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Elimination of Viral Hepatitis: Improving Diagnosis, Treatment and Surveillance

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A special issue of Viruses (ISSN 1999-4915). This special issue belongs to the section "Viral Immunology, Vaccines, and Antivirals".

Deadline for manuscript submissions: closed (30 September 2022) | Viewed by 22732

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Special Issue Editors

Dr. Joseph Doyle

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Guest Editor

The Alfred, Monash University and Burnet Institute, Melbourne, Australia
Interests: viral hepatitis; HIV; population health; implementation science

Dr. Amanda Wade

E-Mail Website
Guest Editor

1. Disease Elimination, Burnet Institute, Melbourne, Australia
2. Department of Infectious Diseases, Barwon Health, Geelong, Australia.
Interests: hepatitis C; models of care; people who inject drugs

Special Issue Information

Dear Colleagues,

This Special Edition of Viruses will explore key challenges in the global elimination of viral hepatitis. It will particularly focus on three broad areas of research that are all needed to reduce the global burden of viral hepatitis. First, it will report innovations in diagnostics to improve and simplify the process of obtaining a reliable, low-cost, and quick diagnosis. Second, it will explore novel pathways that link people to care and treatment, making treatment services acceptable and reducing stigma. Third, it will examine surveillance systems and interventions in healthcare data to monitor progress toward elimination. This edition will encourage submissions from cross-disciplines including epidemiology, clinical, health services, and social research focused on viral hepatitis.

Dr. Joseph Doyle
Dr. Amanda Wade
Guest Editors

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Keywords

Hepatitis B
Hepatitis C
Elimination
Treatment uptake
Surveillance

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Related Special Issue

Elimination of Viral Hepatitis: Improving Diagnosis, Treatment and Surveillance, 2nd Edition in Viruses (5 articles)

Published Papers (9 papers)

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Research

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10 pages, 872 KiB

Open AccessArticle

Leave No-One Behind: A Retrospective Study of Hepatitis C Testing and Linkage to Care for Hospital Inpatients

by Christine Roder, Carl Cosgrave, Kathryn Mackie, Stuart K. Roberts, Margaret E. Hellard, Amanda J. Wade and Joseph S. Doyle

Viruses 2023, 15(4), 913; https://doi.org/10.3390/v15040913 - 31 Mar 2023

Cited by 2 | Viewed by 2091

Abstract

Hospital admissions are a missed opportunity to engage people living with hepatitis C virus (HCV) into care. This study aimed to describe the proportion of hospital inpatients and emergency department (ED) patients identified with hepatitis C who were subsequently linked to care and treatment at a metropolitan health service in Melbourne, Australia. Data were collected retrospectively from hospital databases (admissions, notifiable diseases, and pharmacy) for all adults admitted or attending the ED with separation coding indicating hepatitis C infection from March 2016 to March 2019. There were 2149 patients with at least one separation with hepatitis C coding. 15.4% (331/2149) had a documented antibody test, 4.6% (99/2149) had a documented RNA test, and 8.3% (179/2149) had a DAA prescription dispensed by hospital pharmacy. Antibody positivity was 95.2% (315/331) and RNA (when completed) was detected in 37.4% (37/99). Hepatitis specialist units had the highest rate of hepatitis C coded separations and RNA testing (39/88; 44.3%), mental health had the highest rate of antibody testing (70/276; 25.4%). Emergency had the lowest rate of antibody testing (101/1075; 13.7%) and the third highest rate of RNA testing (32/94; 34.1%), but the highest rate of RNA detected (15/32; 46.9%). This study highlights key steps to improve the care cascade. Simplified diagnostic pathways, expansion of hepatitis C care services, and clear in-hospital pathways to link patients to care would be beneficial in this setting. To scale up hepatitis C testing and treatment as part of national elimination strategies, hospital systems need to target interventions to their local data. Full article

(This article belongs to the Special Issue Elimination of Viral Hepatitis: Improving Diagnosis, Treatment and Surveillance)

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11 pages, 1295 KiB

Open AccessArticle

Patients Treated for HCV Infection and Listed for Liver Transplantation in a French Multicenter Study: What Happens at Five Years?

