1
|
De La Hoz A, Graves K, Bernstein JA, Assoumou SA. HIV and hepatitis C virus-related misinformation may contribute to rising rates of infection and suboptimal clinical outcomes among persons with substance use. AIDS Care 2024:1-10. [PMID: 38991115 DOI: 10.1080/09540121.2024.2372730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 06/21/2024] [Indexed: 07/13/2024]
Abstract
HIV and hepatitis C virus (HCV) infection rates among persons, who use drugs, have risen during the US overdose crisis. We elicited patient perspectives about these interconnected infections to identify the areas of misinformation that might prevent appropriate management. We used in-depth interviews and thematic analysis of coded data collected from patients (N = 24) at detox and from key informants (N = 10). Seventy-one per cent reported injecting drugs. We found that patient narratives included misinformation about HIV and HCV transmission, natural history and treatment. Some participants thought that activities such as sharing drinkware or food with persons with HIV could lead to infection, while others believed that mainly men who have sex with men were at risk. Despite significant improvements in treatment, some participants still believed that HIV was a fatal condition, while others noted that treatment was only necessary at later stages. Some participants thought that HCV was a common, mild infection that might not need immediate attention, and others stated that individuals who were actively using drugs were ineligible for treatment. The current study exposes a considerable level of misinformation about HIV prevention and about the importance and benefits of HCV therapy. Educational interventions are necessary to counter misinformation identified.
Collapse
Affiliation(s)
- Alejandro De La Hoz
- Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA, USA
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Kristin Graves
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Judith A Bernstein
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Sabrina A Assoumou
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, MA, USA
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| |
Collapse
|
2
|
Cordaro F, Qian S, Sinclair B. Investigating hepatitis C screening among people receiving opioid agonist treatment: A retrospective audit study. J Infect Prev 2024; 25:11-16. [PMID: 38362112 PMCID: PMC10866125 DOI: 10.1177/17571774231208317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 09/29/2023] [Indexed: 02/17/2024] Open
Abstract
Background Estimates of the prevalence of hepatitis C virus (HCV) amongst people who inject drugs are in the range of 50%. Opioid Agonist Treatment (OAT) clinics have a large proportion of people who inject drugs. These clinics, therefore, present an excellent opportunity to identify and treat patients with HCV. Despite this, it remains unclear as to how well these clinics screen patients for HCV. Aim This study aims to quantify the rate of HCV screening of patients that enrolled into treatment at an OAT clinic attached to a large teaching hospital in NSW. Methods A retrospective audit of the electronic medical record of patients commencing OAT at the clinic was performed to determine the rate of HCV screening. Findings During the audit period, there were 99 episodes of care that involved the commencement of OAT at the clinic, for patients who had a history of injecting drugs. Successful screening for HCV occurred in 56% (55/99) of these episodes. Of those screened, 26% were ribonucleic acid positive. Analysis of demographics did not reveal a statistically significant difference between those that were screened and those that were not. Discussion This study revealed a suboptimal rate of HCV screening at the OAT clinic. To improve the screening rate, the clinic could consider providing dried blood spot testing at the initial nurse assessment or having a clinician capable of venepuncture at the clinic.
Collapse
Affiliation(s)
- Frank Cordaro
- Drug and Alcohol Service, Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
| | - Siyu Qian
- Drug and Alcohol Service, Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
| | - Barbara Sinclair
- Drug and Alcohol Service, Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
| |
Collapse
|
3
|
Howard KA, Rennert L, Pericot-Valverde I, Heo M, Norton BL, Akiyama MJ, Agyemang L, Litwin AH. Utilizing patient perception of group treatment in exploring medication adherence, social support, and quality of life outcomes in people who inject drugs with hepatitis C. J Subst Abuse Treat 2021; 126:108459. [PMID: 34116813 DOI: 10.1016/j.jsat.2021.108459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 01/15/2021] [Accepted: 04/28/2021] [Indexed: 11/26/2022]
Abstract
People who inject drugs (PWID) have a high prevalence of hepatitis C virus (HCV). Group treatment is a practical option for addressing barriers to treatment in this population. Prior research on group treatment has resulted in mixed conclusions about its effectiveness in addressing barriers to treatment. A patient's perception of the group environment may help to explain this variability. This study sought to explore the association between indicators of group treatment environment and improved outcomes in HCV-infected PWID. This secondary analysis of a randomized controlled trial exploring different models of treatment for HCV in a PWID population consisted of 42 participants randomized to the group treatment branch of the trial. Independent variables consisted of group sessions attended and group climate constructs of engagement, conflict, and avoidance. Dependent variables consisted of medication adherence, social support, and health-related quality of life. The study implemented generalized estimating equations to assess associations with the outcomes at the end of treatment. Factors indicative of group treatment environment were related to medication adherence and other barriers to health for HCV-infected PWID: social support and health-related quality of life. Perceptions of conflict or avoidance were associated with worse outcomes, while increased session attendance was generally associated with better outcomes. The study attests to the importance of examining group environment factors during treatment interventions. Although preliminary, the study provides specific indicators of treatment success for HCV-infected PWID and practical implications to improve patients' health outcomes and better tailor treatment to the patient.
Collapse
Affiliation(s)
- Kerry A Howard
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
| | - Lior Rennert
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
| | - Irene Pericot-Valverde
- Clemson University School of Health Research, Clemson, SC, USA; Department of Medicine, Prisma Health-Upstate, Greenville, SC, USA
| | - Moonseong Heo
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
| | - Brianna L Norton
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Matthew J Akiyama
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Linda Agyemang
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Alain H Litwin
- Clemson University School of Health Research, Clemson, SC, USA; Department of Medicine, Prisma Health-Upstate, Greenville, SC, USA; University of South Carolina School of Medicine Greenville, Greenville, SC, USA.
| |
Collapse
|
4
|
Norton BL, Akiyama MJ, Arnsten JH, Agyemang L, Heo M, Litwin AH. High HCV cure rates among people who inject drugs and have suboptimal adherence: A patient-centered approach to HCV models of care. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 93:103135. [PMID: 33667826 DOI: 10.1016/j.drugpo.2021.103135] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 12/23/2020] [Accepted: 01/20/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Though people who inject drugs (PWID) make up the majority of the hepatitis C virus (HCV) epidemic, concerns about adherence often exclude PWID from receiving direct-acting antiviral (DAA) medication. The most effective models of HCV care to promote sustained virologic response (SVR) and high adherence need to be evaluated. METHODS We conducted a prospective cohort study in three opioid treatment programs (OTPs) in the Bronx, NY. Participants, in collaboration with providers, chose one of three models of onsite care: directly observed therapy (mDOT), group treatment (GT), or self-administered individual treatment (SIT). SVR12, daily adherence, and participant characteristics were compared between groups. RESULTS Of 61 participants, the majority were male (62%) and Latino (67%), with a mean age of 53 (SD 9). Participants received DAAs via one of three models of care: mDOT (21%), GT (25%), or SIT (54%). The majority (59%) used illicit drugs during treatment. Overall, SVR12 was 98% with no differences between models of care: mDOT (100%), GT (100%), and SIT (97%) (p = 1.0). Overall, daily adherence was 73% (SD 16); 86% among those who chose mDOT compared to 71% among those who chose GT (p<0.01) and 73% among those who chose SIT (p<0.01). CONCLUSION Despite ongoing illicit drug use and suboptimal adherence, SVR12 was high among PWID treated onsite at an OTP using any one of three models of care. Shared decision making in real world settings may be key to choosing the appropriate model of care for PWID.
Collapse
Affiliation(s)
- Brianna L Norton
- Department of Medicine, Division of General Internal Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, United States; Department of Medicine, Division of Infectious Diseases, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, United States.
| | - Matthew J Akiyama
- Department of Medicine, Division of General Internal Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, United States; Department of Medicine, Division of Infectious Diseases, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, United States
| | - Julia H Arnsten
- Department of Medicine, Division of General Internal Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, United States; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, United States; Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, United States
| | - Linda Agyemang
- Department of Medicine, Division of General Internal Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, United States
| | - Moonseong Heo
- Department of Public Health Sciences, Clemson University, Clemson, SC, United States; School of Mathematical Science, Clemson University, Clemson, SC, United States
| | - Alain H Litwin
- Department of Medicine, University of South Carolina School of Medicine - Greenville, Greenville, SC, United States; Department of Medicine, Prisma Health-Upstate, Greenville, SC, United States; Clemson University School of Health Research, Clemson, SC, United States
| |
Collapse
|
5
|
Boloori A, Arnetz BB, Viens F, Maiti T, Arnetz JE. Misalignment of Stakeholder Incentives in the Opioid Crisis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7535. [PMID: 33081276 PMCID: PMC7589670 DOI: 10.3390/ijerph17207535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/03/2020] [Accepted: 10/04/2020] [Indexed: 12/14/2022]
Abstract
The current opioid epidemic has killed more than 446,000 Americans over the past two decades. Despite the magnitude of the crisis, little is known to what degree the misalignment of incentives among stakeholders due to competing interests has contributed to the current situation. In this study, we explore evidence in the literature for the working hypothesis that misalignment rooted in the cost, quality, or access to care can be a significant contributor to the opioid epidemic. The review identified several problems that can contribute to incentive misalignment by compromising the triple aims (cost, quality, and access) in this epidemic. Some of these issues include the inefficacy of conventional payment mechanisms in providing incentives for providers, practice guidelines in pain management that are not easily implementable across different medical specialties, barriers in adopting multi-modal pain management strategies, low capacity of providers/treatments to address opioid/substance use disorders, the complexity of addressing the co-occurrence of chronic pain and opioid use disorders, and patients' non-adherence to opioid substitution treatments. In discussing these issues, we also shed light on factors that can facilitate the alignment of incentives among stakeholders to effectively address the current crisis.
Collapse
Affiliation(s)
- Alireza Boloori
- Department of Statistics and Probability, Michigan State University, East Lansing, MI 48824, USA; (F.V.); (T.M.)
- Department of Family Medicine, Michigan State University, Grand Rapids, MI 49503, USA; (B.B.A.); (J.E.A.)
| | - Bengt B. Arnetz
- Department of Family Medicine, Michigan State University, Grand Rapids, MI 49503, USA; (B.B.A.); (J.E.A.)
| | - Frederi Viens
- Department of Statistics and Probability, Michigan State University, East Lansing, MI 48824, USA; (F.V.); (T.M.)
| | - Taps Maiti
- Department of Statistics and Probability, Michigan State University, East Lansing, MI 48824, USA; (F.V.); (T.M.)
| | - Judith E. Arnetz
- Department of Family Medicine, Michigan State University, Grand Rapids, MI 49503, USA; (B.B.A.); (J.E.A.)
