Hepatitis C treatment uptake among people who inject drugs in Oslo, Norway: A registry-based study

Background Improving HCV treatment uptake among people who inject drugs (PWID) is crucial to achieving the WHO elimination targets. The aims were to evaluate HCV treatment uptake and HCV RNA prevalence in a large cohort of PWID in Norway. Methods Registry-based observational study where all users of the City of Oslo's low-threshold social and health services for PWID between 2010–2016 ( n = 5330) were linked to HCV notifications (1990–2019) and dispensions of HCV treatment, opioid agonist treatment (OAT) and benzodiazepines (2004–2019). Cases were weighted to account for spontaneous HCV clearance. Treatment rates were calculated using person-time of observation, and factors associated with treatment uptake were analysed using logistic regression. HCV RNA prevalence was estimated among individuals alive by the end of 2019. Results Among 2436 participants with chronic HCV infection (mean age 46.8 years, 30.7% female, 73.3% OAT), 1118 (45.9%) had received HCV treatment between 2010–2019 (88.7% DAA-based). Treatment rates increased from 1.4/100 PY (95% CI 1.1–1.8) in the pre-DAA period (2010–2013) to 3.5/100 PY (95% CI 3.0–4.0) in the early DAA period (2014–2016; fibrosis restrictions) and 18.4/100 PY (95% CI 17.2–19.7) in the late DAA period (2017–2019; no restrictions). Treatment rates for 2018 and 2019 exceeded a previously modelled elimination threshold of 50/1000 PWID. Treatment uptake was less likely among women (aOR 0.74; 95% CI 0.62–0.89) and those aged 40–49 years (aOR 0.74; 95% CI 0.56–0.97), and more likely among participants with current OAT (aOR 1.21; 95% CI 1.01–1.45). The estimated HCV RNA prevalence by the end of 2019 was 23.6% (95% CI 22.3–24.9). Conclusion Although HCV treatment uptake among PWID increased, strategies to improve treatment among women and individuals not engaged in OAT should be addressed.This research received funding from the following sources. KM receives research grants from the South-Eastern Norway Regional Health Authority , grant number: 2020011 . The funding sponsor has not been involved in study design, collection of data, analysis/interpretation of data, in the writing of the article, or in the decision to submit the article for publication.publishedVersio

HIV/AIDS in a rural community in Uganda: Perceived and objective social factors affecting the HIV epidemic. Case reports and a brief review of literature.

Previous surveys have explored factors that may affect HIV prevalence, incidence, and the implications of the epidemic in Rakai and in other African communities. Yet bystanders are often at loss in understanding the personal experiences in a selected community. In five case reports and in an interview with the founder of a local support group, we examine the self-perceived important issues, in the wake of the HIV-epidemic. Through the literature we seek to verify the findings and study the implications for control of the epidemic in a selected community. Four out of five cases reported that they had experienced HIV related stigmatisation. A majority of the cases also reported withholding information about their HIV status from close family. Furthermore, four out of the five cases cited poverty and lack of food or nutrition as the most difficult part of living with HIV. The surveys reviewed in this report support our findings concerning HIV and stigma, and suggest that HIV related stigmatisation may delay HIV testing, disclosure of HIV status and adversely affect treatment compliance. The reviewed literature also showed that consistent condom use in this population is low and that poverty may have major consequences for the afflicted and their families. Furthermore, those with the highest risk of HIV infection are less likely to accept voluntary testing and counselling (VTC). Moreover, VTC has no effect on HIV incidence and sexual risk behaviour in this area. Our findings highlight the importance of interventions targeting HIV related stigmatisation and poverty in this area

Usage of Antivirals and the Occurrence of Antiviral Resistance in Norway 2021. RAVN