by Lucy Meunier, Mohamed Belkacemi, George Philippe Pageaux, Sylvie Radenne, Anaïs Vallet-Pichard, Pauline Houssel-Debry, Christophe Duvoux, Danielle Botta-Fridlund, Victor de Ledinghen, Filomena Conti, Rodolphe Anty, Vincent Di Martino, Marilyne Debette-Gratien, Vincent Leroy, Theophile Gerster, Pascal Lebray, Laurent Alric, Armand Abergel, Jérôme Dumortier, Camille Besch, Helene Montialoux, Didier Samuel, Jean-Charles Duclos-Vallée and Audrey Coilly Show full author list Hide full author list

Viruses 2023, 15(1), 137; https://doi.org/10.3390/v15010137 - 31 Dec 2022

Cited by 4 | Viewed by 1808

Abstract

Background: Direct-acting antiviral (DAA) agents for the treatment of hepatitis C virus (HCV) infection have been proven safe and effective in cirrhotic patients awaiting liver transplantation (LT). However, in the long term, data remain minimal regarding the clinical impact of viral eradication on patients listed for decompensated cirrhosis or hepatocellular carcinoma (HCC). We aimed to elucidate the clinical outcomes of patients regarding delisting and the evolution of HCC during the long-term follow-up. Methods: An observational, multicenter, retrospective analysis was carried out on prospectively collected data from HCV-positive patients treated with an interferon-free regimen while awaiting LT in 18 French hospitals. Results: A total of 179 patients were included in the study. The indication for LT was HCC in 104 (58.1%) patients and cirrhosis in 75 (41.9%) patients. The sustained virological response was 84.4% and the treatment was well tolerated. At five years, among 75 patients with cirrhosis treated for HCV, 19 (25.3%) were delisted following improvement after treatment. Predictive factors for delisting highlighted an absence of ascites, MELD score ≤ 15, and Child–Pugh score ≤ 7. No patients with refractory ascites were delisted. Among patients with HCC, 82 (78.9%) were transplanted. The drop-out rate was low (6.7%) and few recurrences of HCC after LT were observed. Conclusions: DAAs are safe and effective in patients awaiting LT for cirrhosis or HCC. A quarter of patients with cirrhosis can be delisted because of clinical improvement. Predictive factors for delisting, as a result of improvement, may assist prescribers, before initiating HCV infection therapy in the long-term perspective. Full article

(This article belongs to the Special Issue Elimination of Viral Hepatitis: Improving Diagnosis, Treatment and Surveillance)

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11 pages, 617 KiB

Open AccessArticle

Global Real-World Evidence of Sofosbuvir/Velpatasvir as a Highly Effective Treatment and Elimination Tool in People with Hepatitis C Infection Experiencing Mental Health Disorders

by Heiner Wedemeyer, Vito Di Marco, Montserrat Garcia-Retortillo, Elisabetta Teti, Chris Fraser, Luis Enrique Morano Amado, Sergio Rodriguez-Tajes, Silvia Acosta-López, Joss O’Loan, Michele Milella, Maria Buti, María Fernanda Guerra-Veloz, Alnoor Ramji, Mary Fenech, Alexandra Martins, Sergio M. Borgia, Kim Vanstraelen, Michael Mertens, Cándido Hernández, Ioanna Ntalla, Heribert Ramroth and Scott Milligan Show full author list Hide full author list

Viruses 2022, 14(11), 2493; https://doi.org/10.3390/v14112493 - 11 Nov 2022

Cited by 6 | Viewed by 3098

Abstract

Hepatitis C virus (HCV) is prevalent in people with mental health disorders, a priority population to diagnose and cure in order to achieve HCV elimination. This integrated analysis pooled data from 20 cohorts in seven countries to evaluate the real-world effectiveness of the pangenotypic direct-acting antiviral (DAA) sofosbuvir/velpatasvir (SOF/VEL) in people with mental health disorders. HCV-infected patients diagnosed with mental health disorders who were treated with SOF/VEL for 12 weeks without ribavirin as part of routine clinical practice were included. The primary outcome was sustained virological response (SVR) in the effectiveness population (EP), defined as patients with an available SVR assessment. Secondary outcomes were reasons for not achieving SVR, characteristics of patients with non-virological failures, adherence, and time from HCV RNA diagnosis to SOF/VEL treatment initiation. A total of 1209 patients were included; 142 did not achieve an SVR for non-virological reasons (n = 112; 83 lost to follow-up, 20 early treatment discontinuations) or unknown reasons (n = 30). Of the 1067 patients in the EP, 97.4% achieved SVR. SVR rates in the EP were ≥95% when stratified by type of mental health disorder and other complicating baseline characteristics, including active injection drug use and antipsychotic drug use. Of 461 patients with data available in the EP, only 2% had an adherence level < 90% and 1% had an adherence level < 80%; all achieved SVR. Patients with mental health disorders can be cured of HCV using a well-tolerated, pangenotypic, protease inhibitor-free SOF/VEL regimen. This DAA allows the implementation of a simple treatment algorithm, with minimal monitoring requirements and fewer interactions with central nervous system drugs compared with protease-inhibitor DAA regimens. Full article