| |
Collapse
|
6
|
Pollio DE, North CS, Sims OT, Hong BA. HEPATITIS C PSYCHOEDUCATION CURRICULUM TOPICS GENERATED BY GROUP MEMBERS. SOCIAL WORK WITH GROUPS 2020; 44:83-90. [PMID: 38274393 PMCID: PMC10810246 DOI: 10.1080/01609513.2020.1815631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/13/2020] [Accepted: 07/13/2020] [Indexed: 01/27/2024]
Affiliation(s)
- David E Pollio
- The University of Alabama at Birmingham, Department of Social Work, College of Arts and Sciences, Birmingham, AL, USA
| | - Carol S North
- The University of Texas Southwestern Medical Center, Departments of Psychiatry and Emergency Medicine, Dallas, TX, USA
| | - Omar T Sims
- The University of Alabama at Birmingham, Department of Social Work, College of Arts and Sciences, Birmingham, AL, USA
| | - Barry A Hong
- Washington University School of Medicine, Department of Psychiatry, St. Louis, MO, USA
| |
Collapse
|
7
|
Prevalence and high risk behaviours associated with HCV testing among people who inject drugs: a systematic review and Meta-analysis. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2020; 15:64. [PMID: 32831107 PMCID: PMC7445934 DOI: 10.1186/s13011-020-00306-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/19/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Hepatitis C diagnosis could be a gateway to behavioral change and subsequent decline in transmission among people who inject drugs (PWIDs). We assessed the association between the social determinants of PWID, their risk behaviors and hepatitis C testing. METHODS We searched for studies in English published before May 1, 2020, on PubMed, Scopus, Cochrane, and Web of Science to identify primary studies on the factors associated with hepatitis C virus (HCV) testing among PWID. After reviewing for study duplicates, the full-text of selected articles were assessed for eligibility using Population, Intervention, Comparator, Outcomes (PICO) criteria. i) population: individuals who report injecting drugs; ii) intervention: HCV testing in the past year; iii) comparator: PWIDs who did not have an HCV test; iv) outcome: HCV testing among PWIDs and v) study type: cross-sectional, cohort, and case-control studies. Two independent reviewers (author BA and AB) chose the references in a two-phased monitoring process. The authors gathered data from selected papers, including the surname of the first author, publication date, participant demographic data (age, sex, and level of education) and other characteristics like previous HCV testing, past treatment attempts, duration of injecting drug use and condomless sex. We used fixed and random-effects meta-analysis models to estimate the pooled prevalence, pooled odds ratio (OR), and 95% confidence intervals. The data were analyzed using Stata 12.0 software. RESULTS After a detailed assessment of over 12,000 articles, a total of 16 studies containing 38,952 participants met the eligibility criteria. Our findings showed a pooled prevalence rate of 61.01% (95% CI, 34.65-84.32%) for recent HCV testing among PWIDs. Being female (OR = 1.69, 95%CI = 1.13, 2.26), aged > 30 years, (OR = 2.61, 95%CI = 1.66-3.56) having past treatment attempt (OR = 2.24, 95%CI = 1.80-2.68), and reporting a previous test (OR = 2.03, 95%CI = 1.23-2.82). were significantly associated with having a recent HCV test.,,. Finding of present study was that unprotected sex had a negative association with HCV testing. Those PWIDs who had unprotected sex were 0.56 times less likely to have completed HCV testing during last year (OR = 0.56, 95%CI = 0.33-0.78). CONCLUSION Prevention programs that address age > 30 years, being female, past treatment attempt, previous testing of safe sexual practices, are strongly recommended to prioritize HCV risk reduction strategies.
Collapse
|
8
|
Hochstatter KR, Gustafson DH, Landucci G, Pe-Romashko K, Maus A, Shah DV, Taylor QA, Gill EK, Miller R, Krechel S, Westergaard RP. A Mobile Health Intervention to Improve Hepatitis C Outcomes Among People With Opioid Use Disorder: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e12620. [PMID: 31373273 PMCID: PMC6694728 DOI: 10.2196/12620] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 04/23/2019] [Accepted: 06/18/2019] [Indexed: 12/11/2022] Open
Abstract
Background People who inject drugs are at a disproportionate risk for contracting hepatitis C virus (HCV). However, use of HCV prevention and treatment services remains suboptimal among people with substance use disorders due to various health system, societal, and individual barriers. Mobile health applications offer promising strategies to support people in recovery from substance use disorders. We sought to determine whether the Addiction-Comprehensive Health Enhancement Support System (A-CHESS), an existing mobile health application for opioid use disorder, could be adapted to improve HCV screening and treatment. Objective The goals of this paper are to describe: (1) the components and functionality of an HCV intervention incorporated into the existing A-CHESS system; and (2) how data are collected and will be used to evaluate HCV testing, linkage to care, and treatment. Methods People with recent opioid use were enrolled in a randomized controlled trial to test whether A-CHESS reduced relapse. We developed and implemented HCV intervention content within the A-CHESS platform to simultaneously evaluate whether A-CHESS improved secondary outcomes related to HCV care. All A-CHESS users received the HCV intervention content, which includes educational information, private messages tailored to an individual’s stage of HCV care, and a public discussion forum. Data on patients’ HCV risk behaviors and stage of care were collected through quarterly telephone interviews and weekly surveys delivered through A-CHESS. The proportion of people with opioid use disorder who are HCV untested, HCV-negative, HCV antibody-positive, or HCV RNA–positive, as well as linked to care, treated and cured at baseline is described here. The 24-month follow-up is ongoing and will be completed in April 2020. Survey data will then be used to assess whether individuals who received the HCV-enhanced A-CHESS intervention were more likely to reduce risky injection behaviors, receive HCV testing, link to medical care, initiate treatment, and be cured of HCV compared to the control group. Results Between April 2016 and April 2018, 416 individuals were enrolled and completed the baseline interview. Of these individuals, 207 were then randomly assigned to the control arm and 209 were assigned to the intervention arm. At baseline, 202 individuals (49%) self-reported ever testing HCV antibody-positive. Of those, 179 (89%) reported receiving HCV RNA confirmatory testing, 134 (66%) tested HCV RNA–positive, 125 (62%) were linked to medical care and 27 (13%) were treated and cured of HCV. Of the remaining 214 individuals who had never tested HCV antibody–positive, 129 (31%) had tested HCV antibody–negative within the past year and 85 (20%) had not been tested within the past year. Conclusions The A-CHESS mobile health system allows for the implementation of a bundle of services as well as the collection of longitudinal data related to drug use and HCV care among people with opioid use disorders. This study will provide preliminary evidence to determine whether HCV-specific services embedded into the A-CHESS program can improve HCV outcomes for people engaged in addiction treatment. Trial Registration ClinicalTrials.gov NCT02712034; https://clinicaltrials.gov/ct2/show/NCT02712034 International Registered Report Identifier (IRRID) DERR1-10.2196/12620
Collapse
Affiliation(s)
- Karli R Hochstatter
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States.,Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - David H Gustafson
- Center for Health Enhancement Systems Studies, Department of Industrial and Systems Engineering, University of Wiconsin-Madison, Madison, WI, United States
| | - Gina Landucci
- Center for Health Enhancement Systems Studies, Department of Industrial and Systems Engineering, University of Wiconsin-Madison, Madison, WI, United States
| | - Klaren Pe-Romashko
- Center for Health Enhancement Systems Studies, Department of Industrial and Systems Engineering, University of Wiconsin-Madison, Madison, WI, United States
| | - Adam Maus
- Center for Health Enhancement Systems Studies, Department of Industrial and Systems Engineering, University of Wiconsin-Madison, Madison, WI, United States
| | - Dhavan V Shah
- Center for Health Enhancement Systems Studies, Department of Industrial and Systems Engineering, University of Wiconsin-Madison, Madison, WI, United States
| | - Quinton A Taylor
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Emma K Gill
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Rebecca Miller
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Sarah Krechel
- AIDS Resource Center of Wisconsin, Milwaukee, WI, United States
| | - Ryan P Westergaard
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| |
Collapse
|
9
|
Akiyama MJ, Norton BL, Arnsten JH, Agyemang L, Heo M, Litwin AH. Intensive Models of Hepatitis C Care for People Who Inject Drugs Receiving Opioid Agonist Therapy: A Randomized Controlled Trial. Ann Intern Med 2019; 170:594-603. [PMID: 30959528 PMCID: PMC6868527 DOI: 10.7326/m18-1715] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Many people who inject drugs (PWID) are denied treatment for hepatitis C virus (HCV) infection, even if they are receiving opioid agonist therapy (OAT). Research suggests that HCV in PWID may be treated effectively, but optimal models of care for promoting adherence and sustained virologic response (SVR) have not been evaluated in the direct-acting antiviral (DAA) era. OBJECTIVE To determine whether directly observed therapy (DOT) and group treatment (GT) are more effective than self-administered individual treatment (SIT) in promoting adherence and achieving SVR among PWID receiving OAT. DESIGN Three-group, randomized controlled trial conducted from October 2013 to April 2017. (ClinicalTrials.gov: NCT01857245). SETTING Three OAT programs in Bronx, New York. PARTICIPANTS Persons aged 18 years and older with genotype 1 HCV infection who were willing to receive HCV therapy on site in the OAT program. Of 190 persons screened, 158 were randomly assigned to a study group and 150 initiated treatment: DOT (n = 51), GT (n = 48), and SIT (n = 51). INTERVENTION 2 intensive interventions (DOT and GT) and 1 control condition (SIT). MEASUREMENTS Primary: adherence, measured by using electronic blister packs. Secondary: HCV treatment completion and SVR 12 weeks after treatment completion. RESULTS Mean age was 51 years; 65% of participants had positive results on urine drug testing during the 6 months before treatment, and 75% reported ever injecting drugs. Overall adherence, estimated from mixed-effects models using the daily timeframe, was 78% (95% CI, 75% to 81%) and was greater among participants randomly assigned to DOT (86% [CI, 80% to 92%]) than those assigned to SIT (75% [CI, 70% to 81%]; difference, 11% [CI, 5% to 18%]; Bonferroni-corrected P = 0.001). No significant difference in adherence was observed between participants randomly assigned to GT (80% [CI, 74% to 86%]) and those assigned to SIT (difference, 4.7% [CI, -2% to 11%]; Bonferroni-corrected P = 0.29). The HCV treatment completion rate was 97%, with no differences among groups (P = 0.53). Overall SVR was 94% (CI, 89% to 97%); the SVR rate was 98% in the DOT group, 94% in the GT group, and 90% in the SIT group (P = 0.152). LIMITATION These findings may not be generalizable to PWID not enrolled in OAT programs. CONCLUSION All models of onsite HCV care delivered to PWID in OAT programs resulted in high SVR, despite ongoing drug use. Directly observed therapy was associated with greater adherence than SIT. PRIMARY FUNDING SOURCE National Institute on Drug Abuse and Gilead Sciences.
Collapse
Affiliation(s)
- Matthew J Akiyama
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York (M.J.A., B.L.N., J.H.A., L.A.)
| | - Brianna L Norton
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York (M.J.A., B.L.N., J.H.A., L.A.)
| | - Julia H Arnsten
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York (M.J.A., B.L.N., J.H.A., L.A.)
| | - Linda Agyemang
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York (M.J.A., B.L.N., J.H.A., L.A.)
| | | | - Alain H Litwin
- University of South Carolina School of Medicine-Greenville and Greenville Health System, Greenville, South Carolina, and Clemson University School of Health Research, Clemson, South Carolina (A.H.L.)
| |
Collapse
|
10
|
Chossegros P, Di Nino F. Associating conditional cash transfer to universal access to treatment could be the solution to the HCV epidemic among drug users (DUs). Harm Reduct J 2018; 15:63. [PMID: 30541570 PMCID: PMC6292040 DOI: 10.1186/s12954-018-0264-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 03/06/2018] [Indexed: 11/11/2022] Open
Abstract
Background To understand the limits of HCV screening programs to reach all drug users (DUs). Method The association of the recruitment of a representative sample of a population of DUs in a specific area with the use of a questionnaire that included 250 items allowed the use of uni- and multifactorial analysis to explore the relationship between HCV screening and dimensions until now restricted to qualitative studies. Results We recruited, in less than 2 months, 327 DUs representing about 6% of the total population of DUs. They belonged to a single community whose drug use was the only common characteristic. While almost all DUs (92.6%) who had access to care providers had been screened, this proportion was much lower in out-of-care settings (64%). HCV prevalence among those who had performed a test was low (22.8%). For DUs, the life experience of hepatitis C has not changed in the last 10 years. Screening, studied for the first time according to this life experience, was not influenced by a rational knowledge of the risk taken or the knowledge of treatment efficacy, showing a gap between DUs’ representations and medical recommendations which explains the low level of active screening. Police crackdown on injections, disrupting the previous illusion of safe practices, was the only prior history leading to active screenings. Screenings were related to an access to care providers. GPs held a preponderant position as a source of information and care by being able to give appropriate answers regarding hepatitis C and prescribing opioid substitution treatments (OST). If 48 % of DUs screened positive for HCV had been treated, half of them had been prescribed before 2006. Conclusion While hepatitis has become a major issue for society and, consequently, for services for DUs (SDUs) and GPs, it is not the case for DUs. A widespread screening, even in a city where the offer of care is diversified and free, seems unlikely to reach a universal HCV screening over a short time. The model of respondent-driven sampling recruitment could be a new approach to conditional cash transfer, recruiting and treating DUs who remain outside the reach of care providers, a prerequisite for the universal access to HCV treatments to impact the HCV epidemic.
