The hepatitis C cascade of care in people who inject drugs in Dar es Salaam, Tanzania
Summary The World Health Organisation has recently called for hepatitis C virus (HCV) elimination and has identified people who inject drugs (PWID) as a key population to scale‐up screening and linkage to care. This study reports the cascade of care for HCV in PWID attending the largest opioid subst...
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| Published in | Journal of Viral Hepatitis Vol. 25; no. 12; pp. 1438 - 1445 |
|---|---|
| Main Authors | , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
England
Wiley
01.12.2018
Wiley Subscription Services, Inc Wiley-Blackwell John Wiley and Sons Inc |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1352-0504 1365-2893 1365-2893 |
| DOI | 10.1111/jvh.12966 |
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| Abstract | Summary
The World Health Organisation has recently called for hepatitis C virus (HCV) elimination and has identified people who inject drugs (PWID) as a key population to scale‐up screening and linkage to care. This study reports the cascade of care for HCV in PWID attending the largest opioid substitution treatment (OST) clinic in Dar‐es‐Salaam, Tanzania. Between February 2011 and March 2016, HCV serology for all PWID registered at the Muhimbili National Hospital OST clinic, Dar‐es‐Salaam were obtained from records. In 2015, consecutive HCV‐seropositive PWID were invited to undergo a clinical evaluation including epidemiological questionnaire, liver stiffness measurement (Fibroscan) and virological analysis (HCV RNA viral load and genotyping). During the study period, 1350 persons registered at the OST clinic: all had a HCV serology including 409 (30%) positive results. Among the HCV‐seropositive individuals, 207 (51%) were active attenders and 153 (37%) were enrolled for clinical assessment: 141 (92%) were male, median age: 38 years (IQR 34‐41), and 65 (44%) were co‐infected with HIV; 116 patients (76%) had detectable HCV RNA, with genotypes 1a (68%) and 4a (32%); 21 (17%) had clinically significant fibrosis (≥F2) and 6 (5%) had cirrhosis (F4). None were offered HCV treatment. Chronic hepatitis C among PWID enrolled in the OST centre in Dar‐es‐Salaam is frequent, but its continuum of care is insufficient; integration of HCV diagnosis and treatment should form a part of OST intervention in PWID in Tanzania. |
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| AbstractList | The World Health Organisation has recently called for hepatitis C virus (HCV) elimination and has identified people who inject drugs (PWID) as a key population to scale-up screening and linkage to care. This study reports the cascade of care for HCV in PWID attending the largest opioid substitution treatment (OST) clinic in Dar-es-Salaam, Tanzania. Between February 2011 and March 2016, HCV serology for all PWID registered at the Muhimbili National Hospital OST clinic, Dar-es-Salaam were obtained from records. In 2015, consecutive HCV-seropositive PWID were invited to undergo a clinical evaluation including epidemiological questionnaire, liver stiffness measurement (Fibroscan) and virological analysis (HCV RNA viral load and genotyping). During the study period, 1350 persons registered at the OST clinic: all had a HCV serology including 409 (30%) positive results. Among the HCV-seropositive individuals, 207 (51%) were active attenders and 153 (37%) were enrolled for clinical assessment: 141 (92%) were male, median age: 38 years (IQR 34-41), and 65 (44%) were co-infected with HIV; 116 patients (76%) had detectable HCV RNA, with genotypes 1a (68%) and 4a (32%); 21 (17%) had clinically significant fibrosis (≥F2) and 6 (5%) had cirrhosis (F4). None were offered HCV treatment. Chronic hepatitis C among PWID enrolled in the OST centre in Dar-es-Salaam is frequent, but its continuum of care is insufficient; integration of HCV diagnosis and treatment should form a part of OST intervention in PWID in Tanzania.The World Health Organisation has recently called for hepatitis C virus (HCV) elimination and has identified people who inject drugs (PWID) as a key population to scale-up screening and linkage to care. This study reports the cascade of care for HCV in PWID attending the largest opioid substitution treatment (OST) clinic in Dar-es-Salaam, Tanzania. Between February 2011 and March 2016, HCV serology for all PWID registered