Hepatology, Medicine and Policy

Universal access to the hepatitis C direct acting antiviral (DAAs) regimens presents a unique opportunity to eliminate hepatitis C in Australia. Large numbers of Australians have already been cured using these treatments, however, the numbers presenting for treatment have begun to plateau. This study explored how people experienced and understood being cured of hepatitis C, with the aim of informing interventions to increase uptake of DAA treatment among people with hepatitis C. This qualitative study used semi-structured interviews to explore the experiences of people with hepatitis C taking DAAs accessing both hospital and community clinics. Interviews were conducted 12 weeks after treatment completion. Participants were asked to reflect on their experience of living with hepatitis C, their reasons for seeking treatment, and their experience of, DAA treatments. Participants were also asked to reflect on the meaning of being cured, and how they shared this experience with their peers. Interviews were transcribed verbatim and key themes were identified using inductive thematic analysis. Twenty participants were interviewed. While participants described a range of physical health benefits of achieving a hepatitis C cure it was an improved sense of psychological wellbeing that had the most significant impact on participants’ lives. The majority described their relief about no longer living with the burden of an uncertain future due to anxiety about developing liver disease or cancer, as well as fear of infecting others. Participants who had a past history of injecting drug use, described being cured as a way to break the connection with their past. Participants who were current injectors raised concerns about re-infection. Feeling “normal” and not infectious allows people to live with reduced psychological distress, in addition to the physical benefits of no longer being at risk of developing serious liver disease. Future engagement strategies targeting people who are not accessing hepatitis health care need to promote the lived experience of being cured and the substantial psychological, and physical health benefits, offered by achieving a cure. Interventions aimed at people who are currently injecting also need to highlight the availability of re-treatment in conjunction with primary prevention strategies.

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HCV/HIV coinfection in people who inject drugs is a public health issue, which presents a variety of challenges to healthcare providers. The determinants of HCV/HIV coinfection in this population are nonetheless not well known. The aim of the present study is to identify the factors associated with HCV/HIV coinfection in people who inject drugs and enter drug-related treatment. Linked serological and behavioral data were collected from people who entered 38 opioid substitution treatment clinics in central and southern Greece between January and December 2013. Three mutually exclusive groups were defined based on the presence of HCV and HIV antibodies. Group 1 clients had neither infection, Group 2 had HCV but not HIV, and Group 3 had HCV/HIV coinfection. Multinomial logistic regression analyses identified differences between groups according to socio-demographic, drug use and higher-risk behavioral characteristics. Our study population consisted of 580 people who injected drugs in the past 12 months (79.8 % males, with median age 36 years).79.4 % were HCV and 15.7 % HIV infected. Of those with complete serological data in both HCV and HIV indicators, 20.4 % were uninfected, 64.0 % HCV monoinfected, and 14.9 % HCV/HIV coinfected. HCV infection with or without HIV coinfection was positively associated with living alone or with a spouse/partner without children, prior incarceration, drug injecting histories of ≥10 years, and syringe sharing in the past 12 months, and negatively associated with never having previously been tested for HCV. HCV/HIV coinfection, but not HCV infection alone, was positively associated with residence in urban areas (relative risk ratio [RRR] = 4.8, 95 % confidence interval [CI]: 1.7–13.7, p = 0.004) and averaging >3 injections a day in the past 30 days (RRR = 4.5, 95 % CI: 1.6–12.8, p = 0.005), and negatively associated with using a condom in the last sexual intercourse. People who inject drugs and live in urban areas and inject frequently have higher risk of coinfection. Findings highlight the need for scaling-up needle and syringe programs in inner city areas and promoting access of this population to screening and treatment, especially in prisons. The protective role of living with parents and children could inform the implementation of indicated interventions.

This article describes hepatitis B-related knowledge, attitudes and practices after completion of the Gateway to Care campaign, a citywide public health education program that targeted city residents, health care providers and individuals chronically infected with hepatitis B virus in Haimen City, China. Pre/post questionnaires assessed hepatitis B knowledge change among health care providers and post-campaign surveys evaluated hepatitis B knowledge, attitudes and behaviors (including stigma-related beliefs and practices) among health care providers, city residents and chronically infected individuals. Focus groups were conducted to gain a more in-depth understanding of the needs of the target communities, and to identify future intervention strategies to improve hepatitis B testing and linkage to care and treatment. Results indicate high levels of hepatitis B knowledge among multiple stakeholders in Haimen City, with significant knowledge improvement among health care providers. Stigma-related beliefs and myths regarding separation of infected individuals from certain aspects of family life were common among all stakeholder groups, despite high levels of accurate knowledge about hepatitis B transmission and prevention. Self-report of hepatitis B screening was low among city residents, as was awareness of hepatitis B treatment. More efforts are needed to improve awareness of HBV treatment, decrease HBV-related stigma, improve screening rates, and reduce cost of antiviral treatment. Future interventions in Haimen City should be driven by behavioral change theory, to not only improve knowledge, but to improve screening behaviors and address hepatitis B-related stigma and discrimination.

