“I'm obviously not dying so it's not something I need to sort out today”: Considering hepatitis C treatment in the era of direct acting antivirals

Wright, Cassandra J. C.; Cogger, Shelley; Hsieh, Kai‐Sheng; Goutzamanis, Stelliana; Hellard, Margaret; Higgs, Peter

doi:10.1016/j.idh.2018.10.006

Cited by 25 publications

(22 citation statements)

References 27 publications

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“…Despite significant improvements in treatment efficacy and minimal side-effects of DAA treatments, barriers to treatment uptake PLOS ONE remain in the DAA era. Qualitative research findings suggest limited knowledge of symptoms of hepatitis C and new treatment options among PWID, as well as considerable clinician/provider barriers to treatment initiation [22]. Evidence also suggests large variations in treatment uptake across geographical areas in Australia, driven by population characteristics, health service access and disease burden.…”

Section: Discussionmentioning

confidence: 99%

The impact of universal access to direct-acting antiviral therapy on the hepatitis C cascade of care among individuals attending primary and community health services

et al. 2020

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Background Hepatitis C elimination will require widespread access to treatment and responses at the health-service level to increase testing among populations at risk. We explored changes in hepatitis C testing and the cascade of care before and after the introduction of direct-acting antiviral treatments in Victoria, Australia. Methods De-identified clinical data were retrospectively extracted from eighteen primary care clinics providing services targeted towards people who inject drugs. We explored hepatitis C testing within three-year periods immediately prior to (pre-DAA period) and following (post-DAA period) universal access to DAA treatments on 1 st March 2016. Among ever RNA-positive individuals, we constructed two care cascades at the end of the pre-DAA and post-DAA periods.

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Section: Discussionmentioning

confidence: 99%

The impact of universal access to direct-acting antiviral therapy on the hepatitis C cascade of care among individuals attending primary and community health services

et al. 2020

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“…In the HBM, perceived barriers to care are one of the strongest predictors of health behavior [36]. Housing instability, unreliable transportation, drug and alcohol use, and lack of insurance have all been previously identified to be barriers to care [12][13][14][15][16][17][18][19]37] and were common in our population. Lack of insurance and financial status were commonly perceived to be barriers, despite our clinic's ability to access treatment for all patients, regardless of insurance status.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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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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“…Poverty, homelessness, and unemployment also pose structural barriers for engagement in healthcare (13). Among these marginalized populations, the presence of effective treatment alone is not su cient to increase engagement with HCV care (14,15). This risk environment contributes to the high burden of HCV.…”

Section: Introductionmentioning

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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“I'm obviously not dying so it's not something I need to sort out today”: Considering hepatitis C treatment in the era of direct acting antivirals

Cited by 25 publications

References 27 publications

The impact of universal access to direct-acting antiviral therapy on the hepatitis C cascade of care among individuals attending primary and community health services

The impact of universal access to direct-acting antiviral therapy on the hepatitis C cascade of care among individuals attending primary and community health services

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