(This article belongs to the Special Issue Elimination of Viral Hepatitis: Improving Diagnosis, Treatment and Surveillance)

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9 pages, 254 KiB

Open AccessArticle

Awareness of HCV Status and Preferences for Testing and Treatment among People with Recent Injecting Drug Use at a Peer-Led Needle and Syringe Program: The TEMPO Pilot Study

by Anna Conway, Phillip Read, Rosie Gilliver, Tony McNaughton, Heather Valerio, Evan B. Cunningham, Charles Henderson, Brett Hadlow, Katrina Molloy, Anna Doab, Shane Tillakeratne, Lucy Pepolim, Mary Ellen Harrod, Gregory J. Dore and Jason Grebely

Viruses 2022, 14(11), 2463; https://doi.org/10.3390/v14112463 - 7 Nov 2022

Cited by 6 | Viewed by 2639

Abstract

Background: New technologies and therapies allow the possibility of a single-visit test and treat model for hepatitis C virus (HCV), addressing some of the barriers to care faced by people who inject drugs. Methods: The TEMPO Pilot Study was an interventional cohort study evaluating a single-visit test and treat intervention among people with recent injecting drug use at a one peer-led needle and syringe program (NSP) in Sydney, Australia between September 2019 and February 2021. This analysis evaluated awareness of HCV status and agreement of self-report with HCV RNA test results. The analysis also assessed acceptability of: modality of result delivery, modality of blood sampling, site of treatment, and duration of treatment. Results: Among 101 participants (median age 43; 31% female), 100 had a valid HCV RNA test result and 27% (27/100) were HCV RNA detectable. Overall, 65% (65/100) were aware of their status. Among people with a positive HCV RNA result, 48% (13/27) were aware of their status. People preferred same-day HCV test results (95%, 96/101), and preferred to receive results in person (69%, 70/101). Receiving treatment at an NSP was acceptable (100%, 101/101) and 78% (79/101) were willing to discuss their health with a peer NSP worker. Conclusion: Half of people with current HCV infection were aware of their status. The high acceptability of simplified testing and treatment pathways delivered at NSPs indicates that this is an appropriate strategy to improve HCV awareness and treatment uptake in this population. Full article

(This article belongs to the Special Issue Elimination of Viral Hepatitis: Improving Diagnosis, Treatment and Surveillance)

11 pages, 1190 KiB

Open AccessArticle

Implementation of Novel Quality Assurance Program for Hepatitis C Viral Load Point of Care Testing

by Wayne Dimech, Liza Cabuang, Kylie Davies and Giuseppe Vincini

Viruses 2022, 14(9), 1929; https://doi.org/10.3390/v14091929 - 30 Aug 2022

Viewed by 1667

Abstract

All patients should have access to accurate and timely test results. The introduction of point of care testing (PoCT) for infectious diseases has facilitated access to those unable to access traditional laboratory-based medical testing, including those living in remote and regional locations, or individuals who are marginalized or incarcerated individuals. In many countries, laboratory testing for infectious diseases, such as hepatitis C virus (HCV), is performed in a highly regulated environment. However, this is not the case for PoCT, where testing is performed by non-laboratory staff and quality controls are often lacking. An assessment of the provision of laboratory-based quality assurance to PoCT for infectious disease was conducted and the barriers to participation identified. A novel approach to providing quality assurance to PoCT sites, in particular those testing for HCV, was designed and piloted. This novel approach incudes identifying and validating sample types that are inactivated and stable at ambient temperature, creating cost-effective supply chains to facilitate logistics of samples, and the development of a smart phone-enabled portal for data entry and analyses. The creation and validation of this approach to quality assurance of PoCT removes the barriers to participation and acts to improve the quality and accuracy of testing, reduce errors and waste, and improve patient outcomes. Full article