Collapse
Affiliation(s)
- Philippe Chossegros
- UHSI de Lyon, Centre Hospitalier Lyon SUD, Hospices Civils de LYON, Chemin du Grand Revoyet, 69495, Pierre-Bénite, France.
| | | |
Collapse
|
11
|
Young S, Wood E, Milloy MJ, DeBeck K, Dobrer S, Nosova E, Kerr T, Hayashi PhD K. Hepatitis C cascade of care among people who inject drugs in Vancouver, Canada. Subst Abus 2018; 39:461-468. [PMID: 29949450 DOI: 10.1080/08897077.2018.1485128] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND People who inject drugs (PWID) have high rates of hepatitis C virus (HCV) infection. Little is known about the rates of diagnosis and treatment for HCV among PWID. Therefore, this study aims to characterize the cascade of care in Vancouver, Canada, to improve HCV treatment access and delivery for PWID. METHODS Data were derived from 3 prospective cohort studies of PWID in Vancouver, Canada, between December 2005 and May 2015. The progression of participants was identified through 5 steps in the cascade of care: (1) chronic HCV; (2) linkage to HCV care; (3) liver disease assessment; (4) initiation of treatment; and (5) completion of treatment. Predictors of undergoing liver disease assessment for HCV treatment were identified using a multivariable extended Cox regression model. RESULTS Among 1571 participants with chronic HCV, 1359 (86.5%) had ever been linked to care, 1257 (80.0%) had undergone liver disease assessment, 163 (10.4%) had ever started HCV treatment, and 71 (4.5%) had ever completed treatment. In multivariable analyses, human immunodeficiency virus (HIV) seropositivity, use of methadone maintenance therapy, and hospitalization in the past 6 months were independently and positively associated with undergoing liver disease assessment (all P < .001), whereas daily heroin injection was independently and negatively associated with undergoing liver disease assessment (P < .001). CONCLUSIONS Among this cohort of PWID, few had been started on or completed treatment for HCV. These findings highlight the need to improve the prescribing of HCV treatment among PWID with active substance use.
Collapse
Affiliation(s)
- Samantha Young
- a Department of Medicine , University of British Columbia , Vancouver , British Columbia , Canada
| | - Evan Wood
- a Department of Medicine , University of British Columbia , Vancouver , British Columbia , Canada.,b British Columbia Centre on Substance Use, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , British Columbia , Canada
| | - M-J Milloy
- a Department of Medicine , University of British Columbia , Vancouver , British Columbia , Canada.,b British Columbia Centre on Substance Use, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , British Columbia , Canada
| | - Kora DeBeck
- b British Columbia Centre on Substance Use, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , British Columbia , Canada.,c School of Public Policy , Simon Fraser University , Vancouver , British Columbia , Canada
| | - Sabina Dobrer
- b British Columbia Centre on Substance Use, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , British Columbia , Canada
| | - Ekaterina Nosova
- b British Columbia Centre on Substance Use, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , British Columbia , Canada
| | - Thomas Kerr
- a Department of Medicine , University of British Columbia , Vancouver , British Columbia , Canada.,b British Columbia Centre on Substance Use, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , British Columbia , Canada
| | - Kanna Hayashi PhD
- b British Columbia Centre on Substance Use, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , British Columbia , Canada.,d Faculty of Health Sciences , Simon Fraser University , Burnaby , British Columbia , Canada
| |
Collapse
|
12
|
Krans EE, Rothenberger SD, Morrison PK, Park SY, Klocke LC, Turocy MJ, Zickmund S. Hepatitis C Virus Knowledge Among Pregnant Women with Opioid Use Disorder. Matern Child Health J 2018; 22:1208-1216. [PMID: 29500784 PMCID: PMC6054887 DOI: 10.1007/s10995-018-2506-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Objectives To evaluate Hepatitis C virus (HCV) knowledge and awareness among pregnant women with opioid use disorder (OUD). Methods From May through November 2015, a one-time survey was distributed to a convenience sample of pregnant women with OUD to assess their knowledge and awareness of (a) risk factors for HCV infection, (b) HCV transmission prevention strategies, (c) hepatotoxic risk reduction and (d) perinatal transmission and neonatal implications of HCV infection. Chi square and Fisher's exact tests were used to compare demographic characteristics and HCV knowledge between participants who were HCV positive and negative. Results Of 179 pregnant women with OUD approached, 169 (94%) completed the survey. Of these, 153 (90.5%) reported at least one risk factor for HCV infection, 85 (50.3%) were HCV positive and 38 (44.7%) of HCV positive women were diagnosed with HCV for the first time during pregnancy. When HCV knowledge was evaluated, 114 (66.7%) responded that sharing eating utensils could transmit HCV, 69 (55.0%) responded that there is a vaccine to prevent HCV and 56 (32.7%) did not identify intranasal drug use as a risk factor for HCV transmission. Among HCV positive women, 61 (71.8%) associated breastfeeding with an increased risk for HCV transmission, 33 (38.1%) failed to identify the importance of pediatric follow-up for HCV-exposed children and 16 (18.8%) perceived the risk of HCV vertical transmission as "likely" or "very likely." Conclusions for Practice Gaps in HCV knowledge exist among a rapidly growing population of pregnant women with OUD. Healthcare providers have a unique opportunity to provide HCV education and counseling during pregnancy.
Collapse
Affiliation(s)
- Elizabeth E Krans
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- Magee-Womens Research Institute, 3380 Boulevard of the Allies, Suite 323, Pittsburgh, PA, 15213, USA.
| | - Scott D Rothenberger
- Division of General Internal Medicine, Center for Research on Health Care Data Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Penelope K Morrison
- The Pennsylvania State University, New Kensington Campus, New Kensington, PA, USA
| | - Seo Young Park
- Division of General Internal Medicine, Center for Research on Health Care Data Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Leah C Klocke
- Magee-Womens Research Institute, 3380 Boulevard of the Allies, Suite 323, Pittsburgh, PA, 15213, USA
| | - Mary J Turocy
- Magee-Womens Research Institute, 3380 Boulevard of the Allies, Suite 323, Pittsburgh, PA, 15213, USA
| | - Susan Zickmund
- Informatics, Decision-Enhancement and Analytic Sciences (IDEAS 2.0) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
- Department of Medicine, University of Utah, Salt Lake City, UT, USA
| |
Collapse
|
13
|
Akiyama MJ, Agyemang L, Arnsten JH, Heo M, Norton BL, Schackman BR, Linas BP, Litwin AH. Rationale, design, and methodology of a trial evaluating three models of care for HCV treatment among injection drug users on opioid agonist therapy. BMC Infect Dis 2018; 18:74. [PMID: 29426304 PMCID: PMC5807730 DOI: 10.1186/s12879-018-2964-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 01/16/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND People who inject drugs (PWID) constitute 60% of the approximately 5 million people in the U.S. infected with hepatitis C virus (HCV). Treatment of PWID is complex due to addiction, mental illness, poverty, homelessness, lack of positive social support, poor adherence-related skills, low motivation and knowledge, and poor access to and trust in the health care system. New direct-acting antiviral medications are available for HCV with high cure rates and few side effects. The life expectancy and economic benefits of new HCV treatments will not be realized unless we determine optimal models of care for the majority of HCV-infected patients. The purpose of this study is to evaluate the effectiveness of directly observed therapy and group treatment compared with self-administered individual treatment in a large, urban opioid agonist therapy clinic setting in the Bronx, New York. METHODS/DESIGN In this randomized controlled trial 150 PWID with chronic HCV were recruited from opioid agonist treatment (OAT) clinics and randomized to one of three models of onsite HCV treatment in OAT: 1) modified directly observed therapy; 2) group treatment; or 3) control - self-administered individual treatment. Participants were age 18 or older, HCV genotype 1, English or Spanish speaking, treatment naïve (or treatment experienced after 12/3/14), willing to receive HCV treatment onsite, receiving methadone or buprenorphine at the medication window at least once per week, and able to provide informed consent. Outcomes of interest include adherence (as measured by self-report and electronic blister packs), HCV treatment completion, sustained virologic response, drug resistance, and cost-effectiveness. DISCUSSION This paper describes the design and rationale of a randomized controlled trial comparing three models of care for HCV therapy delivered in an opioid agonist treatment program. Our trial will be critical to rigorously identify models of care that result in high adherence and cure rates. Use of blister pack technology will help us determine the role of adherence in successful cure of HCV. Moreover, the trial methodology outlined here can serve as a template for the development of future programs and studies among HCV-infected drug users receiving opioid agonist therapy, as well as the cost-effectiveness of such programs. TRIAL REGISTRATION This trial was registered with ClinicalTrials.gov ( NCT01857245 ). Trial registration was obtained prospectively on May 20th, 2013.
Collapse
Affiliation(s)
- Matthew J. Akiyama
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY USA
| | - Linda Agyemang
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY USA
| | - Julia H. Arnsten
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY USA
| | - Moonseong Heo
- Department of Epidemiology and Population Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY USA
| | - Brianna L. Norton
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY USA
| | - Bruce R. Schackman
- Department of Healthcare Policy & Research, Weill Cornell Medical College, New York, NY USA
| | - Benjamin P. Linas
- Department of Epidemiology, Boston University School of Public Health, Boston, MA USA
| | - Alain H. Litwin
- Department of Medicine, University of South Carolina School of Medicine–Greenville, Greenville, South Carolina USA
- Department of Medicine, Greenville Health System, Greenville, South Carolina USA
- Department of Medicine, Clemson University School of Health Research, Clemson, South Carolina USA
| |
Collapse
|
14
|
Abstract
Aims and methodA cross-sectional survey was conducted to assess patient knowledge and information provision about opioid substitution treatment among individuals with opiate dependence receiving treatment at four treatment centres in South London.ResultsIn total 118 people were recruited to the study. Participants answered a mean of 14 out of 34 questions assessing a range of factors such as medication, blood-borne viruses and overdose correctly. Participants overestimated their performance on average by almost 40%. Individuals with a history of previous treatments scored significantly higher than those in their first treatment episode. The majority reported having been given written information on most of the topics assessed.Clinical implicationsThe results of this study highlight the need to improve education about opioid dependence and its treatment. Poorly informed patients are unlikely to make optimal treatment choices. Improving patients' knowledge and understanding about treatment may lead to better engagement, retention, treatment adherence and, ultimately, better health outcomes.
Collapse
|
15
|
Li ZB, Zhang L, Wang J, Huang LP, Zhou ZR, Cao YN, Zhao M, Du J. Hepatitis C infection, related services, and barriers to HCV treatment among drug users in methadone maintenance treatment (MMT) clinics in Shanghai, China. Harm Reduct J 2017; 14:71. [PMID: 29096647 PMCID: PMC5667515 DOI: 10.1186/s12954-017-0197-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 10/16/2017] [Indexed: 11/17/2022] Open
Abstract
Background The purpose of this study was to document the prevalence of hepatitis C among MMT patients, hepatitis C virus (HCV) knowledge of patients and MMT staff members, and the barriers preventing them from receiving or delivering HCV-related services in MMT clinics of China. Methods Data were collected from 240 MMT patients and 58 staff members in Shanghai MMT clinics. Structured questionnaires (HCV Knowledge Scale and Alcohol Use Disorders Identification Test) and several self-developed questionnaires were used to assess (1) patient and staff HCV knowledge, (2) attitudes toward HCV-related services in MMT clinics, and (3) what type of HCV-related services the staff members have provided in their routine work. The HCV test results were based on the patients’ medical records. Results The HCV seropositive rate was high (70%), and both patients and staff had limited HCV knowledge. The mean score of patient HCV knowledge was 6.8 out of 20 (SD = 3.7), whereas the mean score of staff HCV knowledge was 10.9 out of 20 (SD = 3.1). For HCV-positive patients, only 13.7% had accessed HCV medical treatment. Barriers included the cost of medical treatment, lack of HCV knowledge, lack of professional training for patients to receive HCV-related services from individuals or MMT clinics, and lack of an adequate policy-making system. Conclusions HCV infection remains an important problem among MMT patients in China. Barriers to HCV-related services are attributable to individual, clinical, and policy-related factors. This study may provide evidence-based information for future work to optimize the resources of MMT clinics. Trial registration ClinicalTrials.gov NCT01647191. Registered 17 April 2012.
