Friday, July 28, 2017 marks World Hepatitis Day. This initiative is in response to the May 2016 World Health Assembly’s where 194 governments adopted the World Health Organization’s Global Strategy on Viral Hepatitis, which includes a goal of eliminating hepatitis B and C in the next 13 years.
Last year’s theme was “NOhep” while this year’s theme is “Show Your Face.” This campaign invites you to share a photo of yourself accompanied by your own personal “I AM” message to help put a human face to the elimination of viral hepatitis.
Although we know that the microbial differences between HIV and HCV have an impact on prevalence, how drugs are obtained and used may also influence prevalence. Recent studies show Puerto Rico has one of the highest HCV prevalence rates in the world.
The authors looked risk factors of 315 rural Puerto Rican people who inject drugs (PWID) and also compared the behaviours of HCV negative and HCV positive participants.
INSTI Rapid HIV and OraQuick Rapid tests were used to determine HIV and HCV status. Additional data was acquired through questionnaires.
HCV + (pos) Characteristics
This adds to current research showing that a notable proportion of HCV infections are due to cooker or cotton sharing.
Abadie, R., Welch-Lazoritz, M., Gelepi-Acosta, C., Reyes, J.C., and Dombrowski, K. (2016). Understanding differences in HIV/HCV prevalence according to differentiated risk behaviors in a sample of PWID in rural Puerto Rico. Harm Reduction Journal. 13:10-13.
The authors make recommendations based on scientific research and expert opinion, which are updated to be in line with international guidelines.
Summery of some of the recommendations:
Impact of drug use on treatment adherence and sustained virologic response (SVR)
If one receives approximately 80% of scheduled treatments he is generally considered to be adhering to the to HCV therapy however, this does not distinguish between missed doses and the stopping of treatment.
In addition, studies have found that lower education and unstable housing are associated with adherence and treatment completion. Other factors associated with low SVR among PWID, include low social functioning, a history of untreated depression, and continued drug use during treatment
Treatment management recommendations
Several models have shown that HCV treatment can be delivered successfully to PWID whether it be within a general hospital, drug detoxification clinics, opioid substitution therapy clinics, prisons or a community-based clinics.
Although there are number of barriers to care for people who inject drugs (PWID), research has shown hepatitis C virus (HCV) treatment to be safe and effective. Enhancement of HCV assessment and treatment strategies is greatly needed due to the burden of HCV-related disease.
Grebely, J.A., Robaeys, G., Bruggmann, P., Aghemo, A, Backmund, M., and Bruneau, J. (2015).
Recommendations for the management of hepatitis C virus infection among people who inject drugs. International Journal of Drug Policy. Vol. 26. Pp 1028-1039.
Hepatitis C virus (HCV) infection prevalence is high among people who inject drugs (PWID) and is a major cause of morbidity and mortality among this population. Due to concerns that HCV treatment may increase injecting risk behaviours among people who inject drugs (PWID) the authors compared recent (past month) injecting risk behaviours between PWID who received and did not receive HCV treatment.
Hepatitis C virus assessment and treatment for people who inject drugs should be enhanced due to its effectiveness as it does not lead to increases in injection risk behaviours and has already been shown to be safe and effective for PWID populations.
Alavi, M., Spelman, T., & Matthews, G.V. (2015). Injecting risk behaviours following treatment for hepatitis C virus infection among people who inject drugs: The Australian Trial in Acute Hepatitis C. International Journal of Drug Policy. Vol. 26. Issue 10, pp. 976-983.
Timely notification of HCV test results is a key opportunity for risk behavior reduction counseling. In addition, there is need to expand post-test counseling services and monitoring in order to address post-diagnosis alcohol use.
Spelman, T., Morris, M.D., and Zang, G. (2015). A longitudinal study of hepatitis C virus testing and infection status notification on behavior change in people who inject drugs. J Epidemiol Community Health. 69(8): 745–752.
Due to the high cost of improved Hepatitis C virus treatment, in most cases, it is not feasible to offer treatment to all injection drug users at once. In order to optimize the benefits for the overall injection population, targeting HCV treatment appropriately is vital. Previously, treatment has been withheld from active injectors because of the risk that they may become re-infected and limit the benefits to themselves and the whole population.
