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Injection Drug Users & HCV - a series of publications on IDUs & HCV treatment: reducing prevalence; prevention & management; cost-effectiveness: HCV eradication, by noted experts in HCV & IDUs
  from Jules Levin, NATAP
Global epidemiology of hepatitis B and hepatitis C in people who inject drugs: results of systematic reviews - 10 Million IDUs HCV+ Globally - 6.4 HBV+......http://www.natap.org/2011/newsUpdates/072811_01.htm
John W Ward. Paul K Nelson MHSc a, Bradley M Mathers MBChB a, Benjamin Cowie PhD b, Holly Hagan PhD c, Prof Don Des Jarlais PhD d, Danielle Horyniak BBioMedSci e, Prof Louisa Degenhardt PhD
Our global systematic review suggested that around 10.0 million IDUs are HCV positive and around 1.2 million are HBsAg positive.....About 10.0 million (range 6.0-15.2) IDUs worldwide might be anti-HCV positive. China (1.6 million), USA (1.5 million), and Russia (1.3 million) had the largest such populations......inadequate capacity to deliver effective interventions compromises outcomes everywhere


........Treatment as Prevention" for IDUs could significantly reduce, perhaps eliminate HCV, end HCV, as a contagious disease among the IDU community, but also contribute to eliminating HCV all together, if all the stakeholders can come together to collaborate.......combine an improvement of testing, link to care, adherence to treatment and change in recommendations to treat as soon as possible was the only strategy that led to a high decrease of prevalence and of the number of complications
Can antiviral therapy for hepatitis C reduce the prevalence of HCV among injecting drug user populations? A modeling analysis of its prevention utility http://www.natap.org/2011/HCV/052311_01.htm
Natasha K. Martin12Corresponding Author Informationemail address, Peter Vickerman12, Graham R. Foster3, Sharon J. Hutchinson45, David J. Goldberg4, Matthew Hickman1
Prevention and Management of Hepatitis C Virus Infection Among People Who Inject Drugs - A published series of articles dedicated to IDUS & HCV http://www.natap.org/2013/HCV/072613_01.htm
- Moving the Agenda Forward: The Prevention and Management of Hepatitis C Virus Infection Among People Who Inject Drugs
Jason Grebely, Philip Bruggmann, Markus Backmund, and Gregory J. Dore
- Injection Drug Use and Hepatitis C Virus Infection in Young Adult Injectors: Using Evidence to Inform Comprehensive Prevention Kimberly Page, Meghan D. Morris, Judith A. Hahn, Lisa Maher, and Maria Prins
- Combination Interventions to Prevent HCV Transmission Among People Who Inject Drugs: Modeling the Impact of Antiviral Treatment, Needle and Syringe Programs, and Opiate Substitution Therapy Natasha K. Martin, Matthew Hickman, Sharon J. Hutchinson, David J. Goldberg, and Peter Vickerman
- Hepatitis C Virus Vaccines Among People Who Inject Drugs
Andrea L. Cox and David L. Thomas
- Understanding Barriers to Hepatitis C Virus Care and Stigmatization From a Social Perspective Carla Treloar, Jake Rance, and Markus Backmund
- Models of Care for the Management of Hepatitis C Virus Among People Who Inject Drugs: One Size Does Not Fit All Philip Bruggmann and Alain H. Litwin
- Assessment and Treatment of Hepatitis C Virus Infection Among People Who Inject Drugs in the Opioid Substitution Setting: ETHOS Study Maryam Alavi, Jason Grebely, Michelle Micallef,, Adrian J. Dunlop,, Annie C. Balcomb, Carolyn A. Day, Carla Treloar, Nicky Bath, Paul S. Haber, Gregory J. Dore, and on behalf of the Enhancing Treatment for Hepatitis C in Opioid Substitution Settings (ETHOS) Study Group
- Enhancing Assessment and Treatment of Hepatitis C in the Custodial Setting Jeffrey J. Post, Amber Arain, and Andrew R. Lloyd
- Peer Support Models for People With a History of Injecting Drug Use Undertaking Assessment and Treatment for Hepatitis C Virus Infection Sione Crawford and Nicky Bath
- Treatment of Hepatitis C Virus Infection Among People Who Are Actively Injecting Drugs: A Systematic Review and Meta-analysis Esther J. Aspinall, Stephen Corson, Joseph S. Doyle, Jason Grebely, Sharon J. Hutchinson, Gregory J. Dore, David J. Goldberg, and Margaret E. Hellard
- Directly Observed Pegylated Interferon Plus Self-Administered Ribavirin for the Treatment of Hepatitis C Virus Infection in People Actively Using Drugs: A Randomized Controlled Trial Robert J. Hilsden, Gisela Macphail, Jason Grebely, Brian Conway, and Samuel S. Lee
- Psychoeducation Improves Hepatitis C Virus Treatment During Opioid Substitution Therapy: A Controlled, Prospective Multicenter Trial Jens Reimer, Christiane Sybille Schmidt, Bernd Schulte, Dirk Gansefort, Jorg Golz, Guido Gerken, Norbert Scherbaum, Uwe Verthein, and Markus Backmund
- Drug-Drug Interactions in the Treatment of HCV Among People Who Inject Drugs Stefan Mauss and Hartwig Klinker
- Management of Hepatitis C Virus/HIV Coinfection Among People Who Use Drugs in the Era of Direct-Acting Antiviral-Based Therapy Lynn E. Taylor, Tracy Swan, and Gail V. Matthews
Cost-effectiveness of hepatitis C virus antiviral treatment for injection drug user populations
Natasha K. Martin,1,2 Peter Vickerman,1,2 Alec Miners,2 Graham R. Foster,3 Sharon J. Hutchinson,4,5 David J. Goldberg,4 and Matthew Hickman1
Eradication of hepatitis C infection:
The importance of targeting people who inject drugs

