The Australasian Hepatology Association consensus guidelines for the provision of adherence support to patients with hepatitis C on direct acting antivirals

Richmond, Jacqui; Sheppard‐Law, Suzanne; Mason, Susan A.; Warner, Sherryne

doi:10.2147/ppa.s117757

Cited by 13 publications

(19 citation statements)

References 53 publications

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“…It is important to connect patients to social support organizations when needed. The involvement of pharmacies to provide daily doses for some patients, especially for those who are receiving opioid substitution therapy from community pharmacies, may improve patients’ adherence to treatment …”

Section: Discussionmentioning

confidence: 99%

Enablers and barriers for the provision of community‐based HCV treatment: A case study of a real‐world practice

Pourmarzi

Smirnov

Hall

et al. 2020

Journal of Viral Hepatitis

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Background Although the availability of fully funded direct‐acting antivirals (DAAs) and the eligibility of primary care providers (PCPs) to provide hepatitis C virus (HCV) have removed barriers related to access to hospital‐based HCV treatment in Australia, there are still many barriers to the provision of HCV treatment in community settings. There is a lack of knowledge regarding the barriers to, and enablers of HCV treatment in community settings in Australia. This study aimed to identify barriers and enablers for the provision of community‐based HCV treatment. Methods This study was a part of a mixed‐method case study of the Cure‐It programme. The programme was studied to better understand barriers and enablers experienced by stakeholders of such programmes. The programme is delivered through the Prince Charles Hospital in Brisbane, Australia, and aimed to improve access to HCV treatment in community settings. Data were collected using semi‐structured interviews with 12 healthcare providers and nine patients between July and December 2018. Purposive sampling was used to ensure diverse views were captured. The interview transcripts were analysed using inductive thematic analysis. Results Ease of access to specialist support, easy and high value treatment, co‐location with or providing other services and motivated patients enabled PCPs to be engaged with the Cure‐It programme. Several interconnected factors related to patients’ characteristics and health system acted synergistically to enable patients to initiate and complete treatment. These included a desire to remove HCV as a source of shame, having children, awareness of HCV consequences, access to DAAs for free, ease of access to general practices and drug and alcohol services, and access to a safe and enabling environment. The identified barriers were interconnected at the levels of patients, PCPs and primary care systems and acted synergistically to prevent patients and PCPs from becoming engaged with HCV treatment. PCPs’ related barriers included a lack of knowledge, their perception of HCV as a specialist area and of patients with HCV as ‘hard to manage’ patients along with the practice preferences and priorities. Patients’ related barriers included their socioeconomic characteristics, internalized stigma, perception of not being sick and lack of knowledge. Additionally, the unavailability of support for patients and existence of stigma in primary health care, along with poor communication between the hospital and primary care system, and the unavailability of FibroScan® in primary care discouraged PCPs and patients engagement specifically with the provision of community‐based HCV treatment. Conclusion Various strategies are needed to improve PCPs and patients’ knowledge and awareness of HCV treatment. Training and support for PCPs need to be easy to access and should cover both clinical and social aspect of HCV. Connecting PCPs to other related services may improve PCPs’ and patients’ engagement with HCV treatment.

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Section: Discussionmentioning

confidence: 99%

Enablers and barriers for the provision of community‐based HCV treatment: A case study of a real‐world practice

Pourmarzi

Smirnov

Hall

et al. 2020

Journal of Viral Hepatitis

View full text Add to dashboard Cite

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“…Nonetheless they indicated it was important to acknowledge the potential for DAA side effects, as this would enable people to plan and establish contingency plans for the treatment course and support adherence. Overall, adherence to the DAAs was not an issue of concern, in this study, participants described how they identified their own memory hooks and existing routines to support the daily administration of the DAAs [ 31 ]. However, these participants were particularly motivated to achieve a cure.…”

