From Care to Cure: Demonstrating a Model of Clinical Patient Navigation for Hepatitis C Care and Treatment in High-Need Patients

Ford, Mary M.; Johnson, Nirah; Desai, Payal; Rude, Eric; Laraque, Fabienne

doi:10.1093/cid/ciw806

Cited by 46 publications

(56 citation statements)

References 23 publications

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“…Studies formally evaluating this approach are ongoing. Numerous outreach programmes have been designed, particularly in large urban centres, with initial data supporting the use of peer navigators to assist with linkage to and retention in care, provision of care by nurses and primary care physicians rather than specialists, and integration of HCV treatment into multidisciplinary care to address other health and social issues 102,103 . Initial results suggest that such models are effective, with cure rates comparable to or better than those seen in clinical trials and real-world cohorts treated in hepatology and infectious disease clinics 96 .…”

Section: Cascade Of Care and Improving Care Models For Hcv [H4]mentioning

confidence: 99%

Accelerating the elimination of viral hepatitis: a Lancet Gastroenterology & Hepatology Commission

Cooke

Andrieux-Meyer

Applegate

et al. 2019

The Lancet Gastroenterology & Hepatology

445

391

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investments to support countries with greatest burden of viral hepatitis All heavily burdened countries to have fully funded elimination plans by 2019 Recognition of need to focus on high burden countries and support for national policy development (All) Funding for national elimination plans Creation of fiscal space for new programmes with costed investment programmes Adopt domestic innovative finance tools where appropriate Support national policy makers in their activity (WHO, UNITAID, NGOs) Provide international support for financing measures (UNITAID, GFATM, bilaterial donors) Prevention Ensure all WHO elimination targets addressed in plans Address operational challenges in delivery of birth dose HBV vaccine Ensure provision of harm reduction services and engage with marginalised group (e.g. prisoners, PWIDs). Ensure clear public health messages to encourage testing and treatment Support countries to decriminalise injecting drug use and ensure equitable access to services for all (NGOs, WHO, civil society) Ensure appropriate funding for HBV vaccine, including birth dose (GAVI, WHO) Support R&D into HCV vaccine development (Research funders and pharma) Testing and Models of Care Focus on substantially scaling up testing for HBV and HCV Create and evaluate simplified care pathways relevant to local setting, integrating with existing services. Promote task sharing and decentralisation of care through capacity building, training and removal of Support operational research into simplified pathways (Research funders, UNITAID) requirements for specialised prescribing Diagnostics Ensure testing is integrated into the wider healthcare system, rather than centralised facilties Ensure access to quality diagnostics through Essential Diagnostic List and prequalification (WHO, funders) Support implementation science for models of care and R&D into novel diagnostics suitable for decentralised settings. (Research funders, FIND, industry) Access to treatment Ensure all Essential Medicines for viral hepatitis are included in national programmes, with an emphasis on pan-genotypic regimens Apply comprehensive policy approach to promoting access, including compulsory licensing Ensure all essential medicines are pre-qualified and either available through voluntary licensing or Medicines Patent Pool (WHO, NGOs, civil society, funders) Support shared procurement mechanisms for treatment (PAHO) Monitor Progress National plans need clearly defined, measurable objectives Develop new indices of national progress Progress of individual countries needs to be closely monitored towards elimination goals (Polaris, WHO, Creation of Elimination Index) Develop greater capacity for advocacy in high burden regions (all) Viral hepatitis is one of the leading causes of death in the world. 96% of those deaths are due to hepatitis B and C, which are the focus of this commission. Unlike many other major diseases, the tools exist to eliminate viral hepatitis. A highly effective vaccine is available to prevent hepatitis B, and a revolution in HCV treat...

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Section: Cascade Of Care and Improving Care Models For Hcv [H4]mentioning

confidence: 99%

Accelerating the elimination of viral hepatitis: a Lancet Gastroenterology & Hepatology Commission

Cooke

Andrieux-Meyer

Applegate

et al. 2019

The Lancet Gastroenterology & Hepatology

445

391

View full text Add to dashboard Cite

show abstract

“…Adherence among patients with chronic HCV infection and comorbid psychiatric disorders remains a concern despite the advent of IFN‐free DAA treatments. Lower adherence is hypothesized due to cases of severe, untreated psychiatric disorders and higher rates of comorbid substance use disorders ; however, DAA regimens have shown similarly high adherence rates in clinical trials among patient populations traditionally considered to be at‐risk for nonadherence including patients with psychiatric disorders, people who inject drugs and patients on stable opioid substitution therapy . In its clinical trial programme, overall adherence to G/P regimens has been reported at >95% with comparable rates among patients with psychiatric disorders, people who inject drugs and patients on stable opioid substitution therapy .…”

Section: Discussionmentioning

confidence: 99%

“…Based on these data, recent HCV treatment guidelines recommend DAA regimens without any restrictions based on psychiatric comorbidities . However, there has been more limited use of DAAs in patients with psychiatric disorders in both late phase trials and clinical practice potentially due to concerns about treatment adherence and drug–drug interactions (DDIs) with neuropsychiatric co‐medications . Thus, there is an unmet need to better understand the impact of psychiatric disorders on the treatment adherence, efficacy and safety of DAA regimens.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of glecaprevir/pibrentasvir in patients with chronic HCV infection and psychiatric disorders: An integrated analysis