MARGARET HELLARD1-3 JOSEPH S. DOYLE1-4 RACHEL SACKS-DAVIS1,3 ALEXANDER J. THOMPSON4,5 EMMA MCBRYDE1,4 1Centre for Population Health, Burnet Institute, Melbourne, Victoria, Australia 2Infectious Diseases Unit, The Alfred Hospital, Melbourne, Victoria, Australia 3Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia 4Victorian Infectious Disease Service, Royal Melbourne Hospital, Parkville, Victoria, Australia 5Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australi
Sustained High Levels of HCV-infection Among IDUs in USA - Prevention of Hepatitis C Virus in Injecting Drug Users: A Narrow Window of Opportunity -editorial
http://www.natap.org/2011/HCV/020511_08.htm Jason Grebely and Gregory J. Dore
Barriers to HCV Screening/Care among IDUs: "Perceptions of drug users regarding Hepatitis C screening and care: a qualitative study"......http://www.natap.org/2013/HCV/122713_04.htm
There were few participants who reported being encouraged to have regular medical follow-up to monitor their HCV infection but without recommendation for treatment, Participants specifically described a lack of explanation and clarity regarding the treatment options for HCV, As part of this uncertainty about treatment, many people came away with an implicit message that there was not much else that could or needed to be done to treat HCV or to prevent liver damage, Some participants, despite having been told they were HCV positive, did not believe they were infected because their providers did not offer them treatment, Mistrust of health care providers' motivations, One of the barriers participants reported complicating engagement in HCV care was active drug use. Participants reported that when they were using actively they were less likely to get tested for HCV.....While testing for HCV was common among focus group participants, most reported being unaware of voluntary testing sites. Most participants were eager to have access to voluntary HCV testing.
"HIV testing is much more accessible to me, more accessible than hepatitis C" Many participants found to be HCV positive reported receiving their results but coming away from post-test counseling without a clear understanding of the significance of the diagnosis or what next steps to take, feeling fatalistic with a generalized nihilism about managing their infection: "I don't know what to do. Except just walk around dying from it".
96% of IDUs Not eligible for HCV Therapy, in this study....published in 2006 http://www.natap.org/2006/HCV/020106_02.htm
CDC HIV & Hepatitis C Screening & Services Guidelines / Recommendations - IDUs Highlighted - published in 2012 http://www.natap.org/2012/HCV/113012_01.htm
"All persons who use or inject drugs illicitly should routinely be offered screening and counseling for HCV infection. Persons with a history of risk, even those who have injected illicitly once or many years ago, should be offered screening and counseling for HCV infection. Facilities that provide counseling and testing should include services or referrals for medical evaluation and management of persons identified as infected with HCV."
HCV Survives/Maintains Infectivity in Syringe/On Surfaces- 2 studies http://www.natap.org/2014/HCV/020314_02.htm
EASL: HCV in India at EASL: IDUs, Burden, Limited Access http://www.natap.org/2014/EASL/EASL_117.htm
Global HCV 150 Million: reused syringes, IDU, sexual transmission, HIV coinfection, China/India/Pakistan, Africa http://www.natap.org/2011/HCV/080211_01.htm
HCV Death Rate Doubles Among IDUs in Last 5 Years......http://www.natap.org/2006/IAS/IAS_74.htm......hepatitis C (HCV), which contributed to 60.3% of liver disease deaths, was reported twice as often in 2003 (12.4%) as in 1999 (6.1%)
HCV Barriers to Care & Treatment, New Study - Hepatitis C treatment and SVR: the gap between clinical trials and real-world treatment aspirations.......http://www.natap.org/2012/HCV/121112_01.htm
"The most commonly cited categories of barriers to care.....were medical ineligibilities...... and patient barriers....... Less often described categories of barriers to care were care provider barriers........ and system barriers.....medical ineligibilities for treatment......substance use disorder....psychiatric disorder.....medical comorbidity.....hematologic abnormalities..... severe anemia and thrombocytopenia.....previous treatment (28% of HCV studies), and medical and psychiatric......patient barriers.......patients' attitudes, personal resources, preferences and ultimate decisions.......patient barriers to treatment........ refusal of recommended treatment...... fear of side effects ......... loss to follow-up (five HCV studies and one HCV/HIV-coinfection study)........ low confidence in treatment effectiveness.......perception of liver disease as too mild....... not feeling symptoms.......competing medical and/or psychosocial prioritiess......need to continue working that could be compromised by treatment, desire for pregnancy or contraception issues.......desire to drink and take drugs rather than abstinence required to undergo treatment or desire to focus on HIV treatment rather than starting HCV treatment.......The most commonly mentioned care provider barriers mentioned were failure to discuss the illness with the patient and deferral of treatment...... failure to screen for HCV or refer to treatment, lack of knowledge or skill for diagnosis and treatment of HCV, poor communication skills and care provider stigma (e.g., related to drug use, homosexuality and sexual promiscuity)."
Mapping Diverse Global HCV Genotype Distribution- Europe/1b in Far East http://www.natap.org/2014/HCV/022114_04.htm
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