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  1. Article ; Online: Nobody Left Outside (NLO) Checklist

    Jeffrey V. Lazarus / Mario Cascio / Rachel Halford / Denis Onyango / Eberhard Schatz / Alyna Smith / Freek Spinnewijn / Luca Stevenson

    International Journal of Integrated Care, Vol 19, Iss

    Improving access to healthcare for vulnerable and underserved groups

    2019  Volume 4

    Abstract: Introduction: Many marginalised, vulnerable people in Europe who are most in need of healthcare, such as migrants, sex workers, the homeless, people who inject drugs (PWID), prisoners, or LGTBI people, are amongst the least likely to receive it. This is ... ...

    Abstract Introduction: Many marginalised, vulnerable people in Europe who are most in need of healthcare, such as migrants, sex workers, the homeless, people who inject drugs (PWID), prisoners, or LGTBI people, are amongst the least likely to receive it. This is owing to a complex mix of administrative and structural barriers, and often a lack of understanding or unintentional discriminatory practices by service providers. Innovative policy responses and a rethink of health service design, informed by the groups affected, are needed to address these inherent inequities. Policy context and objective: Sustainable Development Goal target 3.8 emphasises universal access to quality health services. Despite being at elevated risk of poor health, marginalised groups are underserved by health systems. Their exclusion from health service planning results in a misalignment between the service design and the users’ fundamental needs, which limits their uptake and effectiveness. The Nobody Left Behind (NLO) Platform provides a forum for community organisations to collaborate at European level to identify common challenges and solutions to improve access to integrated health and social services. The NLO Platform has developed a Service re-Design Checklist intended for use by health service providers and policymakers to design and deliver targeted services that are accessible to all, particularly underserved, vulnerable people, and for advocacy use by community representatives. Targeted groups: Migrant, homeless, PWID, sex worker, prisoner and LGTBI communities Highlights: The NLO Checklist resulted from project meetings, research and a policy incubation workshop at the European Health Forum, Gastein (2017). It provides a structured series of questions which service providers and policymakers should consider to ensure that health services are accessibie to target groups and to foster engagement with community representatives. Following the World Health Organization Health Systems Framework, the NLO Checklist comprises six sections. ...
    Keywords access to healthcare ; vulnerable communities ; health inequalities ; health service redesign ; Medicine (General) ; R5-920
    Subject code 360
    Language English
    Publishing date 2019-08-01T00:00:00Z
    Publisher Ubiquity Press
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  2. Article ; Online: Harm reduction and viral hepatitis C in European prisons

    Rob Bielen / Samya R. Stumo / Rachel Halford / Klára Werling / Tatjana Reic / Heino Stöver / Geert Robaeys / Jeffrey V. Lazarus

    Harm Reduction Journal, Vol 15, Iss 1, Pp 1-

    a cross-sectional survey of 25 countries

    2018  Volume 10

    Abstract: Abstract Background Current estimates suggest that 15% of all prisoners worldwide are chronically infected with the hepatitis C virus (HCV), and this number is even higher in regions with high rates of injecting drug use. Although harm reduction services ...

    Abstract Abstract Background Current estimates suggest that 15% of all prisoners worldwide are chronically infected with the hepatitis C virus (HCV), and this number is even higher in regions with high rates of injecting drug use. Although harm reduction services such as opioid substitution therapy (OST) and needle and syringe programs (NSPs) are effective in preventing the further spread of HCV and HIV, the extent to which these are available in prisons varies significantly across countries. Methods The Hep-CORE study surveyed liver patient groups from 25 European countries in 2016 and mid-2017 on national policies related to harm reduction, testing/screening, and treatment for HCV in prison settings. Results from the cross-sectional survey were compared to the data from available reports and the peer-reviewed literature to determine the overall degree to which European countries implement evidence-based HCV recommendations in prison settings. Results Patient groups in nine countries (36%) identified prisoners as a high-risk population target for HCV testing/screening. Twenty-one countries (84%) provide HCV treatment in prisons. However, the extent of coverage of these treatment programs varies widely. Two countries (8%) have NSPs officially available in prisons in all parts of the country. Eleven countries (44%) provide OST in prisons in all parts of the country without additional requirements. Conclusion Despite the existence of evidence-based recommendations, infectious disease prevention measures such as harm reduction programs are inadequate in European prison settings. Harm reduction, HCV testing/screening, and treatment should be scaled up in prison settings in order to progress towards eliminating HCV as a public health threat.
    Keywords Cross-sectional survey ; Harm reduction ; Hepatitis C ; Injecting drug use ; Needle and syringe program ; Opioid substitution therapy ; Public aspects of medicine ; RA1-1270
    Subject code 360
    Language English
    Publishing date 2018-05-01T00:00:00Z
    Publisher BMC
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  3. Article ; Online: Strategic treatment optimization for HCV (STOPHCV1)

    Graham S. Cooke / Sarah Pett / Leanne McCabe / Chris Jones / Richard Gilson / Sumita Verma / Stephen D. Ryder / Jane D. Collier / Stephen T. Barclay / Aftab Ala / Sanjay Bhagani / Mark Nelson / Chinlye Ch'Ng / Ben Stone / Martin Wiselka / Daniel Forton / Stuart McPherson / Rachel Halford / Dung Nguyen /
    David Smith / Azim Ansari / Emily Dennis / Fleur Hudson / Eleanor J. Barnes / Ann Sarah Walker

    Wellcome Open Research, Vol

    a randomised controlled trial of ultrashort duration therapy for chronic hepatitis C [version 2; peer review: 2 approved]

    2021  Volume 6

    Abstract: Background: The World Health Organization (WHO) has identified the need for a better understanding of which patients with hepatitis C virus (HCV) can be cured with ultrashort course HCV therapy. Methods: A total of 202 individuals with chronic HCV were ... ...

