A Model for Integrating Hepatitis C Services into an HIV/AIDS Program

Stringari-Murray, Suzan; Clayton, Alison; Chang, Joyce

doi:10.1177/1055329003255581

Cited by 9 publications

(16 citation statements)

References 8 publications

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“…Successful examples include the incorporation of mental health services, lipid level management, gynecological services, and hepatitis C virus infection treatment into HIV primary care [18][19][20], all of which have improved patient health outcomes [21]. To achieve a similar level of success with buprenorphine maintenance therapy integration, 4 key questions must be answered.…”

Section: Challenges and Models Of Integrationmentioning

confidence: 99%

Models for Integrating Buprenorphine Therapy into the Primary HIV Care Setting

Basu

Rohrberg

Bruce

et al. 2006

Clinical Infectious Diseases

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Opiate dependence among human immunodeficiency virus (HIV)-infected patients has been associated with negative clinical outcomes, yet few affected patients receive appropriate and coordinated treatment for both conditions. The introduction of buprenorphine maintenance therapy into HIV care settings provides an opportunity for providers to integrate treatment for opiate dependence into their practices. Buprenorphine maintenance therapy has been associated with reductions in opiate use, increased social stability, improved adherence to antiretroviral therapy, and lowered rates of injection drug use. We describe the following 4 models for the integration of buprenorphine maintenance therapy into HIV care: (1) a primary care model, in which the highly active antiretroviral therapy-administering clinician also prescribes buprenorphine; (2) a model that relies on an on-site specialist in addiction medicine or psychiatry to prescribe the buprenorphine; (3) a hybrid model, in which an on-site specialist provides the induction (with or without stabilization phases) and the HIV care provider provides the maintenance phase; and (4) a drug treatment model that provides buprenorphine maintenance therapy services with HIV services in the substance abuse clinic setting. The key barriers against effective integration of buprenorphine maintenance therapy and primary HIV services are discussed, and we suggest several mechanisms to overcome such obstacles.

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Section: Challenges and Models Of Integrationmentioning

confidence: 99%

Models for Integrating Buprenorphine Therapy into the Primary HIV Care Setting

Basu

Rohrberg

Bruce

et al. 2006

Clinical Infectious Diseases

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“…One study failed to describe the study participants and setting in detail, one study did not clearly mention how the exposure (receiving care at the community settings) was measured . The majority of studies failed to address confounders such as patients’ socioeconomic characteristics, HIV or HBV co‐infections, history of HCV treatment and types of healthcare providers . The other criteria (standard criteria for measuring the condition, valid and reliable way for measuring the outcomes and appropriate statistical analysis) were met by all studies.…”

Section: Resultsmentioning

confidence: 99%

Clinical effectiveness, cost effectiveness and acceptability of community‐based treatment of hepatitis C virus infection: A mixed method systematic review

Pourmarzi

Hall

Hepworth

et al. 2019

Journal of Viral Hepatitis

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Summary Several community‐based models for treating hepatitis C virus (HCV) infection have been implemented to improve treatment accessibility and health outcomes. However, there is a lack of knowledge regarding how well these models achieve the desired goals. We conducted a mixed‐method systematic review of quantitative and qualitative evidence about clinical effectiveness, cost effectiveness and acceptability of community‐based HCV treatment models. Seventeen databases were researched for published and unpublished studies. Methodological quality was assessed using The Joanna Briggs Institute Critical Appraisal tools. Quantitative findings were synthesized in narrative form and qualitative findings were synthesized using meta‐synthesis. Forty‐two quantitative and six qualitative studies were included. No relevant cost effectiveness studies were found. Five categories of community‐based models were identified: telehealth, integration of HCV and addiction services, integration of HCV and HIV services, integration of HCV and primary care, and implementation by a home care and health care management company. The range of reported outcomes included; end of treatment response: 48.7% to 96%, serious side effects: 3.3% to 27.8%, sustained virological response: 22.3% to 95.5%, relapse: 2.2% to 16.7%, and treatment completion: 33.4% to 100%. Inconsistent measures of uptake and adherence were used; uptake ranged from 8.3% to 92%, and 68.4% to 100% of patients received ≥80% of prescribed doses. Patient reported experiences included trusted and supportive care providers, safe and trusted services, easily accessible care, and positive psychological and behavioural changes. The clinical effectiveness and acceptability reported from the included studies are similar to or better than reported outcomes from systematic reviews of studies in tertiary settings. Studies of the cost effectiveness of community‐based models for treating HCV are needed.

