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Brothers S, DiDomizio E, Nichols L, Brooks R, Villanueva M. Perceptions Towards HCV Treatment with Direct Acting Antivirals (DAAs): A Qualitative Analysis with Persons with HIV/HCV Co-infection Who Delay or Refuse Treatment. AIDS Behav 2023; 27:119-133. [PMID: 35776253 PMCID: PMC9663279 DOI: 10.1007/s10461-022-03749-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2022] [Indexed: 01/24/2023]
Abstract
In the United States, approximately 25% of people with HIV (PWH) are co-infected with hepatitis C (HCV). Since 2014, highly effective and well-tolerated direct-acting antivirals (DAAs) have revolutionized HCV treatment. Uptake of DAAs by people with HIV/HCV co-infection has improved but remains suboptimal due to system, provider, and patient-level barriers. To explore patient-level issues by better understanding their attitudes towards DAA treatment, we conducted qualitative interviews with 21 persons with HIV/HCV co-infection who did not consent to DAA treatment or delayed treatment for at least 1 year after diagnosis. We found PWH perceived DAA treatment barriers and facilitators on multiple levels of the social-ecological environment: the individual (HCV disease and treatment literacy), interpersonal (peer influence), institutional (media and healthcare provider relationship), and structural levels (treatment cost and adherence support). Recommendations to improve DAA treatment uptake include HCV-treatment adherence support, HCV disease and treatment literacy training (particularly for substance use and DAA treatment interactions), and encouraging PWH who have successfully completed DAA treatment to speak with their peers.
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Affiliation(s)
- Sarah Brothers
- Department of Sociology, Pennsylvania State University, 316 Oswald Tower, University Park, PA, 16802, USA.
- HIV/AIDS Program, Yale University School of Medicine, Section of Infectious Diseases, New Haven, CT, USA.
| | - Elizabeth DiDomizio
- HIV/AIDS Program, Yale University School of Medicine, Section of Infectious Diseases, New Haven, CT, USA
| | - Lisa Nichols
- HIV/AIDS Program, Yale University School of Medicine, Section of Infectious Diseases, New Haven, CT, USA
| | - Ralph Brooks
- HIV/AIDS Program, Yale University School of Medicine, Section of Infectious Diseases, New Haven, CT, USA
| | - Merceditas Villanueva
- HIV/AIDS Program, Yale University School of Medicine, Section of Infectious Diseases, New Haven, CT, USA
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Norwood J, Kheshti A, Shepherd BE, Rebeiro PF, Ahonkhai A, Kelly S, Wanjalla C. The Impact of COVID-19 on the HIV Care Continuum in a Large Urban Southern Clinic. AIDS Behav 2022; 26:2825-2829. [PMID: 35194699 PMCID: PMC8863570 DOI: 10.1007/s10461-022-03615-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2022] [Indexed: 11/18/2022]
Abstract
Access to care is essential for people with HIV (PWH) but may have been affected during the COVID-19 pandemic. We conducted a retrospective cross-sectional study of adult PWH receiving care in a large southeastern comprehensive care clinic in the United States. Patients in care between January 1, 2017, and July 30, 2020, were included. Race/ethnicity, sex, HIV-1 RNA, CD4 + lymphocyte count were included as baseline covariates. Outcomes included clinic attendance, receipt of HIV-1 RNA PCR testing, and virologic suppression (HIV-1 RNA < 200 copies/mL); outpatient encounters included new patient encounters, follow-up visits, and mental health encounters. Total medical encounters, including telemedicine, decreased by 827 visits (33%) when comparing the second quarters of 2019 and 2020. New patient encounters decreased by 23.5% from 81 to 62 during this period. The second quarter of 2020 saw the lowest number of new patient visits since 2017. HIV-1 RNA testing and the proportion of patients with virologic suppression decreased during the pandemic (p < 0.001 for both). Total mental health encounters, on the other hand, increased by 14% during April-June 2020 compared to April-June 2019. Mental health electronic communications increased by 60% from 312 to 500 during the same period, with a 20% increase in medication refills. The COVID-19 pandemic affected outpatient visits, viral load surveillance, and virologic suppression but led to an increase in mental health encounters in a comprehensive care clinic setting.
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Affiliation(s)
- Jamison Norwood
- Division of Infectious Disease, Department of Medicine, Vanderbilt University Medical Center, A-2200 MCN, 1161 21st Ave S., Nashville, TN, 37232-2582, USA.
| | - Asghar Kheshti
- Division of Infectious Disease, Department of Medicine, Vanderbilt University Medical Center, A-2200 MCN, 1161 21st Ave S., Nashville, TN, 37232-2582, USA
| | - Bryan E Shepherd
- Department of Biostatistics, Vanderbilt University, Nashville, TN, USA
| | - Peter F Rebeiro
- Division of Infectious Disease, Department of Medicine, Vanderbilt University Medical Center, A-2200 MCN, 1161 21st Ave S., Nashville, TN, 37232-2582, USA
- Department of Biostatistics, Vanderbilt University, Nashville, TN, USA
| | - Aimalohi Ahonkhai
- Division of Infectious Disease, Department of Medicine, Vanderbilt University Medical Center, A-2200 MCN, 1161 21st Ave S., Nashville, TN, 37232-2582, USA
| | - Sean Kelly
- Division of Infectious Disease, Department of Medicine, Vanderbilt University Medical Center, A-2200 MCN, 1161 21st Ave S., Nashville, TN, 37232-2582, USA
| | - Celestine Wanjalla
- Division of Infectious Disease, Department of Medicine, Vanderbilt University Medical Center, A-2200 MCN, 1161 21st Ave S., Nashville, TN, 37232-2582, USA.
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