Viral Hepatitis Testing Research Articles

Emerging challenges: clozapine-associated hepatotoxicity in bipolar disorder: a case report

Introduction: Clozapine can cause major adverse effects, including rare but serious drug-induced liver injury. Understanding how clozapine causes liver injury is crucial for prompt diagnosis and effective management. Case presentation: We presented a case of a 42-year-old man with bipolar disorder who presented to our emergency department with a complaint of fatigue, nausea, vomiting, and pain in the upper right abdomen for 1 week. The patient was commenced with clozapine 1 month prior. He appeared jaundiced with a slightly swollen abdomen. Blood tests revealed highly elevated liver enzymes (AST 1679 U/L, ALT 1752 U/L) and bilirubin levels (total bilirubin 8.5 mg/dL, direct bilirubin 3.02 mg/dL). Tests for viral hepatitis and autoimmune diseases were negative. Suspecting clozapine-induced liver injury, we stopped the medication and provided supportive care. Discussion: Clozapine-induced liver injury likely occurs through a variety of pathophysiological pathways that include its metabolism by cytochrome P450 enzymes. Recognizing symptoms like jaundice and abdominal pain early is crucial for diagnosis. Our case reflects similar cases in literature, highlighting the variability in how this condition presents and the importance of prompt intervention to prevent severe consequences. Treatment involves stopping clozapine, supportive care, and closely monitoring the patient’s recovery. Conclusion: Physicians who prescribe clozapine should make sure that liver function is closely monitored, especially in the initial few months of the medication, and stop it if liver function become more than 3 times of upper limit of normal and patient developed signs and symptoms of liver injury.

Uptake of guideline-based testing for chronic viral hepatitis in Australian primary care: retrospective analysis of electronic medical record data.

Background Diagnosis is essential for engagement in care for chronic hepatitis B (CHB) and chronic hepatitis C (CHC), however, many Australians remain undiagnosed, especially for CHB. Primary care represents an important setting for testing, and this study sought to examine coverage in a large representative cohort of patients. Methods We analysed retrospective data from the electronic medical records of active patients visiting 566 primary care clinics in Victoria, Australia. Pathology records were assessed to identify the proportion of patients with a record of CHB/CHC serology testing based on risk factors identified in national guidelines (ethnicity, Indigenous status, history of injecting drug use, diagnosed HIV, and/or indications of liver disease). Results Of 1,593,774 patients, 393,948 (24.7%) had an indication for testing for CHB and/or CHC, of which 150,821 (38.3%) had evidence of testing. This proportion was highest in patients with HIV (65.6%) or injecting drug use history (60.0%), and lowest for those whose Indigenous status/ethnicity indicated testing (38.2%) or with elevated liver enzymes (39.1%). The proportion with evidence of testing was only moderate among those with a cirrhosis diagnosis (48.6%) or probable cirrhosis based on laboratory testing (50.6%). Conclusions This analysis demonstrated considerable gaps in testing for CHB and CHC in a large population of patients, including many with evidence of cirrhosis, suggesting higher risk of adverse outcomes. Primary care practices should be supported to comprehensively offer testing for viral hepatitis, particularly where there is evidence of liver disease, and these findings should be used to guide future interventions.

Barriers and facilitators to viral hepatitis testing in Uzbekistan: scoping qualitative study among key stakeholders, healthcare workers, and the general population

IntroductionIn the World Health Organization European Region, an estimated 14 million people live with a chronic hepatitis B virus infection (HBV), and 12 million are affected by a hepatitis C virus infection (HCV). Uzbekistan bears a major burden of HBV and has one of the highest HCV prevalence in the region. Following a presidential decree in May 2022, significant funds were allocated to the viral hepatitis (VH) elimination program in Uzbekistan. The program expands VH testing to reach 500,000 people annually during 2022–2025 as part of the VH elimination strategy that includes the provision of free testing and affordable treatment. Exploring the existing barriers and facilitators to VH testing is pivotal for informing these interventions.MethodsThis study uses a cross-sectional qualitative design to identify and explore the barriers and facilitators to VH testing among the general population in Uzbekistan. We collected data during October-November 2022 through semi-structured interviews with 12 key informants (KIs) and 7 focus group discussions with two target populations: the general population and healthcare workers (HCW) in Tashkent, Uzbekistan.ResultsFollowing the capability-opportunity-motivation-behavior model (COM-B model) as a framework for the analysis, we identified major capability barriers to VH testing primarily linked to low health literacy and limited knowledge about VH types, symptoms, transmission, testing and treatment. Physical opportunity barriers included the time and financial costs associated with testing, diagnostics, and treatment. Sociocultural opportunity barriers involved anticipated negative reactions and stigmatization, particularly affecting women. Motivational barriers included a reluctance to be tested when asymptomatic and a general fear of receiving positive test results. The involvement of healthcare workers in promoting VH awareness and motivating the general population emerged as a facilitator.ConclusionsA multi-pronged approach is recommended to achieve VH testing goals among the general population, focusing on raising awareness and health literacy and creating an enabling environment that ensures easy accessibility and minimizing VH testing-associated costs.

