ABSTRACT
Background and aims: Providing testing and treatment for hepatitis C (HCV) for people who inject drugs (PWID) is critical in eliminating HCV, but reaching this population with traditional healthcare services can be challenging. Combining point-of-care (PoC) testing with peer support and counselling is a model of care (MoC) that can be effective for PWID. This study aims to investigate if a peer-led mobile van equipped with rapid PoC tests for HCV antibodies (Ab) and RNA could simplify testing and link PWID to care and treatment. Method: In Copenhagen, Denmark, a peer-led mobile service providing counselling, Ab testing (In-Tec™) and linkage to standard of care was equipped with a PoC HCV-RNA finger-prick test (Xpert HCV Viral Load Finger-Stick Point-of-Care Assay, Cepheid). Eligible HCV-RNA+ individuals were offered assisted referral to a fast-track hospital clinic for evaluation and treatment, with peer support available if needed. Results: From 1 May 2019 to 25 October 2021, 1013 people were tested for HCV-RNA and 10.2% (n = 103) were positive. Nine additional individuals with HCV infection contacted the service to be linked to care. Of the 112 individuals with chronic HCV infection, 72.3% (n = 81) were evaluated for treatment at the hospital clinic, of whom86.4% (n = 70) initiated direct-acting antiviral therapy and 3.7% (n = 3) are waiting to initiate treatment. Major reasons for not being evaluated for treatment included being undocumented (38.7%;n = 12) and being lost to follow-up (32.3%;n = 10). Among those who initiated treatment, 20.0% (n = 14) were connected to drug addiction treatment services. The peer-led service assisted all treated with communication with the hospital nurse, collection of treatment medicine and accompaniment to follow-up visits. Conclusion: We found that a peer-led mobile PoC service is an MoC that can engage PWID in HCV testing and link them to treatment, even during the COVID-19 pandemic. We identified being an undocumented migrant as a major cause for not accessing care. This poses a challenge for HCVelimination in Denmark due to the risk of onward transmission. Next steps include engaging with health authorities to provide care for these migrants.
ABSTRACT
Viroporins are ion channels found in many viruses, where they contribute to virus life cycle and thereby pathogenesis. Viroporin targeting is a known, yet largely unexplored, therapeutic strategy so far only used in Influenza A with the drugs amantadine and rimantadine. In this review, we seek to utilize the inhibition by amantadine of the viroporin Protein E in SARS-CoV-2 in an attempt to treat COVID-19 in its early stages. We are executing a double-blinded placebo-controlled trial based on promising in vivo and in vitro work as a stepping-stone for establishing a therapeutic antiviral regime: blocking of viroporins.
ABSTRACT
Coronavirus disease 2019 (COVID-19) is caused by infection with severe acute respiratory syndrome corona virus 2. High age, hypertension, diabetes, and obesity are risk factors for severe COVID-19 with increased mortality. In this review, we discuss potential mechanisms by which diabetes and obesity modulate the host viral interactions and host-immune response. Glucose levels should be monitored rigorously, and patient-tailored aggressive treatment of hyperglycaemia is recommended, often with the use of insulin. Persons with diabetes and obesity are susceptible to severe outcomes from COVID-19 © 2021, Ugeskrift for Laeger. All Rights Reserved.