Reasons for Not Seeking Hepatitis C Treatment among People Who Inject Drugs

Morris, Leith; Williams, Owain David; Gilks, Charles F.; Smirnov, Andrew

doi:10.1080/10826084.2020.1846198

Cited by 6 publications

(6 citation statements)

References 39 publications

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“…However, suboptimal knowledge such as unawareness about DAA treatment hindered some participants from seeking treatment. This is also in line with the literature 48 . Thus, given the WHO target plan for 2030, it seems appropriate for health care providers to repeatedly ask patients about their specific knowledge and correct it in case of misinformation.…”

Section: Discussionsupporting

confidence: 78%

Initiation of oral hepatitis C virus treatment: Which barriers are pertinent for ambulatory individuals with a history of illicit substance use? A qualitative interview study

Barbati,

Strasser,

Allemann

et al. 2024

Health Science Reports

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Background and AimsThe World Health Organization has set a goal to eradicate hepatitis C virus (HCV) by the year 2030. Nonadherence to HCV treatment has substantial economic implications due to high treatment costs, among others. Barriers to start HCV treatment may be critical. The aim of this study was to assess pertinent barriers to HCV treatment in ambulatory patients with a history of illicit substance use and to compare them to the literature.MethodsBarriers to HCV treatment mentioned by the key risk group (i.e., people who inject drugs) were retrieved from literature through a pragmatic literature search. From 34 published articles, we identified 80 modifiable barriers that were bundled in 23 items within the four topics “Personal difficulties and barriers to treatment,” “Personal motivation to be treated,” “Knowledge about the disease,” and “Received information about the medicine.” In‐depth semistructured interviews were performed face‐to‐face with ambulatory patients from the University Psychiatric Clinics in Basel, Switzerland. Transcripts were coded inductively.ResultsInterviews were performed with seven individuals (mean age: 48.3 years; range: 38–63 years; one woman) treated with oral direct‐acting antivirals between 2014 and 2022. Thirteen barriers to start HCV treatment were mentioned that corresponded to the five categories: information, attitudes, swallowing difficulties, social environment, and unfavorable lifestyle. The barrier “swallowing difficulties” emerged exclusively from the statements provided by the interviewees.ConclusionBarriers to the initiation of HCV treatment indicated by our interviewees clearly differed from the literature. Notably, the challenge of swallowing medicines may be particularly relevant for physicians prescribing and pharmacists dispensing HCV medication.

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Section: Discussionsupporting

confidence: 78%

Initiation of oral hepatitis C virus treatment: Which barriers are pertinent for ambulatory individuals with a history of illicit substance use? A qualitative interview study

Barbati,

Strasser,

Allemann

et al. 2024

Health Science Reports

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“…Among Aboriginal people, return for follow‐up was positively associated with older age and negatively associated with unknown current injecting drug use status; return for follow‐up was not associated with other individual or structural factors. The negative association with unknown injecting status may reflect lower engagement with health services resulting in incomplete data or stigma associated with injecting drug use and a reluctance to disclose to health services 21,22 . Shame and stigma are commonly cited barriers for Aboriginal people in accessing healthcare, including HCV care and harm reduction services 16,23–25 .…”

Section: Discussionmentioning

confidence: 99%

“…The negative association with unknown injecting status may reflect lower engagement with health services resulting in incomplete data or stigma associated with injecting drug use and a reluctance to disclose to health services. 21,22 Shame and stigma are commonly cited barriers for Aboriginal people in accessing healthcare, including HCV care and harm reduction services. 16,[23][24][25] Expansion of culturally safe harm reduction and HCV prevention strategies for Aboriginal people who inject drugs, including tailored needle and syringe programmes, opioid agonist therapy and HCV education, may assist in preventing primary infection and reinfection.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of direct‐acting antiviral therapy among Aboriginal and Torres Strait Islander peoples with HCV infection in Australia: A national real‐world cohort (REACH‐C)