ТРУДНОСТИ ДИАГНОСТИКИ ОСЛОЖНЕНИЙ ДИВЕРТИКУЛЯРНОЙ БОЛЕЗНИ ДВЕНАДЦАТИПЕРСТНОЙ КИШКИ

Abstract. Introduction. Duodenal diverticulum is a hernia‒like protrusion of the duodenal wall. In terms of prevalence, this disease ranks second among all diverticula of the gastrointestinal tract after colonic diverticula. Aim. To substantiate the difficulty of diagnosing duodenal diverticulum perforation, based on a clinical case. Materials and Methods. A clinical case dated December 2021 of successful diagnostics and treatment of duodenal diverticulum perforation in female patient A. aged 68 is presented, based on the practice of the surgeons of the Surgery Unit in the Clinic of Hospital Surgery of Samara State Medical University. A set of laboratory investigations was performed, such as clinical blood analysis, biochemical blood analysis, coagulation profile, clinical urine analysis, and blood tests for HIV, viral hepatitis, and syphilis. Instrumental diagnostic methods were used, such as ultrasound (Aloka SSD 1700 (Japan)), CT (Revolution EVO (Russia)) of abdominal organs, review radiography, and Napalkov test. Results and Discussion. Laboratory and instrumental diagnostics, such as ultrasound and survey radiography, and primary laparotomy turned out to be insufficient for correct diagnosis and reasonable treatment. Napalkov test was performed, which revealed the contrast agent flow into retroperitoneum. The patient underwent relaparotomy, during which the duodenal diverticulum perforation by a foreign body (a fragment of a laurel leaf) was found. Conclusions. The case presented is an example of timely diagnosis of duodenal diverticulum perforation. The surgeons’ experience allowed them to suspect perforation in a short time, which helped avoid serious complications and contributed to the patient’s recovery. With timely diagnosis of such a rare and grave complication as duodenal diverticulum perforation, its clinical cure is justified.

Acceptability and Feasibility of the Plasma Separation Card for an Integrated Model of Care for HBV and HCV Screening Among People Attending HIV Clinics in Cameroon and Uganda.

Sub-Saharan African countries have a high burden of viral hepatitis and poor access to screening and care. The aim of this study was to evaluate the feasibility and acceptability of using the plasma separation card (PSC) for viral hepatitis B and C screening among people living with HIV (PLHIV) in Cameroon and Uganda. This is a cross-sectional study carried out between 05/2021 and 03/2023 including 192 PLHIV in Cameroon (n = 104) and Uganda (n = 88). Basic sociodemographic variables and whole blood samples were collected. Adequate filling with blood of PSCs was used to determine feasibility together with participant responses to questions on acceptability. A logistic regression model was carried out to assess the relationship between PSC acceptability and factors of interest. 70% of participants reported PSC as an acceptable viral hepatitis screening tool, and it was significantly more accepted in Uganda than Cameroon (100% vs. 43.2%, p < 0.001). Similarly, 75% of PSCs had at least one spot sample filled and were viable for analysis, 99% were correctly filled in Uganda and 53.4% in Cameroon. Reported ease of method performance (aOR: 24.77 95% CI 2.97-206.42, p = 0.003) and reduced collection time (aOR: 3.73 95% CI 1.26-11.04, p = 0.017) were associated with greater odds of PSC acceptance. HBsAg + and anti-HCV + prevalence were 11.1% and 1.0%, respectively. In spite of country differences, overall, the PSC was reported as a feasible and acceptable viral hepatitis testing method. Acceptability and feasibility of the method must be explored in heterogeneous target communities and qualitative research to better understand country-specific barriers and facilitators should be carried out.