at the Muhimbili National Hospital OST clinic, Dar-es-Salaam were obtained from records. In 2015, consecutive HCV-seropositive PWID were invited to undergo a clinical evaluation including epidemiological questionnaire, liver stiffness measurement (Fibroscan) and virological analysis (HCV RNA viral load and genotyping). During the study period, 1350 persons registered at the OST clinic: all had a HCV serology including 409 (30%) positive results. Among the HCV-seropositive individuals, 207 (51%) were active attenders and 153 (37%) were enrolled for clinical assessment: 141 (92%) were male, median age: 38 years (IQR 34-41), and 65 (44%) were co-infected with HIV; 116 patients (76%) had detectable HCV RNA, with genotypes 1a (68%) and 4a (32%); 21 (17%) had clinically significant fibrosis (≥F2) and 6 (5%) had cirrhosis (F4). None were offered HCV treatment. Chronic hepatitis C among PWID enrolled in the OST centre in Dar-es-Salaam is frequent, but its continuum of care is insufficient; integration of HCV diagnosis and treatment should form a part of OST intervention in PWID in Tanzania. The World Health Organisation has recently called for hepatitis C virus (HCV) elimination and has identified people who inject drugs (PWID) as a key population to scale‐up screening and linkage to care. This study reports the cascade of care for HCV in PWID attending the largest opioid substitution treatment (OST) clinic in Dar‐es‐Salaam, Tanzania. Between February 2011 and March 2016, HCV serology for all PWID registered at the Muhimbili National Hospital OST clinic, Dar‐es‐Salaam were obtained from records. In 2015, consecutive HCV‐seropositive PWID were invited to undergo a clinical evaluation including epidemiological questionnaire, liver stiffness measurement (Fibroscan) and virological analysis (HCV RNA viral load and genotyping). During the study period, 1350 persons registered at the OST clinic: all had a HCV serology including 409 (30%) positive results. Among the HCV‐seropositive individuals, 207 (51%) were active attenders and 153 (37%) were enrolled for clinical assessment: 141 (92%) were male, median age: 38 years (IQR 34‐41), and 65 (44%) were co‐infected with HIV; 116 patients (76%) had detectable HCV RNA, with genotypes 1a (68%) and 4a (32%); 21 (17%) had clinically significant fibrosis (≥F2) and 6 (5%) had cirrhosis (F4). None were offered HCV treatment. Chronic hepatitis C among PWID enrolled in the OST centre in Dar‐es‐Salaam is frequent, but its continuum of care is insufficient; integration of HCV diagnosis and treatment should form a part of OST intervention in PWID in Tanzania. The World Health Organisation has recently called for hepatitis C virus (HCV) elimination and has identified people who inject drugs (PWID) as a key population to scale-up screening and linkage to care. This study reports the cascade of care for HCV in PWID attending the largest opioid substitution treatment (OST) clinic in Dar-es-Salaam, Tanzania. Between February 2011 and March 2016, HCV serology for all PWID registered at the Muhimbili National Hospital OST clinic, Dar-es-Salaam were obtained from records. In 2015, consecutive HCV-seropositive PWID were invited to undergo a clinical evaluation including epidemiological questionnaire, liver stiffness measurement (Fibroscan) and virological analysis (HCV RNA viral load and genotyping). During the study period, 1350 persons registered at the OST clinic: all had a HCV serology including 409 (30%) positive results. Among the HCV-seropositive individuals, 207 (51%) were active attenders and 153 (37%) were enrolled for clinical assessment: 141 (92%) were male, median age: 38 years (IQR 34-41), and 65 (44%) were co-infected with HIV; 116 patients (76%) had detectable HCV RNA, with genotypes 1a (68%) and 4a (32%); 21 (17%) had clinically significant fibrosis (≥F2) and 6 (5%) had cirrhosis (F4). None were offered HCV treatment. Chronic hepatitis C among PWID enrolled in the OST centre in Dar-es-Salaam is frequent, but its continuum of care is insufficient; integration of HCV diagnosis and treatment should form a part of OST intervention in PWID in Tanzania. Summary The World Health Organisation has recently called for hepatitis C virus (HCV) elimination and has identified people who inject drugs (PWID) as a key population to scale‐up screening and linkage to care. This study reports the cascade of care for HCV in PWID attending the largest