Improving support and education of low‐income baby boomers diagnosed with chronic hepatitis C virus infection through universal screening

Abstract

Aims and objectives The objective of this study was to identify support needs of low income baby boomers recently diagnosed with chronic hepatitis C virus infection. Background The United States Preventive Services Task Force has endorsed one-time screening of all baby boomers (born 1945 to 1965) for hepatitis C because 75% of the estimated 2 to 3 million persons with chronic infection are in this age range. We hypothesized that persons diagnosed by routine screening would have significant psycho-emotional, cognitive, and health care challenges that need to be met by collaborative care and services from nurses and other health care personnel. Design Qualitative descriptive study of data from three focus groups with predominantly minority participants (N=16). Data were analyzed using qualitative content analysis, transcribed data were categorized by 3 domains in a previously developed model and a new domain identified in this study. Frequencies of unique participants’ comments about each theme were calculated. Results Elucidated domains were: 1) psycho-emotional effects due to social stigma, shame, fear, dealing with risky behaviors; 2) social effects due to concerns about infecting others; and 3) cognitive deficits because of poor understanding about HCV infection and its care. A new domain related to health care emerged reflecting the following themes: poor access to care, barriers to costly treatment, and navigating complex care for comorbidities. Despite these challenges, participants strongly endorsed universal baby boomer hepatitis C virus screening. Conclusion This study describes psycho-emotional and social challenges of people dealing with a hepatitis C diagnosis that are compounded by poor knowledge and barriers to supportive care. Relevance to clinical practice Nursing and other allied health personnel require structured support programs to assist older persons diagnosed with hepatitis C with addressing these common challenges with the ultimate goal of achieving a cure.

Patient and provider‐level barriers to hepatitis C screening and linkage to care: A mixed‐methods evaluation

“…Prior literature suggests that more modest designs that emphasize EHR‐based tools can also achieve remarkable increases in screening and linkage to care 12‐ . However, additional evidence‐based interventions such as reflex RNA testing among patients with positive antibody results, patient navigation 15 and case management 16 may further enhance HCV screening and linkage to care.…”

“…For example, patients need greater assurance that currently available treatments have dramatically increased the likelihood of being cured. Additional support for emotional and social challenges need to be provided such as assisting low‐income older adults with more comorbidities and/or barriers in access to care 16 . Similarly, continued knowledge gaps among patients, particularly those earlier in the screening process, highlight an opportunity for better patient education when interfacing with primary care providers.…”

“…Additional support for emotional and social challenges need to be provided such as assisting low-income older adults with more comorbidities and/or barriers in access to care. 16 Similarly, continued knowledge gaps among patients, particularly those earlier in the screening process, highlight an opportunity for better patient education when interfacing with primary care providers. It is pos- and (c) enlisting nurses in primary care clinics to pend orders during intake for patients with incomplete HCV screening results (eg antibody-reactive result with no confirmatory HCV test).…”

CDC Recommendations for Hepatitis C Screening Among Adults — United States, 2020

“…No study compared harms systematically using comparison groups associated with different screening approaches. Harms informed by the alladult review included physical harms of screening (two studies) (48,49); anxiety/stress related to testing or waiting for results (five studies) (49-53); cost (one study) (54); anxiety related to receiving positive results (one study) (55); interpersonal outcomes (e.g., problems related to family, friends from learning HCV infection status) (five studies) (51,(55)(56)(57)(58); attitudes toward persons with hepatitis C, including stigma (11 studies) (49,55,(57)(58)(59)(60)(61)(62)(63)(64)(65); time for screening (two studies) (49,66); and false-positive results, including among left ventricular assist device patients, possibly precluding heart transplantation (six studies) (67)(68)(69)(70)(71)(72). Harms informed by the pregnancy review included physical harms of screening (one study) (73), anxiety (five studies) (74)(75)(76)(77)(78), stigma (one study) (77), psychological issues (two studies) (73,79), fears related to sexual relationships (one study) (80), legal ramifications and potential loss of infant custody (one study) (81), decreased quality of life (one study) (82), social repercussions (one study)…”

Integrating Management of Hepatitis C Infection into Primary Care: the Key to Hepatitis C Elimination Efforts

“…50 Studies have identified psycho-emotional and social challenges that reflect poor knowledge and barriers to supportive care of patients who have been newly diagnosed with chronic HCV. 51 Thus, patients with chronic HCV need to be offered educational resources that can be efficiently provided on a mobile app to address these issues. 21,52 Barrier #2: Linkage to HCV Care.…”