Viral hepatitis testing and treatment in community pharmacies: a systematic review and meta-analysis

The World Health Organization seeks to eliminate viral hepatitis as a public health threat by 2030. This review and meta-analysis aims to evaluate the effectiveness of programs for hepatitis B and C testing and treatment in community pharmacies. Medline, Embase, Cochrane CENTRAL, and Global Health were searched from database inception until 12 November 2023. Comparative and single arm intervention studies were eligible for inclusion if they assessed delivery of any of the following interventions for hepatitis B or C in pharmacies: (1) pre-testing risk assessment, (2) testing, (3) pre-treatment assessment or (4) treatment. Primary outcomes were proportions testing positive and reaching each stage in the cascade. Random effects meta-analysis was used to estimate pooled proportions stratified by recruitment strategy and setting where possible; other results were synthesised narratively. This study was pre-registered (PROSPERO: CRD42022324218). Twenty-seven studies (4 comparative, 23 single arm) were included, of which 26 reported hepatitis C outcomes and four reported hepatitis B outcomes. History of injecting drug use was the most identified risk factor from pre-testing risk assessments. The pooled proportion hepatitis C antibody positive from of 19 studies testing 5096 participants was16.6% (95% CI 11.0%-23.0%; heterogeneity I2=96.6%). The pooled proportion antibody positive was significantly higher when testing targeted people with specified risk factors (32.5%, 95% CI 24.8%-40.6%; heterogeneity I2=82.4%) compared with non-targeted or other recruitment methods 4.0% (95% CI 2.1%-6.5%; heterogeneity I2=83.5%). Meta-analysis of 14 studies with 813 participants eligible for pre-treatment assessment showed pooled attendance rates were significantly higher in pharmacies (92.7%, 95% CI 79.1%-99.9%; heterogeneity I2=72.4%) compared with referral to non-pharmacy settings (53.5%, 95% CI 36.5%-70.1%; heterogeneity I2=92.3%). The pooled proportion initiating treatment was 85.6% (95% CI 74.8%-94.3%; heterogeneity I2=75.1%). This did not differ significantly between pharmacy and non-pharmacy settings. These findings add pharmacies to the growing evidence supporting community-based testing and treatment for hepatitis C. Few comparative studies and high degrees of statistical heterogeneity were important limitations. Hepatitis B care in pharmacies presents an opportunity for future research. None.

Piloting a simplified bio-behavioural survey methodology, the BBS-Lite, among people who inject drugs in Georgia

BackgroundDuring 2021 and 2023 two simplified Biological and Behavioural Study (BBS-Lite) surveys, and in 2022 one Standard Integrated Biological and Behavioural Study (IBBS), were conducted among people who inject drugs in seven cities in Georgia. From these, an opportunity to compare the implementation of these survey methods and results was able to be gained. MethodsThe two survey types were compared to find points of similarity and difference in their methodologies. The methodologies of the IBBS and BBS-Lite studies shared many characteristics, including the cities where they were implemented, recruitment criteria, sample sizes, and common questionnaire items. All studies were multi-centre cross-sectional involving administration of a face-to-face behavioural questionnaire and collection of biological specimens for testing of HIV, syphilis, hepatitis B virus (HBV), and hepatitis C virus (HCV). The main differences were in the sampling methods. The IBBS utilised respondent-driven sampling (RDS) while participants of the BBS-Lite studies were enrolled through consecutive recruitment at the harm reduction (HR) programme sites and on outreach and through snowball sampling. We compared the results from each study as well as the implementation modalities modalities such as time taken and budgetary requirements, and the complexity of implementation. ResultsConsiderably less time was required for recruitment, as well as for interviewing, data entry (4 times less) and the analysis for the BSS-Lite studies compared to the IBBS. The BSS-Lite study budgets were at least 2.5 times less than of the IBBS study.The recruited samples were comparable for age distribution, median age at first injection, the last drug injected, sharing of drug injecting equipment or receiving opioid agonist maintenance treatment (OAMT) during the last 12 months. HIV and HCV prevalence were similar including for stratifications by age, client status and city of recruitment. ConclusionOur findings have demonstrated that if implemented on a regular basis, the BBS-Lite can be a complementary solution for systematic data collection, filling surveillance gaps and addressing the challenges that persist in obtaining important data on people who inject drugs (PWID) between IBBS rounds in the country. The methodology is recommended for testing in other settings and in other key populations. In addition, the data collected on a routine base can help the harm reduction (HR) program to better understand the changes in the drug scene and observe new trends in HIV risks and drug injecting behaviours, possible barriers for access to harm reduction, drug treatment, and HIV and/or viral hepatitis testing and treatment services.