Hudson‐Buhagiar

Carson

Monaghan

et al. 2023

Journal of Viral Hepatitis

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Aboriginal and Torres Strait Islander peoples experience a disproportionate burden of hepatitis C virus (HCV) infection. This study assessed the effectiveness of direct‐acting antiviral (DAA) therapy among Aboriginal peoples in the three years following universal access in Australia. REACH‐C, a national multicentre prospective cohort study, evaluated HCV treatment outcomes from sequential DAA initiations across 33 health services between March 2016 and June 2019. DAA effectiveness was assessed by sustained virological response (SVR) in the total (full analysis set) and effectiveness (modified analysis set excluding those lost to follow‐up) populations. Overall, 915 (10%) Aboriginal and 8095 (90%) non‐Indigenous people commenced DAA therapy, of whom 30% and 16% reported current injecting drug use and 73% and 42% were treated in primary care, respectively. SVR in the total and effectiveness populations was 74% and 94% among Aboriginal people and 82% and 94% among non‐Indigenous people, with loss to follow‐up contributing to lower SVR in the total population analysis (22% Aboriginal, 13% non‐Indigenous). Among Aboriginal people, returning for follow‐up was positively associated with older age (aOR 1.20; 95% CI 1.04, 1.39) and SVR was negatively associated with cirrhosis (aOR 0.39; 95% CI 0.19, 0.80) and prior DAA treatment (aOR 0.14; 95% CI 0.04, 0.49). Factors reflecting higher vulnerability or inequity were not associated with returning for testing or SVR. DAA therapy was highly effective among Aboriginal peoples with HCV treated through primary and tertiary services. Tailored community‐led interventions are necessary to optimize follow‐up and engagement. Sustained DAA uptake and equitable access to care, treatment and prevention are required for HCV elimination.

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“…This findings are consistent with the previous trials, demonstrated that continuity of substitutional therapy was independent predictor of getting anti-HCV treatment, while ongoing drug use and unstable housing were often cited as the main reasons for inability or unwillingness of the patients to undergo HCV treatment. [33][34][35] We will continue follow up after the study participants to detect long time re-infection risk and evaluate possible impact of HCV eradication on drug use practices and risky behavior.…”

Section: Discussionmentioning

confidence: 99%

Hepatitis C Virus Elimination in Methadone-treated Patients: Implementation of Hepatology Clinic in a Methadone Treatment Program

Katchman

Adelson²,

Avitan³

et al. 2022

J Addict Med

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ObjectivesPatient ignorance and bureaucratic obstacles prevent initiation of hepatitis C virus (HCV) treatment in patients participating in methadone treatment program. Despite high safety and efficacy of currently available oral medications, the rate of patient-initiated treatment remains low. We evaluated the impact of an interventional program on treatment success rate and factors associated with treatment engagement.MethodsAn intervention performed from 2018 to 2020 included an on-site Fibroscan and hepatologist evaluation, anti-viral HCV treatment initiation, and close support and follow-up by a dedicated team. Demographic and medical data were collected and comparison between patients who completed vs. patients who did not complete HCV treatment was done.ResultsFifty-nine out of 74 HCV polymerase chain reaction-positive patients (79.7%) were willing and capable of undergoing on-site hepatologist and Fibroscan evaluations. Twelve (25%) of the participants had cirrhosis, 2 of whom were decompensated. Fifty of the 57 patients that got an anti-viral medication prescription (87%) initiated the treatment. Premature treatment discontinuation was rare (3 patients), intention-to-treat sustain virologic response (SVR) rate was 81% and per-protocol SVR rate was 97%. The rate of treatment initiation during the intervention was significantly higher than the patients’ self-initiation rate (44 vs 12 patients). The main factors associated with successful completion of the care cascade was full abstinence from street drugs for 6 months before treatment initiation.ConclusionsInstalling a hepatology clinic in an methadone treatment program center was associated with a 3-fold increase in the HCV treatment, with high adherence to treatment levels, and a high SVR rate. The main factor associated with low engagement to treatment was ongoing street drug use.

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Reasons for Not Seeking Hepatitis C Treatment among People Who Inject Drugs

Cited by 6 publications

References 39 publications

Initiation of oral hepatitis C virus treatment: Which barriers are pertinent for ambulatory individuals with a history of illicit substance use? A qualitative interview study

Initiation of oral hepatitis C virus treatment: Which barriers are pertinent for ambulatory individuals with a history of illicit substance use? A qualitative interview study

Effectiveness of direct‐acting antiviral therapy among Aboriginal and Torres Strait Islander peoples with HCV infection in Australia: A national real‐world cohort (REACH‐C)

Hepatitis C Virus Elimination in Methadone-treated Patients: Implementation of Hepatology Clinic in a Methadone Treatment Program

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