(This article belongs to the Special Issue Elimination of Viral Hepatitis: Improving Diagnosis, Treatment and Surveillance)

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15 pages, 701 KiB

Open AccessArticle

A Testing Campaign Intervention Consisting of Peer-Facilitated Engagement, Point-of-Care HCV RNA Testing, and Linkage to Nursing Support to Enhance Hepatitis C Treatment Uptake among People Who Inject Drugs: The ETHOS Engage Study

by Anna Conway, Heather Valerio, Maryam Alavi, David Silk, Carla Treloar, Behzad Hajarizadeh, Alison D. Marshall, Marianne Martinello, Andrew Milat, Adrian Dunlop, Carolyn Murray, Bianca Prain, Charles Henderson, Janaki Amin, Phillip Read, Pip Marks, Louisa Degenhardt, Jeremy Hayllar, David Reid, Carla Gorton, Thao Lam, Michael Christmass, Alexandra Wade, Mark Montebello, Gregory J. Dore and Jason Grebely Show full author list Hide full author list

Viruses 2022, 14(7), 1555; https://doi.org/10.3390/v14071555 - 16 Jul 2022

Cited by 11 | Viewed by 2945

Abstract

This study evaluated HCV treatment initiation among people who inject drugs (PWID) following an intervention of campaign days involving peer connection, point-of-care HCV RNA testing, and linkage to nursing support. ETHOS Engage is an observational cohort study of PWID attending 25 drug treatment clinics and needle and syringe programs in Australia (May 2018–September 2019). Point-of-care results were provided to the nurse, facilitating confirmatory testing and treatment. The study aimed to evaluate treatment uptake and factors associated with treatment at 24 months post-enrolment. There were 317 people with current HCV infection and eligible for treatment (median age 43, 65% male, 15% homeless, 69% receiving opioid agonist treatment, 70% injected in last month). Overall, 15% (47/317), 27% (85/317), 38% (120/317), and 49% (155/317) of people with current HCV infection had initiated treatment at 3-, 6-, 12-, and 24-months following testing, respectively. Homelessness (adjusted hazard ratio (aHR): 0.40; 95% confidence interval: 0.23, 0.71) and incarceration in the past 12 months (vs. never, aHR:0.46; 0.28, 0.76) were associated with decreased treatment initiation in the 24 months post-enrolment. This testing campaign intervention facilitated HCV treatment uptake among PWID. Further interventions are needed to achieve HCV elimination among people experiencing homelessness or incarceration. Full article

(This article belongs to the Special Issue Elimination of Viral Hepatitis: Improving Diagnosis, Treatment and Surveillance)

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15 pages, 1587 KiB

Open AccessArticle

Real-World Safety, Effectiveness, and Patient-Reported Outcomes in Patients with Chronic Hepatitis C Virus Infection Treated with Glecaprevir/Pibrentasvir: Updated Data from the German Hepatitis C-Registry (DHC-R)

by Markus Cornberg, Albrecht Stoehr, Uwe Naumann, Gerlinde Teuber, Hartwig Klinker, Thomas Lutz, Hjördis Möller, Dennis Hidde, Kristina Lohmann and Karl-Georg Simon

Viruses 2022, 14(7), 1541; https://doi.org/10.3390/v14071541 - 14 Jul 2022

Cited by 4 | Viewed by 2179

Abstract

Using data from the German Hepatitis C-Registry (Deutsche Hepatitis C-Register, DHC-R), we report the real-world safety and effectiveness of glecaprevir/pibrentasvir (GLE/PIB) treatment and its impact on patient-reported outcomes (PROs) in underserved populations who are not typically included in clinical trials, yet who will be crucial for achieving hepatitis C virus (HCV) elimination. The DHC-R is an ongoing, non-interventional, multicenter, prospective, observational cohort study on patients treated for chronic HCV infection in Germany. The data cutoff was 17 January 2021. The primary effectiveness endpoint was sustained virologic response at post-treatment Week 12 (SVR12). Safety outcomes were assessed in all patients receiving GLE/PIB. PROs were assessed using the SF-36 survey. Of 2354 patients, 1964 had valid SVR12 data (intention-to-treat analysis). Of these, 1905 (97.0%) achieved SVR12 with rates similar across the comorbidities analyzed, except for people who actively use drugs (PWUD (active)) (86.4%). Excluding those who discontinued treatment and did not achieve SVR12, or were reinfected with HCV, the rate was 99.3%, with similar results regardless of comorbidity. PWUD (active) and those with psychiatric disorders had the most meaningful improvements in PROs. Adverse events (AEs) occurred in 631/2354 patients (26.8%), and serious AEs in 44 patients (1.9%). GLE/PIB was highly effective and well tolerated in this real-world study of patient groups key to HCV elimination. Full article

