Barriers and Facilitators to Hepatitis C Treatment for People who Inject Drugs:
A qualitative study, June 2012, WHO Europe

This qualitative study aims to assess the barriers and facilitators to HCV treatment access and completion for PWID in drug and alcohol (D&A) settings. We examine the barriers and facilitators to HCV treatment by: describing pathways to hepatitis C treatment, including referral, as well as factors mediating treatment access in the D&A setting. Through qualitative interviews with HCV treatment providers and PWID we explore the experience of HCV treatment access and delivery from patient, provider and ‘system’ perspectives in order to develop guidance regarding HCV treatment system improvement, including referral and coordination, and the provision of psycho-social interventions targeting patients and providers.


Sampling Bias In Transgender Studies,
Greta R Bauer, Ayden I Scheim, The Lancet, Vol. 13, October 2013

Sampling bias is common in studies of transgender women, in which convenience samples are primarily drawn from urban sites over-representing street-active women, including HIV testing sites. Although such studies are important in reporting HIV vulnerabilities experienced by segments of the transgender population, we caution against broadly extrapolating to transgender women.

The Burden of Viral Hepatitis C In Europe: A Propensity Analysis of Patient Outcomes,
Marco daCosta DiBonaventura et al., European Journal of Gastroenterology & Hepatology 2012, Vol 24 No 8

Across Europe, an estimated 250 000 individuals die annually from HCV-related causes.   Indeed, a number of patients in Europe are unaware that they are infected with the virus. Less than 60% of urban French residents with HCV-positive sera were aware of their status. The rates of awareness for most other European countries vary between 60 and 90%, although Germany and Poland have been estimated at closer to 10%.

Cost-Effectiveness of Hepatitis C Virus Antiviral Treatment for Injection Drug User Populations
Natasha K. Martin,Peter Vickerman,Alec Miners,Graham R. Foster,Sharon J. Hutchinson,David J. Goldberg,and Matthew Hickman, Hepatology 2012

Treatment and prevention of HCV transmission among IDUs, is critical to reducing the burden of liver disease.Prevention measures such as opiate substitution therapy and high coverage needle and syringe programs can reduce HCV transmission. Previous mathematical modeling work suggested HCV antiviral treatment could prevent HCV transmission. Current HCV antiviral treatment regimens can achieve a SVR in 45% (genotype 1) to 80% (genotype 2/3) of infections and economic evaluations suggest treatment is cost-effective for populations with no risk of reinfection.

Decline in Incidence of HIV and Hepatitis C Virus Infection Among Injecting Drug Users in Amsterdam; Evidence for Harm Reduction?
Anneke S. de Vos et al., Addiction, 108, 1070–1081, 2013

Marked decreases in HIV and HCV in Amsterdam since 1990 could be due partly to harm reduction measures; however, they may also be attributable largely to changes in the IDU population. Future research aimed at quantifying the benefits of interventions should not neglect the impact of natural epidemic progression and demographic changes.

Sustained Drug Use Changes Following Hepatitis C Screening and Counseling Among Recently Infected Persons who Inject Drugs:
A Longitudinal Study Bruneau, J et al., Clinical Infectious Diseases, December 2013

Our results indicate that notification of HCV-positive status is associated with reduced injection drug use among seroconverters. Amongst PWIDs deemed seronegative after screening, there is no sustained trend for change in risk behavior.

Eradication of Hepatitis C Infection: The Importance of Targeting People who Inject Drugs,
Margaret Hellard PhD et al., Hepatology 2013

To achieve eradication, public health efforts must focus on PWID, the key drivers of HCV transmission. A sustained, multipronged approach could substantially reduce HCV infection in PWID over the next 10–20 years through a focus on HCV treatment as prevention, meaning improved access to more effective and well-tolerated HCV treatment. Other major elements include increasing coverage of opiate substitution therapy (OST), needle and syringe programs (NSPs), and regular HCV screening and counseling


Frequent HCV Reinfection and Superinfection in a Cohort of Injecting Drug Users in Amsterdam,
Thijs J.W. van de Laar et al., Journal of Hepatology 51 (2009) 667–674

HCV reinfection and superinfection are common among actively injecting drug users. This might further complicate the development of an effective HCV vaccine.

Hepatitis C Virus Clearance, Reinfection, and Persistence, with Insights from Studies of Injecting Drug Users: Towards a Vaccine,
Jason Grebely et al,. Lancet Infect Dis 2012

Results from studies of reinfection risk after spontaneous clearance in injecting drug users are confl icting, but some people seem to have protection against HCV persistence. To guide future vaccine development, we assess data from studies of HCV reinfection after spontaneous clearance, discuss fl aws in the methods of previous human studies, and suggest essential components for future investigations of control of HCV infection.

