Key Data to be Presented

Source: International Conference on Hepatitis Care in Substance Users 2019 (INHSU 2019)

Jason Grebely, PhD
Released: August 23, 2019

The annual INHSU 2019 conference held by the International Network on Hepatitis in Substance Users will be held in several weeks in Montreal, Canada. The strength of the conference program is due to the strong interest shown by our global network of people working in this area. We received over 350 abstract submissions and there will be over 80 oral presentations and 200 poster presentations. It will bring together people living with viral hepatitis, people who use drugs, advocates, health care providers, programme managers, harm reduction experts, researchers, the pharmaceutical industry, and policy-makers from every region with over 800 participants expected to attend the conference. The conference will cover the latest advances on hepatitis C epidemiology, management and treatment of hepatitis C among people who use drugs, including some of the broader health issues and drug-related harms among people who use drugs. In addition to the invited talks which will form part of the conference, here are my thoughts on some of the key oral research presentations to keep an eye on:

Progress towards hepatitis C elimination

Tracking real-world progress towards hepatitis C elimination will be a major theme at INHSU 2019. The conference features invited and abstract-driven presentations from Australia, Canada, England, Georgia, Iceland, and Scotland, highlighting some of the real-world examples of settings that have made major strides towards hepatitis C elimination. Real-world data will be presented from England and Scotland on hepatitis C treatment uptake and prevalence reduction in national surveys of people who inject drugs. Data from Australia will also be presented from the ETHOS Engage study, a large cohort study in Australia evaluating factors associated with hepatitis C treatment uptake and progress towards hepatitis C elimination among people who inject drugs attending drug treatment clinics and needle and syringe programs. Collectively, these studies are critical for identifying key populations that will need further efforts to enhance linkage to care and treatment to achieve hepatitis C elimination. The conference will also feature some interesting social research exploring the complex processes and meaning of “viral elimination” and unpacking ‘evidence-making’ processes of how models and targets ‘work’ in making-up elimination futures.

Hepatitis C risk and prevention

INHSU 2019 will feature several important analyses from the HEPCO study, an observational cohort investigating a range of important health outcomes among people who inject drugs in Montreal, Canada. Several presentations from this cohort will investigate the importance of homelessness and detention patterns on risk for hepatitis C acquisition. Presentations at INSHU 2019 will also draw on data from Brazil, France, Tanzania, and Ukraine to better understand the risks for hepatitis C acquisition in a range of different settings and strategies to prevent hepatitis C acquisition.

Strategies to enhance HCV testing, treatment and care

The INHSU 2019 conference will feature research describing innovative strategies to improve current testing methods and identify strategies to enhance testing, linkage to care and treatment among people who use drugs. There will be some interesting presentations on how currently available diagnostic tests, such as point-of-care hepatitis C antibody testing and finger-stick HCV RNA testing could provide a quicker time to a result. Achieving a more rapid time to hepatitis C diagnosis could lead to reduced wait times for diagnosis and improved linkage to treatment. As will be highlighted by a modelling presentation at INSHU 2019, increasing hepatitis C testing will be critical to ensure that the World Health Organization targets will be met.

Task-shifting to expand the range and reach of where people can access hepatitis C testing is critical. A presentation from Canada will investigate the use of point-of-care testing by peer outreach workers with lived experience to engage with highly marginalized populations.

The importance of peer-based support in the delivery of hepatitis C testing, linkage to care, and treatment will be a recurring theme throughout the conference. A range of different models of care highlighting the importance of involving people who use drugs in the delivery of hepatitis C services will be presented from a diverse range of settings, including Australia, Canada, India, Indonesia, Kenya, Nepal, Norway, and Vietnam.

INHSU 2019 is broadening its understanding of how different  models of care are operating in a range of settings, with an expansion to work happening in low- and middle-income countries, including Georgia, India, Indonesia, KenyaMalaysia, Nepal, and Vietnam.

Data will be presented from Iran from the ENHANCE and ROSTAM studies highlighting programs that have been successful in engaging people who use drugs in hepatitis C testing and treatment.

Enhancing hepatitis C care for Indigenous people

The INHSU 2019 conference is fortunate to have a strong representation of invited talks, research presentations, and models of care focusing on innovative approaches to enhancing hepatitis C care led

by, with, and for Indigenous people. This will include research focusing on the importance of peer-based support and using Indigenous-led approaches to exploring wholistic wellness for Indigenous persons and communities impacted by hepatitis C, HIV and substance use. Models of care from Quebec and Saskatchewan will also highlight innovative ways to improve access to care for hepatitis C and other health issues among Indigenous people.

