High Effectiveness of Broad Access Direct-Acting Antiviral Therapy for Hepatitis C in an Australian Real-World Cohort: The REACH-C Study

Australia was one of the first countries with unrestricted access to government subsidized direct-acting antiviral (DAA) therapy for adults with chronic hepatitis C virus. This study assessed real-world DAA treatment outcomes across a diverse range of Australian clinical services and evaluated factors associated with successful treatment and loss to follow-up. Real-world Effectiveness of Antiviral therapy in Chronic Hepatitis C (REACH-C) consisted a national observational cohort of 96 clinical services including specialist clinics and less traditional settings such as general practice. Data were obtained on consecutive individuals who commenced DAAs from March 2016 to June 2019. Effectiveness was assessed by sustained virological response ≥12 weeks following treatment (SVR) using intention-to-treat (ITT) and per-protocol (PP) analyses. Within REACH-C, 10,843 individuals initiated DAAs (male 69%; ≥50 years 52%; cirrhosis 22%). SVR data were available in 85% (9,174 of 10,843). SVR was 81% (8,750 of 10,843) by ITT and 95% (8,750 of 9,174) by PP. High SVR (≥92%) was observed across all service types and participant characteristics. Male gender (adjusted odds ratio [aOR] 0.56, 95% confidence interval [CI] 0.43-0.72), cirrhosis (aOR 0.52, 95% CI 0.41-0.64), recent injecting drug use (IDU; aOR 0.64, 95% CI 0.46-0.91) and previous DAA treatment (aOR 0.50, 95% CI 0.28-0.90) decreased the likelihood of achieving SVR. Multiple factors modified the likelihood of loss to follow-up including IDU ± opioid agonist therapy (OAT; IDU only: aOR 1.75, 95% CI 1.44-2.11; IDU + OAT: aOR 1.39, 95% CI 1.11-1.74; OAT only, aOR 1.36; 95% CI 1.13-1.68) and age (aOR 0.97, 95% CI 0.97-0.98). Conclusion: Treatment response was high in a diverse population and through a broad range of services following universal access to DAA therapy. Loss to follow-up presents a real-world challenge. Younger people who inject drugs were more likely to disengage from care, requiring innovative strategies to retain them in follow-up

Retreatment for hepatitis C virus direct-acting antiviral therapy virological failure in primary and tertiary settings: The REACH-C cohort

Virological failure occurs in a small proportion of people treated for hepatitis C virus (HCV) with direct-acting antiviral (DAA) therapies. This study assessed retreatment for virological failure in a large real-world cohort. REACH-C is an Australian observational study (n = 10,843) evaluating treatment outcomes of sequential DAA initiations across 33 health services between March 2016 to June 2019. Virological failure retreatment data were collected until October 2020. Of 408 people with virological failure (81% male; median age 53; 38% cirrhosis; 56% genotype 3), 213 (54%) were retreated once; 15 were retreated twice. A range of genotype specific and pangenotypic DAAs were used to retreat virological failure in primary (n = 56) and tertiary (n = 157) settings. Following sofosbuvir/velpatasvir/voxilaprevir availability in 2019, the proportion retreated in primary care increased from 21% to 40% and median time to retreatment initiation declined from 294 to 152 days. Per protocol (PP) sustained virological response (SVR12) was similar for people retreated in primary and tertiary settings (80% vs 81%; p = 1.000). In regression analysis, sofosbuvir/velpatasvir/voxilaprevir (vs. other regimens) significantly decreased likelihood of second virological failure (PP SVR12 88% vs. 77%; adjusted odds ratio [AOR] 0.29; 95%CI 0.11–0.81); cirrhosis increased likelihood (PP SVR12 69% vs. 91%; AOR 4.26; 95%CI 1.64–11.09). Indigenous Australians had lower likelihood of retreatment initiation (AOR 0.36; 95%CI 0.15–0.81). Treatment setting and prescriber type were not associated with retreatment initiation or outcome. Virological failure can be effectively retreated in primary care. Expanded access to simplified retreatment regimens through decentralized models may increase retreatment uptake and reduce HCV-related mortality

Obesogenic slurs: How pervasive fat-shaming undermines the battle against juvenile obesity

The purpose of this paper is to deepen understanding about the biopsychosocial relationship between fat-shaming and vulnerability to weight gain and inability to lose weight among school children and youth. The growing juvenile obesity trend in Africa is associated with multiple risk factors, such as dietary habits, physical activity pattern, built environment, school physical education curriculum and socio-economic status of obese individuals and their communities. An important issue that has not been significantly theorized and investigated to inform juvenile obesity containment policies in the African context is the use and consequences of obesogenic slurs or fat-shaming in homes, schools, communities, mass media and health care systems. Fatshaming is often used by well-meaning or mean-spirited significant others such as parents, peers, teachers, coaches and medical workers to discourage unhealthy dietary and sedentary habits in chubby kids in the hope of inducing behaviour modification. Paradoxically, the use of fatshaming to induce weight loss is a significant public health issue, as it has been linked to eating and exercise psychopathology. As juvenile obesity increases in African societies, there is a continuing risk that obese school children and adolescents in physical activity settings will become targets of fat-shaming that damage their developing self-image and weight management efficacy. The thesis of this paper is that fat-shaming in physical activity contexts can undermine efforts to stem juvenile obesity, promote lifelong physical activity and redress health inequities. The paper is based on review of contemporary literature on the correlates and consequences of fat-shaming. Implications of fat-shaming for physical education pedagogy and juvenile obesity interventions in Africa are drawn.Keywords: Physical education, juvenile obesity, fat-shaming vulnerability, maladaptiveconsequences

Anuario administrativo del personal del cuerpo de Torreros de Faros : que contiene el reglamento, escalafón rectificado en 1º de marzo de 1892 y disposiciones de carácter general referentes al cuerpo

SignaturizadoDa p. 60 á 76 las h. están plegDa p. 60 á 76 as f. están ple

Mapa de España con espresion del estado de los Ferro-carriles Canales y Faros

Escala también expresada en 120 millas geográficas de 60 al grado [= 8,7 cm] y 50 leguas francesas de 25 al grado [= 8,8 cm]. Coordenadas referidas al meridiano de Madrid (O 7°28'--E 9°28°/N 44°00'--N 35°36'). Red geográfica de 1º en 1ºIndica el radio de alcance de los farosTabla de signos convencionales para indicar los núcleos de población de distinta categoría, faros de distintas características de destello, líneas ferroviarias y canales, construidos o en proceso