Collapse
Affiliation(s)
- Zhi-Bin Li
- Jiading Mental Health Center, Shanghai, China
| | - Lei Zhang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Wang
- Yangpu Mental Health Center, Shanghai, China
| | | | | | - Yi-Ning Cao
- Minhang Mental Health Center, Shanghai, China
| | - Min Zhao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China. .,Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China. .,Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China.
| | - Jiang Du
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| |
Collapse
|
16
|
Mukherjee TI, Pillai V, Ali SH, Altice FL, Kamarulzaman A, Wickersham JA. Evaluation of a hepatitis C education intervention with clients enrolled in methadone maintenance and needle/syringe programs in Malaysia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 47:144-152. [PMID: 28652072 DOI: 10.1016/j.drugpo.2017.05.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 05/11/2017] [Accepted: 05/15/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Approximately 40%-90% of people who inject drugs (PWID) in Malaysia have hepatitis C (HCV). PWID continue to be disproportionately affected by HCV due to their lack of knowledge, perceived risk and interest in HCV treatment. Education interventions may be an effective strategy for increasing HCV knowledge in PWID, and harm reduction services are uniquely positioned to implement and deploy such interventions. METHODS We recruited 176 clients from methadone maintenance treatment (MMT: N=110) and needle/syringe programs (NSP: N=66) between November 2015 and August 2016. After baseline knowledge assessments, clients participated in a standardized, 45-min HCV education program and completed post-intervention knowledge assessments to measure change in knowledge and treatment interest. RESULTS Participants were mostly male (96.3%), Malay (94.9%), and in their early 40s (mean=42.6years). Following the intervention, overall knowledge scores and treatment interest in MMT clients increased by 68% and 16%, respectively (p<0.001). In contrast, NSP clients showed no significant improvement in overall knowledge or treatment interest, and perceived greater treatment barriers. Multivariate linear regression to assess correlates of HCV knowledge post-intervention revealed that optimal dosage of MMT and having had an HIV test in the past year significantly increased HCV knowledge. Having received a hepatitis B vaccine, however, was not associated with increased HCV knowledge after participating in an education session. CONCLUSION Generally, HCV knowledge and screening is low among clients engaged in MMT and NSP services in Malaysia. Integrating a brief, but comprehensive HCV education session within harm reduction services may be a low-cost and effective strategy in improving overall HCV knowledge and risk behaviors in resource-limited settings. In order to be an effective public health approach, however, education interventions must be paired with strategies that improve social, economic and political outcomes for PWID. Doing so may reduce HCV disparities by increasing screening and treatment interest.
Collapse
Affiliation(s)
- Trena I Mukherjee
- Yale School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA
| | - Veena Pillai
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Siti Hafizah Ali
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Frederick L Altice
- Yale School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA; Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Yale University School of Public Health, Division of Epidemiology of Microbial Diseases, CT, USA
| | - Adeeba Kamarulzaman
- Yale School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA; Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Jeffrey A Wickersham
- Yale School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA; Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| |
Collapse
|
17
|
Crowley D, Cullen W, Laird E, Lambert JS, Mc Hugh T, Murphy C, Van Hout MC. Exploring Patient Characteristics and Barriers to Hepatitis C Treatment in Patients on Opioid Substitution Treatment Attending a Community Based Fibro-scanning Clinic. J Transl Int Med 2017; 5:112-119. [PMID: 28721344 PMCID: PMC5506411 DOI: 10.1515/jtim-2017-0017] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Hepatitis C virus (HCV) infection is a major public health issue. There is substandard uptake in HCV assessment and treatment among people who inject drugs (PWID). Community fibroscanning is used to assess disease severity and target treatment. METHODS A survey was administered to a cohort of chronically HCV infected patients attending a community fibroscanning clinic. Questions targeted diagnosis of HCV, suitability, willingness and barriers to engagement in treatment. Descriptive and regression analysis, with thematic analysis of open-ended data was conducted. RESULTS There was high acceptance of community fibroscanning among this cohort with over 90% (68) attending. High levels of unemployment (90%) and homelessness (40%) were identified. Most patients were on methadone treatment and had been HCV infected for greater than 10 years with length of time since HCV diagnosis being significantly longer in patients with fibroscan scores > 8.5 kPa (P = 0.016). With each unit increase in methadone dose, the odds of the >8.5 fibroscan group increased by 5.2%. Patient identified barriers to engagement were alcohol and drug use, fear of HCV treatment and liver biopsy, imprisonment, distance to hospital and early morning appointments. CONCLUSION The study highlights the usefulness of community fibroscanning. Identifying barriers to treatment in this cohort affords an opportunity to increase the treatment uptake. The availability of afternoon clinics and enhanced prison linkage are warranted.
Collapse
Affiliation(s)
| | | | - Eamon Laird
- Trinity College Dublin, University College Dublin, Dublin2, Ireland
| | - John S Lambert
- Infectious Disease Department, Mater Hospital, Dublin7, Ireland
| | | | - Carol Murphy
- Infectious Disease Department, Mater Hospital, Dublin7, Ireland
| | - Marie Claire Van Hout
- Public Health Institute, Liverpool John Moore’s University, Liverpool, United Kingdom
| |
Collapse
|
18
|
Butner JL, Gupta N, Fabian C, Henry S, Shi JM, Tetrault JM. Onsite treatment of HCV infection with direct acting antivirals within an opioid treatment program. J Subst Abuse Treat 2017; 75:49-53. [DOI: 10.1016/j.jsat.2016.12.014] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 12/02/2016] [Accepted: 12/16/2016] [Indexed: 12/22/2022]
|
19
|
Examination of the Hepatitis C Virus care continuum among individuals with an opioid use disorder in substance use treatment. J Subst Abuse Treat 2017; 76:77-80. [PMID: 28162850 DOI: 10.1016/j.jsat.2017.01.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 01/27/2017] [Accepted: 01/27/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Hepatitis C Virus (HCV) risk is elevated for individuals with an opioid use disorder (OUD). Routine HCV testing is recommended for high-risk individuals, including those with an injection drug use history. HCV antibody testing addresses the first step in the HCV treatment care cascade, with uptake and completion of HCV treatment among individuals with chronic HCV as the optimal care cascade endpoint. The aim of this study was to characterize self-reported HCV treatment cascade outcomes among individuals with an OUD in outpatient medication assisted treatment (MAT). METHODS Individuals receiving methadone or buprenorphine treatment (N=202, 67.8% female, M age=35.0, SD=8.4) completed a brief, anonymous paper-and-pencil survey examining self-reported history of HCV testing, diagnosis, and treatment. Descriptive statistics characterized HCV treatment cascade outcomes. RESULTS A majority (79.3%) endorsed a lifetime HCV testing history; 34.9% were tested for HCV during the past year. Of those with a lifetime HCV testing history, 42.7% indicated they have been told they have HCV (n=67/157), with 21% (n=14/67) of those individuals reporting that they have been told they have chronic HCV, and 71.4% (n=10/14) of those with chronic HCV reporting receipt of HCV treatment. DISCUSSION Results underscore gaps in the HCV care continuum among individuals with OUD in MAT. Interventions to increase uptake of HCV testing, communication of HCV diagnostic and treatment information by medical providers, linkage to HCV medical care, and uptake and adherence to HCV treatment are urgently needed, particularly among individuals with an OUD in MAT.
Collapse
|
20
|
Konerman MA, Lok ASF. Hepatitis C Treatment and Barriers to Eradication. Clin Transl Gastroenterol 2016; 7:e193. [PMID: 27657495 PMCID: PMC5288596 DOI: 10.1038/ctg.2016.50] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 07/29/2016] [Indexed: 12/19/2022] Open
Abstract
Current treatment for chronic hepatitis C (CHC) is highly efficacious, well-tolerated, and of short duration for the majority of patients. Despite the dramatic advances in therapy, there remain several barriers to disease eradication. These include deficiencies in screening, diagnosis, and access to care, and high cost of the direct-acting antiviral medications. In addition, incident cases and reinfection associated with injection drug use contribute to the persistent worldwide disease burden. This article will review the current CHC treatments, and outline the remaining gaps in therapy and barriers to disease eradication.
Collapse
Affiliation(s)
- Monica A Konerman
- Department of Internal Medicine, University of Michigan Health System, Division of Gastroenterology and Hepatology, Ann Arbor, Michigan, USA
| | - Anna S F Lok
- Department of Internal Medicine, University of Michigan Health System, Division of Gastroenterology and Hepatology, Ann Arbor, Michigan, USA
| |
Collapse
|
21
|
Oramasionwu CU, Kashuba AD, Napravnik S, Wohl DA, Mao L, Adimora AA. Non-initiation of hepatitis C virus antiviral therapy in patients with human immunodeficiency virus/hepatitis C virus co-infection. World J Hepatol 2016; 8:368-75. [PMID: 26981174 PMCID: PMC4779165 DOI: 10.4254/wjh.v8.i7.368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 10/24/2015] [Accepted: 12/03/2015] [Indexed: 02/06/2023] Open
Abstract
AIM To assess whether reasons for hepatitis C virus (HCV) therapy non-initiation differentially affect racial and ethnic minorities with human immunodeficiency virus (HIV)/HCV co-infection. METHODS Analysis included co-infected HCV treatment-naïve patients in the University of North Carolina CFAR HIV Clinical Cohort (January 1, 2004 and December 31, 2011). Medical records were abstracted to document non-modifiable medical (e.g., hepatic decompensation, advanced immunosuppression), potentially modifiable medical (e.g., substance abuse, severe depression, psychiatric illness), and non-medical (e.g., personal, social, and economic factors) reasons for non-initiation. Statistical differences in the prevalence of reasons for non-treatment between racial/ethnic groups were assessed using the two-tailed Fisher's exact test. Three separate regression models were fit for each reason category. Odds ratios and their 95%CIs (Wald's) were computed. RESULTS One hundred and seventy-one patients with HIV/HCV co-infection within the cohort met study inclusion. The study sample was racially and ethnically diverse; most patients were African-American (74%), followed by Caucasian (19%), and Hispanic/other (7%). The median age was 46 years (interquartile range = 39-50) and most patients were male (74%). Among the 171 patients, reasons for non-treatment were common among all patients, regardless of race/ethnicity (50% with ≥ 1 non-modifiable medical reason, 66% with ≥ 1 potentially modifiable medical reason, and 66% with ≥ 1 non-medical reason). There were no significant differences by race/ethnicity. Compared to Caucasians, African-Americans did not have increased odds of non-modifiable [adjusted odds ratio (aOR) = 1.47, 95%CI: 0.57-3.80], potentially modifiable (aOR = 0.72, 95%CI: 0.25-2.09) or non-medical (aOR = 0.90, 95%CI: 0.32-2.52) reasons for non-initiation. CONCLUSION Race/ethnicity alone is not predictive of reasons for HCV therapy non-initiation. Targeted interventions are needed to improve access to therapy for all co-infected patients, including minorities.
Collapse
Affiliation(s)
- Christine U Oramasionwu
- Christine U Oramasionwu, Angela DM Kashuba, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599, United States
| | - Angela Dm Kashuba
- Christine U Oramasionwu, Angela DM Kashuba, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599, United States
| | - Sonia Napravnik
- Christine U Oramasionwu, Angela DM Kashuba, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599, United States
| | - David A Wohl
- Christine U Oramasionwu, Angela DM Kashuba, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599, United States
| | - Lu Mao
- Christine U Oramasionwu, Angela DM Kashuba, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599, United States
| | - Adaora A Adimora
- Christine U Oramasionwu, Angela DM Kashuba, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599, United States
| |
Collapse
|
22
|
Hepatitis C virus-related knowledge and willingness to receive treatment among patients on methadone maintenance. J Addict Med 2016; 8:249-57. [PMID: 24820257 DOI: 10.1097/adm.0000000000000041] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Although persons who inject drugs have high prevalence of hepatitis C virus (HCV) infection, few receive treatment mostly because of lack of knowledge about the infection and its treatment. We assessed the level of HCV-related knowledge and willingness to participate in HCV treatment among methadone-maintained patients. METHODS A 30-item survey covering HCV-related knowledge and willingness to engage in HCV-related education and treatment was developed and completed by 320 methadone-maintained patients. RESULTS Respondents' mean age was 53 ± 8.7 years, 59.5% were male, 55.1% were African American, and 38.3% were Hispanic. The mean duration of methadone maintenance was 7 ± 6.7 years. In the preceding 6 months, 6.9% of patients reported injection drug use, whereas 37.3% used noninjection drugs. Hepatitis C virus seropositivity was self-reported by 46.3% of patients. The majority of patients (78%) expressed willingness to participate in HCV-related education and to receive HCV treatment. Most patients (54.7%) correctly answered 5 or more of 7 questions assessing HCV knowledge. Hepatitis C virus-seropositive individuals and prior attendees at HCV-related educational activities demonstrated a higher level of HCV-related knowledge (P < 0.001 and P = 0.002, respectively). Younger patients (P = 0.014), those willing to attend an HCV-related educational activity (P < 0.001), and those with higher-HCV-related knowledge (P = 0.029) were more accepting of HCV treatment. Fear of medication-related side effects was the most common reason for treatment avoidance. CONCLUSIONS The majority of patients reported willingness to receive HCV-related education and treatment. Treatment willingness was significantly associated with previous attendance at an HCV educational activity and a higher level of HCV-related knowledge.
