Abstract
Background
Despite the goal set by WHO to eliminate hepatitis C virus (HCV) as a public health threat, uptake of HCV testing and treatment remains low. To achieve this target, evidence-based interventions are needed to address the barriers to care for people with, or at risk of, HCV infection. We aimed to assess the efficacy of interventions to improve HCV antibody testing, HCV RNA testing, linkage to HCV care, and treatment initiation.
Methods
In this systematic review and meta-analysis, we searched MEDLINE (PubMed), Scopus, Web of Science, the Cochrane Central Register of Controlled Trials, and PsycINFO without language restrictions for reports published between database inception and July 21, 2020, assessing the following primary outcomes: HCV antibody testing; HCV RNA testing; linkage to HCV care; and direct-acting antiviral treatment initiation. We also searched key conference abstracts. We included randomised and non-randomised studies assessing non-pharmaceutical interventions that included a comparator or control group. Studies were excluded if they enrolled only paediatric populations (aged <18 years) or if they conducted the intervention in a different health-care setting to that of the control or comparator. Authors were contacted to clarify study details and to obtain additional population-level data. Data were extracted from the records identified into a pre-piloted and standardised data extraction form and a random-effects meta-analysis was used to pool the effects of the interventions on study outcomes. This study is registered in PROSPERO, CRD42020178035.
Findings
Of 15 342 unique records identified, 142 were included, which reported on 148 unique studies (47 randomised controlled trials and 101 non-randomised studies). Medical chart reminders, provider education, and point-of-care antibody testing significantly improved at least three study outcomes compared with a comparator or control. Interventions that simplified HCV testing, including dried blood spot testing, point-of-care antibody testing, reflex RNA testing, and opt-out screening, significantly improved testing outcomes compared with a comparator or control. Enhanced patient and provider support through patient education, provider care coordination, and provider education also significantly improved testing outcomes compared with a comparator or control. Integrated care and patient navigation or care coordination significantly improved linkage to care and the uptake of direct-acting antiviral treatment compared with a comparator or control.
Interpretation
Several interventions to improve HCV care that address several key barriers to HCV care were identified. New models of HCV care must be designed and implemented to address the barriers faced by the population of interest. Further high-quality research, including rigorously designed randomised studies, is still needed in key populations.
Funding
None.
Despite the goal set by WHO to eliminate hepatitis C virus (HCV) as a public health threat, uptake of HCV testing and treatment remains low. To achieve this target, evidence-based interventions are needed to address the barriers to care for people with, or at risk of, HCV infection. We aimed to assess the efficacy of interventions to improve HCV antibody testing, HCV RNA testing, linkage to HCV care, and treatment initiation.
Methods
In this systematic review and meta-analysis, we searched MEDLINE (PubMed), Scopus, Web of Science, the Cochrane Central Register of Controlled Trials, and PsycINFO without language restrictions for reports published between database inception and July 21, 2020, assessing the following primary outcomes: HCV antibody testing; HCV RNA testing; linkage to HCV care; and direct-acting antiviral treatment initiation. We also searched key conference abstracts. We included randomised and non-randomised studies assessing non-pharmaceutical interventions that included a comparator or control group. Studies were excluded if they enrolled only paediatric populations (aged <18 years) or if they conducted the intervention in a different health-care setting to that of the control or comparator. Authors were contacted to clarify study details and to obtain additional population-level data. Data were extracted from the records identified into a pre-piloted and standardised data extraction form and a random-effects meta-analysis was used to pool the effects of the interventions on study outcomes. This study is registered in PROSPERO, CRD42020178035.
Findings
Of 15 342 unique records identified, 142 were included, which reported on 148 unique studies (47 randomised controlled trials and 101 non-randomised studies). Medical chart reminders, provider education, and point-of-care antibody testing significantly improved at least three study outcomes compared with a comparator or control. Interventions that simplified HCV testing, including dried blood spot testing, point-of-care antibody testing, reflex RNA testing, and opt-out screening, significantly improved testing outcomes compared with a comparator or control. Enhanced patient and provider support through patient education, provider care coordination, and provider education also significantly improved testing outcomes compared with a comparator or control. Integrated care and patient navigation or care coordination significantly improved linkage to care and the uptake of direct-acting antiviral treatment compared with a comparator or control.
Interpretation
Several interventions to improve HCV care that address several key barriers to HCV care were identified. New models of HCV care must be designed and implemented to address the barriers faced by the population of interest. Further high-quality research, including rigorously designed randomised studies, is still needed in key populations.
Funding
None.
