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Prevention, Treatment and Care of Hepatitis C among People W ho I nject D rugs. Jason Grebely, PhD Senior Lecturer Viral Hepatitis Clinical Research Program The Kirby Institute University of New South Wales. Prevention, Treatment and Care of HCV among PWID. Issues. - PowerPoint PPT Presentation
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Prevention, Treatment and Care of Hepatitis C among People Who Inject Drugs
Jason Grebely, PhDSenior LecturerViral Hepatitis Clinical Research ProgramThe Kirby InstituteUniversity of New South Wales
• 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
Prevention, Treatment and Care of HCV among PWID
Issues
PWID are the core of the HCV epidemic and “ageing cohorts” of PWID will lead to considerable advanced liver disease burden
PWID are at the core of the HCV epidemic
1) Hajarizadeh B, et al. Nature Rev Gastroenterol Hepatol 2013. 2) Grebely J and Dore GJ Antiviral Research 2014. In Press.
PEOPLE LIVING WITH HCV INFECTION
PWID are at the core of the HCV epidemic
1) Hajarizadeh B, et al. Nature Rev Gastroenterol Hepatol 2013. 2) Grebely J and Dore GJ Antiviral Research 2014. In Press.
80% OF NEW INFECTIONS OCCUR AMONG CURRENT PWID IN MANY COUNTRIES
PEOPLE LIVING WITH HCV INFECTION
PWID are at the core of the HCV epidemic
1) Hajarizadeh B, et al. Nature Rev Gastroenterol Hepatol 2013. 2) Grebely J and Dore GJ Antiviral Research 2014. In Press.
60% OF EXISTING INFECTIONS ARE AMONG CURRENT & FORMER PWID IN MANY COUNTRIES
PEOPLE LIVING WITH HCV INFECTION
HCV is a major public health problem among PWID
Nelson PK, et al. Lancet 2011
• Global estimation: 10.0 million PWIDs (range 6.0–15.2) in 2010 were HCV antibody positive
• Global prevalence: 67.0%
Eastern Europe 2.3m
East and Southeast Asia 2.6m
North America 1.7m
Latin America 1.7m
Sub-saharan Africa0.8m
Disease burden due to HCV is substantial
Kwong et al PLoS One 2012
Human papilloma virus
E. ColiHIV/AIDS
Staphylococcus aureus
C. DificileRhinovirus
Group B StrepGroup A Strep
Haemophilus influenza
LegionellaChlamydia
AdenovirusGonorrhea
Health Adjusted Life Years (HALYs)
0 2000 4000 6000 8000 1000
Tuberculosis
Influenza
Hepatitis B virus
Hepatitis C virus
Respiratory syncytial virusParainfluenza virus
Years of Life Lost
Year-equivalents of reduced functioning
Streptococcal pneumonia
Liver-related mortality increases with age
Deans G, et al CMAJ Open. 2013
HCV transmission continues to occur among PWID
• Higher prevalence of HCV infection (67% vs. 20%)• Higher risk of infection (3-5% for HCV vs 1-2% for HIV)
Harm reduction interventions have been less effective for HCV
Mehta SH, Journal of Infectious Diseases 2011.
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.
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
PWID have a high willingness to receive HCV treatment
PWID LIVING WITH HCV INFECTION
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 2001. Walley AY, J Substance Abuse Treatment 2005. Doab A, Clinical Infectious Diseases 2005. Fischer B, et al. Presse Med 2005. Strathdee S, et al Clinical Infectious Diseases 2005. Grebely J, et al. Drug and Alcohol Dependence 2008. Alavi M, et al. Clinical Infectious Diseases 2013.
Treatment uptake among PWID is still low….
80% OF PWID ARE WILLING TO RECEIVE HCV TREATMENT
PWID LIVING WITH HCV INFECTION
1-2%are treatedeach year
1) Grebely J. J Viral Hepatitis 2009. 2) Mehta S. J Community Health 2008. 3) Iversen J, J Viral Hepatitis. 2013. 4) Alavi M. Liver International. 2014.
Barriers to HCV assessment and treatment
Barriers to HCV assessment and treatment
PATIENT
Barriers to HCV assessment and treatment
PROVIDER
Barriers to HCV assessment and treatment
SYSTEM
HCV treatment can be highly successful among PWID
HCV treatment is effective in PWID - PEG-IFN/RBV
Dimova R, et al Clinical Infectious Diseases 2013
HCV treatment is effective in PWID - PEG-IFN/RBV
Dimova R, et al Clinical Infectious Diseases 2013
Strategies to enhance HCV assessment and treatment among PWID
The HCV Care Cascade – PWID in Australia
HCV TESTING
ASSESS &MONITOR
ENGAGE INTREATMENT
ENHANCE RESPONSE
80% 40% 10% 5%
The HCV Care Cascade – Future requirements
HCV TESTING• guidelines
• systematic programs for HCV screening and diagnosis
• point-of-care HCV testing
The HCV Care Cascade – Future requirements
HCV 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
First global recommendations for HCV among PWID
Robaeys* and Grebely*, et al. Clinical Infectious Diseases 2013
The HCV Care Cascade – Future requirements
HCV TESTING
ASSESS &MONITOR
ENGAGE INTREATMENT
• 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
The HCV Care Cascade – Future requirements
HCV TESTING
ASSESS &MONITOR
ENGAGE INTREATMENT
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
40%1998
55%2002
70%2012
90%2018
(projected)
95%of infected people were not receiving treatment in 2012
Efficacious treatments do not work if not given…..Effi
cacy
of t
reat
men
t (%
)
Amount of infected people treated (%)
Thomas DL Nature Medicine 2013. Grebely J and Dore GJ Antiviral Research 2014.
Acknowledgements
University of New South WalesThe Kirby Institute Prof. Gregory Dore
Arud Zentren für SuchtmedizinDr. Philip Bruggmann
INHSU executive boardMarkus Backmund, GermanyJulie Bruneau, CanadaOlav Dalgard, NorwayGreg Dore, AustraliaJason Grebely, AustraliaMatt Hickman, UKAlain Litwin, USGeert Robaeys, BelgiumTracy Swan, US