Collapse
|
23
|
Alavi M, Micallef M, Fortier E, Dunlop AJ, Balcomb AC, Day CA, Treloar C, Bath N, Haber PS, Dore GJ, Grebely J. Effect of treatment willingness on specialist assessment and treatment uptake for hepatitis C virus infection among people who use drugs: the ETHOS study. J Viral Hepat 2015; 22:914-25. [PMID: 25996567 DOI: 10.1111/jvh.12415] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 03/01/2015] [Indexed: 12/13/2022]
Abstract
Among people who inject drugs (PWID) with chronic HCV, the association between HCV treatment willingness and intent, and HCV specialist assessment and treatment were evaluated. The Enhancing Treatment for Hepatitis C in Opioid Substitution Settings (ETHOS) is a prospective observational cohort. Recruitment was through six opioid substitution treatment clinics, two community health centres and one Aboriginal community controlled health organisation in Australia. Analyses were performed using logistic regression. Among 415 participants (mean age 41 years, 71% male), 67% were 'definitely willing' to receive HCV treatment and 70% reported plans to initiate therapy 12 months postenrolment. Those definitely willing to receive HCV treatment were more likely to undergo specialist assessment (64% vs 32%, P < 0.001) and initiate therapy (36% vs 9%, P < 0.001), compared to those with lower treatment willingness. Those with early HCV treatment plans were more likely to undergo specialist assessment (65% vs 27%, P < 0.001) and initiate therapy (36% vs 5%, P < 0.001), compared to those without early plans. In adjusted analyses, HCV treatment willingness independently predicted specialist assessment (aOR 3.06, 95% CI 1.90, 4.94) and treatment uptake (aOR 4.33, 95% CI 2.14, 8.76). In adjusted analysis, having early HCV treatment plans independently predicted specialist assessment (aOR 4.38, 95% CI 2.63, 7.29) and treatment uptake (aOR 9.79, 95% CI 3.70, 25.93). HCV treatment willingness was high and predicted specialist assessment and treatment. Strategies for enhanced HCV care should be developed with an initial focus on people willing to receive treatment and to increase treatment willingness among those less willing.
Collapse
Affiliation(s)
- M Alavi
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - M Micallef
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - E Fortier
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.,Université de Montréal, Montréal, QC, Canada
| | - A J Dunlop
- University of Newcastle, Newcastle, NSW, Australia.,Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - A C Balcomb
- Clinic 96, Kite St Community Health Centre, Orange, NSW, Australia
| | - C A Day
- Drug Health Service, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Discipline of Addiction Medicine, Central Clinical School, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - C Treloar
- Centre for Social Research in Health, The University of New South Wales, Sydney, NSW, Australia
| | - N Bath
- NSW Users & AIDS Association, Inc., Sydney, NSW, Australia
| | - P S Haber
- Drug Health Service, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - G J Dore
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - J Grebely
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | | |
Collapse
|
24
|
Lee S, Zhai S, Zhang GY, Ma XS, Lu X, Tan Y, Siu P, Seals B, Ma GX. Factors Associated with Hepatitis C Knowledge Before and After an Educational Intervention among Vietnamese Americans. CLINICAL MEDICINE INSIGHTS. GASTROENTEROLOGY 2015; 8:45-53. [PMID: 26561280 PMCID: PMC4629630 DOI: 10.4137/cgast.s24737] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 06/01/2015] [Accepted: 06/03/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Hepatitis C virus (HCV) is a major cause of chronic liver disease and cancer. Vietnamese Americans are at high risk of HCV infection, with men having the highest US incidence of liver cancer. This study examines an intervention to improve HCV knowledge among Vietnamese Americans. STUDY Seven Vietnamese community-based organizations in Pennsylvania and New Jersey recruited a total of 306 Vietnamese participants from 2010 to 2011. RESULTS Average knowledge scores for pretest and posttest were 3.32 and 5.88, respectively (maximum 10). After adjusting for confounding variables, age and higher education were positively associated with higher pretest scores and having a physician who spoke English or Vietnamese was negatively associated with higher pretest scores. Additionally, after adjusting for confounding variables, household income, education, and having an HCV-infected family member significantly increased knowledge scores. CONCLUSIONS Promotion and development of HCV educational programs can increase HCV knowledge among race and ethnic groups, such as Vietnamese Americans. Giving timely information to at-risk groups provides the opportunity to correct misconceptions, decrease HCV risk behaviors, and encourage testing that might improve timely HCV diagnosis and treatment.
Collapse
Affiliation(s)
- Sunmin Lee
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, MD, USA
| | - Shumenghui Zhai
- Center for Asian Health, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Guo Yolanda Zhang
- Center for Asian Health, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Xiang S Ma
- Center for Asian Health, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Xiaoxiao Lu
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, MD, USA
| | - Yin Tan
- Center for Asian Health, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Philip Siu
- Greater Philadelphia Health Action, Inc., Philadelphia, PA, USA. ; Chinatown Medical Services, Philadelphia, PA, USA
| | - Brenda Seals
- Center for Asian Health, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Grace X Ma
- Department of Public Health, Center for Asian Health, College of Public Health, Temple University, Philadelphia, PA, USA
| |
Collapse
|
25
|
How to build trustworthy hepatitis C services in an opioid treatment clinic? A qualitative study of clients and health workers in a co-located setting. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2014; 25:865-70. [PMID: 24559604 DOI: 10.1016/j.drugpo.2014.01.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 01/14/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND Given the increasing burden of hepatitis C (HCV) related liver disease, innovative health care models are required to extend the reach of HCV care and treatment. Opioid substitution treatment (OST) clinics are places of high HCV prevalence. The OST clinic is a complex environment, quite distinct to other health care settings, with punitive regulations and practices, and a client population likely to be mistrustful of systems of authority. Nonetheless, trust is widely documented as essential to effective therapeutic encounters. This paper examines what is required to develop a trustworthy service in a place, the OST clinic, described by some critics as a site of "social control". METHODS In-depth interviews were conducted with 57 clients and 19 staff from four NSW pilot clinics participating in the Australian ETHOS study. RESULTS Interview data were examined using Hall's framework of trust, involving five principle domains: fidelity, competence, honest, confidentiality and global trust. 'Honesty' was found to be key to participants' establishing trust in the co-located service and its staff. However, the clinic site was also found to be a place of rationed trust, in which the themes of OST as "ruling peoples' lives" and the fear of repercussions resulting from perceived transgressions against clinic rules, threatened to over-ride or undermine the development of trust in HCV services. Client participants described trusting health workers "to a point". They expressed concerns about the fidelity of co-located HCV and OST services and described fears of "institutionalised lies" and breaches of confidentiality. Anxieties around the latter revealed a sense of "us and them" held by some clients, one in which health workers were perceived to "stick together" by putting their own interests before those of the clients. DISCUSSION Although the co-location of HCV and opioid treatments makes intuitive policy sense, HCV health workers in the OST space may be seen as representatives of a deeply mistrusted system. For the effective development of a trustworthy HCV care service, policy and practice activities are required to engender trust through clearly articulated explanations of service boundaries and the promotion of "success stories" through trusted peer networks.
Collapse
|
26
|
Education and counseling in the methadone treatment setting improves knowledge of viral hepatitis. J Subst Abuse Treat 2013; 46:528-31. [PMID: 24462241 DOI: 10.1016/j.jsat.2013.10.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 10/18/2013] [Accepted: 10/29/2013] [Indexed: 12/11/2022]
Abstract
The aim of this study was to evaluate the effectiveness of an educational method of providing viral hepatitis education for methadone maintenance patients. Four hundred forty participants were randomly assigned to either a control or a motivationally-enhanced viral hepatitis education and counseling intervention. Viral hepatitis A (HAV), B (HBV), and C (HCV) knowledge tests were administered at baseline, following each of two education sessions (post-education), and at a 3-month follow-up assessment. Results indicated a significant increase in knowledge of HAV, HBV, and HCV over time. No differences were found in knowledge between the intervention groups in knowledge acquisition regarding any of the hepatitis viruses suggesting that a motivational interviewing style may not augment hepatitis knowledge beyond standard counseling. A two-session viral hepatitis education intervention effectively promotes hepatitis knowledge and can be integrated in methadone treatment settings.
Collapse
|
27
|
Shah HA, Abu-Amara M. Education provides significant benefits to patients with hepatitis B virus or hepatitis C virus infection: a systematic review. Clin Gastroenterol Hepatol 2013; 11:922-33. [PMID: 23639601 DOI: 10.1016/j.cgh.2013.04.024] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 03/12/2013] [Accepted: 04/10/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Education of individuals who are at risk for, or have been diagnosed with, chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infections can improve their participation in disease management. We performed a systematic review to evaluate the effects of educational interventions for patients with HBV or HCV infections. METHODS We searched multiple databases for peer-reviewed studies of individuals with HBV or HCV infection, or those at risk for infection. Our final analysis included 14 studies that evaluated any educational intervention and reported the effectiveness or patient outcomes relevant to the intervention (7 patients with HCV infection, 4 patients with HBV infection, and 3 patients with either). Data extracted from studies included details on educational interventions, patient populations, comparison groups, and outcome measures. The quality of each study was appraised. RESULTS Types of educational interventions assessed ranged from information websites and nurse-led sessions to community-wide and institutional programs. The educational interventions showed significant (P < .05) improvements to patients' knowledge about their disease, behaviors (including testing and uptake of vaccination), willingness to commence and adhere to treatment, and other outcomes such as self-efficacy and vitality or energy scores. These significant benefits were shown in 5 of 7 studies of HBV infection and 8 of 10 studies of HCV infection. On a 20-point quality scale, study scores ranged from 6 to 19. CONCLUSIONS Simple educational interventions for patients with HBV or HCV infection significantly increase patients' knowledge about their disease. More complex, multimodal educational interventions seem to cause behavioral changes that increase rates of testing, vaccination (for HBV), and treatment.
Collapse
Affiliation(s)
- Hemant A Shah
- Francis Family Liver Clinic, Toronto Western Hospital, University Health Network and Division of Gastroenterology, University of Toronto, Toronto, Ontario, Canada.
| | | |
Collapse
|
28
|
Lubega S, Agbim U, Surjadi M, Mahoney M, Khalili M. Formal hepatitis C education enhances HCV care coordination, expedites HCV treatment and improves antiviral response. Liver Int 2013; 33:999-1007. [PMID: 23509897 PMCID: PMC3692599 DOI: 10.1111/liv.12150] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 02/19/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Formal Hepatitis C virus (HCV) education improves HCV knowledge but the impact on treatment uptake and outcome is not well described. We aimed to evaluate the impact of formal HCV patient education on primary provider-specialist HCV comanagement and treatment. METHODS Primary care providers within the San Francisco safety-net health care system were surveyed and the records of HCV-infected patients before and after institution of a formal HCV education class by liver specialty (2006-2011) were reviewed retrospectively. RESULTS Characteristics of 118 patients who received anti-HCV therapy were: mean age 51, 73% males and ~50% White and uninsured. The time to initiation of HCV treatment was shorter among those who received formal education (median 136 vs 284 days, P < 0.0001). When controlling for age, gender, race and HCV viral load, non-1 genotype (OR 6.17, 95% CI 2.3-12.7, P = 0.0003) and receipt of HCV education (OR 3.0, 95% CI 1.1-7.9, P = 0.03) were associated with sustained virologic treatment response. Among 94 provider respondents (response rate = 38%), mean age was 42, 62% were White, and 63% female. Most providers agreed that the HCV education class increased patients' HCV knowledge (70%), interest in HCV treatment (52%), and provider-patient communication (56%). A positive provider attitude (Coef 1.5, 95% CI 0.1-2.9 percent, P = 0.039) was independently associated with referral rate to education class. CONCLUSIONS Formal HCV education expedites HCV therapy and improves virologic response rates. As primary care provider attitude plays a significant role in referral to HCV education class, improving provider knowledge will likely enhance access to HCV specialty services in the vulnerable population.
