1,721,017 research outputs found
PTU-112 hepatology outreach services to overcome inequalities in hepatitis C care in an isolated uk population
No full textIntroduction: increasingly effective treatments for Hepatitis C virus (HCV) infection are unlikely to have a significant impact on disease prevalence unless barriers to specialist care and treatment are overcome.The Isle of Wight (IOW) is situated 3 miles off the coast of the UK and is without a local HCV treatment service. The aims of this study are to compare the care outcomes in patients with HCV living in this isolated community to a nearby mainland cohort and describe the initial impact of a hepatology outreach service to the island.Method: the medical records of a representative 77 HCV patients from the IOW were compared to a random sample of 79 patients from Southampton City. Patients from the IOW who had been diagnosed by the drug support or sexual health services, but had never been seen by a Hepatology specialist, were contacted and invited to community based Hepatology outreach clinics. [PTU-112 Table 1 A comparison of demographic characteristics and care outcomes for patients with chronic hepatitis C from the Isle of Wight and Southampton City not included]Results: patients from the IOW were older (p 0.007) and had a significantly higher prevalence of liver cirrhosis (p 0.01). Significantly more patients with HCV had died from liver disease on the IOW (p 0.03), although similar numbers had been treated (p 0.57) (Table 1). Those patients who were seen in hepatology clinics were reviewed in a similar time frame with 79% of IOW and 89% of Southampton patients being seen within 1 year of diagnosis (p 0.33). 14 patients on the IOW have been invited to 3 community outreach clinics in the sexual health and drug and alcohol support centres. Of these 7 attended, 3 have subsequently been referred for treatment, with 3 declining due to the distance and cost of travel to the mainland.Conclusion: the IOW has a higher prevalence of advanced liver disease with excess mortality. In an attempt to address this inequality outreach clinics have been established and have initially proved effective at re-engaging patients with a known diagnosis of HCV into specialist care. However, in an isolated community the effectiveness of this will be limited without the provision of community-based treatment.<br/
Alcohol use disorder and the liver
No full textAlcohol use disorders (AUD) cause a range of physical harms, but the major cause of alcohol-related mortality is alcohol-related liver disease (ALD), in some countries accounting for almost 90% of alcohol-related deaths. The risk of ALD has an exponential relationship with increasing alcohol consumption, but is also associated with genetic factors, other life-style factors and social deprivation. ALD includes a spectrum of progressive pathology, from liver steatosis to fibrosis and liver cirrhosis. There are no specific treatments for liver cirrhosis, but abstinence from alcohol is key to limit progression of the disease. Over time, cirrhosis can progress (often silently) to decompensated cirrhosis and hepatocellular carcinoma (HCC). Liver transplantation may be suitable for patients with decompensated liver cirrhosis and may also be used as a curative intervention for HCC, but only for a few selected patients, and complete abstinence is a prerequisite. Patients with AUD are also at risk of developing alcoholic hepatitis, which has a high mortality and limited evidence for effective therapies. There is a strong evidence base for the effectiveness of psychosocial and pharmacological interventions for AUD, but very few of these have been trialled in patients with comorbid ALD. Integrated specialist alcohol and hepatology collaborations are required to develop interventions and pathways for patients with ALD and ongoing AUD.</p
Hepatitis C
No full textHepatitis C virus (HCV) is a major public health problem and a leading cause of chronic liver disease. Over 150 million people worldwide have chronic HCV infection and are at risk of developing its life-threatening complications. Acute infection is usually asymptomatic, with most patients unaware that they have contracted the virus. Some patients clear the virus spontaneously, but most become chronic carriers. If carriers are identified, they can be treated with antiviral therapy, the main goal being prevention of cirrhosis, liver failure and hepatocellular carcinoma by eradicating the virus. During the past decade, there has been impressive progress in the efficacy and tolerability of therapy, with modern treatment regimens able to eradicate the virus in >90% of cases with minimal adverse effects. However, therapy is costly, many infected individuals are unaware that they carry the virus, and for many there are barriers preventing them from accessing medical care. In the future, HCV could be eliminated, but to achieve this strategies to increase screening for infection and improve the uptake of treatment are needed.</p
Type 2 diabetes, prediabetes, and MASLD: who and when to screen and how to treat?
