Access to hep C treatment reducing morbidity and mortality among people who inject drugs

1. Access to hep C treatment reducing morbidity and mortality among people who inject drugs

With continued testing, treatment, and interventions, HCV infection could be eliminated within the next decade

Abstract: https://www.acpjournals.org/doi/10.7326/M21-3846 

URLs go live when the embargo lifts

A longitudinal cohort study of persons with a history of injection drug use has found that more people who inject drugs (PWID) are receiving Hepatitis C virus (HCV) treatment, which is associated with significant reductions in liver disease and mortality. According to the authors, continued testing, treatment, and community-based interventions could move the United States closer to 2030 HCV elimination goals set by the World Health Organization (WHO) and U.S. Department of Health and Human Services (HHS) within the next decade. The findings are published in Annals of Internal Medicine.

HCV is curable for 95% of cases. The challenges is identifying people in the community with HCV infection and linking them to care and treatment. In high-income regions like the United States, most persons chronically infected with HCV are PWID who face structural barriers to both HCV testing and treatment. They also have a disproportionate burden of comorbidities, such as HIV and alcohol use disorder, that may substantially alter the net effect of HCV treatment on mortality.

Researchers from Johns Hopkins Bloomberg School of Public Health studied 1,323 participants enrolled in the ALIVE (AIDS Linked to the IntraVenous Experience) study from 2006 to 2019 in Baltimore, Maryland to assess whether all-oral HCV treatments were accessed by PWID and if those treatments reduced liver disease burden and mortality. All participants studied had chronic HCV infection. They were tested for HCV RNA biennially from 2006 to 2012 and yearly from 2014 to 2019. The researchers found that the proportion of participants in whom HCV RNA was found decreased significantly from 100% of participants in 2006 to 48% in 2019 representing substantial increases in treatment. At the same time, they observed a strong association between this decrease in HCV RNA and liver disease. IN this same period, cirrhosis decreased from being present in 15% of participants in 2006 and 8% in 2019. According to the authors, given that 48% of participants in the sample remain chronically infected, their findings also underscore the heterogeneity of treatment uptake among PWID and the imperative to overcome these residual barriers to eliminate HCV infection in the United States. They also add that because the goal of a 65% reduction in mortality by 2030 is relative to 2015, progress toward achieving this target must include HCV epidemiologic data collected before 2015.

Media contacts: For an embargoed PDF or to speak with an author, please contact Angela Collom at acollom@acponline.org.

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2.  ACP position paper offers suggestions for supporting and improving long term care services in the United States

Abstract:    

URL goes live when the embargo lifts

The nation’s system of long-term services and supports face many challenges and need improvement to adequately care for an increasing number of older adults, says the American College of Physicians (ACP) in a new position paper. ACP provides recommendations about how to reform and improve the long-term services and support (LTSS) sector so that care is high quality, accessible, equitable, and affordable. The position paper is published in Annals of Internal Medicine.

LTSS can be delivered in nursing homes or other institutional settings, but they are also delivered to patients who reside in their own homes. They include assistance with everyday tasks like bathing, eating, dressing, and other activities of daily living so that the individual can maintain or improve their quality of life. Accessing LTSS can be extremely expensive, depending on the level of care an individual needs, and financial coverage of these services is complex and fragmented. ACP believes that the LTSS sector must be strengthened to ensure that patients can maintain quality of life, while also retaining their financial stability as they age.

Specifically, ACP recommends:

• A multipronged public–private sector approach to reforming LTSS financing. That should include a publicly funded, universal catastrophic LTSS insurance program, as well as policies to make private long-term care insurance affordable, accessible, and viable. We also need to improve access to home and community-based services.

• Addressing shortages in the workforce for the LTSS sector through comprehensive training, pay increases, benefit packages, and opportunities for career advancement and growth. We also need policies designed to assist unpaid caregivers through respite care, training, and reimbursement.

• Evidence-based interventions to assure and improve the quality of LTSS across settings. We need robust monitoring, enforcement of quality reporting and improvement requirements; federal minimum nurse staffing levels for nursing homes; expanded quality and safety information for consumers; research and implementation of emerging alternatives to institutional care; and models to better integrate medical care and LTSS.

• Research into the effect of ownership status on the LTSS sector, including quality of care, staff and patient safety, costs, and staffing ratios. Nursing homes and other LTSS providers should be required to disclose comprehensive ownership and cost information, including private equity investment and related data.

• Funding, assistance, and staff support for nursing homes and other LTSS organizations to develop and implement emergency preparedness plans to ensure the safety of patients and staff.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with someone from ACP, please contact Jacquelyn Blaser at jblaser@acponline.org.

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Abstract: https://www.acpjournals.org/doi/10.7326/M22-0148