Collapse
Affiliation(s)
- Samali Lubega
- Department of Medicine, San Francisco General Hospital and University of California San Francisco, San Francisco, CA
| | - Uchenna Agbim
- Department of Medicine, San Francisco General Hospital and University of California San Francisco, San Francisco, CA
| | - Miranda Surjadi
- Department of Medicine, San Francisco General Hospital and University of California San Francisco, San Francisco, CA
| | - Megan Mahoney
- Department of Family and Community Medicine, San Francisco General Hospital and University of California San Francisco, San Francisco, CA
| | - Mandana Khalili
- Department of Medicine, San Francisco General Hospital and University of California San Francisco, San Francisco, CA,Liver Center, University of California San Francisco, San Francisco, CA
| |
Collapse
|
29
|
Abstract
OBJECTIVES Despite high rates of hepatitis C virus (HCV) infection, relatively few current or former injection drug users receive evaluation and treatment for HCV. Here, we demonstrate the feasibility and effectiveness of integrating HCV care and methadone maintenance treatment (MMT). We hypothesized that colocation of these services would result in improved access to and utilization of HCV care. METHODS In this retrospective observational study, all patient charts from a single MMT clinic were reviewed 2 years after HCV care and MMT were integrated. Information obtained included screening for and counseling about HCV infection status, on-site HCV treatment and outcomes, and demographic and substance abuse data. RESULTS Two hundred ninety-one patient charts were reviewed. Two hundred eighty-one (99%) patients were screened for HCV antibody (HCV-Ab), and 188 (65%) were positive. Forty-nine (17%) patients were HIV/HCV coinfected. Ninety-eight percent of the HCV-Ab-positive patients received HCV counseling. Hundred fifty-nine (85%) of the HCV-Ab-positive patients were eligible to receive further evaluation and treatment for HCV on site, and 125 (78%) accepted. Hundred eighteen (94%) patients were tested for chronic HCV, and 83 were determined to have chronic HCV. Twenty-five patients received liver biopsy; low-stage disease was found in 7 patients. Twenty-one patients initiated HCV treatment. Sustained viral response was achieved in 8 patients. Seventeen patients had contraindications to HCV treatment. Further workup was prevented or delayed in 45 patients for various reasons, most commonly due to personal choice (29 patients). CONCLUSIONS This study demonstrates that current and former injection drug users can be engaged successfully in evaluation and treatment of HCV infection when these services are collocated with MMT.
Collapse
|
30
|
Jordan AE, Masson CL, Mateu-Gelabert P, McKnight C, Pepper N, Bouche K, Guzman L, Kletter E, Seewald RM, Des-Jarlais DC, Sorensen JL, Perlman DC. Perceptions of drug users regarding hepatitis C screening and care: a qualitative study. Harm Reduct J 2013; 10:10. [PMID: 23786800 PMCID: PMC3695813 DOI: 10.1186/1477-7517-10-10] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 06/12/2013] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Illicit drug users have a high prevalence of HCV and represent the majority of newly infected persons in the U.S. Despite the availability of effective HCV treatment, few drug users have been evaluated or treated for HCV. Racial and ethnic minorities have a higher incidence and prevalence of HCV and higher HCV-related mortality. Factors contributing to poor engagement in care are incompletely understood. METHODS Fourteen mixed-gender focus groups of either African American or Latino/a drug users (N = 95) discussed barriers to HCV testing and treatment. Themes were identified through content analysis of focus group discussions. RESULTS Many drug users were tested for HCV in settings where they were receiving care. Outside of these settings, most were unaware of voluntary test sites. After testing HCV positive, drug users reported not receiving clear messages regarding the meaning of a positive HCV test, the impact of HCV infection, or appropriate next steps including HCV clinical evaluations. Many drug users perceived treatment as unimportant because they lacked symptoms, healthcare providers minimized the severity of the diagnosis, or providers did not recommend treatment. Mistrust of the motivations of healthcare providers was cited as a barrier to pursuing treatment. Social networks or social interactions were a source of HCV-related information and were influential in shaping drug users perceptions of treatment and its utility. CONCLUSION Drug users perceived a paucity of settings for self-initiated HCV testing and poor provider-patient communication at test sites and during medical encounters. Notably, drug users reported having an unclear understanding about the meaning of a positive HCV test, the health implications of HCV infection, the importance of clinical evaluations and monitoring, and of treatment options for HCV. Efforts to improve the delivery of clinical messages about HCV infection for drug users at test settings and clinical encounters are needed.
Collapse
Affiliation(s)
- Ashly E Jordan
- Beth Israel Medical Center, 120 East 16th St, Floor 12, New York, NY, 10003, USA
- Center for Drug Use and HIV Research, 120 East 16th St, Floor 12, New York, NY, 10003, USA
| | - Carmen L Masson
- Department of Psychiatry, San Francisco General Hospital, University of California, San Francisco, 1001 Potrero Avenue, Building 20, Suite 2100, San Francisco, CA, 94110, USA
| | - Pedro Mateu-Gelabert
- Center for Drug Use and HIV Research, 120 East 16th St, Floor 12, New York, NY, 10003, USA
- National Development and Research Institutes Inc, 71 West 23rd St. Floor 8, New York, NY, 10010, USA
| | - Courtney McKnight
- Beth Israel Medical Center, 120 East 16th St, Floor 12, New York, NY, 10003, USA
- Center for Drug Use and HIV Research, 120 East 16th St, Floor 12, New York, NY, 10003, USA
| | - Nicole Pepper
- Department of Psychiatry, San Francisco General Hospital, University of California, San Francisco, 1001 Potrero Avenue, Building 20, Suite 2100, San Francisco, CA, 94110, USA
| | - Katie Bouche
- Prevention Point, San Francisco AIDS Foundation, HIV Prevention Project, San Francisco AIDS Foundation, 1035 Market Street, Suite 400, San Francisco, CA, 94103, California
| | - Laura Guzman
- Mission Neighborhood Resource Center, 165 Capp Street, San Francisco, CA, 94110, California
| | - Evan Kletter
- BAART Programs, 433 Turk Street, San Francisco, CA, 94102, California
| | - Randy M Seewald
- Beth Israel Medical Center, 120 East 16th St, Floor 12, New York, NY, 10003, USA
| | - Don C Des-Jarlais
- Beth Israel Medical Center, 120 East 16th St, Floor 12, New York, NY, 10003, USA
- Center for Drug Use and HIV Research, 120 East 16th St, Floor 12, New York, NY, 10003, USA
| | - James L Sorensen
- Department of Psychiatry, San Francisco General Hospital, University of California, San Francisco, 1001 Potrero Avenue, Building 20, Suite 2100, San Francisco, CA, 94110, USA
| | - David C Perlman
- Beth Israel Medical Center, 120 East 16th St, Floor 12, New York, NY, 10003, USA
- Center for Drug Use and HIV Research, 120 East 16th St, Floor 12, New York, NY, 10003, USA
| |
Collapse
|
31
|
Grebely J, Matthews GV, Lloyd AR, Dore GJ. Elimination of Hepatitis C Virus Infection Among People Who Inject Drugs Through Treatment as Prevention: Feasibility and Future Requirements. Clin Infect Dis 2013; 57:1014-20. [DOI: 10.1093/cid/cit377] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
|
32
|
Harris M, Rhodes T. Hepatitis C treatment access and uptake for people who inject drugs: a review mapping the role of social factors. Harm Reduct J 2013; 10:7. [PMID: 23651646 PMCID: PMC3686576 DOI: 10.1186/1477-7517-10-7] [Citation(s) in RCA: 187] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 04/13/2013] [Indexed: 02/06/2023] Open
Abstract
Background Evidence documents successful hepatitis C virus (HCV) treatment outcomes for people who inject drugs (PWID) and interest in HCV treatment among this population. Maximising HCV treatment for PWID can be an effective HCV preventative measure. Yet HCV treatment among PWID remains suboptimal. This review seeks to map social factors mediating HCV treatment access. Method We undertook a review of the social science and public health literature pertaining to HCV treatment for PWID, with a focus on barriers to treatment access, uptake and completion. Medline and Scopus databases were searched, supplemented by manual and grey literature searches. A two step search was taken, with the first step pertaining to literature on HCV treatment for PWID and the second focusing on social structural factors. In total, 596 references were screened, with 165 articles and reports selected to inform the review. Results Clinical and individual level barriers to HCV treatment among PWID are well evidenced. These include patient and provider concerns regarding co-morbidities, adherence, and side effect management. Social factors affecting treatment access are less well evidenced. In attempting to map these, key barriers fall into the following domains: social stigma, housing, criminalisation, health care systems, and gender. Key facilitating factors to treatment access include: combination intervention approaches encompassing social as well as biomedical interventions, low threshold access to opiate substitution therapy, and integrated delivery of multidisciplinary care. Conclusion Combination intervention approaches need to encompass social interventions in relation to housing, stigma reduction and systemic changes in policy and health care delivery. Future research needs to better delineate social factors affecting treatment access.
Collapse
Affiliation(s)
- Magdalena Harris
- Centre for Research on Drugs and Health Behaviour, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H9SH, UK.
| | | |
Collapse
|
33
|
Abstract
OBJECTIVES To explore attitudes toward hepatitis C antiviral therapy in a real-world setting, we asked patients in opioid agonist treatment who were offered antiviral therapy about perceived barriers to initiating therapy. METHODS We recruited patients in opioid agonist treatment who had previously been offered cost-free hepatitis C antiviral therapy in a clinical trial. We collected demographic and open-ended interview data. The semistructured interview guide included questions about attitudes toward hepatitis C therapy and barriers to initiating treatment. Each interview was audio recorded and transcribed verbatim. We used the qualitative editing method to analyze the interview transcripts. RESULTS We enrolled 19 patients who had been approached to initiate hepatitis C therapy in a clinical trial. All participants were low-income men, with one third self-identifying as racial minorities. When asked about possible barriers to treatment, multiple problems emerged, including the fear of treatment side effects, difficulties with health care providers, limited access to medical care and health information, and misperceptions about antiviral therapy. CONCLUSIONS 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.
Collapse
|
34
|
Ti L, Kaplan K, Hayashi K, Suwannawong P, Wood E, Kerr T. Low rates of hepatitis C testing among people who inject drugs in Thailand: implications for peer-based interventions. J Public Health (Oxf) 2013; 35:578-84. [PMID: 23335599 DOI: 10.1093/pubmed/fds105] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Regular testing for hepatitis C virus (HCV) provides an opportunity for HCV prevention and treatment efforts. In Thailand, the barriers and facilitators of HCV testing among people who inject drugs (IDU) are not known. METHODS Using data derived from the Mitsampan Community Research Project between July and October 2011, we assessed the prevalence and factors associated with ever having been tested for HCV antibodies using bivariate statistics and multivariate logistic regression. RESULTS Among 427 participants, 141 (33.0%) reported a history of HCV antibody testing. In multivariate analyses, factors positively associated with receiving an HCV antibody test included higher than secondary education [adjusted odds ratio (AOR) = 2.20; 95% confidence interval (CI): 1.35-3.64], binge drug use (AOR = 1.81; 95% CI: 1.12-2.93), methadone treatment enrollment (AOR = 3.47; 95% CI: 1.85-6.95) and having received peer-based education on HCV (AOR = 4.22; 95% CI: 2.66-6.77). CONCLUSIONS We found one-third of Thai IDU in our sample reporting a history of HCV testing. The finding that IDU who received peer-based HCV education were more likely to access HCV testing provides evidence for the value of peer-based interventions for this population.
Collapse
Affiliation(s)
- L Ti
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6
| | | | | | | | | | | |
Collapse
|
35
|
Abstract
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.