    Abstract Background: The World Health Organization (WHO) has identified the need for a better understanding of which patients with hepatitis C virus (HCV) can be cured with ultrashort course HCV therapy. Methods: A total of 202 individuals with chronic HCV were randomised to fixed-duration shortened therapy (8 weeks) vs variable-duration ultrashort strategies (VUS1/2). Participants not cured following first-line treatment were retreated with 12 weeks’ sofosbuvir/ledipasvir/ribavirin. The primary outcome was sustained virological response 12 weeks (SVR12) after first-line treatment and retreatment. Participants were factorially randomised to receive ribavirin with first-line treatment. Results: All evaluable participants achieved SVR12 overall (197/197, 100% [95% CI 98-100]) demonstrating non-inferiority between fixed-duration and variable-duration strategies (difference 0% [95% CI -3.8%, +3.7%], 4% pre-specified non-inferiority margin). First-line SVR12 was 91% [86%-97%] (92/101) for fixed-duration vs 48% [39%-57%] (47/98) for variable-duration, but was significantly higher for VUS2 (72% [56%-87%] (23/32)) than VUS1 (36% [25%-48%] (24/66)). Overall, first-line SVR12 was 72% [65%-78%] (70/101) without ribavirin and 68% [61%-76%] (69/98) with ribavirin (p=0.48). At treatment failure, the emergence of viral resistance was lower with ribavirin (12% [2%-30%] (3/26)) than without (38% [21%-58%] (11/29), p=0.01). Conclusions: Unsuccessful first-line short-course therapy did not compromise retreatment with sofosbuvir/ledipasvir/ribavirin (100% SVR12). SVR12 rates were significantly increased when ultrashort treatment varied between 4-7 weeks rather than 4-6 weeks. Ribavirin significantly reduced resistance emergence in those failing first-line therapy. ISRCTN Registration: 37915093 (11/04/2016).
    Keywords Medicine ; R ; Science ; Q
    Language English
    Publishing date 2021-07-01T00:00:00Z
    Publisher Wellcome
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  4. Article ; Online: Variable short duration treatment versus standard treatment, with and without adjunctive ribavirin, for chronic hepatitis C

    Graham S Cooke / Sarah Pett / Leanne McCabe / Christopher Jones / Richard Gilson / Sumita Verma / Stephen D Ryder / Jane D Collier / Stephen T Barclay / Aftab Ala / Sanjay Bhagani / Mark Nelson / Chin Lye Ch’Ng / Benjamin Stone / Martin Wiselka / Daniel Forton / Stuart McPherson / Rachel Halford / Dung Nguyen /
    David Smith / M Azim Ansari / Helen Ainscough / Emily Dennis / Fleur Hudson / Eleanor J Barnes / Ann Sarah Walker / the STOP-HCV trial team

    Efficacy and Mechanism Evaluation, Vol 8, Iss

    the STOP-HCV-1 non-inferiority, factorial RCT

    2021  Volume 17

    Abstract: Background: High cure rates with licensed durations of therapy for chronic hepatitis C virus suggest that many patients are overtreated. New strategies in individuals who find it challenging to adhere to standard treatment courses could significantly ... ...

    Abstract Background: High cure rates with licensed durations of therapy for chronic hepatitis C virus suggest that many patients are overtreated. New strategies in individuals who find it challenging to adhere to standard treatment courses could significantly contribute to the elimination agenda. Objectives: To compare cure rates using variable ultrashort first-line treatment stratified by baseline viral load followed by retreatment, with a fixed 8-week first-line treatment with retreatment with or without adjunctive ribavirin. Design: An open-label, multicentre, factorial randomised controlled trial. Randomisation: Randomisation was computer generated, with patients allocated in a 1 : 1 ratio using a factorial design to each of biomarker-stratified variable ultrashort strategy or fixed duration and adjunctive ribavirin (or not), using a minimisation algorithm with a probabilistic element. Setting: NHS. Participants: A total of 202 adults (aged ≥ 18 years) infected with chronic hepatitis C virus genotype 1a/1b or 4 for ≥ 6 months, with a detectable plasma hepatitis C viral load and no significant fibrosis [FibroScan® (Echosens, Paris, France) score F0–F1 or biopsy-proven minimal fibrosis], a hepatitis C virus viral load < 10,000,000 IU/ml, no previous exposure to direct-acting antiviral therapy for this infection and not pregnant. Patients co-infected with human immunodeficiency virus were eligible if human immunodeficiency virus viral load had been < 50 copies/ml for > 24 weeks on anti-human immunodeficiency virus drugs. Interventions: Fixed-duration 8-week first-line therapy compared with variable ultrashort first-line therapy, initially for 4–6 weeks (continuous scale) stratified by screening viral load (variable ultrashort strategy 1, mean 32 days of treatment) and then, subsequently, for 4–7 weeks (variable ultrashort strategy 2 mean 39 days of duration), predominantly with ombitasvir, paritaprevir, ritonavir (Viekirax®; AbbVie, Chicago, IL, USA), and dasabuvir (Exviera®; AbbVie, Chicago, IL, USA) or ...
    Keywords hepatitis c ; precision medicine ; direct-acting antivirals ; Medicine ; R
    Subject code 616 ; 610
    Language English
    Publishing date 2021-10-01T00:00:00Z
    Publisher NIHR Journals Library
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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