Innovation is needed to increase viral hepatitis testing globally.

Innovation is needed to increase viral hepatitis testing globally.

The use and impact of European Testing Week regional awareness campaigns to increase HIV and viral hepatitis testing coverage.

Since 2013, the European Testing Week (ETW) awareness campaign has become a key regional event influencing testing efforts for HIV, viral hepatitis, and sexually transmitted infections (STIs) through participation of 720 organizations. Here, we report on a survey from May to June 2022 aimed at assessing the participant-reported impact of the campaign. All past and current participating organizations were asked to complete an online questionnaire between 12 May and 17 June 2022. Multiple choice and open-text questions included organization information, usage of ETW to engage in local testing-related activities, and the effect of a regional campaign to reach a wider audience and generate impact. Of the 52 respondents, 34 (65%) stated first participating in ETW 5-10 years ago. ETW was used for awareness raising by 40 respondents (83%), new testing activities by 37 (77%), advocacy initiatives by 15 (31%), and training/capacity building by 18 (38%). For awareness raising, 95% used ETW to highlight the importance of and to encourage testing; for new testing activities, 74% used ETW to reach new groups. In total, 44 (85%) reported added benefits of a Europe-wide campaign compared with national/local campaigns, particularly the increased visibility and collaboration opportunities. Impact at the local level was observed by 24 (51%), and impact at a national level was observed by 20 (43%). A total of 28 (79%) reported increases in the number of tests performed and 25 (75%) reported increases in clients accessing services. Regional awareness campaigns reach wider audiences, boost local and national efforts to increase testing, and sensitize key populations about the critical value of testing compared with local/national campaigns.

Viral hepatitis in Asia-Pacific: a post-COVID-19 reset

Viral hepatitis in Asia-Pacific: a post-COVID-19 reset

Public knowledge and attitudes toward liver diseases and liver cancer in the Brazilian population: a cross sectional study

Little is known about the knowledge of the Brazilian population regarding prevention/screening/diagnosis of cirrhosis and hepatocellular carcinoma (HCC). We aimed to investigate the public knowledge/attitudes toward liver diseases in Brazil. A cross-sectional survey was conducted in which 1.995 adults were prospectively interviewed regarding knowledge about cirrhosis/HCC and attitudes toward vaccination and viral hepatitis (VH) testing. Most of the Brazilian subjects believe that alcohol abuse (63%-87%), NAFLD (29%-53%) and smoking (31%-47%) are the leading causes of cirrhosis/HCC. VH were less often linked to both diseases. Brazilians agreed that NAFLD is a risk factor for cirrhosis, cancer and cardiovascular diseases; 66%, 48% and 40% were submitted to hepatitis B vaccination and hepatitis B and C testing, particularly those with older age, higher level of education and income. VH was not considered by the majority of the Brazilians as an important cause liver disease, leading a large proportion of those subjects to neglect hepatitis B vaccination and hepatitis B and C testing. This work was supported by Brazilian Liver Institute.

Global prevalence of hepatitis B or hepatitis C infection among patients with tuberculosis disease: systematic review and meta-analysis

There is a substantial overlap in the epidemiology of chronic hepatitis B (HBV), hepatitis C (HCV) and tuberculosis (TB) due to overlapping risk factors. Testing for viral hepatitis is not widely recommended for patients with TB. The aim of this systematic review was to evaluate the global prevalence of chronic viral hepatitis infection among patients with TB. MEDLINE, EMBASE, Web of Science, Cochrane Library, African Journals Online, LILACS, and country TB reports were searched for studies published between January 1st, 2011 and June 17th 2021. Random-effects meta-analyses for proportions were conducted to obtain pooled prevalences. The prevalence of chronic HBV/HCV infection among patients with TB was also compared to that in the general population. The protocol was registered on PROSPERO (CRD42021276468). This analysis included 127 studies (83 for both HBV and HCV, 28 for HBV only, and 25 for HCV only) and data from 94,936 patients. The global pooled seroprevalence was 5.8% (95% CI 5.0-6.8) for HBs-antigen and 10.3% (95% CI 8.4-12.3) for HCV-antibodies. Pooled prevalence was highest in the WHO African Region for HBV at 7.8% (95% CI 5.2-10.9) and in the WHO European Region at 17.5% (95% CI 12.2-23.5) for HCV. In studies among TB patients who inject drugs, HCV prevalence was 92.5% (95% CI 80.8-99.0). Pooled HCV-antibody seroprevalence among patients with TB was higher than in the general population in all six WHO regions while HBs-antigen seroprevalence was higher in 3/6 regions. This review highlights the syndemicity of chronic viral hepatitis and TB and suggests that routine testing for hepatitis upon TB diagnosis may be justified. The prevalence of chronic HBV and HCV infections was higher among patients with TB than in the general population. This study was study was funded by the Global Tuberculosis Programme, World Health Organization.