The authors of this study look at the population-level benefits of treating one chronically HCV infected injection drug user in a population of high- and low- risk users. They then compared the benefits of treating one high or low risk user to develop an optimal treatment strategy.
(1 high-risk injector = 1 low-risk injector).
To enhance the preventative impact of hepatitis C virus treatment, interventions should be targeted based on how often the patient shares injecting equipment. When Hepatitis C virus is relatively uncommon among injectors, it is best to cure infected high-risk injectors. When the virus is relatively common, low-risk injectors should be targeted.
De Vos, A.S., Prins, M., and Kretzschmar, M.E.E. (2015). Hepatitis C virus treatment as prevention among injecting drug users: who should we cure first? Addiction. Vol.110, pp. 975-983.
Population size is a key factor in modeling of cost-effectiveness analysis and resource allocation, yet there is no gold standard method of estimating the size of “hidden” populations such as people who inject drugs (PWID) and there is no ideal method for all drugs and settings. Chronic hepatitis C virus (HCV) infection is high (approximately 50%) in current PWID. Due to the development of effective treatment for hepatitis C virus (HCV) there is growing interest to understand how increased treatment uptake will impact the burden of HCV.
Role of OST, NST and Prisons in Prevention of HCV
In order to develop appropriate public health policy and services to people who inject drugs (PWID), the ability to estimate current and former PWID populations is vital for both HCV treatment and prevention in new and existing measures such as opioid substitution treatment and needle and syringe programs. Improving epidemiological data on people who inject drugs is key for increasing the effectiveness of future interventions
Larney., L., Grebely, J., Hickman, M., De Angelis, D., Dore, G.J., and Degenhardt, L. (2015). Defining populations and injecting parameters among people who inject drugs: Implications for the assessment of hepatitis C treatment programs. The International Journal of Drug Policy. Vol 26:10. Pp. 950-957.
Hepatitis C Virus prevalence in people who inject drugs (PWID) ranges from 40%-90%. The volume of residual fluid within syringes depends on needle size and length, amount of space remaining in the hub of the syringe once the needle is attached and if the needles are detachable from the syringe barrel. Although they retain the least volume, syringes with fixed needles are not always acceptable to people who inject drugs (PWID). This has lead to the development of detachable needle-syringe combinations to reduce dead space.
People who inject drugs who use syringes with larger volumes and detachable needles need to be made aware that they are at increased risk for HCV transmission compared to fixed needle syringes if injection equipment is reused. This applies even when using two part low dead space (LDS) syringes and after several rinses with water. HCV prevention should focus on traditional harm reduction approaches such as preparing drugs and injecting them only with new, sterile equipment, minimizing contamination of injection locales, and hypochlorite bleach disinfection. Further research is needed on the overall impact of syringe type on HCV transmission among people who inject drugs.
Binka, M., Painstil, E., Patel, A. et al. (2015).Survival of Hepatitis C Virus in Syringes Is Dependent on the Design of the Syringe-Needle and Dead Space Volume. PLOS.
2016 is a pivotal year for viral hepatitis. At the World Health Assembly in May, WHO Member States adopted the first ever Elimination Strategy for Viral Hepatitis, with ambitious targets and a goal to eliminate hepatitis as a public health threat by 2030. This will be the first time national governments sign up and commit to the goal of eliminating viral hepatitis.
To mark this historic moment, the theme of elimination for World Hepatitis Day (WHD) 2016 will be used. This means every activity that addresses viral hepatitis is a step towards elimination. In other words, no matter what your plans are to mark WHD, be it a rally or press briefing or screening events, they can all come under the theme of elimination.
To elevate the theme of elimination NOhep, a global elimination movement, will be launched to bring people together and provide a platform for people to speak out, be engaged and take action to ensure global commitments are met and viral hepatitis is eliminated by 2030.
In order to achieve the NOhep objective of reaching 300 million by 2030, we need your help. Whether you do something as large as launching NOhep on WHD in your country or as simple as signing up to the movement, every action has an impact. Be part of making the elimination of viral hepatitis our next greatest achievement.
1. SIGN UP: Log on to www.NOhep.org to sign up to the movement.
– Please note that NOhep.org will be officially launched on July 28th
2. UPLOAD YOUR WHD ACTIVITY TO THE MAP OF IMPACT
3. USE WHD MATERIALS IN YOUR COUNTRY
4. ADD NOhep logo to your materials