Individual and network factors associated with HCV treatment uptake among people who inject drugs

Falade‐Nwulia, Oluwaseun; Sacamano, Paul; McCormick, Sean D.; Yang, Cui; Kirk, Greg; Thomas, David L.; Sulkowski, Mark S.; Latkin, Carl A.; Mehta, Shruti H.

doi:10.1016/j.drugpo.2020.102714

Cited by 20 publications

(14 citation statements)

References 47 publications

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“…The importance of peer and social supports was further echoed in participants’ descriptions of community members as trusted sources of knowledge who essentially vouched for DAAs, such as by alleviating potential concerns (e.g., related to side effects and eligibility) and by substantiating the safety and effectiveness of novel treatments. These findings align with recent research underscoring the influence of peers (i.e., other PWID with lived experience of HCV) on health seeking behaviours and the spread of health information, particularly in regard to DAA treatments [ 20 , 83 – 85 ]. To further promote linkages to HCV care and the equitable scale-up of DAAs among PWID, additional public health efforts to implement and optimize peer-driven and network-based interventions are warranted.…”

Section: Discussionsupporting

confidence: 87%

“I want to get better, but…”: identifying the perceptions and experiences of people who inject drugs with respect to evolving hepatitis C virus treatments

Goodyear

Brown

Browne

et al. 2021

Int J Equity Health

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Background The advent of highly tolerable and efficacious direct-acting antiviral (DAA) medications has transformed the hepatitis C virus (HCV) treatment landscape. Yet, people who inject drugs (PWID) – a population with inequitably high rates of HCV and who face significant socio-structural barriers to healthcare access – continue to have disproportionately low rates of DAA uptake. The objective of this study is to explore how PWID with lived experience of HCV perceive and experience DAA treatment, in a setting with universal coverage of these medications since 2018. Methods Informed by a critical interpretive framework, we thematically analyze data from in-depth, semi-structured interviews conducted between January and June 2018 in Vancouver, Canada, with a purposive sample (n = 56) of PWID at various stages (e.g., pre, peri, post) of DAA treatment. Results The analysis yielded three key themes: (i) life with HCV, (ii) experiences with and perceptions of evolving HCV treatments, and (iii) substance use and the uptake of DAA treatments. First, participants described how health and healthcare conditions, such as the deprioritizing of HCV (e.g., due to: being asymptomatic, healthcare provider inaction, gatekeeping) and catalysts to care (e.g., symptom onset, treatment for co-morbidities) shaped DAA treatment motivation and access. Second, participants described how individual and community-level accounts of evolving HCV treatments, including skepticism following negative experiences with Interferon-based treatment and uncertainty regarding treatment eligibility, negatively influenced willingness and opportunities to access DAAs. Concurrently, participants described how peer and community endorsement of DAAs was positively associated with treatment uptake. Third, participants favoured HCV care that was grounded in harm reduction, which included the integration of DAAs with other substance use-related services (e.g., opioid agonist therapy, HIV care), and which was often contrasted against abstinence-focused care wherein substance use is framed as a contraindication to HCV treatment access. Conclusions These findings underscore several equity-oriented healthcare service delivery and clinician adaptations that are required to scale up DAAs among PWID living with HCV, including the provision of harm reduction-focused, non-stigmatizing, integrated, and peer-led care that responds to power differentials.

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Section: Discussionsupporting

confidence: 87%

“I want to get better, but…”: identifying the perceptions and experiences of people who inject drugs with respect to evolving hepatitis C virus treatments

Goodyear

Brown

Browne

et al. 2021

Int J Equity Health

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“…A recent systematic review emphasized how peer support and connection to relevant services bolsters community‐based HCV treatment initiation and completion 40 . Indeed, factors such as housing, finances, legal difficulties and drug use have repeatedly been cited as barriers for people living with HCV to engaging with care 28,41–43 . As part of the HCV treatment triumvirate, the provision of holistic support is therefore indispensable, and integrating that support into increasingly simplified and shortened treatment pathways will be an essential challenge moving forward.…”

Section: Discussionmentioning

confidence: 99%

Provider‐related barriers and enablers to the provision of hepatitis C treatment by general practitioners in Scotland: A behaviour change analysis

Whiteley

Speakman

Elliott

et al. 2020

Journal of Viral Hepatitis

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The ease of direct‐acting antiviral (DAA) medications for hepatitis C virus (HCV) has provided an opportunity to decentralize HCV treatment into community settings. However, the role of non‐specialist clinicians in community‐based pathways has received scant attention to date. This study examined barriers and enablers to expanding the role of general practitioners (GPs) in HCV treatment provision, using simple behaviour change theory as a conceptual framework. A maximum variation sample of 22 HCV treatment providers, GPs and HCV support workers participated in semi‐structured interviews. Data were inductively coded, and the resulting codes deductively mapped into three principal components of behaviour change: capability, opportunity and motivation (COM‐B). By this process, a number of provider‐ and systemic‐level barriers and enablers were identified. Key barriers included the pre‐treatment assessment of liver fibrosis, GP capacity and the ‘speciality’ of HCV care. Enablers included the simplicity of the drugs, existing GP/patient relationships and the provision of holistic care. In addition to these specific factors, the data also exposed an overarching provider understanding of ‘HCV treatment’ as triumvirate in nature, incorporating the assessment of liver fibrosis, the provision of holistic support and the treatment of disease. This understanding imposes a further fundamental barrier to GP‐led treatment as each of these three components needs to be individually addressed. To enable sustainable models of HCV treatment provision by GPs, a pragmatic re‐examination of the ‘HCV treatment triumvirate’ is required, and a paradigm shift from the ‘refer and treat’ status quo.