Back

Belperio

Bondin

et al. 2019

Journal of Viral Hepatitis

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Although direct-acting antivirals (DAAs) for chronic hepatitis C virus (HCV) infection are highly efficacious and safe, treatment initiation is often limited in patients with neuropsychiatric disorders due to concerns over reduced treatment adherence and drug-drug interactions. Here, we report adherence, efficacy, safety and patient-reported outcomes (PROs) from an integrated analysis of registrational studies using the pangenotypic DAA regimen of glecaprevir and pibrentasvir (G/P). Patients with chronic HCV genotypes 1-6 infection with compensated liver disease (with or without cirrhosis) receiving G/P for 8, 12 or 16 weeks were included in this analysis. Patients were classified as having a psychiatric disorder based on medical history and/or comedications. Primary analyses assessed treatment adherence, efficacy (sustained virologic response at post-treatment week 12; SVR12), safety and PROs. Among 2522 patients receiving G/P, 789 (31%) had a psychiatric disorder with the most common diagnoses being depression (64%; 506/789) and anxiety disorders (27%; 216/789).Treatment adherence was comparably high (>95%) in patients with and without psychiatric disorders. SVR12 rates were 97.3% (768/789; 95% CI = 96.2-98.5) and 97.5% (1689/1733; 95% CI = 96.7-98.2) in patients with and without psychiatric disorders, respectively. Among patients with psychiatric disorders, SVR12 rates remained >96% by individual psychiatric diagnoses and co-medication classes. Overall, most adverse S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section at the end of the article. How to cite this article: Back D, Belperio P, Bondin M, et al. Efficacy and safety of glecaprevir/pibrentasvir in patients with chronic HCV infection and psychiatric disorders: An integrated analysis. J Viral Hepat. 2019;26:951-960. https ://doi.

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“…High-needs patients, including those with mental illness, substance use disorders, and/or a lack of social support, may face a variety of barriers to HCV care and treatment, including limited access to health care services and difficulties navigating the health care system (5,6). Care coordination programs addressing these barriers for chronic diseases have shown improved outcomes in similar populations (7,8).…”

Section: Discussionmentioning

confidence: 99%

Patient-Reported Satisfaction and Associated Changes in Health and Behavior Pre- and Post- Project INSPIRE: a Comprehensive Hepatitis C Care Coordination Program

Deming¹,

Mageras²,

Davidson³

et al. 2020

Preprint

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Background Individuals infected with hepatitis C (HCV) often present with co-morbidities and complex socio-behavioral risk factors. Project INSPIRE was a care coordination and telementoring demonstration project which aimed to treat and cure HCV-infected patients while providing them with services and education to improve overall health outcomes and self-sufficiency. We examined changes in HCV-related health and behavior associated with completion of Project INSPIRE (the “intervention”). Methods Patients were enrolled into Project INSPIRE at clinical sites where they received HCV clinical care paired with care coordination services. Baseline and post-intervention surveys were distributed to participants in-person at a clinical site and/or via mail at two time-points, one before and one after the intervention. Surveys were mailed back to the researchers by participants, and participant-identifying information was used to link survey responses to clinical data for each respondent. Logistic models using generalized estimating equations to account for partially overlapping observations examined the association between intervention participation and changes in self-reported overall health, emergency department (ED) visits and hospitalizations in the past 6 months, drug and alcohol use in the past 6 months, HCV knowledge, and general self-efficacy, adjusting for potential demographic and sociobehavioral confounding variables. Results The response rates for complete and partial surveys were 14.0% of 883 for baseline and 9.9% of 1,552 for post-intervention. In multivariable analyses (N=269, of which 50 were paired and 219 were unpaired), INSPIRE intervention participation was associated with a decreased odds of self-reported ED visits (OR: 0.34, 95% CI: 0.20–0.57), hospitalizations (OR: 0.30, 95% CI: 0.16–0.57), alcohol use (OR: 0.35, 95% CI: 0.18–0.69), and injection drug use (OR: 0.09, 95% CI: 0.02–0.34), and a 6.8% (CI: 1.6-12.2%) increase in reported self-efficacy (p=0.01). Conclusions Survey results suggest that INSPIRE successfully improved participant health behavior and self-efficacy, indicating the intervention’s value to patients, providers, and insurance companies beyond the immediate benefits of HCV treatment and cure. Participants also had a generally positive experience working with their care teams, indicating that further research should explore how an individualized care team can improve retention and patient referral rates compared with the HCV standard of care.

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From Care to Cure: Demonstrating a Model of Clinical Patient Navigation for Hepatitis C Care and Treatment in High-Need Patients

Cited by 46 publications

References 23 publications

Accelerating the elimination of viral hepatitis: a Lancet Gastroenterology & Hepatology Commission

Accelerating the elimination of viral hepatitis: a Lancet Gastroenterology & Hepatology Commission

Efficacy and safety of glecaprevir/pibrentasvir in patients with chronic HCV infection and psychiatric disorders: An integrated analysis

Patient-Reported Satisfaction and Associated Changes in Health and Behavior Pre- and Post- Project INSPIRE: a Comprehensive Hepatitis C Care Coordination Program

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