Costs of a structured early detection program for advanced liver fibrosis and cirrhosis: insights on the "plus" of Check-up 35.

The implementation of an early detection program for liver cirrhosis in a general population has been discussed for some time. Recently, the effectiveness of a structured screening procedure, called SEAL (Structured Early detection of Asymptomatic Liver cirrhosis), using liver function tests (AST and ALT) and APRI to early detect advanced fibrosis and cirrhosis in participants of the German "Check-up 35" was investigated. This study identifies the expected diagnostic costs of SEAL in routine care and their drivers and reports on prevailing CLD etiologies in this check-up population. The analysis is based on theoretical unit costs, as well as on the empirical billing and diagnostic data of SEAL participants. Screening costs are mainly driven by liver biopsies, which are performed in a final step in some patients. Depending on the assumed biopsy rates and the diagnostic procedure, the average diagnostic costs are between EUR 5.99 and 13.74 per Check-up 35 participant and between EUR 1,577.06 and 3,620.52 per patient diagnosed with fibrosis/cirrhosis (F3/F4). The prevailing underlying etiology in 60% of cases is non-alcoholic fatty liver disease. A liver screening following the SEAL algorithm could be performed at moderate costs. Screening costs in routine care depend on actual biopsy rates and procedures, attendance rates at liver specialists, and the prevalence of fibrosis in the Check-up 35 population. The test for viral hepatitis newly introduced to Check-up 35 as once-in-a-lifetime part of Check-up 35 is no alternative to SEAL.

Results of Testing for Viral Hepatitis B and C in the Kyrgyz Republic, 2008 -2021

Results of Testing for Viral Hepatitis B and C in the Kyrgyz Republic, 2008 -2021

S3070 Macro AST: An Uncommon Yet Benign Entity

Introduction: An isolated increase in serum aspartate aminotransferase (AST) can be attributed to many conditions, including alcoholic liver disease, myocardial injury or skeletal muscle injury. Persistent elevations in AST without an obvious source can lead to diagnostic confusion. When evaluating such a patient, one must consider macro-enzyme aspartate aminotransferase (macro-AST). Macro-AST is an uncommon, yet benign condition in which a macro-enzyme is formed from self-polymerization of AST molecules or by the formation of a complex with other serum proteins such as immunoglobulins (Ig). These macro-enzymes circulate in the blood stream and can lead to an accumulation along with decreased clearance from the blood stream. Below, is an example of a woman without suggestive symptoms found to have persistently elevated AST. Case Description/Methods: The patient is a 60-year-old Hispanic female with hypothyroidism, hypertension who presented to the emergency room with complaints of lower back pain. Initial blood work revealed an AST of 404 U/L (normal 8-34 U/L) without other significant laboratory abnormalities. A computed tomography (CT) scan of the abdomen and pelvis with intravenous (IV) contrast showed lumbar spinal stenosis without other abnormalities. A right upper quadrant abdominal ultrasound with Doppler showed a normal appearing liver, biliary tree and patent vasculature. She denied any changes in her medications or use of supplements. She denied any history of liver disease, alcohol use or a family history of liver disease. Acetaminophen, ethanol and urine drug screens were negative. Testing for viral hepatitis, autoimmune hepatitis, ceruloplasmin, alpha-1-antitrypsin, ferritin, creatinine kinase, troponin I, Celiac disease and thyroid function tests were all unremarkable. Her AST level remained persistently elevated throughout hospitalization and after discharge. Given unremarkable workup and chronic AST elevation, macro-AST was the likely diagnosis. Discussion: Macro-AST is a benign cause of persistently elevated AST. Though its prevalence is not well known, some reports suggest that they can be seen across a wide age range and have no genetic basis as relatives of the patients have normal AST levels. Some cases have suggested a means of confirming the diagnosis via polyethylene glycol precipitation or electrophoresis. As these elevations can persist for over ten years, it is important for clinicians to be aware of this entity to avoid unnecessary procedures or testing.