No full textCommentar
The social and genetic epidemiology of Hepatitis C in an isolated network of people who inject drugs
No full textBackground and AimsHepatitis C (HCV) causes liver cirrhosis, liver cancer and is a leading cause of death worldwide. In the UK the commonest risk factor for HCV is current or previous injecting drug use but many cases are undiagnosed and many known cases are disengaged from treatment services. The Isle of Wight (IOW) is a deprived, rural and geographically isolated population but suffers from the same obstacles to HCV care as larger nearby mainland populations.The overall aim of this thesis is to understand the burden of HCV in people who inject drugs (PWID) on the IOW and how their social network could be utilised in an HCV elimination strategy.MethodA sequential mixed method research design was used. Qualitative methods informed the design of a quantitative survey, which recruited PWID via respondent driven sampling (RDS) for a social network questionnaire and HCV bio-behavioural survey. This was used to estimate the population prevalence of HCV and the total population size of PWID on the IOW. Data from the social network survey were combined with a phylogenetic analysis of HCV RNA positive cases and qualitative narratives to give a representation of the HCV transmission network in PWID. This network was then used in an individualbased model (IBM) testing different treatment strategies.ResultsSixty-nine PWID participated in the HCV bio-behavioural and social network surveys. The estimated prevalence of HCV was 29% (95% CI 13.3-44%) and the estimated total population size was 262 individuals.The social network survey described 179 PWID, connected together into a cohesive network component via injecting partnerships. Phylogenetic analysis indicated that a number of these partnerships had led to the transmission of HCV and that genotype 3a virus had been transmitted between PWID living on the IOW. In the IBM the preferential treatment of well-connected PWID, via injecting and social relationships, led to significantly fewer new infections of HCV than treating at random (9.56 vs. 6.58 P<0.01 and 9.56 vs. 7.84 p=0.011 respectively).ConclusionThe burden of HCV in PWID on the IOW is lower than expected and existing case-finding initiatives are effective. The qualitative and quantitative results indicate that PWID are linked together in a dense network and the treatment of well-connected nodes within this network may be an effective treatment as prevention strategy for the elimination of HCV on the IOW
RE: early application of haemostatic powder added to standard management for oesophagogastric variceal bleeding: a randomised trial
No full textThe role of natural experiments in hepatology research: filling the gap between clinical trials and service evaluations
No full textResearch developing and testing interventions that address the social determinants of liver disease are urgently needed; however, this cannot be achieved using conventional clinical research designs. A different approach is needed to conduct widely applicable, inclusive, and community-based research that addresses upstream factors driving liver morbidity. Natural experimental studies encompass a well-established field of research methodology that is less familiar to clinical hepatologists than conventional research methods such as the randomized control trial. The key strength of natural experiments is that, when robustly designed, they can be used to imply causality from routinely collected data. As such, they are well placed to test the impact of community interventions that aim to address social determinants of liver disease that cannot feasibly be assessed in a randomized control trial. In this review, we define natural experiments and their potential utility. We then work through examples of where they have already been used in clinical hepatology to highlight a range of research designs, analytical approaches, and best practices regarding their conduct and reporting. In doing so, we hope to equip clinical hepatologists with another tool to ensure the hepatology community can meet the global liver disease epidemic with evidence-based interventions
Building on hepatitis C testing: the potential to identify alcohol-related liver disease through community pharmacy
No full textCommunity pharmacy can identify people who may have alcohol-related liver disease, but research is needed to ascertain the best approach
Testing key underlying assumptions of respondent-driven sampling within a real-world network of people who inject drugs
No full textIn this study, we collected mixed method social network data alongside a survey of people who inject drugs (PWID) to assess key assumptions of respondent-driven sampling (RDS). We found adherence to some assumptions and non-adherence to others. Specifically, sampling did occur through a connected network of PWID and the reported degree size of survey participants did correlate with network degree and likelihood of recruitment. However, recruitment was significantly more likely via a multiplex relationship and recruitmen dyads were significantly more likely to live in the same geographical area. In addition, people actively injecting drugs, those with ‘two lives’ and ‘dealers’, may have been isolated from the survey. We believe this is the first mixed-method social network study to report an assessment of the assumptions of RDS. We highlight the potential value of network data in understanding the validity of population-level estimates in surveys using RDS.</p
Implementation of a national peer workforce: oncreasing capacity, reach, inclusion and equity within the UK’s Hepatitis C Elimination Programme
No full textWHO goals to eliminate hepatitis C (HCV) worldwide require large incidence and mortality
reductions. In the UK, HCV mainly affects people who inject drugs and others who health services find challenging to engage. Under the national elimination programme, NGO The Hepatitis C Trust (HCT) recruits and trains people with lived experience (peers) to improve this engagement. 130 paid and 355 volunteer peers work in every local NHS HCV team and prison. Peer roles encompass education, support, and clinical services e.g. BBV testing, ultrasounds. In four years, peers have tested 121,987 people and supported 11,570 into HCV treatment.
Aims: to examine the process and impacts of embedding peers into UK NHS teams.
Methods: We draw on findings from two university-led qualitative studies exploring HCT’s peer
work and direct implementation experience.
Results: Data from these studies suggest that integrating peers into NHS teams has impacts for the peer, the patient and the service. Peers can deliver a range of services, increasing NHS
capacity and reach and, as a trusted intermediary for people unable to engage, diffuse tensions and fear. Successfully integrating this peer workforce requires a balance of governance structures; these must enable freedom to innovate whilst providing the systems and oversight to deliver high clinical standards and clear, well supported roles. Equity and inclusion are strengthened by an ‘equity cascade’ stemming from HCT (peer-led and managed). HCT’s inclusive ethos strengthens local peers’ expectations and behaviour, which in turn strengthen inclusion in teams, for volunteers and for patients. This has also improved patient-centred care e.g. through innovative outreach and structural changes to make secondary care more accessible. The integration of peers into a health care system can extend and expand healthcare service delivery, increasing reach and offering valuable benefits to services that need to address severe health inequalities
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