Perceived barriers related to testing, management and treatment of HCV infection among physicians prescribing opioid agonist therapy: The C‐SCOPE Study

Abstract

The aim of this analysis was to evaluate perceived barriers related to HCV testing, management and treatment among physicians practicing in clinics offering opioid agonist treatment (OAT). C‐SCOPE was a study consisting of a self‐administered survey among physicians practicing at clinics providing OAT in Australia, Canada, Europe and the United States between April and May 2017. A 5‐point Likert scale (1 = not a barrier, 3 = moderate barrier, 5 = extreme barrier) was used to measure responses to perceived barriers for HCV testing, evaluation and treatment across the domains of the health system, clinic and patient. Among the 203 physicians enrolled (40% USA, 45% Europe, 14% Australia/Canada), 21% were addiction medicine specialists, 29% psychiatrists and 69% were metro/urban. OAT physicians in this study reported poor access to on‐site venepuncture (35%), point‐of‐care HCV testing (16%), and noninvasive liver disease assessment (25%). Only 30% of OAT physicians reported personally treating HCV infection. Major perceived health system barriers to HCV management included the lack of funding for noninvasive liver disease testing, long wait times to see an HCV specialist, lack of funding for new HCV therapies, and reimbursement restrictions based on drug/alcohol use. Major perceived clinic barriers included the lack of peer support programmes and/or HCV case managers to facilitate linkage to care, the need to refer people off‐site for noninvasive liver disease staging, the lack of support for on‐site phlebotomy and the lack of on‐site delivery of HCV therapy. This study highlights several important modifiable barriers to enhance HCV testing, evaluation and treatment among PWID attending OAT clinics.

Hepatitis C cure improved patient‐reported outcomes in patients with and without liver fibrosis in a prospective study at a large urban medical center

“…Much wider use of these treatments will be needed to achieve national and international public health goals for HCV elimination. Fear of treatment‐related side effects, a legacy of the interferon therapy, is a barrier to accessing DAA treatment that has been reported by both patients and providers . Our study demonstrated that HCV cure leads to significant improvements in 24 of 25 PROs in real‐world patients.…”

“…Fear of treatment-related side effects, a legacy of the interferon therapy, is a barrier to accessing DAA treatment that has been reported by both patients and providers. 11,12 Our study demonstrated that HCV cure leads to significant improvements in 24 of 25 PROs in real-world patients. The increases exceeded 5% (considered to be a meaningful clinical change 14 ) in 23 of the domains and included a 30% improvement in the SF-36 vitality score.…”

“…Multiple investigations demonstrated that interferon‐based therapy further decreased (worsened) PRO scores and work‐related productivity during treatment . The intense side effects of interferon‐based therapy are widely known and are cited by both patients and providers as a source of fear that creates a barrier to accessing DAA‐based therapy …”

“…[8][9][10] The intense side effects of interferon-based therapy are widely known and are cited by both patients and providers as a source of fear that creates a barrier to accessing DAA-based therapy. 11,12 DAAs, which are now the standard of care, improved PROs by sustained virologic response (SVR)12 when directly compared to interferon-based regimens. [8][9][10]13 These results are important; however, most studies examining the relationship between DAA treatment and PROs were carried out on patients enrolled in pharmaceutical registration trials, which may limit their generalizability.…”

Macro-efforts for the micro-elimination of hepatitis C targeting people who inject drugs

“…Belonging to the category of PWID was not uncommonly associated with lower likelihood of access to DAAs (Rivero-Juarez et al, 2019). Physicians delivering opioid agonist treatment experienced barriers in providing HCV testing and management in Australia, Canada, Europe and US (Litwin et al, 2019). Strategies focusing on PWID were largely absent in developing countries, as reported in a study covering Eastern Europe and Asia (Luhmann et al, 2015).…”