The Contributions of Viral Hepatitis and Alcohol to Liver-Related Deaths in Opioid-Dependent People,
Sarah Larney et al., Drug and Alcohol Dependence 131 (2013) 252– 257

Liver-related deaths were shown to be increasing in this heroin-dependent population, and the majority of these deaths involved chronic viral hepatitis infection. Increased uptake of treatment for hepatitis C virus infection is crucial to reducing the burden of liver-related mortality in this population. Hepatitis B vaccination, and screening of OST patients for alcohol use disorders and delivery of brief interventions as clinically indicated may also be of benefit.

High Incidence of Hepatitis C Virus Reinfection within a Cohort of Injecting Drug Users,
J. M. Micallef et al., Journal of Viral Hepatitis, 2007, 14, 413–418

A retrospective cohort study was established of injecting drug users (IDUs) to assess evidence for hepatitis C virus (HCV) protective immunity through a comparison of incidence of initial HCV infection and HCV reinfection.

Hepatitis C Treatment for Injection Drug Users: A Review of the Available Evidence,
Margaret Hellard et al., Clinical Infectious Diseases 2009; 49:561–73

There is evidence that a sizeable proportion of IDUs who begin hepatitis C treatment achieve a sustained virological response (SVR). In chronic hepatitis C treatment trials, the SVR rate among IDUs appears to be comparable to rates among non-IDUs; in trials prescribing pegylated interferon plus ribavirin, the median rate of SVR among IDUs was 54.3% (range, 18.1%–94.1%), compared with 54%–63% in the large treatment trials. Few trials of acute hepatitis C treatment report on outcomes in IDUs; however, among these trials, the SVR among IDUs was 68.5%, compared with 81.5% among non-IDUs.

Hepatitis C Treatment Access and Uptake for People who Inject Drugs:
A Review Mapping The Role of Social Factors,
Harris and Rhodes Harm Reduction Journal 2013, 10:7

Combination intervention approaches need to encompass social interventions in relation to housing, stigma reduction and systemic changes in policy and health care delivery. Future research needs to better delineate social factors affecting treatment access.

The Burden of Hepatitis C in Europe from the Patients' Perspective: A Survey in 5 Countries,
Jeffrey Vietri et al., BMC Gastroenterology 2013, 13:16

Few studies have examined the impact of Hepatitis C virus (HCV) infection on patient reported outcomes in Europe. This study was conducted to assess the burden of HCV infection in terms of work productivity loss, activity impairment, health-related quality of life, healthcare resource utilization, and associated costs.

Perceptions of Drug Users Regarding Hepatitis C Screening and Care:
A Qualitative Study, Jordan et al. Harm Reduction Journal 2013, 10:10

Drug users perceived a paucity of settings for self-initiated HCV testing and poor provider-patient communication at test sites and during medical encounters. Notably, drug users reported having an unclear understanding about the meaning of a positive HCV test, the health implications of HCV infection, the importance of clinical evaluations, monitoring, and of treatment options for HCV. Efforts to improve the delivery of clinical messages about HCV infection for drug users at test settings and clinical encounters are needed

“To Share or Not to Share?” Serosorting by Hepatitis C Status in the Sharing of Drug Injection Equipment Among NHBS-IDU2 Participants,
Bryce D. Smith et al., The Journal of Infectious Diseases 2013;208:1934–42

This study examines injection equipment serosorting considering HCV serostatus when deciding whether and with whom to share injection equipment. Our analysis suggests PWID are more likely to share injection equipment with persons of concordant HCV status.

Treatment of Hepatitis C Virus Infection Among People Who Are Actively Injecting Drugs:
A Systematic Review and Meta-analysis, Esther J. Aspinall et al., Clinical Infectious Diseases 2013;57(S2):S80–9

HCV treatment outcomes are acceptable in PWID, supporting treatment guidelines. The pooled estimate of HCV reinfection risk was low, but there was considerable uncertainty around this estimate. Further studies on the risk of reinfection are needed to assess the long-term effectiveness of HCV treatment in PWID.

Assessment and Treatment of Hepatitis C Virus Infection Among People Who Inject Drugs in the Opioid Substitution Setting:
ETHOS Study, Maryam Alavi et al., Clinical Infectious Diseases 2013;57(S2):S62–9

HCV treatment uptake was relatively high among this highly marginalized population of PWID. Potentially modifiable factors associated with treatment include drug use and social support.

Understanding Barriers to Hepatitis C Virus Care and Stigmatization From a Social Perspective,
Carla Treloar et al,. Clinical Infectious Diseases 2013;57(S2):S51–5

There is little literature that specifically examines stigma as a barrier to HCV care and treatment. This review argues that the relationship between the person living with HCV and their health worker can work to ameliorate the effects of stigma. We draw on an emerging literature that examines the positive association between a patient’s “trust” in their health worker and outcomes such as increased healthcare utilization and reduced risk behaviors. We investigate a growing body of health services research that acknowledges the importance of stigma and demonstrates ways to build positive, enabling relationships between patient, health worker, and health setting.