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“…For example, in Marin County, the HCV Screening Program has been integrated into the HIV Testing and Outreach Program in order to implement HCV testing and HCV medical care in a cost effective manner. 31 In addition, the Specialty Clinic, whose mission was initially to provide primary care for HIV-infected Marin County residents, has been expanded to include medical consultation services for HCV. Columbus, Ohio's experience with integrating viral hepatitis into a sexual health and HIV counseling and testing site involved securing staff buy-in, educating the staff on hepatitis, and developing hepatitis protocols.…”

Section: Introductionmentioning

confidence: 99%

“…32 There are a number of challenges, however, that have been identified in integrating HCV services into existing HIV infrastructures, including: (1) the fact that prevention messages for the two viruses are often not the same, given the greater efficiency of parenteral transmission of HCV and the higher sexual transmission risk of HIV 25,33 ; (2) patients have uneven knowledge about the two viruses; (3) a lack of a referral infrastructure, with services such as vaccination for hepatitis A and B and treatment for HCV often unavailable or contraindicated for some individuals; (4) a lack of funding and resources, including a high rate of uninsured or underinsured patients; (5) categorical funding streams that prevent the use of dedicated monies for one virus to be used for supporting services for the other; (6) reluctance or opposition on the part of management and staff to integrate services (including case management); and (7) the additional burden on HIV/AIDS counselors to incorporate counseling for HCV or coinfection. 31,34 While research has documented the extensive provision of HIV patient services by many drug treatment units in the United States, [35][36][37] little is currently known about the extent to which these units have integrated HCV services into their HIV service infrastructures, or the units' perspectives and challenges concerning this integration of services. This paper therefore uses data collected in a nationwide sample (n ϭ 89) of drug treatment units in order to examine the health service areas in which the units have performed this integration, and the experiences they have had in doing so.…”

Section: Introductionmentioning

confidence: 99%

Integrating Hepatitis C Services into Existing HIV Services: The Experiences of a Sample of U.S. Drug Treatment Units

Strauß

Astone

Jarlais

et al. 2005

AIDS Patient Care and STDs

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Hepatitis C virus (HCV) is the most prevalent blood-borne infectious disease in the United States, especially among drug users, and coinfection with HIV is common. Because drug users are often medically underserved, drug treatment units are important sites of opportunity for providing services for these infectious diseases. Given the commonalities in the routes of transmission of HIV and HCV, and the fact that many drug treatment units have established an infrastructure to provide HIV services, some have suggested integrating HCV services into those already established for HIV. Using data collected in a telephone survey with 89 drug treatment units throughout the United States, this paper examines the extent to which drug treatment units have expanded their HIV services to include those for HCV, and the extent to which this expansion was facilitated by having HIV services in place. Overall, a greater proportion of methadone maintenance than drug-free treatment units provided services for HIV and HCV. The majority of units in both modalities that provided HIV- and HCV-related services expanded their HIV service delivery to include similar HCV services, and one third expanded all of their HIV services. A large number of these units, however, indicated that having an HIV service infrastructure did not facilitate this expansion, often because the units wanted to emphasize differences in the two viral infections. Policy makers and individual treatment units need to develop strategies that capitalize on existing infrastructures while maintaining the distinction between HIV and HCV primary and secondary prevention efforts.

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A Model for Integrating Hepatitis C Services into an HIV/AIDS Program

Cited by 9 publications

References 8 publications

Models for Integrating Buprenorphine Therapy into the Primary HIV Care Setting

Models for Integrating Buprenorphine Therapy into the Primary HIV Care Setting

Clinical effectiveness, cost effectiveness and acceptability of community‐based treatment of hepatitis C virus infection: A mixed method systematic review

Integrating Hepatitis C Services into Existing HIV Services: The Experiences of a Sample of U.S. Drug Treatment Units

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