Related Experiment Video
Updated: Jul 19, 2025
12:24
A Three-Dimensional Spheroid Model to Investigate the Tumor-Stromal Interaction in Hepatocellular Carcinoma
Published on: September 30, 2021
5.3K
Engagement with the HCV care cascade among high-risk groups: A population-based study
Aysegul Erman1,2, Karl Everett2, William W L Wong1,2,3
1Toronto Health Economics and Technology Assessment Collaborative (THETA), University Health Network, Toronto, ON, Canada.
Hepatology Communications
|August 9, 2023
Summary
Hepatitis C virus (HCV) elimination in Ontario faces challenges, with treatment initiation being a key gap. Improving HCV screening and linkage to care for at-risk populations is crucial for equitable outcomes.
Area of Science:
- Hepatology and Viral Hepatitis Research
- Public Health and Epidemiology
- Health Services Research
Background:
- Understanding the Hepatitis C Virus (HCV) care cascade is essential for elimination strategies.
- A comprehensive description of the HCV care cascade in the direct-acting antiviral (DAA) era has not been previously documented for Ontario, Canada.
- Key at-risk populations, including baby boomers, immigrants, and individuals experiencing residential instability, require specific attention within the HCV care cascade.
Purpose of the Study:
- To describe the population-level HCV care cascade in Ontario, Canada.
- To stratify the HCV care cascade by key risk groups: baby boomers, immigrants, and individuals experiencing residential instability.
- To identify demographic and socioeconomic predictors of engagement with different stages of HCV care.
Main Methods:
- A population-based cohort study was conducted using HCV testing data from Ontario residents between January 1, 1999, and December 31, 2018.
- The HCV care cascade, including antibody diagnosis, RNA testing, genotyping, treatment initiation, sustained virologic response, and reinfection/relapse, was mapped.
- Cause-specific hazard modeling was employed to determine predictors of engagement across the HCV care continuum.
Main Results:
- Among 108,428 individuals with an HCV antibody diagnosis, 88% received RNA testing, 62% tested RNA positive, and 94% of those were genotyped.
- Only 53% of individuals with confirmed viremia initiated treatment, with 76% achieving sustained virologic response; approximately 1% experienced reinfection or relapse.
- Lower engagement rates across the HCV care cascade were observed in males, older cohorts, long-term residents, individuals with substance use disorder or social marginalization, and those diagnosed pre-DAA era.
Conclusions:
- Despite advancements in the DAA era, a significant gap remains in HCV treatment initiation.
- Enhanced HCV screening and improved linkage-to-treatment strategies are necessary, particularly for individuals with a history of substance use disorder and social marginalization.
- Equitable closure of HCV care gaps in Ontario necessitates targeted interventions for vulnerable populations.
Related Concept Videos
01:10Retrovirus Life Cycles
46.2K
Retroviruses have a single-stranded RNA genome that undergoes a special form of replication. Once the retrovirus has entered the host cell, an enzyme called reverse transcriptase synthesizes double-stranded DNA from the retroviral RNA genome. This DNA copy of the genome is then integrated into the host’s genome inside the nucleus via an enzyme called integrase. Consequently, the retroviral genome is transcribed into RNA whenever the host’s genome is transcribed, allowing the...
46.2K
01:22Healthcare Associated Infections II: Preventive Measures
2.7K
Essential infection prevention measures are based on the knowledge of the infection chain, the modes of transmission in healthcare settings, and the use of the best practices in all healthcare settings. Compulsory public reporting of healthcare-associated infection rates is needed to allow individuals and the community to make informed choices regarding selecting a healthcare facility.
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
2.7K
01:29Chronic Pancreatitis II: Collaborative Care
113
The management of chronic pancreatitis is multifaceted, involving a comprehensive approach that includes thorough assessment, diagnostic testing, and a variety of management strategies.
Assessment:
Assessment:
113
01:28Chronic Kidney Disease III: Interprofessional Care
42
Chronic kidney disease (CKD) requires collaborative and comprehensive management. CKD progresses through stages and can lead to end-stage kidney disease (ESKD) if untreated. Interprofessional collaboration and patient education are crucial, enabling patients to manage their health and improve their quality of life.Diagnostic approach for chronic kidney diseaseThe diagnosis of CKD primarily focuses on the glomerular filtration rate (GFR), which assesses kidney function by measuring how well...
42
01:28Esophageal Varices-II: Clinical Features and Management
96
Esophageal varices often manifest as gastrointestinal bleeding episodes, presenting symptoms like hematemesis (vomiting of blood), hematochezia (passing fresh blood via the rectum), and melena (black, tarry stools). Other signs can include weight loss, anorexia, abdominal discomfort, jaundice, pruritus, altered mental status, and muscle cramps.
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...
96
01:30Preventive Healthcare Services
1.1K
Preventive healthcare services keep people healthy via frequent check-ups, screening, and counseling. They primarily aid in disease prevention rather than treating an acute or chronic illness. Preventive treatment also keeps individuals productive and energetic, allowing them to work well into their retirement years. Examples of preventive care services include:
1.1K