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“…We know that peers in PWID networks share their experiences with one another, acting as sources of knowledge on health-related matters (Falade-Nwulia et al 2020). In the advent of new guidelines easing DAA treatment criteria for many PWID in most Canadian settings, updating local knowledge of HCV and treatment eligibility is vitally important to increasing treatment uptake.…”

Section: Reshaping the Narrative Of Hcv Care Among Young Pwid Networkmentioning

confidence: 99%

“…Outdated information about the interferon medication and its associated side effects is still prevalent and can negatively impact treatment uptake (Jost et al 2019). Thus, sharing the latest information among peers can be an avenue through which treatment uptake can be improved (Falade-Nwulia et al 2020), given that those sharing the knowledge have lived experience with the process, access to new information, and opportunities to navigate the health care system (Richmond et al 2018;Falade-Nwulia et al 2020).…”

Section: Reshaping the Narrative Of Hcv Care Among Young Pwid Networkmentioning

confidence: 99%

Will peer-based interventions improve hepatitis C virus treatment uptake among young people who inject drugs?

Jacob

Knight

2020

Can J Public Health

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People who inject drugs (PWID) are disproportionately affected by hepatitis C virus (HCV) and have low rates of direct-acting antiviral (DAA) treatment uptake, despite universal coverage of the medication in most Canadian settings. Investigation into peer-based interventions as a means of improving treatment uptake has yielded promising results in adult PWID populations. In this commentary, we discuss the benefits and considerations of integrating peer-based interventions into HCV care for adolescent and young adult PWID living with HCV. Given that young PWID experience high transmission rates and account for most new infections, improving strategies for youth engagement with DAA treatment is critical. We describe how peer-based interventions can feature the unique importance of peer relationships in this period of life and provide a low-barrier way of delivering health promotion messages. In particular, we discuss the ability of peer-based interventions to reshape the narrative of HCV care in young PWID peer networks by empowering youth to share experiences and knowledge with others. We conclude by addressing knowledge gaps in the literature which must be filled in order to strengthen the impact of peer-based interventions on treatment uptake rates among young PWID. RésuméLes personnes qui font usage de drogues par injection (PUDI) sont démesurément touchées par le virus de l'hépatite C (VHC) et présentent de faibles taux de recours aux traitements antiviraux à action directe (AAD), pourtant couverts par la plupart des régimes d'assurance-médicaments au Canada. Une enquête sur l'intervention par les pairs comme moyen d'améliorer le recours aux traitements a donné des résultats prometteurs dans des populations de PUDI adultes. Dans notre commentaire, nous expliquons les avantages d'intégrer l'intervention par les pairs dans les soins des adolescents et des jeunes adultes vivant avec le VHC qui font usage de drogues par injection, ainsi que les éléments à considérer. Comme les jeunes PUDI affichent des taux de transmission élevés et sont responsables de la plupart des nouveaux cas d'infection, il est essentiel d'améliorer les stratégies de recours aux traitements par AAD chez les jeunes. Nous expliquons que l'intervention par les pairs mise sur l'importance unique des égaux durant cette période de la vie et constitue un moyen « à bas seuil » de faire passer les messages de promotion de la santé. En particulier, nous expliquons que l'intervention par les pairs peut transformer le discours sur les soins du VHC dans les réseaux d'entraide de jeunes PUDI en donnant à ces jeunes le pouvoir de partager leur expérience et leurs connaissances avec d'autres. En conclusion, nous abordons les lacunes à combler dans la littérature scientifique pour renforcer l'impact de l'intervention par les pairs sur les taux de recours aux traitements chez les jeunes PUDI. KeywordsHepatitis C . Peer-based intervention . Young people who inject drugs . Treatment Mots-clés Hépatite C . intervention par les pairs . jeunes qui font usage de dr...

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Individual and network factors associated with HCV treatment uptake among people who inject drugs

Cited by 20 publications

References 47 publications

“I want to get better, but…”: identifying the perceptions and experiences of people who inject drugs with respect to evolving hepatitis C virus treatments

“I want to get better, but…”: identifying the perceptions and experiences of people who inject drugs with respect to evolving hepatitis C virus treatments

Provider‐related barriers and enablers to the provision of hepatitis C treatment by general practitioners in Scotland: A behaviour change analysis

Will peer-based interventions improve hepatitis C virus treatment uptake among young people who inject drugs?

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