Hepatitis C treatment

Data is emerging from some key studies looking at strategies to enhance hepatitis C testing and treatment among people who use drugs. INHSU 2019 will feature results from a cluster randomized trial of pharmacy-led versus conventional treatment for people receiving opioid agonist therapy in Scotland. Preliminary results will also be presented on nurse-led outcomes for direct-acting antiviral (DAA) therapy from the TAP (Treatment and Prevention) study, a randomized trial of individual versus a “bring a friend” approach for HCV treatment among people who inject drugs. Interestingly, there will be a presentation on the characteristics of different treatment as prevention study designs which could inform future studies in this area. Some interesting data will also be presented on a randomized controlled trial evaluating the provision of low-threshold care in needle and syringe programs versus referral to existing services as a strategy to enhance treatment uptake among people who inject drugs. Data from the SIMPLIFY and D3FEAT studies and from a cohort of people who inject drugs attending a primary health centre in Sydney, Australia, will also provide some novel insights into adherence to therapy during DAA therapy. A presentation from Iceland will evaluate hepatitis C treatment outcomes among people predominantly using methamphetamine, filling an important gap in the literature.

The INHSU 2019 conference will have several presentations highlighting some interesting social research exploring the experiences of DAA therapy among people who use drugs, providers, and community-based organizations. One study from Australia explored the barriers and facilitators to engaging in hepatitis C management and DAA therapy among general practitioners and drug and alcohol specialists. Several studies will be presented that explore the experiences among people from Australia and Canada who have received HCV DAA therapy, and reflections on DAA therapy roll-out among people from Australia who are engaged in national or state-based drug user and viral hepatitis intervention or advocacy work.

Models of hepatitis C treatment and care

INHSU 2019 continues to receive interesting abstracts focused on novel and innovative models of hepatitis C care. It is encouraging to see a growing number of different models being implemented in harm reduction services, including from Australia, Georgia, Kenya, Myanmar, Portugal, Spain, and the United States. There is also a push to evaluate a variety of strategies to facilitate on-site testing, treatment and care, such as projects being conducted in Georgia and India. In an attempt to bring services to those who need them, different outreach models (e.g. using mobile vans) are starting to emerge from a number of countries, including Australia, Norway, Spain, and the United States. It is also exciting that a number of unconventional models are starting to emerge to provide hepatitis C care to those who might be less connected with services, including in pharmacies, emergency departments, homelessness settings, and perinatal care.

Hepatitis prevention, treatment, and care in prisons

The expansion of hepatitis C testing and treatment in prisons will be critical to further efforts at hepatitis C elimination. In an INHSU 2019 session on HCV in prisons, research will explore the cascade of hepatitis C care in prisons, barriers and facilitators towards HCV treatment uptake in prisons, and the importance of the period following release from prison. Data from the SToP-C study, the first study to prospectively evaluate hepatitis C treatment as prevention in prisons, provides insights into injecting cultures following DAA treatment in prisons and the implications for harm reduction services and prevention of HCV reinfection in prisons.

Hepatitis C reinfection following successful treatment

INHSU 2019 will feature a number of important presentations on HCV reinfection from Canada, including a population-based study of HCV reinfection following DAA therapy in British Columbia and the risk of HCV reinfection among men who inject drugs or who have sex with men. Several studies of HCV reinfection will be presented including the final results from the C-EDGE CO-STAR study and several real-world cohorts from Vancouver and Zurich. Lastly, results from the largest systematic review and meta-analysis of HCV reinfection following interferon-based and DAA therapy will be presented.

Health beyond hepatitis C for people who use drugs

INHSU has made a clear decision to include issues of health for people who use drugs beyond hepatitis C at INHSU 2019. In another presentation from the HEPCO study, the spatial distribution of people who inject drugs was investigated to identify hotspots of social injecting activity. In research that will be presented at INHSU 2019, investigators explored the overall health benefits of scaling-up OAT among

people who inject drugs in three varied global settings, including Kyiv (Ukraine), Tehran (Iran), and Kentucky (USA). Further research will highlight issues relating to ageing among people receiving opioid agonist therapy, a systematic review of opioid agonist therapy doses, and overdose following HCV therapy. These topics highlight the importance of considering the broader health of people who use drugs, beyond hepatitis C.

The INHSU 2019 conference hopes to bring together people living with viral hepatitis, people who use drugs, advocates, health care providers, programme managers, harm reduction experts, researchers, the pharmaceutical industry, and policy-makers to learn from each other, share good practices, and make new connections, furthering our efforts towards a common goal of improving the lives of people who use or inject drugs.

I look forward to seeing you in Montreal in a couple of weeks. 

Jason Grebely, INHSU President