(This article belongs to the Special Issue Elimination of Viral Hepatitis: Improving Diagnosis, Treatment and Surveillance)

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13 pages, 1433 KiB

Open AccessArticle

Timely Hepatitis C RNA Testing and Treatment in the Era of Direct-Acting Antiviral Therapy among People with Hepatitis C in New South Wales, Australia

by Mohammad T. Yousafzai, Maryam Alavi, Heather Valerio, Behzad Hajarizadeh, Jason Grebely and Gregory J. Dore

Viruses 2022, 14(7), 1496; https://doi.org/10.3390/v14071496 - 8 Jul 2022

Cited by 9 | Viewed by 2559

Abstract

This study aimed to identify the factors associated with timely (within four weeks) HCV RNA testing and timely (within six months) DAA initiation following HCV notification in the DAA era. We conducted a cohort study of people with an HCV notification in NSW, Australia. Notifications of positive HCV serology were linked to administrative datasets. Weights were applied to account for spontaneous clearance. Logistic regression analyses were performed. Among 5582 people with an HCV notification during 2016–2017, 3867 (69%) were tested for HCV RNA, including 2770 (50%) who received timely testing. Among an estimated 3925 people with chronic HCV infection, 2372 (60%) initiated DAA therapy, including 1370 (35%) who received timely treatment. Factors associated with timely HCV RNA testing included age (≥30 years), female sex, non-Aboriginal ethnicity, country of birth being Australia, and no history of drug dependence. Factors associated with timely treatment were age (≥30 years), male sex, non-Aboriginal ethnicity, country of birth being Australia, no history of drug dependence, and HCV/HIV co-infection. In the DAA era, 50% of people with an HCV notification did not receive timely HCV RNA testing. Most people with an HCV infection received therapy; however, DAA initiation was delayed among many. Full article

(This article belongs to the Special Issue Elimination of Viral Hepatitis: Improving Diagnosis, Treatment and Surveillance)

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Review

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Open AccessReview

Systematic Review of Hepatitis C Virus Prevalence in the WHO Western Pacific Region

by Jenny Iversen, Handan Wand, Po-Lin Chan, Linh-Vi Le and Lisa Maher

Viruses 2022, 14(7), 1548; https://doi.org/10.3390/v14071548 - 15 Jul 2022

Cited by 4 | Viewed by 2536

Abstract

Background: This review aimed to identify hepatitis C virus (HCV) prevalence estimates among the general population and six key populations (people who inject drugs, men who have sex with men, sex workers, prisoners/detainees, Indigenous people, and migrants) in the World Health Organization Western Pacific Region (WHO WPR). Methods: Original research articles published between 2016 and 2020 were identified from bibliographic databases. Publications were retrieved, replicas removed, and abstracts screened. Retained full texts were assessed and excluded if inclusion criteria were not met. Methodological quality was assessed using the Johanna Briggs Institute critical appraisal checklist for prevalence data. Data on HCV exposure and active infection were extracted and aggregated and forest plots generated for each population by country. Results: There were no HCV prevalence estimates in any population for more than half of WPR countries and territories. Among the 76 estimates, 97% presented prevalence of exposure and 33% prevalence of active infection. General population viraemic prevalence was 1% or less, except in Mongolia. Results confirm the endemic nature of HCV among people who inject drugs, with estimates of exposure ranging from 30% in Cambodia to 76% in Hong Kong. Conclusions: Countries require detailed knowledge of HCV prevalence in diverse populations to evaluate the impact of efforts to support WHO HCV elimination goals. Results provide baseline estimates from which to monitor and evaluate progress and by which to benchmark future elimination efforts. Full article

(This article belongs to the Special Issue Elimination of Viral Hepatitis: Improving Diagnosis, Treatment and Surveillance)

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