| Original language | English |
|---|---|
| Pages (from-to) | 426-445 |
| Number of pages | 20 |
| Journal | The Lancet Gastroenterology and Hepatology |
| Volume | 7 |
| Issue number | 5 |
| Early online date | 15 Mar 2022 |
| DOIs | |
| Publication status | Published - 1 May 2022 |
Bibliographical note
Funding Information:The Kirby Institute is funded by the Australian Government Department of Health and Ageing. The views expressed in this Article do not necessarily represent the position of the Australian Government. We thank Jeremy Grimshaw for his valuable input on the manuscript. We thank the individuals who responded to requests for additional data, including Gupse Adali, Erik Anderson, Christoph Andreas Fux, Ade Apoola, Tooba Arif, Francisco Averhoff, Tyler Scott Bartholomew, Claudia Berger, Andrea Bregenzer, Jennifer Broad, Mark Cassell, Patrick Chan, Curtis Cooper, Catelyn Coyle, Noel Craine, Bridget Draper, Shelley Facente, Alex Federman, Stuart Flanagan, Carolina de la Flor, Graham Foster, Marta Gallach, Anna Maria Geretti, Erik Groessl, Geoffrey Haar, Alberto Hernandez Bustabed, Manuel Hernandez Guerra, Karli Hochstatter, Maxine Horne, William Irving, Kathryn Jack, Mamta Jain, Amy Jessop, David Kaebler, Mandana Khalili, Jennifer Kiser, Miriam Levy, Charles Maclean, Lora Magaldi, Amy Malaguti, Alessandra Mangia, Rui Marinho, Kate Mason, Stuart McPherson, Shivan Mehta, Manuel Mendizabal, Salim Mezaache, Lee Middleton, Dalia Morales-Arraez, Jennifer Murira, Ank Nijhawan, Carol North, Mary Olson, Kamil Ozdil, Stephanie Perrett, Kristyn Pierce, Esmaeil Porsa, Jeff Powis, Sarah Ailleen Reifeis, Jens Reimer, Catherine Reitz, Cristina Reygosa, Nicole Rich, Catriona Ritchie, Geert Robaeys, Sahar Saeed, Vinay Sathyanarayana, Süleyman Sayar, Elissa Schechter-Perkins, Christiane Schmidt, Jennifer Schwartz, John Scott, Shaun Shadaker, Yusuke Shono, Marcelo Silva, Amit Singal, Heather Sperring, Alan Stacy, Laura Starbird, Benjamin Stone, Julian Surey, Brian Thomson, Prem Thurairajah, Nicholas Turner, Deyaun Villarreal, Amanda Wade, Su Wang, Kathleen Ward, Jeffrey Weiss, Jaymie Yango, Andrew Youssef, and David Ziegelman.
Funding Information:
JG is a consultant or adviser for, and has received research grants from, AbbVie, Camurus, Cepheid, Gilead Sciences, Hologic, Indivor, and Merck, and has received honoraria from AbbVie, Cepheid, Gilead Sciences, and Merck. GJD is a consultant or adviser for, and has received research grants from, AbbVie, Abbot Diagnostics, Gilead Sciences, Bristol Myers Squibb, Cepheid, GlaxoSmithKline, Merck, Janssen, and Roche. JWW is supported by The Task Force for Global Health, which receives funds for the general support of the Coalition for Global Hepatitis Elimination from Abbott, Gilead, AbbVie, Merck, Siemens, Cepheid, Roche, Pharco, Zydus-Cadila, governmental agencies, and philanthropic organisations. MH has received unrestricted honoraria and travel expenses from MSD and Gilead unrelated to the submitted work. PV has received research grants from Gilead Sciences and is in receipt of grants from the UK National Institute of Health Research. All other authors declare no competing interests. No input into this work was provided by any of the aforementioned listed organisations or institutions.
Funding Information:
The Kirby Institute is funded by the Australian Government Department of Health and Ageing. The views expressed in this Article do not necessarily represent the position of the Australian Government. We thank Jeremy Grimshaw for his valuable input on the manuscript. We thank the individuals who responded to requests for additional data, including Gupse Adali, Erik Anderson, Christoph Andreas Fux, Ade Apoola, Tooba Arif, Francisco Averhoff, Tyler Scott Bartholomew, Claudia Berger, Andrea Bregenzer, Jennifer Broad, Mark Cassell, Patrick Chan, Curtis Cooper, Catelyn Coyle, Noel Craine, Bridget Draper, Shelley Facente, Alex Federman, Stuart Flanagan, Carolina de la Flor, Graham Foster, Marta Gallach, Anna Maria Geretti, Erik Groessl, Geoffrey Haar, Alberto Hernandez Bustabed, Manuel Hernandez Guerra, Karli Hochstatter, Maxine Horne, William Irving, Kathryn Jack, Mamta Jain, Amy Jessop, David Kaebler, Mandana Khalili, Jennifer Kiser, Miriam Levy, Charles Maclean, Lora Magaldi, Amy Malaguti, Alessandra Mangia, Rui Marinho, Kate Mason, Stuart McPherson, Shivan Mehta, Manuel Mendizabal, Salim Mezaache, Lee Middleton, Dalia Morales-Arraez, Jennifer Murira, Ank Nijhawan, Carol North, Mary Olson, Kamil Ozdil, Stephanie Perrett, Kristyn Pierce, Esmaeil Porsa, Jeff Powis, Sarah Ailleen Reifeis, Jens Reimer, Catherine Reitz, Cristina Reygosa, Nicole Rich, Catriona Ritchie, Geert Robaeys, Sahar Saeed, Vinay Sathyanarayana, Süleyman Sayar, Elissa Schechter-Perkins, Christiane Schmidt, Jennifer Schwartz, John Scott, Shaun Shadaker, Yusuke Shono, Marcelo Silva, Amit Singal, Heather Sperring, Alan Stacy, Laura Starbird, Benjamin Stone, Julian Surey, Brian Thomson, Prem Thurairajah, Nicholas Turner, Deyaun Villarreal, Amanda Wade, Su Wang, Kathleen Ward, Jeffrey Weiss, Jaymie Yango, Andrew Youssef, and David Ziegelman.
Publisher Copyright:
© 2022 Elsevier Ltd
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