou Co. Ltd). HCV tests was carried out using ACON hepatitis C test strip (ACON Laboratory, INC USA) and confirmed with ELISA HCV kit (ORTHO HCV version 3.0; Ortho-Clinical Diagnostics, Raritan, New Jersey, USA). The results were expressed in percentages&#x0D; Results: The result of the study revealed that 28 representing 1.56% tested positive for HBV and 3(0.17%) was HCV positive. On disaggregation, Commercial sex workers (CSW) and prison inmates had the highest prevalence of HBV and HCV 8.5% and 1.41% respectively. The highest number of positive cases of HBV was recorded among the males in the age range of 40-44 (3.25%), while the highest cases among the females was within the age range of 35-39 (6.8%). HCV positive cases were one male and two females within the age range of 20-24. HBV was higher in urban communities (3.70%), while HCV was higher in rural communities (0.17%).&#x0D; Conclusion: Interventions such as vaccination against HBV, sexual education prevention of blood exposure was suggested to mitigate further transmission of these infections