Hepatitis C virus (HCV) imposes a considerable disease burden in China, with at least 10 million people chronically infected. Little is known about the financial impact of the HCV epidemic, nor about the extent to which various forms of insurance are providing HCV patients with financial protection. A cross-sectional multi-site study was conducted to acquire data that will aid policy-makers and other stakeholders in developing effective strategies to address this situation. At 29 hospitals across China, inpatients and outpatients with chronic HCV were surveyed about their insurance coverage and medical costs. Percentages, means and medians were calculated, and differences in continuous variables among multiple groups were analyzed using the Kruskal-Wallis test or Wilcoxon two-sample test. Many inpatients (N = 593) and outpatients (N = 523) reported being covered by one of three major types of government health insurance, but 13 % of inpatients and 43 % of outpatients reported having no insurance. Among inpatients, the total median cost per hospitalization per patient was 8212 Renminbi (RMB). The category of expenditure with the highest median cost per hospitalization was Western medicine, followed by lab tests and Chinese medicine. The median cost per hospitalization was far higher for patients who had hepatocellular carcinoma than for those with less severe forms of liver disease. Outpatient antiviral therapy costs ranged from a median of 377 RMB for ribavirin to a median of 37,400 RMB for pegylated interferon-alpha for up to one year of treatment. For uninsured chronic HCV patients in China, inpatient and outpatient costs may be financially devastating. Research is needed on how different approaches to financing HCV treatment and care might improve health outcomes as well as achieve cost savings by enabling more people to be cured of HCV.

The Hepatitis C virus (HCV) is very common among people who inject drugs (PWID), yet PWID in India have suboptimal access to HCV testing and treatment. This study sought to identify HCV risk factors among male PWID who utilized a free needle and syringe exchange program and to examine the predisposing, enabling, and need factors associated with utilization of HCV testing services by those PWID reporting that they had been tested. A cross-sectional study was conducted in Imphal, Manipur and Amritsar, Punjab. These two settings have high HCV prevalence and large numbers of PWID. A team of 18 field investigators obtained data through face-to-face interviews using a structured multiple-choice questionnaire. The questionnaire was administered to 1241 of 2644 male PWID aged 15 years and above enrolled in the needle and syringe program of India’s AIDS Control Program, with study participants selected through consecutive sampling. Statistical analyses included descriptive statistics and multivariate regression. Twenty-four percent of PWID in our study sample reported having been tested for HCV. Unlike PWID in Imphal, more than half of PWID in Amritsar reported unprotected sex and use of alcohol or non-injecting drugs as being among their HCV risk factors (67.1 and 77.8 %, respectively). However, opioid substitution therapy non-adherence was reported more often in Imphal than in Amritsar. Education, marital status, place of residence and duration of injecting drug use were found to significantly enable access to HCV testing while alcohol use, frequent mobility and unprotected sex were found to significantly inhibit access to HCV testing for PWID after controlling for other explanatory variables. Predisposing and enabling determinants provide an area for developing effective interventions to improve HCV testing practices among PWID. HCV prevention programs that address safe injecting and sexual practices, OST adherence and frequent mobility customized for PWID by age are strongly recommended.

Ấn Độ là quê hương của 1 trong 14 ca viêm gan B mạn tính (HBV), điều này có nghĩa là cần phát triển các can thiệp đối với HBV có thể áp dụng trong bối cảnh Ấn Độ. Tiêm chủng là công cụ quan trọng nhất để ngăn chặn chu trình nhiễm HBV. Việc tiêm chủng HBV không được đưa vào chương trình tiêm chủng mở rộng do chính phủ Ấn Độ tài trợ cho đến năm 2011, và nhiều trẻ em sinh ra trước đó vẫn chưa được tiêm chủng. Nghiên cứu này nhằm quan sát tác động của sáng kiến HOPE trong việc can thiệp tại trường học nhằm tăng cường tỷ lệ tiêm chủng bằng cách nâng cao nhận thức về HBV trong số học sinh tại Lucknow, Uttar Pradesh. Tại 430 trường học trong các khu vực hành chính ở và xung quanh Lucknow, học sinh đã xem một bộ phim tài liệu giáo dục về HBV và hoàn thành hai bảng câu hỏi, một bảng ngay trước khi chiếu phim và một bảng khác sau sáu tuần. Cả hai bảng câu hỏi đều hỏi 14 câu hỏi giống nhau, được tổ chức thành năm lĩnh vực: kiến thức về mức độ của vấn đề HBV; kiến thức về các con đường lây truyền của HBV; kiến thức về hậu quả của nhiễm HBV; nhận thức về HBV; và thái độ liên quan đến HBV. Bảng câu hỏi cơ bản cũng hỏi học sinh liệu họ đã được tiêm chủng chống lại HBV hay chưa. Tại thời điểm theo dõi hai năm sau, các nhà nghiên cứu đã đo lường mức độ tiêm chủng tại một tập con gồm 30 trường học tham gia can thiệp và sáu trường không tham gia can thiệp để đánh giá thêm tác động của can thiệp. 11.250 học sinh đã hoàn thành bảng câu hỏi cơ bản, và 9.698 học sinh đã hoàn thành bảng câu hỏi sau can thiệp. Điểm số kiến thức về mức độ của vấn đề HBV đã cải thiện từ 41% ở cơ sở lên 74% trong lần theo dõi, và điểm số kiến thức về các con đường lây truyền, từ 38% lên 75% (p < 0,05 cho cả hai). Mức độ tiêm chủng HBV ở học sinh nhận can thiệp ở mức 21%. Hai năm sau can thiệp, 45% học sinh (N = 4284) báo cáo đã được tiêm chủng tại các trường học tham gia can thiệp, so với 22% (N = 1264) tại các trường không tham gia can thiệp. Những gia tăng quan sát được về nhận thức, kiến thức và tỷ lệ tiêm chủng HBV trong nghiên cứu này chỉ ra rằng các can thiệp tại trường học có thể được sử dụng để đạt được tỷ lệ tiêm chủng cao hơn trong số trẻ em Ấn Độ. Bộ phim tài liệu được phát hiện là một công cụ tiết kiệm chi phí để tiếp cận đông đảo khán giả. Cần có thêm nhiều nghiên cứu để xác thực tác động của can thiệp này và khám phá khả năng áp dụng của nó cho các nguyên nhân xã hội khác.