Perceived Barriers to Hepatitis C Therapy for Patients Receiving Opioid Agonist Treatment

Zickmund, Susan; Campbell, S.; Tirado, Carlos; Zook, Carolyn L.; Weinrieb, Robert M.

doi:10.1097/adm.0b013e31825f491b

Cited by 13 publications

(21 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In their recent qualitative study carried out on patients receiving opioid agonist therapy who were offered HCV therapy, Zickmund et al . described antiviral therapies, poor relations with health providers and the lack of access to health care as the remaining critical barriers despite intense educational efforts. Patients' negative perceptions of HCV therapy are mainly influenced by their peer networks .…”

Section: Obstacles To Treatment Uptakementioning

confidence: 99%

Accessing Hepatitis C patients who are difficult to reach: it is time to overcome barriers

Bruggmann

2012

Journal of Viral Hepatitis

View full text Add to dashboard Cite

With the arrival of simple, efficient and safe interferon-free treatment regimens, hepatitis C virus (HCV) therapy will have the potential to be successfully used for the majority of infected patients and prevent the associated morbidity and mortality. With the current treatment uptake rates, only a very small proportion of HCV-infected patients are reached. Paradoxically, treatment rates are lowest in the most affected at-risk group - people who inject drugs (PWID) - which is the major driving force behind the spread of HCV infection. To conquer the increasing problem of HCV-related liver disease, many existing but modifiable obstacles, which prevent detection, assessment and treatment uptake, have to be overcome in this population. This review article summarizes the existing literature on the most relevant barriers preventing HCV care and describes measures to overcome these obstacles.

show abstract

Section: Obstacles To Treatment Uptakementioning

confidence: 99%

Accessing Hepatitis C patients who are difficult to reach: it is time to overcome barriers

Bruggmann

2012

Journal of Viral Hepatitis

View full text Add to dashboard Cite

show abstract

“…Social factors, including stigma related to HCV and substance use, act as system- and provider-level barriers to HCV treatment (Butt, 2008; Harris and Rhodes, 2013; Lekas et al, 2011; Sgorbini et al, 2009; Swan et al, 2010; Treloar et al, 2013; Zickmund et al, 2003, 2012). Health-care settings, in particular, are frequently associated with HCV-related stigma and discrimination by current and former substance users (Harris and Rhodes, 2013).…”

Section: Introductionmentioning

confidence: 99%

“Hepatitis C treatment turned me around:” Psychological and behavioral transformation related to hepatitis C treatment

Batchelder

Peyser

Nahvi

et al. 2015

Drug and Alcohol Dependence

View full text Add to dashboard Cite

Background Hepatitis C (HCV) is a significant public health problem that primarily affects current and former substance users. However, individuals with a history of substance use are less likely to have access to or engage in HCV care. Psychological and behavioral barriers prevent many HCV-infected individuals from initiating or engaging in HCV treatment. This study aimed to investigate the psychological and behavioral experiences of current and former substance users receiving HCV treatment within a combined methadone and primary care clinic in the United States. Methods We conducted 31 semi-structured qualitative interviews with opioid-dependent adults enrolled in an integrated HCV treatment program within a methadone maintenance clinic in the Bronx, NY. We used thematic analysis, informed by grounded theory, and inquired about perceptions of HCV before and after initiating HCV treatment, reasons for initiating HCV treatment, and the decision to participate in individual versus group HCV treatment. Results Participants described psychological and behavioral transformation over the course of HCV treatment. These included reductions in internalized stigma and shame related to HCV and addiction, increases in HCV disclosure and self-care, reductions in substance use, and new desire to help others who are living with HCV. Conclusions Integrating HCV treatment with methadone maintenance has the potential to create psychological and behavioral transformations among substance using adults, including reductions in HCV- and addiction-related shame and improvements in overall self-care.

show abstract

“…Although similar in effect to comparable interventions linking individuals to HIV care, it is noteworthy that less than half of NCM participants and only one‐quarter of UC participants attended an HCV appointment, despite >70% having a referral to HCV care. Patient self‐scheduling specialty appointments are a known barrier to engaging in care . The NCM intervention bypassed the scheduling barrier, but persistently low scheduling and attendance rates underscore a need to expand HCV treatment to nonspecialist or community‐based providers who may already have trusting relationships with patients and are equally effective in achieving sustained virologic response (SVR) compared to HCV specialists .…”

Section: Discussionmentioning

confidence: 99%

“…Uncontrolled HIV is associated with not being prescribed DAAs, despite evidence of high cure rates and HCV treatment guidelines that recommend prioritizing treatment for PLWH . Other barriers to engaging in HCV care include comorbidities and competing priorities such as substance use, poor access to specialty care, navigating the healthcare system, low knowledge and perceived threat of HCV, lack of provider expertise and nonreferral to specialty care by primary care providers . High prevalence of drug interactions between antiretroviral therapy (ART) and DAAs which may necessitate modification of ART regimens has introduced an additional barrier to initiating HCV treatment among PLWH …”

Section: Introductionmentioning

confidence: 99%

Nurse case management to improve the hepatitis C care continuum in HIV co‐infection: Results of a randomized controlled trial

Starbird

Budhathoki

Han

et al. 2019

Journal of Viral Hepatitis

View full text Add to dashboard Cite

The opportunity to eliminate hepatitis C virus (HCV) is at hand, but challenges remain that negatively influence progress through the care continuum, particularly for persons co‐infected with HIV who are not well engaged in care. We conducted a randomized controlled trial to test the effect of nurse case management (NCM) on the HCV continuum among adults co‐infected with HIV compared to usual care (UC). Primary outcomes included linkage to HCV care (attendance at an HCV practice appointment within 60 days) and time to direct‐acting antiviral (DAA) initiation (censored at 6 months). Sixty‐eight participants were enrolled (NCM n = 35; UC n = 33). Participants were 81% Black/African American, 85% received Medicaid, 46% reported illicit drug use, 41% alcohol use, and 43% had an undetectable HIV viral load. At day 60, 47% of NCM participants linked to HCV care compared to 25% of UC participants (P = .031; 95% confidence bound for difference, 3.2%‐40.9%). Few participants initiated DAAs (12% NCM; 25% UC). There was no significant difference in mean time to treatment initiation (NCM = 86 days; UC = 110 days; P = .192). Engagement in HCV care across the continuum was associated with drinking alcohol, knowing someone who cured HCV and having a higher CD4 cell count (P < .05). Our results support provision of NCM as a successful strategy to link persons co‐infected with HIV to HCV care, but interventions should persist beyond linkage to care. Capitalizing on social networks, treatment pathways for patients who drink alcohol, and integrated substance use services may help improve the HCV care continuum.

show abstract

Perceived Barriers to Hepatitis C Therapy for Patients Receiving Opioid Agonist Treatment

Abstract: Despite intense educational efforts, concerns over antiviral therapy, relations with providers, and access to the health care system remain critical barriers. These factors should be addressed to improve antiviral therapy rates for patients receiving opioid agonist treatment.

Cited by 13 publications

References 36 publications

Accessing Hepatitis C patients who are difficult to reach: it is time to overcome barriers

Accessing Hepatitis C patients who are difficult to reach: it is time to overcome barriers

“Hepatitis C treatment turned me around:” Psychological and behavioral transformation related to hepatitis C treatment

Nurse case management to improve the hepatitis C care continuum in HIV co‐infection: Results of a randomized controlled trial

Contact Info

Product

Resources

About