Hepatitis C Management Simplification From Test to Cure: A Framework for Primary Care Providers

Kapadia, Shashi N; Marks, Kristen

doi:10.1016/j.clinthera.2018.05.010

Cited by 44 publications

(40 citation statements)

References 46 publications

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“…There is now consensus among the medical community that all patients should be able to access care and that treating PWID in particular is a priority to reduce HCV transmission [ 5 , 29 ]. Pangenotypic regimens that are currently available require minimal pre-, during and post-treatment monitoring and can be used effectively to treat large numbers of previously underserved populations, thus maximising efforts towards HCV elimination [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

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: 99%

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

et al. 2020

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“…Limited timeframes for available appointments can impact patients' ability to attend appointments. Simpli cations to the HCV care model have been proposed, including rapid testing, test-and-treat models, minimal on-treatment monitoring, and limited patient visits, which may serve to reduce barriers, make treatment more accessible, and facilitate treatment expansion (35).…”

Section: Patient-provider Relationshipmentioning

confidence: 99%

A qualitative study of perceived barriers to hepatitis C care among people who did not attend appointments in the non-urban U.S. South

Sherbuk

Tabackman

McManus

et al. 2020

Preprint

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Background: Most people diagnosed with Hepatitis C virus (HCV) have not linked to care, despite the availability of safe and effective treatment. We aimed to understand why people diagnosed with HCV have not pursued care in the non-urban southern United States. Methods: We conducted a survey and semi-structured interview with participants referred to an HCV clinic who did not attend an appointment between 2014 and 2018. Our clinic is located in a non-urban region of Virginia at a university hospital. Qualitative data collection was guided by the Health Belief Model (HBM). Data was analyzed using qualitative content analysis to identify key factors influencing patient perceptions regarding HCV and pursuit of care.Results: Over half of previously referred patients (N=200) could not be reached by phone. Eleven participants enrolled, including 7 men and 4 women. Based on survey responses, unreliable transportation, unstable housing, substance use, and lack of insurance were common. Participants demonstrated good knowledge of HCV disease, complications, and treatment. On qualitative analysis of semi-structured interviews, final themes emerged from within and between HBM constructs. Emerging themes influencing patient perceptions included (1) structural barriers, (2) stigma, (3) prior experiences of HCV disease and treatment, (4) discordance between the recognized severity of HCV and expected impacts on one’s own health, and (5) patient-provider relationship. Substance use was not identified to be a barrier to care.Conclusions: Participants perceived individual and structural barriers to linking to care. A strong HCV knowledge base was not sufficient to motivate pursuit of care. Efforts to improve linkage to care must address barriers at multiple levels, and system-level changes are needed. As the majority of previously referred patients could not be contacted by phone, current approaches to patient engagement are not effective for reaching these populations. Expansion of HCV care to primary care settings with an established patient-provider relationship or co-located treatment within substance use treatment programs may serve to increase access to HCV treatment.

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“…Patient-provider relationships were most important when either the interaction occurred at a key step in the disease process, such as at time of diagnosis, or when based on a long-standing trusted relationship. testing, test-and-treat models, minimal on-treatment monitoring, and limited patient visits, which may serve to reduce barriers, make treatment more accessible, and facilitate treatment expansion (35).…”

Section: Patient-provider Relationshipmentioning

confidence: 99%

A qualitative study of perceived barriers to hepatitis C care among people who did not attend appointments in the non-urban U.S. South

Sherbuk

Tabackman

McManus

et al. 2020

Preprint

View full text Add to dashboard Cite

Background Most people diagnosed with Hepatitis C virus (HCV) have not linked to care, despite the availability of safe and effective treatment. We aimed to understand why people diagnosed with HCV have not pursued care in the non-urban southern United States. Methods We conducted a demographic survey and semi-structured interview with participants referred to an HCV clinic who did not attend an appointment between 2014 and 2018. Our clinic is located in a non-urban region of Virginia at a university hospital. Qualitative data collection was guided by the Health Belief Model (HBM). Data was analyzed using qualitative content analysis to identify the key factors influencing patient perceptions regarding HCV and pursuit of care. Results Over half of previously referred patients could not be reached by phone. Eleven participants enrolled, including 7 men and 4 women. Common barriers to care included being uninsured (n = 4), having unreliable transportation (n = 5), unstable housing (n = 4), and drug use in the past year (n = 5). Participants demonstrated good knowledge of HCV disease, complications, and treatment. On qualitative analysis, final themes emerged from within and between HBM constructs. Emerging themes influencing patient perceptions included (1) structural barriers, (2) stigma, (3) prior experiences of HCV disease and treatment, (4) discordance between the recognized severity of HCV and expected impacts on one’s own health, and (5) patient-provider relationship. Substance use was not identified to be a barrier to care. Conclusions Participants perceived individual and structural barriers to linking to care. A strong HCV knowledge base was not sufficient to motivate pursuit of care. Efforts to improve linkage to care must address barriers at multiple levels, and system-level changes are needed. As the majority of previously referred patients could not be contacted by phone, current approaches to patient engagement are not effective for reaching these populations. Expansion of HCV care to primary care settings with an established patient-provider relationship or co-located treatment within substance use treatment programs may serve to increase access to HCV treatment.

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Hepatitis C Management Simplification From Test to Cure: A Framework for Primary Care Providers

Cited by 44 publications

References 46 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

A qualitative study of perceived barriers to hepatitis C care among people who did not attend appointments in the non-urban U.S. South

A qualitative study of perceived barriers to hepatitis C care among people who did not attend appointments in the non-urban U.S. South

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