S2907 COVID-19 Vaccine-Induced Liver Injury: A Case Series

Introduction: The coronavirus 2019 (COVID-19) pandemic has caused over 248 million cases and over 5 million deaths worldwide. Given its high morbidity and mortality, there was a rapid effort to develop a vaccine within a year of the commencement of the pandemic. Although these vaccines have excellent safety profiles, there is a risk of adverse effects such as fever, fatigue, arthralgias, injection site pain, and, less commonly, anaphylactic reaction. Drug-induced hepatotoxicity (DIH) is a rare side effect of vaccines that has rarely been reported. We report a cohort of four patients who presented with DIH following COVID-19 vaccination. Case Description/Methods: Our cohort includes four patients, aged 39-70, who presented between 12 to 82 days after their second dose of Pfizer COVID-19 vaccine. Only one patient had a history of COVID-19 infection. One patient had a history of hepatic steatosis. All four patients had normal alanine transaminase [ALT] and aspartate transaminase [AST] within one year before the current presentation. All patients demonstrated a hepatocellular pattern of liver injury (peak ALT range of 57 to 904 U/L and AST range of 51 to 828 U/L). Tests for acute viral hepatitis were negative. One patient was found to have positive antinuclear antibodies and anti-smooth muscle antibodies. One patient was found to have an elevated antimitochondrial antibody. Liver stiffness measurement in three patients showed no evidence of fibrosis. Three patients underwent liver biopsy of which two suggested evidence of toxic/drug induced liver injury while the other demonstrated nonspecific inflammation. (Figure) Discussion: DIH leads to 10% of all cases of acute hepatitis and up to 50% of all cases of liver failure, making it one of the common reasons for withdrawal of medications from the market. We observed that our patients developed hepatic injury after Pfizer COVID-19 vaccination. Vaccine-induced immune-mediated hepatitis is a known phenomenon thought to be secondary to the COVID-19 spike protein triggering an auto-immune-like hepatic condition. This could explain the findings seen in our patients, raising the question of inflammatory response in patients with underlying autoimmune conditions. It is important that these patients receive pre and post vaccination laboratory monitoring, especially given the emergence of booster vaccinations. There is a need to follow these patients in the long-term to monitor for changes in clinical and laboratory studies in order to assess the risk of complications and outcomes.Figure 1.: Patient demographics and characteristics

Viral Hepatitis A, B and C in a Group of Transgender Women in Central Brazil.

Transgender women (TGW) have limited access to affordable viral hepatitis testing, hepatitis B vaccination, and treatment. We aimed to estimate the prevalence of viral hepatitis A, B, and C, as well as to compare the adherence and immunogenicity of two hepatitis B vaccine schedules among TGW in Central Brazil. A total of 440 TGW were interviewed and tested for hepatitis A, B, and C serological markers from 2017 to 2018. The hepatitis B vaccine was offered to 230 eligible TGW: 112 received a super accelerated hepatitis B vaccine schedule (G1) and 118 a standard schedule (G2). The antibody against the hepatitis A virus (HAV) was detected in 75.63% of the participants, and 12.3% of the TGW were exposed to the hepatitis B virus (HBV). Two (0.46%) participants were HBV carriers. Only 41.5% of the participants showed a serological profile of hepatitis B vaccination. The antibody against the hepatitis C virus (anti-HCV) was found in six participants (1.37%). Of the TGW who received the first vaccine dose, 62 (55.36%) and 49 (41.52%) in G1 and G2, respectively, received three doses (p = 0.036). The vaccine response was evaluated in 28 G1 and 22 G2 TGW; of these, 89.3% and 100% developed protective anti-hepatitis B surface-antigen titers, respectively (p = 0.113). Since one-third of younger transgender women are susceptible to HAV, hepatitis B immunization is low, and the anti-HCV rate is higher in this group than in the general population in Central Brazil, public-health attention is warranted. The super-accelerated scheme demonstrated better adhesion and good immunogenicity, suggesting that it would be a more cost-effective solution.