Collapse
Affiliation(s)
- P Bruggmann
- Arud Centres of Addiction Medicine, Zurich, Switzerland.
| |
Collapse
|
36
|
Stein MR, Soloway IJ, Jefferson KS, Roose RJ, Arnsten JH, Litwin AH. Concurrent group treatment for hepatitis C: implementation and outcomes in a methadone maintenance treatment program. J Subst Abuse Treat 2012; 43:424-32. [PMID: 23036920 DOI: 10.1016/j.jsat.2012.08.007] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Revised: 07/31/2012] [Accepted: 08/08/2012] [Indexed: 01/12/2023]
Abstract
Chronic hepatitis C virus (HCV) infection is highly prevalent among current and former drug users. However, the minority of patients enrolled in drug treatment programs have initiated HCV treatment. New models are needed to overcome barriers to care. In this retrospective study, we describe the implementation and outcomes of 42 patients treated in a concurrent group treatment (CGT) program. Patients participated in weekly provider-led group treatment sessions which included review of side effects; discussion of adherence and side effect management; administration of interferon injections; brief physical examination; and ended with brief meditation. Of the first 27 patients who initiated CGT, 42% achieved a sustained viral response. In addition, 87% (13/15) of genotype-1 infected patients treated with direct acting antiviral agent achieved an undetectable viral load at 24 weeks. The CGT model may be effective in overcoming barriers to treatment and improving adherence and outcomes among patients enrolled in drug treatment programs.
Collapse
Affiliation(s)
- Melissa R Stein
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | | | | | | | | | | |
Collapse
|
37
|
TRELOAR CARLA, HULL PETER, DORE GREGORYJ, GREBELY JASON. Knowledge and barriers associated with assessment and treatment for hepatitis C virus infection among people who inject drugs. Drug Alcohol Rev 2012; 31:918-24. [DOI: 10.1111/j.1465-3362.2012.00468.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
|
38
|
Astell-Burt T, Flowerdew R, Boyle P, Dillon J. Is travel-time to a specialist centre a risk factor for non-referral, non-attendance and loss to follow-up among patients with hepatitis C (HCV) infection? Soc Sci Med 2012; 75:240-7. [PMID: 22516762 DOI: 10.1016/j.socscimed.2012.02.046] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2011] [Revised: 02/01/2012] [Accepted: 02/22/2012] [Indexed: 01/17/2023]
Abstract
Little is known about why many people diagnosed with hepatitis C virus (HCV) infection fail to reach and stay within specialist care services. We used a Geographic Information System and logit regression to investigate whether travel-time to a specialist centre was associated with an increased likelihood of non-referral, non-attendance and loss to follow-up among persons diagnosed with HCV between 1991 and 2003 in Tayside, Scotland (UK). Information was available on referral to, and utilisation of, the single HCV specialist centre in Tayside between 1991 and 2006. Longer travel-time to a specialist centre was associated with an increased likelihood of non-referral to a specialist centre following diagnosis (Odds Ratio: 1.25, 95% Confidence Interval: 1.09, 1.44). Patients living further from an HCV specialist centre were less likely to be referred to it for treatment that could cure their HCV infection. Neither a history of intravenous drug use (IDU), nor area deprivation predicted non-referral. Subsequent to referral, travel-time to a specialist centre was not associated with either non-attendance (0.83 (0.56, 1.21)) or loss to follow-up (0.98 (0.78, 1.22)), although a history of IDU was a strong predictor of both non-attendance and loss to follow-up. Non-attendance was less likely among older patients, while loss to follow-up was more common among those living in deprived areas. Once referred, patients appear able to cope with stress and financial cost of long and frequent journeys to hospital. However, as rates of referral improve from more geographically remote areas, long travel-times to an HCV specialist centre may become an important factor determining future utilisation.
Collapse
|
39
|
Salmon-Ceron D, Cohen J, Winnock M, Roux P, Sadr FB, Rosenthal E, Martin IP, Loko MA, Mora M, Sogni P, Spire B, Dabis F, Carrieri MP. Engaging HIV-HCV co-infected patients in HCV treatment: the roles played by the prescribing physician and patients' beliefs (ANRS CO13 HEPAVIH cohort, France). BMC Health Serv Res 2012; 12:59. [PMID: 22409788 PMCID: PMC3325848 DOI: 10.1186/1472-6963-12-59] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Accepted: 03/12/2012] [Indexed: 01/19/2023] Open
Abstract
Background Treatment for the hepatitis C virus (HCV) may be delayed significantly in HIV/HCV co-infected patients. Our study aims at identifying the correlates of access to HCV treatment in this population. Methods We used 3-year follow-up data from the HEPAVIH ANRS-CO13 nationwide French cohort which enrolled patients living with HIV and HCV. We included pegylated interferon and ribavirin-naive patients (N = 600) at enrolment. Clinical/biological data were retrieved from medical records. Self-administered questionnaires were used for both physicians and their patients to collect data about experience and behaviors, respectively. Results Median [IQR] follow-up was 12[12-24] months and 124 patients (20.7%) had started HCV treatment. After multiple adjustment including patients' negative beliefs about HCV treatment, those followed up by a general practitioner working in a hospital setting were more likely to receive HCV treatment (OR[95%CI]: 1.71 [1.06-2.75]). Patients followed by general practitioners also reported significantly higher levels of alcohol use, severe depressive symptoms and poor social conditions than those followed up by other physicians. Conclusions Hospital-general practitioner networks can play a crucial role in engaging patients who are the most vulnerable and in reducing existing inequities in access to HCV care. Further operational research is needed to assess to what extent these models can be implemented in other settings and for patients who bear the burden of multiple co-morbidities.
Collapse
|
40
|
Abstract
PURPOSE OF REVIEW Despite a high burden of hepatitis C virus (HCV) and HIV infection among IDUs and the advent of effective therapies, assessment and treatment remain limited. The current review focuses on the management of HCV and HIV among IDUs, focusing particularly on recent strategies to enhance assessment, uptake and response to HCV and HIV treatment. RECENT FINDINGS There are compelling data demonstrating that with the appropriate programs, treatment for HIV and HCV among IDUs is successful. However, assessment and treatment for HCV and HIV lags far behind the numbers of IDUs who could benefit from therapy, related to systems, provider and patient-related barriers to care. Strategies for enhancing assessment and treatment for HCV and HIV have been developed, including novel models integrating HCV/HIV care within existing community-based and drug and alcohol clinics, innovative methods for education delivery (including peer-support models) and directly observed therapy. SUMMARY As we move forward, research must move beyond demonstrating that HCV and HIV infections can be successfully treated among IDUs. There is clear evidence that this is both feasible and effective. Novel strategies to enhance assessment, uptake and response to treatment should be evaluated among IDUs to elucidate mechanisms to enhance care for this underserved population.
Collapse
|
41
|
Proeschold-Bell RJ, Hoeppner B, Taylor B, Cohen S, Blouin R, Stringfield B, Muir AJ. An interrupted time series evaluation of a hepatitis C intervention for persons with HIV. AIDS Behav 2011; 15:1721-31. [PMID: 21191643 DOI: 10.1007/s10461-010-9870-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Accurate HCV knowledge is lacking among high-risk groups, including people with HIV/AIDS (PLWHA). Liver disease primarily due to HCV has emerged as a serious cause of mortality among PLWHA. We used an Interrupted Time Series design to evaluate a social-ecologically based intervention for PLWHA, where an infectious disease clinic serving a six-county intervention area was monitored before (7 months) and after (17 months) intervention onset. The intervention included education of PLWHA and medical providers, HIV/HCV support groups, and adaptation of the patient chart top sheet to include HCV test information. Clinic-level outcomes were assessed prospectively every other week for 2 years by interviewing patients (n = 259) with clinic appointments on assessment days. Abrupt, gradual and delayed intervention effects were tested. Weighted regression analyses showed higher average HCV knowledge and a higher prevalence of patients reporting HCV discussion with their medical providers after intervention onset. A delayed effect was found for HCV awareness, and a gradually increasing effect was found for knowing one's HCV status. Other communities may consider adopting this intervention. Additional HCV interventions for PLWHA with HIV are needed.
Collapse
|
42
|
Krauskopf K, McGinn TG, Federman AD, Halm EA, Leventhal H, McGinn LK, Gardenier D, Oster A, Kronish IM. HIV and HCV health beliefs in an inner-city community. J Viral Hepat 2011; 18:785-91. [PMID: 20950406 DOI: 10.1111/j.1365-2893.2010.01383.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Chronic infection with the hepatitis C virus (HCV) is more prevalent than human immunodeficiency virus (HIV) infection, but more public health resources are allocated to HIV than to HCV. Given shared risk factors and epidemiology, we compared accuracy of health beliefs about HIV and HCV in an at-risk community. Between 2002 and 2003, we surveyed a random patient sample at a primary care clinic in New York. The survey was organized as domains of Common Sense Model of Self-Regulation: causes ('sharing needles'), timeline/consequences ('remains in body for life', 'causes cancer') and controllability ('I can avoid this illness', 'medications may cure this illness'). We compared differences in accuracy of beliefs about HIV and HCV and used multivariable linear regression to identify factors associated with relative accuracy of beliefs. One hundred and twenty-two subjects completed the survey (response rate 42%). Mean overall health belief accuracy was 12/15 questions (80%) for HIV vs 9/15 (60%) for HCV (P < 0.001). Belief accuracy was significantly different across all domains. Within the causes domain, 60% accurately believed sharing needles a risk factor for HCV compared to 92% for HIV (P < 0.001). Within the timeline/consequences domain, 42% accurately believed HCV results in lifelong infection compared to 89% for HIV (P < 0.001). Within the controllability domain, 25% accurately believed that there is a potential cure for HCV. Multivariable linear regression revealed female gender as significantly associated with greater health belief accuracy for HIV. Thus, study participants had significantly less accurate health beliefs about HCV than about HIV. Targeting inaccuracies might improve public health interventions to foster healthier behaviours and better hepatitis C outcomes.
Collapse
Affiliation(s)
- K Krauskopf
- Division of General Internal Medicine, Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10029, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Surjadi M, Torruellas C, Ayala C, Yee HF, Khalili M. Formal patient education improves patient knowledge of hepatitis C in vulnerable populations. Dig Dis Sci 2011; 56:213-9. [PMID: 20972850 PMCID: PMC3008930 DOI: 10.1007/s10620-010-1455-3] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Accepted: 10/05/2010] [Indexed: 02/06/2023]
Abstract
BACKGROUND Hepatitis C (HCV) knowledge is limited in injection drug users (IDU). Vulnerable populations including IDUs are disproportionally affected by HCV. Effective HCV education can potentially reduce disparity in HCV prevalence and its outcome in this population. AIM This study aimed to assess the impact of formal HCV education and factors associated with improved HCV knowledge in the vulnerable population. METHODS Over 18 months, 201 HCV-infected patients underwent a 2-h standardized education and completed demographic and pre- and post-education questionnaires. RESULTS Patient characteristics were: 69% male, mean age 49±10, 49% White (26% AA, 10% Latino), 75% unemployed, 83% high school education and above, 64% were IDU, and 7% were HIV co-infected. On multivariate analysis, baseline knowledge scores were higher in patients with at least a high school education (coef 7.1, p=0.045). Baseline knowledge scores were lower in African Americans (coef -12.3, p=0.004) and older patients (coef -0.7, p=0.03). Following HCV education, the overall test scores improved significantly by 14% (p=0.0001) specifically in the areas of HCV transmission (p=0.003), general knowledge (p=0.02), and health care maintenance (p=0.004). There was a high compliance with liver specialty clinic attendance following education. CONCLUSIONS Formal HCV education is effective in improving HCV knowledge. Although White race, younger age, and higher education were predictors of having more HCV knowledge prior to education, all patients independent of racial background had a significant improvement in their knowledge after education. Therefore, promoting effective HCV education among vulnerable populations may be an important factor in reducing the disparities in HCV disease.