The usage of antivirals According to The Norwegian Drug Wholesales Statistics Database, the sales of antiviral drugs measured in defined daily doses (DDDs) were reduced in 2021, after several years of increase. This reduction was primarily due to a small decrease in sales of antivirals against HIV, which make up a large proportion of the antiviral drugs sold in Norway. There was no decrease in the number of people being treated with HIV drugs compared to previous years, but as a growing proportion of patients is treated with single tablet regimens, the number of drugs sold is reduced. When looking at the number of persons treated with antiviral drugs, the antiviral treatment received by the highest number of patients are drugs used against herpes viruses. In 2021, the sale of antivirals against herpes virus, especially valaciclovir, increased even further. There was a decrease in the sales of agents against hepatitis C and influenza, while treatments for hepatitis B were unchanged. Influenza virus Similar to the previous influenza season, the season of 2021/2022 was also unusual, mainly due to the infection control measures implemented in response to the pandemic. There was a very low incidence of influenza at the beginning of the season, followed by a short period with significant spread of infection during the spring of 2021. No drug resistance against neuraminidase inhibitors was detected, but a mutation conferring resistance to the new drug baloxavir marboxil was found in one sample. Human immunodeficiency virus-1 The decreasing trend in the number of new HIV-infections has continued in 2021, which is also reflected in a reduction in the number of samples received for surveillance of primary drug resistance. A total of 64 samples were analysed as part of the surveillance in 2021, and only 13 of these were from patients infected in Norway. For the first time, we have been able to classify cases according to site of residence at the time of infection. Among those living in Norway at the time of infection, as much as 88% of the cases reported to MSIS were also reported to RAVN. This indicates that national routines for follow-up of newly diagnosed patients with regard to antiviral resistance are good. Resistance mutations were detected in 11% of the examined samples, which is comparable to previous years. In 2021, only mutations affecting reverse transcriptase inhibitors and none affecting protease inhibitors were found. Hepatitis B virus In 2021, a total of 134 samples with hepatitis B virus (HBV) were analysed for resistance mutations. Most of these samples (n=117) had been submitted to the reference laboratory for genotyping prior to treatment. These samples constitute the Norwegian surveillance of primary resistance. The remaining 17 samples were from patients with ongoing antiviral treatment and were submitted for investigation of resistance as a possible cause of treatment failure. Relevant resistance mutations were found in five of the 17 samples from patients with treatment failure. No resistance mutations were found in any of the surveillance samples. Human herpes viruses: Cytomegalovirus In 2021, 19 samples were submitted for resistance testing at the reference laboratory for cytomegalovirus (CMV). Relevant resistance mutations were detected in five of these samples. Low or moderate resistance to ganciclovir was found in four of these samples, while moderate resistance to the new drug maribavir was found in one sample. There is no systematic surveillance of resistance in CMV, and the true incidence of drug resistance cannot be determined. Human herpes viruses: Herpes simplex virus In 2021, only five samples with herpes simplex virus (HSV) were analysed for resistance. Two of the samples had mutations conferring resistance to aciclovir. Despite an increase in the use of aciclovir both as treatment and prophylaxis, samples are rarely submitted for resistance testing. Like CMV, there is no systematic surveillance of HSV drug resistance. Hepatitis C virus A systematic surveillance system for newly diagnosed HCV infections was launched in May 2022. In 2021, resistance testing was performed on a limited number of samples submitted for resistance testing. Drug resistance data is cross-referenced with epidemiological data from MSIS to enable comparisons of different subgroups. Resistance associated substitutions were detected in seven out of eight samples analysed for resistance, two of which were from treatment experienced patients, one sample was from a patient with no previous treatment exposure and the remaining four were from patients where treatment exposure was not known. SARS-CoV-2 Surveillance of antiviral resistance in SARS-CoV-2 has not been collected to RAVN in 2021. Oral drugs for the treatment of COVID-19 will be available in Norway from the autumn of 2022, and a system for surveillance of antiviral resistance will probably be implemented from the beginning of 2023. This surveillance will be based on the same sequence data that is part of the national monitoring of variants

Challenges in preparing and implementing a clinical trial at field level in an Ebola emergency: A case study in Guinea, West Africa.

During the large Ebola outbreak that affected West Africa in 2014 and 2015, studies were launched to evaluate potential treatments for the disease. A clinical trial to evaluate the effectiveness of the antiviral drug favipiravir was conducted in Guinea. This paper describes the main challenges of the implementation of the trial in the Ebola treatment center of Guéckédou. Following the principles of the Good Clinical Research Practices, we explored the aspects of the community's communication and engagement, ethical conduct, trial protocol compliance, informed consent of participants, ongoing benefit/risk assessment, record keeping, confidentiality of patients and study data, and roles and responsibilities of the actors involved. We concluded that several challenges have to be addressed to successfully implement a clinical trial during an international medical emergency but that the potential for collaboration between research teams and humanitarian organizations needs to be highlighted

Challenges in preparing and implementing a clinical trial at field level in an Ebola emergency: A case study in Guinea, West Africa

During the large Ebola outbreak that affected West Africa in 2014 and 2015, studies were launched to evaluate potential treatments for the disease. A clinical trial to evaluate the effectiveness of the antiviral drug favipiravir was conducted in Guinea. This paper describes the main challenges of the implementation of the trial in the Ebola treatment center of Guéckédou. Following the principles of the Good Clinical Research Practices, we explored the aspects of the community's communication and engagement, ethical conduct, trial protocol compliance, informed consent of participants, ongoing benefit/risk assessment, record keeping, confidentiality of patients and study data, and roles and responsibilities of the actors involved. We concluded that several challenges have to be addressed to successfully implement a clinical trial during an international medical emergency but that the potential for collaboration between research teams and humanitarian organizations needs to be highlighted.status: publishe

Key recommendations for a trial implementation in an Ebola outbreak.

<p>Key recommendations for a trial implementation in an Ebola outbreak.</p