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Prevention, Treatment and Care of Hepatitis C among People Who Inject Drugs
Jason Grebely, PhD Senior Lecturer Viral Hepatitis Clinical Research Program The Kirby Institute University of New South Wales
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Prevention, Treatment and Care of HCV among PWID
Issues The burden of HCV in many countries is driven by PWID and continues to grow Transmission of HCV continues among PWID Although HCV treatment uptake is low due to a number of barriers, treatment willingness is high among PWID HCV treatment is effective among PWID Strategies to enhance HCV assessment and treatment among PWID are required
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PWID are the core of the HCV epidemic and “ageing cohorts” of PWID will lead to considerable advanced liver disease burden
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PWID are at the core of the HCV epidemic
PEOPLE LIVING WITH HCV INFECTION 1) Hajarizadeh B, et al. Nature Rev Gastroenterol Hepatol ) Grebely J and Dore GJ Antiviral Research In Press.
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PWID are at the core of the HCV epidemic
80% OF NEW INFECTIONS OCCUR AMONG CURRENT PWID IN MANY COUNTRIES PEOPLE LIVING WITH HCV INFECTION 1) Hajarizadeh B, et al. Nature Rev Gastroenterol Hepatol ) Grebely J and Dore GJ Antiviral Research In Press.
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PWID are at the core of the HCV epidemic
60% OF EXISTING INFECTIONS ARE AMONG CURRENT & FORMER PWID IN MANY COUNTRIES PEOPLE LIVING WITH HCV INFECTION 1) Hajarizadeh B, et al. Nature Rev Gastroenterol Hepatol ) Grebely J and Dore GJ Antiviral Research In Press.
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HCV is a major public health problem among PWID
Eastern Europe 2.3m North America 1.7m East and Southeast Asia 2.6m Sub-saharan Africa 0.8m Latin America 1.7m Global estimation: 10.0 million PWIDs (range 6.0–15.2) in 2010 were HCV antibody positive Global prevalence: 67.0% Nelson PK, et al. Lancet 2011
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Disease burden due to HCV is substantial
Hepatitis C virus Streptococcal pneumonia Human papilloma virus Hepatitis B virus E. Coli HIV/AIDS Staphylococcus aureus Influenza C. Dificile Rhinovirus Respiratory syncytial virus Parainfluenza virus Group B Strep Years of Life Lost Group A Strep Year-equivalents of reduced functioning Haemophilus influenza Tuberculosis Legionella Chlamydia Adenovirus Gonorrhea 2000 4000 6000 8000 1000 Health Adjusted Life Years (HALYs) Kwong et al PLoS One 2012
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Liver-related mortality increases with age
Deans G, et al CMAJ Open. 2013
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HCV transmission continues to occur among PWID
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Harm reduction interventions have been less effective for HCV
Higher prevalence of HCV infection (67% vs. 20%) Higher risk of infection (3-5% for HCV vs 1-2% for HIV) Mehta SH, Journal of Infectious Diseases 2011.
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Interventions to prevent HCV among IDUs
Opioid substitution therapy1-2 High NSP coverage2 Multiple combined interventions most effective2-3 1) Nolan S, et al. Addiction 2014 (In Press); 2) Turner KM, et al. Addiction 2011; 3) Hagan H, et al. Journal of Infectious Diseases 2011.
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HCV treatment uptake among people who inject drugs is low, due to a number of barriers at the levels of the system, provider and patient
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PWID have a high willingness to receive HCV treatment
PWID LIVING WITH HCV INFECTION
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PWID have a high willingness to receive HCV treatment
80% OF PWID ARE WILLING TO RECEIVE HCV TREATMENT PWID LIVING WITH HCV INFECTION Stein MD, Drug and Alcohol Dependence Walley AY, J Substance Abuse Treatment Doab A, Clinical Infectious Diseases Fischer B, et al. Presse Med Strathdee S, et al Clinical Infectious Diseases Grebely J, et al. Drug and Alcohol Dependence Alavi M, et al. Clinical Infectious Diseases 2013.
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Treatment uptake among PWID is still low….
80% OF PWID ARE WILLING TO RECEIVE HCV TREATMENT 1-2% are treated each year PWID LIVING WITH HCV INFECTION 1) Grebely J. J Viral Hepatitis ) Mehta S. J Community Health ) Iversen J, J Viral Hepatitis ) Alavi M. Liver International
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Barriers to HCV assessment and treatment
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Barriers to HCV assessment and treatment
PATIENT
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Barriers to HCV assessment and treatment
PROVIDER
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Barriers to HCV assessment and treatment
SYSTEM
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HCV treatment can be highly successful among PWID
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HCV treatment is effective in PWID - PEG-IFN/RBV
Dimova R, et al Clinical Infectious Diseases 2013
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HCV treatment is effective in PWID - PEG-IFN/RBV
Dimova R, et al Clinical Infectious Diseases 2013
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Strategies to enhance HCV assessment and treatment among PWID
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The HCV Care Cascade – PWID in Australia
TESTING ASSESS & MONITOR ENGAGE IN TREATMENT ENHANCE RESPONSE 80% 40% 10% 5%
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The HCV Care Cascade – Future requirements
TESTING guidelines systematic programs for HCV screening and diagnosis point-of-care HCV testing
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The HCV Care Cascade – Future requirements
TESTING ASSESS & MONITOR guidelines systematic programs for HCV screening and diagnosis point-of-care HCV testing education guidelines infrastructure for HCV services non-invasive fibrosis assessment
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First global recommendations for HCV among PWID
Robaeys* and Grebely*, et al. Clinical Infectious Diseases 2013
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The HCV Care Cascade – Future requirements
TESTING ASSESS & MONITOR ENGAGE IN TREATMENT guidelines systematic programs for HCV screening and diagnosis point-of-care HCV testing education guidelines infrastructure for HCV services non-invasive fibrosis assessment linkage to care multidisciplinary care models effective, tolerable, simple, short-duration HCV therapy
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The HCV Care Cascade – Future requirements
TESTING ASSESS & MONITOR ENGAGE IN TREATMENT ENHANCE RESPONSE guidelines systematic programs for HCV screening and diagnosis point-of-care HCV testing education guidelines infrastructure for HCV services non-invasive fibrosis assessment linkage to care multidisciplinary care models effective, tolerable, simple, short-duration HCV therapy strategies to enhance adherence risk reduction to prevent reinfection
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Efficacious treatments do not work if not given…..
40% 1998 90% 2018 (projected) 95% of infected people were not receiving treatment in 2012 55% 2002 70% 2012 Efficacy of treatment (%) Amount of infected people treated (%) Thomas DL Nature Medicine Grebely J and Dore GJ Antiviral Research 2014.
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Acknowledgements INHSU executive board Arud Zentren für Suchtmedizin
Dr. Philip Bruggmann University of New South Wales The Kirby Institute Prof. Gregory Dore INHSU executive board Markus Backmund, Germany Julie Bruneau, Canada Olav Dalgard, Norway Greg Dore, Australia Jason Grebely, Australia Matt Hickman, UK Alain Litwin, US Geert Robaeys, Belgium Tracy Swan, US
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