Collapse
Affiliation(s)
- Miranda Surjadi
- Department of Medicine, San Francisco General Hospital, University of California San Francisco, 1001 Potrero Ave, NH-3D, San Francisco, CA 94110 USA
| | - Cara Torruellas
- Department of Medicine, San Francisco General Hospital, University of California San Francisco, 1001 Potrero Ave, NH-3D, San Francisco, CA 94110 USA
| | - Claudia Ayala
- Department of Medicine, San Francisco General Hospital, University of California San Francisco, 1001 Potrero Ave, NH-3D, San Francisco, CA 94110 USA
| | - Hal F. Yee
- Department of Medicine, San Francisco General Hospital, University of California San Francisco, 1001 Potrero Ave, NH-3D, San Francisco, CA 94110 USA ,UCSF/SFGH Center for Specialty Access & Quality, San Francisco, CA USA
| | - Mandana Khalili
- Department of Medicine, San Francisco General Hospital, University of California San Francisco, 1001 Potrero Ave, NH-3D, San Francisco, CA 94110 USA ,UCSF/SFGH Center for Specialty Access & Quality, San Francisco, CA USA
| |
Collapse
|
44
|
Coupland H, Maher L. Notions of Injecting Drug Users' Candidacy for Hepatitis C Treatment: Conflicting Provider, Patient, and Public Health Perspectives. ACTA ACUST UNITED AC 2010. [DOI: 10.1177/009145091003700403] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Uptake of hepatitis C treatment by injecting drug users (IDUs) remains low and little is known about factors influencing treatment uptake by ethnic minority groups. The influence of notions of “candidacy” on “accomplishing” access to antiviral treatment are explored using data from an ethnographic study. Fieldwork and in-depth interviews were conducted with 72 Indo-Chinese IDUs. Cultural contexts, everyday realities of drug use and marginalization, and disengagement from the health system produced notions of candidacy in participants' local worlds. Among the minority assessed for treatment, adjudications of candidacy were perceived to be influenced by power dynamics. Demonstrating abstinence from drug use was understood to be central to establishing legitimate claims for candidacy, suggesting conflicting provider, patient, and public health perspectives. Further research is needed to identify drivers of institutional notions of candidacy and determine ways to ensure these do not produce discriminatory practices and policies that exclude and disadvantage particular groups.
Collapse
|
45
|
Nyamathi A, Tyler D, Sinha K, Marfisee M, Cohen A, Greengold B. Predictors of hepatitis knowledge improvement among methadone maintained clients enrolled in a hepatitis intervention program. J Community Health 2010; 35:423-32. [PMID: 20358265 PMCID: PMC2926441 DOI: 10.1007/s10900-010-9266-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This randomized, controlled study (n = 256) was conducted to compare three interventions designed to promote hepatitis A virus (HAV) and hepatitis B virus (HBV) vaccination completion, among clients undergoing methadone maintenance treatment (MMT) in Los Angeles and Santa Monica. The participants were randomized into three groups: Motivational Interviewing-Single Session (MI-Single), Motivational Interviewing-Group (MI-Group), or Nurse-Led Hepatitis Health Promotion (HHP). All three treatment groups received the 3-series HAV/HBV vaccine. The MI sessions were provided by trained therapists, the Nurse-Led HHP sessions were delivered by a research nurse. The main outcome variable of interest was improvement in HBV and HCV knowledge, measured by a 6-item HBV and a 7-item HCV knowledge and attitude tool that was administered at baseline and at 6-month follow-up. The study results showed that there was a significant increase in HBV- and HCV-related knowledge across all three groups (p < 0.0001). There were no significant differences found with respect to knowledge acquisition among the groups. Irrespective of treatment group, gender (P = 0.008), study site (P < 0.0001) and whether a participant was abused as a child (P = 0.017) were all found to be predictors of HCV knowledge improvement; only recruitment site (P < 0.0001) was found to be a predictor of HBV knowledge. The authors concluded that, although MI-Single, MI-Group and Nurse-Led HHP are all effective in promoting HBV and HCV knowledge acquisition among MMT clients, Nurse-Led HHP may be the method of choice for this population as it may be easier to integrate and with additional investigation may prove to be more cost efficient.
Collapse
Affiliation(s)
- Adeline Nyamathi
- UCLA, School of Nursing, 700 Tiverton Avenue, Los Angeles, CA 90095-1702, USA.
| | | | | | | | | | | |
Collapse
|
46
|
Abstract
OBJECTIVE Liver disease associated with hepatitis C virus (HCV) is a serious cause of mortality among people living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) (PLWHA). Little is known about the HCV knowledge of PLWHA. METHODS One hundred seventy-nine patients at an infectious disease clinic were interviewed on HCV knowledge and alcohol use. RESULTS Sixty-six percent of participants indicated that HCV is transmitted through blood; 53% indicated that persons with HIV-HCV co-infection can benefit from HCV treatment; and 79% and 74%, respectively, indicated that safer sex and safer injection techniques can prevent HCV transmission. Among PLWHA with self-reported HCV, 97% indicated that persons with HCV should not drink alcohol, but 32% reported using alcohol in the past 30 days. CONCLUSIONS Health education is needed to prevent HCV infections and increase HCV treatment-seeking. Higher education levels were related to more accurate HCV knowledge, indicating the need for health promotion for PLWHA of lower education levels.
Collapse
|
47
|
Canfield KM, Smyth E, Batki SL. Methadone maintenance patients' knowledge, attitudes, beliefs, and experiences concerning treatment for hepatitis C virus infection. Subst Use Misuse 2010; 45:496-514. [PMID: 20141461 DOI: 10.3109/10826080903452538] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Hepatitis C virus (HCV) knowledge, attitudes, beliefs, and experiences (KABE) of 64 HCV antibody positive methadone maintenance treatment (MMT) patients were assessed in conjunction with acceptability of an on-site semi-structured HCV education session, HCV RNA diagnostic testing, HCV treatment motivational assessment, and initiation of HCV treatment. The KABE interviews were conducted in 2006 and 2007 in an urban New York State MMT clinic in affiliation with a NIDA-funded HCV research project. The majority had basic knowledge of HCV disease, but poor understanding of HCV testing and treatment. While the majority of participants expressed fear of HCV treatment side effects, 88% accepted HCV RNA testing and 78% expressed willingness to start HCV treatment with the majority of chronically infected choosing to start HCV treatment medications. Study limitations and implications are discussed.
Collapse
Affiliation(s)
- Kelly M Canfield
- Department of Psychiatry, SUNY Upstate Medical University, Syracuse, New York 13210, USA.
| | | | | |
Collapse
|
48
|
Grebely J, Petoumenos K, Matthews GV, Haber P, Marks P, Lloyd AR, Kaldor JM, Dore GJ, Hellard M. Factors associated with uptake of treatment for recent hepatitis C virus infection in a predominantly injecting drug user cohort: The ATAHC Study. Drug Alcohol Depend 2010; 107:244-9. [PMID: 19926405 PMCID: PMC2853739 DOI: 10.1016/j.drugalcdep.2009.09.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2009] [Revised: 09/18/2009] [Accepted: 09/22/2009] [Indexed: 12/14/2022]
Abstract
Despite that the majority of hepatitis C virus (HCV) infection occurs among injection drug users (IDUs), little is known about HCV treatment uptake in this group, particularly during recent infection. We evaluated uptake of treatment for recent HCV infection, including associated factors, within a population predominantly made up of IDUs. The Australian Trial in Acute Hepatitis C was a study of the natural history and treatment of recent HCV infection. All participants with detectable HCV RNA at screening were offered HCV treatment, assessed for eligibility and those initiating treatment were identified. Logistic regression analyses were used to identify predictors of HCV treatment uptake. Between June 2004 and February 2008, 163 were enrolled, with 146 positive for HCV RNA at enrolment. The mean age was 35 years, 77% (n=113) participants had ever injected illicit drugs and 23% (n=34) reported having ever received methadone or buprenorphine treatment. The uptake of HCV treatment was 76% (111 of 146) among those who were eligible on the basis of positive HCV RNA. Estimated duration of HCV infection (OR=1.03 per week, 95% CI=1.00-1.06, P=0.035) and log(10) HCV RNA (OR=1.92 per log(10) increase, 95% CI=1.36-2.73, P<0.001) were independently associated with treatment uptake whereas injection drug use was not. This study demonstrates that a high uptake of HCV treatment can be achieved among participants with recently acquired HCV infection. Decisions about whether to initiate treatment for recently acquired HCV were mainly driven by clinical factors, rather than factors related to sociodemographics or injecting behaviors.
Collapse
Affiliation(s)
- J Grebely
- National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, 376 Victoria Street, Darlinghurst, Sydney, NSW 2010, Australia.
| | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Cohen-Moreno R, Schiff M, Levitt S, Bar-Hamburger R, Strauss S, Neumark Y. Knowledge about Hepatitis-C among methadone maintenance treatment patients in Israel. Subst Use Misuse 2010; 45:58-76. [PMID: 20025439 DOI: 10.3109/10826080902864894] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Ignorance about Hepatitis-C (HCV) among drug users, treatment staff, and policy makers thwarts treatment uptake and facilitates virus transmission. We assessed knowledge about HCV among methadone patients in Israel, where effective HCV-treatment is provided at low-cost within the national health insurance framework, yet few infected methadone patients are treated. In 2006, 512 patients in two methadone clinics in Israel were interviewed, of whom 53% were HCV-positive. The clinics were purposively selected from the 11 methadone clinics in the country. Respondents exhibited poor knowledge about HCV, particularly about diagnosis and treatment. Lesser-educated respondents were three times more likely to score low on HCV-knowledge compared to those with 12+ years of schooling (AOR = 2.97, 95% CI = 1.5-5.7. HCV-negative patients were also three-times more likely than HCV-positive patients to score low on the HCV-knowledge scale (Adjusted Odds Ratio = 3.0, 95% Confidence Interval = 1.9-4.7). Enhancing HCV-knowledge may help patients avoid becoming infected and infecting others, allay exaggerated fears about hepatitis, and facilitate HCV-treatment initiation among those infected.
Collapse
Affiliation(s)
- Rinat Cohen-Moreno
- Braun School of Public Health and Community Medicine, Hebrew University-Hadassah, Jerusalem, Israel
| | | | | | | | | | | |
Collapse
|
50
|
Brady KA, Weiner M, Turner BJ. Undiagnosed hepatitis C on the general medicine and trauma services of two urban hospitals. J Infect 2009; 59:62-9. [PMID: 19473706 PMCID: PMC4020138 DOI: 10.1016/j.jinf.2009.04.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Revised: 04/22/2009] [Accepted: 04/23/2009] [Indexed: 12/20/2022]
Abstract
The inpatient medical service may be an important location to identify undiagnosed hepatitis C virus (HCV) infection. We conducted a cross-sectional HCV prevalence study in consecutive patients aged 18-65 admitted in a three-month period to two urban hospitals' general internal medicine and trauma services. Patient sera were anonymously screened for anti-HCV antibody with an enzyme-linked immunoassay and, when anti-HCV positive (+), for HIV. Health system records were examined for prior HCV testing or diagnosis or an HIV diagnosis then linked anonymously to test results. Multivariate logistic regression was used to examine associations of patient and health care factors with unknown HCV+ status. Of 786 unique patients tested (60.3% of all admitted patients), 62 (7.9%) were HCV+ without a prior HCV+ test or diagnosis while 61 patients (7.8%) tested HCV+ but had prior HCV+ test or diagnosis. Of 62 patients with unknown HCV+, 6 (9.7%) were HIV+ but only 3 had a prior HIV diagnosis; of 61 patients with known HCV+, all 9 (14.8%) HIV+ had been diagnosed. Among the 640 patients with prior unknown HCV status, an HCV+ test was strongly associated with age: 50-65 (adjusted odds ratio [AOR] 5.44, CI 2.20-13.48) and age 36-49 (AOR 4.65, CI 1.91-11.32) versus. 18-35. In this anonymous study, we could not obtain HCV risk factor data but the positive and negative predictive values of HCV testing all inpatients with an unknown HCV status were 99.3% and 99.0%, respectively. In similar urban general medicine and trauma services, broader efforts to test for HCV in inpatients aged 36-65 may be warranted.
Collapse
Affiliation(s)
- Kathleen A. Brady
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania, United States
- Philadelphia Department of Public Health, United States
| | - Mark Weiner
- Division of General Internal Medicine, Department of Medicine, University of Pennsylvania, United States
| | - Barbara J. Turner
- Division of General Internal Medicine, Department of Medicine, University of Pennsylvania, United States
| |
Collapse
|