opioid substitution treatment (OST) clinic in Dar‐es‐Salaam, Tanzania. Between February 2011 and March 2016, HCV serology for all PWID registered at the Muhimbili National Hospital OST clinic, Dar‐es‐Salaam were obtained from records. In 2015, consecutive HCV‐seropositive PWID were invited to undergo a clinical evaluation including epidemiological questionnaire, liver stiffness measurement (Fibroscan) and virological analysis (HCV RNA viral load and genotyping). During the study period, 1350 persons registered at the OST clinic: all had a HCV serology including 409 (30%) positive results. Among the HCV‐seropositive individuals, 207 (51%) were active attenders and 153 (37%) were enrolled for clinical assessment: 141 (92%) were male, median age: 38 years (IQR 34‐41), and 65 (44%) were co‐infected with HIV; 116 patients (76%) had detectable HCV RNA, with genotypes 1a (68%) and 4a (32%); 21 (17%) had clinically significant fibrosis (≥F2) and 6 (5%) had cirrhosis (F4). None were offered HCV treatment. Chronic hepatitis C among PWID enrolled in the OST centre in Dar‐es‐Salaam is frequent, but its continuum of care is insufficient; integration of HCV diagnosis and treatment should form a part of OST intervention in PWID in Tanzania. The World Health Organisation has recently called for hepatitis C virus ( HCV ) elimination and has identified people who inject drugs ( PWID ) as a key population to scale‐up screening and linkage to care. This study reports the cascade of care for HCV in PWID attending the largest opioid substitution treatment ( OST ) clinic in Dar‐es‐Salaam, Tanzania. Between February 2011 and March 2016, HCV serology for all PWID registered at the Muhimbili National Hospital OST clinic, Dar‐es‐Salaam were obtained from records. In 2015, consecutive HCV ‐seropositive PWID were invited to undergo a clinical evaluation including epidemiological questionnaire, liver stiffness measurement (Fibroscan) and virological analysis ( HCV RNA viral load and genotyping). During the study period, 1350 persons registered at the OST clinic: all had a HCV serology including 409 (30%) positive results. Among the HCV ‐seropositive individuals, 207 (51%) were active attenders and 153 (37%) were enrolled for clinical assessment: 141 (92%) were male, median age: 38 years ( IQR 34‐41), and 65 (44%) were co‐infected with HIV ; 116 patients (76%) had detectable HCV RNA , with genotypes 1a (68%) and 4a (32%); 21 (17%) had clinically significant fibrosis (≥F2) and 6 (5%) had cirrhosis (F4). None were offered HCV treatment. Chronic hepatitis C among PWID enrolled in the OST centre in Dar‐es‐Salaam is frequent, but its continuum of care is insufficient; integration of HCV diagnosis and treatment should form a part of OST intervention in PWID in Tanzania. |
| Author | Jin U. Kim Simon D. Taylor‐Robinson John Rwegasha Sanjay Bhagani Jessie Mbwambo Stéphane Chevaliez Lila Poiteau Mark R. Thursz Maud Lemoine Zameer Mohamed Yusuke Shimakawa |
| AuthorAffiliation | 5 The Royal Free Hospital London UK 3 Unité d'Épidémiologie des Maladies Émergentes Institut Pasteur Paris France 1 Department of Hepatology Imperial College London St Mary's Hospital London UK 4 Department of Virology French National Reference Center for Viral Hepatitis B, C and Delta Hopital Henri Mondor Université Paris‐Est Créteil France 6 Department of Psychiatry Muhimbili University of Health and Allied Sciences Muhimbili National Hospital Dar es Salaam Tanzania 2 Department of Gastroenterology Muhimbili National Hospital Dar es Salaam Tanzania |
| AuthorAffiliation_xml | – name: 4 Department of Virology French National Reference Center for Viral Hepatitis B, C and Delta Hopital Henri Mondor Université Paris‐Est Créteil France – name: 5 The Royal Free Hospital London UK – name: 1 Department of Hepatology Imperial College London St Mary's Hospital London UK – name: 2 Department of Gastroenterology Muhimbili National Hospital Dar es Salaam Tanzania – name: 3 Unité d'Épidémiologie des Maladies Émergentes Institut Pasteur Paris France – name: 6 Department of Psychiatry Muhimbili University of Health and Allied Sciences Muhimbili National Hospital Dar es Salaam Tanzania |
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| BackLink | https://cir.nii.ac.jp/crid/1870865117907836032$$DView record in CiNii https://www.ncbi.nlm.nih.gov/pubmed/29974582$$D View this record in MEDLINE/PubMed https://pasteur.hal.science/pasteur-02875234$$DView record in HAL |
