Documents de recherche

@article{D2021,
title = {Potential interventions to support HCV treatment uptake among HIV co-infected people in Canada: Perceptions of patients and health care providers},
author = {D, Ortiz-Paredes; A, Amoako; D, Lessard; K, Engler; B, Lebouché; M, Klein; },
url = {https://canlivj.utpjournals.press/doi/full/10.3138/canlivj-2021-0021},
doi = {10.3138/canlivj-2021-0021},
year = {2021},
date = {2021-11-05},
journal = {Canadian Liver Journal},
abstract = {BACKGROUND: Increasing direct-acting antiviral (DAA) treatment uptake is key to eliminating HCV infection as a public health threat in Canada. People living with human immunodeficiency virus (HIV) and hepatitis C (HCV) co-infection face barriers to HCV treatment initiation. We sought to identify interventions that could support HCV treatment initiation based on patient and HCV care provider perspectives. METHODS: Eleven people living with HIV with a history of HCV infection and 12 HCV care providers were recruited for this qualitative descriptive study. Participants created ranked-ordered lists of potential interventions during nominal groups (n = 4) and individual interviews (n = 6). Following the nominal group technique, transcripts and intervention lists underwent thematic analysis and ranking scores were merged to create consolidated and prioritized lists from patient and provider perspectives. RESULTS: Patient participants identified a total of eight interventions. The highest-ranked interventions were multidisciplinary clinics, HCV awareness campaigns and patient education, nurse- or pharmacist-led care, peer involvement, and more and better-prepared health professionals. Provider participants identified 11 interventions. The highest-ranked were mobile outreach, DAA initiation at pharmacies, a simplified process of DAA prescription, integration of primary and specialist care, and patient-centred approaches. CONCLUSION: Participants proposed alternatives to hospital-based specialist HCV care, which require increasing capacity for nurses, pharmacists, primary care providers, and peers to have more direct roles in HCV treatment provision. They also identified the need for structural changes and educational initiatives. In addition to optimizing HCV care, these interventions might result in broader benefits for the health of HIV–HCV co-infected people.},
keywords = {Direct-acting antivirals, hepatitis C, HIV infection, Indigenous peoples, men who have sex with men, People who inject drugs, Treatment uptake, Women},
pubstate = {published},
tppubtype = {article}
}

@article{S2017,
title = {Disparities in direct acting antivirals uptake in HIV-hepatitis C co-infected populations in Canada},
author = {Saeed S and Strumpf EC and Moodie EEM and Young J and Nitulescu R and Cox J and Wong A and Walmsely S and Cooper C and Vachon ML and Martel-Laferriere V and Hull M and Conway B and Klein MB},
url = {https://pubmed.ncbi.nlm.nih.gov/29116684/},
doi = {10.1002/jia2.25013},
year = {2017},
date = {2017-11-01},
journal = {Journal of the International AIDS Society},
abstract = {Background: Direct acting antivirals (DAAs) have revolutionized hepatitis C (HCV) treatment with >90% cure rates even in real-world studies, giving hope that HCV can be eliminated. However, for DAAs to have a population-level impact on the burden of HCV disease, treatment uptake needs to be expanded. We investigated temporal trends in HCV treatment uptake and evaluated factors associated with second-generation DAA initiation and efficacy among key HIV-HCV co-infected populations in Canada.

Methods: The Canadian HIV-HCV Co-Infection Cohort Study prospectively follows 1699 participants from 18 centres. Among HCV RNA+ participants, we determined the incidence of HCV treatment initiation per year overall and by key populations between 2007 and 2015. Key populations were based on World Health Organization (WHO) guidelines including: people who actively inject drugs (PWID) (reporting injection drug use, last 6 months); Indigenous people; women and men who have sex with men (MSM). Multivariate Cox models were used to estimate adjusted hazard ratios (aHR) and 2-year probability of initiating second-generation DAAs for each of the key populations.

Results: Overall, HCV treatment initiation rates increased from 8 (95% CI, 6-11) /100 person-years in 2013 to 28 (95% CI, 23-33) /100 person-years in 2015. Among 911 HCV RNA + participants, there were 202 second-generation DAA initiations (93% with interferon-free regimens). After adjustment (aHR, 95% CI), active PWID (0.60, 0.38-0.94 compared to people not injecting drugs) and more generally, people with lower income (<$18 000 CAD/year) (0.50, 0.35, 0.71) were less likely to initiate treatment. Conversely, MSM were more likely to initiate 1.95 (1.33, 2.86) compared to heterosexual men. In our cohort, the population profile with the lowest 2-year probability of initiating DAAs was Indigenous, women who inject drugs (5%, 95% CI 3-8%). Not having any of these risk factors resulted in a 35% (95% CI 32-38%) probability of initiating DAA treatment. Sustained virologic response (SVR) rates were >82% in all key populations.

Conclusion: While treatment uptake has increased with the availability of second-generation DAAs, marginalized populations, already engaged in care, are still failing to access treatment. Targeted strategies to address barriers are needed to avoid further health inequities and to maximize the public health impact of DAAs.},
keywords = {Direct acting antivirals (DAAs), Disparities, HIV-HCV co-infection, Indigenous peoples, Men who have sex with men (MSM), People who inject drug (PWID), Women},
pubstate = {published},
tppubtype = {article}
}