Section: Discussionmentioning

confidence: 99%

Achieving a hepatitis C cure: a qualitative exploration of the experiences and meanings of achieving a hepatitis C cure using the direct acting antivirals in Australia

Richmond

Ellard

Wallace

et al. 2018

Hepatology Medicine Policy

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BackgroundUniversal access to the hepatitis C direct acting antiviral (DAAs) regimens presents a unique opportunity to eliminate hepatitis C in Australia. Large numbers of Australians have already been cured using these treatments, however, the numbers presenting for treatment have begun to plateau. This study explored how people experienced and understood being cured of hepatitis C, with the aim of informing interventions to increase uptake of DAA treatment among people with hepatitis C.MethodsThis qualitative study used semi-structured interviews to explore the experiences of people with hepatitis C taking DAAs accessing both hospital and community clinics. Interviews were conducted 12 weeks after treatment completion. Participants were asked to reflect on their experience of living with hepatitis C, their reasons for seeking treatment, and their experience of, DAA treatments. Participants were also asked to reflect on the meaning of being cured, and how they shared this experience with their peers. Interviews were transcribed verbatim and key themes were identified using inductive thematic analysis.ResultsTwenty participants were interviewed. While participants described a range of physical health benefits of achieving a hepatitis C cure it was an improved sense of psychological wellbeing that had the most significant impact on participants’ lives. The majority described their relief about no longer living with the burden of an uncertain future due to anxiety about developing liver disease or cancer, as well as fear of infecting others. Participants who had a past history of injecting drug use, described being cured as a way to break the connection with their past. Participants who were current injectors raised concerns about re-infection.ConclusionFeeling “normal” and not infectious allows people to live with reduced psychological distress, in addition to the physical benefits of no longer being at risk of developing serious liver disease. Future engagement strategies targeting people who are not accessing hepatitis health care need to promote the lived experience of being cured and the substantial psychological, and physical health benefits, offered by achieving a cure. Interventions aimed at people who are currently injecting also need to highlight the availability of re-treatment in conjunction with primary prevention strategies.

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“…Adherence is defined by the WHO as “the extent to which a person’s behavior–taking medication, following a diet, and/or executing lifestyle changes–corresponds with agreed recommendations from a health care provider.” 58 Medication adherence, specifically, refers to the way patients take a prescribed medication, including the correct medication, dose, time, duration, as well as obtaining timely refills. 59 Medication adherence is particularly important in HIV, whereby poor adherence is associated with negative outcomes, including virologic failure and resistance. 60 Several interventions aimed at improving ART adherence have shown promise, 61 with those involving peer counseling and a mobile phone short message service delivery the most widely studied and implemented to date.…”

Section: Considering the Human Immunodeficiency Virus Care Cascade Asmentioning

confidence: 99%

Hepatitis C Virus Elimination in the Human Immunodeficiency Virus–Coinfected Population

Clement

Collins

Wilder

et al. 2018

Infectious Disease Clinics of North America

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The objective of this review is to consider how existing human immunodeficiency virus (HIV) infrastructure may be leveraged to inform and improve hepatitis C virus (HCV) treatment efforts in the HIV-HCV coinfected population. Current gaps in HCV care relevant to the care continuum are reviewed. Successes in HIV treatment are then applied to the HCV treatment model for coinfected patients. Finally, the authors give examples of HCV treatment strategies for coinfected patients in both domestic and international settings.

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The Australasian Hepatology Association consensus guidelines for the provision of adherence support to patients with hepatitis C on direct acting antivirals

Cited by 13 publications

References 53 publications

Enablers and barriers for the provision of community‐based HCV treatment: A case study of a real‐world practice

Enablers and barriers for the provision of community‐based HCV treatment: A case study of a real‐world practice

Achieving a hepatitis C cure: a qualitative exploration of the experiences and meanings of achieving a hepatitis C cure using the direct acting antivirals in Australia

Hepatitis C Virus Elimination in the Human Immunodeficiency Virus–Coinfected Population

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