Testing for Drug-Related Infectious Diseases and Determinants among People Who Use Drugs in a Low-Resource Setting: A Respondent-Driven Cross-Sectional Survey.

(1) Background: There is a dearth of data on the levels and determinants of testing for drug-related infectious diseases among people who use drugs (PWUD). We assessed the proportions and determinants of testing for drug-related infectious diseases to inform ongoing interventions for PWUD. (2) Methods: A cross-sectional study involving 599 PWUD was conducted in Dar es Salaam and Tanga between January and February 2019. Data were collected through a researcher-administered questionnaire using handheld tablets. Logistic regression models were used to identify independent testing determinants for drug-related infectious diseases. (3) Results: A majority (98.0%) of participants were males, with a mean age of 36.8 (SD = 7.8) years. 75.0%, 40.6%, 38.6%, and 8.2% reported having ever tested for HIV, tuberculosis (TB), sexually transmitted infections (STIs), and viral hepatitis, respectively. The likelihood of HIV testing was higher among those living with someone (AOR = 2.18, 95% CI: 1.09–4.68) compared with those who were homeless and perceived treatment was appropriate (AOR = 2.18, 95% CI: 1.05–4.46), but was lower among those who experienced mild to moderate (AOR = 0.44, 95% CI: 0.21–0.95) and severe internalized stigma (AOR = 0.44, 95% CI: 0.22–0.94) compared with those reporting no internalized stigma, and among those who experienced financial difficulties resulting from spending on health care services (AOR = 0.60, 95% CI: 0.40–0.89). Perception of treatment appropriateness (AOR = 2.29, 96% CI: 1.10–5.06) and severe enacted stigma (AOR = 1.90, 95% CI: 1.06–3.42) were associated with increased odds of TB testing. The odds of STIs testing increased among those who were married (AOR = 2.31, 95% CI: 1.45–3.72) compared with those who were single and those who had experienced mild (AOR = 2.39, 95% CI: 1.28–4.53) or severe (AOR = 6.20, 95% CI: 1.99–23.83) sexual violence, compared with those who had not experienced sexual violence. However, the odds decreased among those who had been remanded in the past month (AOR = 0.64, 95% CI: 0.43–0.95) compared with those who were not remanded and among those who had financial difficulties resulting from spending on health care services (AOR = 0.66, 95% CI: 0.47–0.94). The likelihood of testing for viral hepatitis testing increased among those who had heard about the comprehensive HIV intervention package (CHIP) (AOR = 2.59, 95% CI: 1.40–4.94); however, it decreased among those who had financial difficulties resulting from spending on health care services (AOR = 0.48, 95% CI: 0.24–0.92). (4) Conclusions: Except for HIV, PWUD had undergone limited testing for drug-related infectious diseases. The study findings highlight some factors influencing testing for the selected infectious diseases investigated, which should be targeted for tailored interventions to improve diagnosis and treatment.

AASLD practice guidance on drug, herbal, and dietary supplement-induced liver injury.

AASLD practice guidance on drug, herbal, and dietary supplement-induced liver injury.

A randomized controlled trial enhancing viral hepatitis testing in primary care via digital crowdsourced intervention

Despite the availability of hepatitis B virus (HBV) and hepatitis C virus (HCV) testing in primary care, testing rates in China remain low. Social media is an inexpensive means of disseminating information and could facilitate hepatitis testing promotion. We evaluated the capacity of digitally crowdsourced materials to promote HBV/HCV testing uptake via a randomized controlled trial (identifier: ChiCTR1900025771), which enrolled 750 Chinese primary care patients. We randomized patients (1:1) to receive crowdsourced HBV/HCV promotion materials through social media or facility-based care without promotional materials for four weeks. Exposure to all intervention materials was associated with increased odds of HBV (aOR = 1.79, 95% CI: 1.09–3.00) and HCV (aOR = 1.95, 95% CI: 1.29–2.99) testing compared to facility-based care. There was a significant reduction in hepatitis stigma among intervention group participants (HBV slope: −0.15, p < 0.05; and HCV slope: −0.13, p < 0.05). Digitally crowdsourced promotion messages could enhance hepatitis testing uptake and should be considered in hepatitis reduction strategies.Trial registration: Chinese Clinical Trial Registry (ChiCTR1900025771) on September 9, 2019. Available from: http://www.chictr.org.cn/showproj.aspx?proj=42788