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| CitedBy_id | crossref_primary_10_1016_j_jhep_2019_09_022 crossref_primary_10_1111_jvh_13073 crossref_primary_10_51821_84_4_015 crossref_primary_10_1016_j_drugalcdep_2018_11_026 crossref_primary_10_1016_S1473_3099_20_30051_7 crossref_primary_10_1111_liv_14315 crossref_primary_10_1155_2020_3701379 crossref_primary_10_1002_jia2_25817 crossref_primary_10_1016_j_biopha_2022_113024 crossref_primary_10_1016_j_drugpo_2019_04_001 crossref_primary_10_1186_s12954_019_0346_y crossref_primary_10_1002_jia2_25730 crossref_primary_10_1016_S1473_3099_20_30049_9 crossref_primary_10_3389_fmed_2024_1429516 crossref_primary_10_1016_j_drugpo_2021_103458 crossref_primary_10_1016_j_clinre_2020_11_001 crossref_primary_10_1111_jvh_13646 crossref_primary_10_1016_j_drugpo_2019_102613 crossref_primary_10_1016_j_drugpo_2019_102634 crossref_primary_10_3390_v15030661 crossref_primary_10_1007_s40121_019_0249_y crossref_primary_10_1016_j_drugpo_2020_103095 |
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| ContentType | Journal Article |
| Contributor | This study was supported by the Wellcome Trust Global Centre and the United Kingdom National Institute for Health Research (NIHR) Biomedical Facility at Imperial College London (G606101) Royal Free Hospital [London, UK] Epidémiologie des Maladies Emergentes - Emerging Diseases Epidemiology ; Pasteur-Cnam Risques infectieux et émergents (PACRI) ; Institut Pasteur [Paris] (IP)-Conservatoire National des Arts et Métiers [CNAM] (CNAM) ; HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Institut Pasteur [Paris] (IP)-Conservatoire National des Arts et Métiers [CNAM] (CNAM) ; HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers univers |
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| Copyright | 2018 The Authors. Published by John Wiley & Sons Ltd 2018 The Authors. Journal of Viral Hepatitis Published by John Wiley & Sons Ltd. Copyright © 2018 John Wiley & Sons Ltd Attribution |
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| Keywords | hepatitis C virus fibrosis cascade of care Sub-Saharan Africa people who inject drugs |
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The World Health Organisation has recently called for hepatitis C virus (HCV) elimination and has identified people who inject drugs (PWID) as a key... The World Health Organisation has recently called for hepatitis C virus ( HCV ) elimination and has identified people who inject drugs ( PWID ) as a key... The World Health Organisation has recently called for hepatitis C virus (HCV) elimination and has identified people who inject drugs (PWID) as a key population... |
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| SubjectTerms | 1103 Clinical Sciences 1108 Medical Microbiology [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie Adult cascade of care Cirrhosis Continuity of Patient Care Continuity of Patient Care - organization & administration DISEASE Disease Management Female Fibrosis Gastroenterology & Hepatology Genotype Genotypes Genotyping HARM REDUCTION HCV Hepacivirus Hepacivirus - classification Hepacivirus - genetics Hepacivirus - isolation & purification Hepatitis Hepatitis C hepatitis C virus Hepatitis C, Chronic Hepatitis C, Chronic - diagnosis Hepatitis C, Chronic - drug therapy Hepatitis C, Chronic - epidemiology HIV Human immunodeficiency virus Humans INFECTIONS Infectious Diseases Interferon Life Sciences Life Sciences & Biomedicine Liver Liver cirrhosis LIVER FIBROSIS ASSESSMENT Male Mass Screening Mass Screening - organization & administration MESH: Adult MESH: Continuity of Patient Care MESH: Disease Management MESH: Female MESH: Genotype MESH: Hepacivirus MESH: Hepatitis C, Chronic MESH: Humans MESH: Male MESH: Mass Screening MESH: Substance Abuse, Intravenous MESH: Tanzania MESH: Viral Load Opioids Original Original Articles people who inject drugs PLATELET RATIO PREVALENCE Ribonucleic acid RNA Santé publique et épidémiologie Science & Technology Serology Sub-Saharan Africa Substance Abuse, Intravenous Substance Abuse, Intravenous - complications Tanzania Tanzania - epidemiology TRANSIENT ELASTOGRAPHY USERS Viral Load Virology |
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| Title | The hepatitis C cascade of care in people who inject drugs in Dar es Salaam, Tanzania |
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