Beyond cure: patient reported outcomes of hepatitis C treatment among people who inject drugs in Australia

Madden, Annie; Hopwood, Max; Neale, Joanne; Treloar, Carla

doi:10.1186/s12954-018-0248-4

Cited by 54 publications

(60 citation statements)

References 37 publications

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“…However, findings from this survey suggest that the majority of PWID reported a positive impact on their ability to engage in wider society and explore new interests/hobbies after HCV treatment. Previous studies have also shown similar positive outcomes beyond HCV cure that are valued highly among PWID [ 16 , 31 ].…”

Section: Discussionmentioning

confidence: 66%

“…There is still a need to understand what motivates PWID to engage in care. Qualitative research has illustrated that eliminating the virus is not the only factor that motivates PWID to start therapy [ 31 ]. The results of our survey suggest that awareness of the availability of effective and well-tolerated treatments and the potentially severe consequences of untreated HCV are key motivators.…”

Section: Discussionmentioning

confidence: 99%

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Beyond clinical outcomes: the social and healthcare system implications of hepatitis C treatment

et al. 2020

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Background Hepatitis C virus (HCV) infections in people who inject drugs (PWID) can now be treated and cured. However, the impact that HCV treatment has on drug-user health, practices and wellbeing is not known. The aim of this research was to understand the non-clinical impact that HCV treatment has in PWID and their reasons for accessing and completing treatment. Methods Participants aged 25–67 years who had injected opioids or stimulants (currently or in the past) and had completed direct-acting antiviral treatment were recruited from seven European countries. Participants completed a 30-min online survey administered face-to-face between September 2018 and April 2019. The questionnaire responses were used to assess the mental and physical impact of having completed treatment. Results Of the 124 participants who completed the survey questionnaire, 75% were male, 69% were over 45 years old and 65% were using opioids and/or stimulants at the start of HCV treatment. Participants reported improvements in the following areas after completing HCV treatment: outlook for the future (79%); self-esteem (73%); ability to plan for the future (69%); belief in their abilities (68%); confidence (67%); empowerment (62%); energy levels (59%); and ability to look after themselves (58%). The most common reasons for starting HCV treatment were: becoming aware of treatments that were well tolerated (77%) and effective (75%); and understanding the potentially severe consequences of HCV (75%). Conclusions The benefits of HCV treatment go beyond clinical outcomes and are linked to improved drug-user health and wellbeing. Sharing information about well-tolerated and effective HCV treatments, and raising awareness about the potentially severe consequences of untreated HCV are likely to increase the number of PWID who are motivated to access and complete HCV treatment in future.

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Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Beyond clinical outcomes: the social and healthcare system implications of hepatitis C treatment

et al. 2020

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“…( 31 ) We also identified a need to increase awareness and understanding of the benefits of treatment with DAAs among patients, providers, and key stakeholders. ( 32 ) Some stakeholders perceived patients to be wary of treatment because of known historical side effects. Stakeholders suggested enlisting the help of peer educators ( 33 ) who can act as a bridge between the patient and provider, to increase motivation for treatment and to reduce self‐stigma among patients with HCV and provide encouragement to engage and comply with treatment.…”

Section: Discussionmentioning

confidence: 99%

Recommendations for Implementing Hepatitis C Virus Care in Homeless Shelters: The Stakeholder Perspective

et al. 2020

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Compared with the general population, homeless individuals are at higher risk of hepatitis C infection (HCV) and may face unique barriers in receipt of HCV care. This study sought the perspectives of key stakeholders toward establishing a universal HCV screening, testing, and treatment protocol for individuals accessing homeless shelters. Four focus groups were conducted with homeless shelter staff, practice providers, and social service outreach workers (n = 27) in San Francisco, California, and Minneapolis, Minnesota. Focus groups evaluated key societal, system, and individuallevel facilitators and barriers to HCV testing and management. Interviews were transcribed and analyzed thematically. The societal-level barriers identified were lack of insurance, high-out-of-pocket expenses, restriction of access to HCV treatment due to active drug and/or alcohol use, and excessive paperwork required for HCV treatment authorization from payers. System-level barriers included workforce constraints and limited health care infrastructure, HCV stigma, low knowledge of HCV treatment, and existing shelter policies. At the individual level, client barriers included competing priorities, behavioral health concerns, and health attitudes. Facilitators at the system level for HCV care service integration in the shelter setting included high acceptability and buy in, and linkage with social service providers. Conclusion: Despite societal, system, and individual-level barriers identified with respect to the scale-up of HCV services in homeless shelters, there was broad support from key stakeholders for increasing capacity for the provision of HCV services in shelter settings. Recommendations for the scale-up of HCV services in homeless shelter settings are discussed. (Hepatology Communications 2020;4:646-656).H epatitis C virus (HCV) prevalence is underestimated in underserved populations, including people experiencing homelessness who are at increased risk of HCV infection. (1) According to a recent systematic review of infectious disease prevalence studies, the prevalence of HCV among homeless adults ranges from 9.8% to 52.5%. (2) Among people experiencing homelessness, substance use and mental health disorders are common, and are risk factors for HCV infection. (3,4) Moreover, homelessness has consistently been associated with injection drug use, (5) and engaging in unsafe injection drug-use practices likely drives the high rates of HCV infection documented among this population.

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“…An Australian study reported that PWUDs are seeking outcomes “beyond cure” including improved physical and mental health and positive changes in identity and social relationships. ( 37 )…”

Section: Discussionmentioning

confidence: 99%

ITTREAT (Integrated Community Test ‐ Stage ‐ TREAT) Hepatitis C service for people who use drugs: Real‐world outcomes

O’Sullivan

Jones

Gage

et al. 2020

Liver International

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Background/aims: Direct-acting antivirals (DAAs) provide an unprecedented opportunity for a "find-and-treat strategy." We aimed to report real-world clinical, patient reported and health economic outcomes of community-based hepatitis C virus (HCV) screening/treatment in people who use drugs (PWUDs). Methods:Project ITTREAT (2013-2021), established at a drug and alcohol treatment centre, offered a comprehensive service. Generic (SF-12v2 and EQ-5D-5L) and liverspecific (SFLDQoL) health-related quality of life (HRQoL) were assessed before and after HCV treatment. Costs/case detected and cured were calculated. Primary outcome measure was sustained virological response (SVR) (intention to treat).Results: Till March 2018, 573 individuals recruited, 462 (81%) males, mean age 40.5 ± 10.0 years. Of the 125 treated, 115 (92%) had past/current history of injecting drug use, 88 (70%) were receiving opioid agonist treatment and 50 (40%) were homeless. Twenty-six per cent received interferon-based and 74% DAA-only regimens. SVR (ITT) was 87% (90% with DAAs). Service uptake/HCV treatment completion rates were >95%, HCV reinfection being 2.63/100 person years (95% CI 0.67-10.33).HRQoL improved significantly at end of treatment (EOT) in those with SVR: SFLDQoL (symptoms, memory, distress, loneliness, hopelessness, sleep and stigma) (P

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Beyond cure: patient reported outcomes of hepatitis C treatment among people who inject drugs in Australia

Cited by 54 publications

References 37 publications

Beyond clinical outcomes: the social and healthcare system implications of hepatitis C treatment

Beyond clinical outcomes: the social and healthcare system implications of hepatitis C treatment

Recommendations for Implementing Hepatitis C Virus Care in Homeless Shelters: The Stakeholder Perspective

ITTREAT (Integrated Community Test ‐ Stage ‐ TREAT) Hepatitis C service for people who use drugs: Real‐world outcomes

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