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Korb-Savoldelli V, Tran Y, Perrin G, Touchard J, Pastre J, Borowik A, Schwartz C, Chastel A, Thervet E, Azizi M, Amar L, Kably B, Arnoux A, Sabatier B. Psychometric Properties of a Machine Learning-Based Patient-Reported Outcome Measure on Medication Adherence: Single-Center, Cross-Sectional, Observational Study. J Med Internet Res 2023; 25:e42384. [PMID: 37843891 PMCID: PMC10616746 DOI: 10.2196/42384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 03/31/2023] [Accepted: 03/31/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Medication adherence plays a critical role in controlling the evolution of chronic disease, as low medication adherence may lead to worse health outcomes, higher mortality, and morbidity. Assessment of their patients' medication adherence by clinicians is essential for avoiding inappropriate therapeutic intensification, associated health care expenditures, and the inappropriate inclusion of patients in time- and resource-consuming educational interventions. In both research and clinical practices the most extensively used measures of medication adherence are patient-reported outcome measures (PROMs), because of their ability to capture subjective dimensions of nonadherence. Machine learning (ML), a subfield of artificial intelligence, uses computer algorithms that automatically improve through experience. In this context, ML tools could efficiently model the complexity of and interactions between multiple patient behaviors that lead to medication adherence. OBJECTIVE This study aimed to create and validate a PROM on medication adherence interpreted using an ML approach. METHODS This cross-sectional, single-center, observational study was carried out a French teaching hospital between 2021 and 2022. Eligible patients must have had at least 1 long-term treatment, medication adherence evaluation other than a questionnaire, the ability to read or understand French, an age older than 18 years, and provided their nonopposition. Included adults responded to an initial version of the PROM composed of 11 items, each item being presented using a 4-point Likert scale. The initial set of items was obtained using a Delphi consensus process. Patients were classified as poorly, moderately, or highly adherent based on the results of a medication adherence assessment standard used in the daily practice of each outpatient unit. An ML-derived decision tree was built by combining the medication adherence status and PROM responses. Sensitivity, specificity, positive and negative predictive values (NPVs), and global accuracy of the final 5-item PROM were evaluated. RESULTS We created an initial 11-item PROM with a 4-point Likert scale using the Delphi process. After item reduction, a decision tree derived from 218 patients including data obtained from the final 5-item PROM allowed patient classification into poorly, moderately, or highly adherent based on item responses. The psychometric properties were 78% (95% CI 40%-96%) sensitivity, 71% (95% CI 53%-85%) specificity, 41% (95% CI 19%-67%) positive predictive values, 93% (95% CI 74%-99%) NPV, and 70% (95% CI 55%-83%) accuracy. CONCLUSIONS We developed a medication adherence tool based on ML with an excellent NPV. This could allow prioritization processes to avoid referring highly adherent patients to time- and resource-consuming interventions. The decision tree can be easily implemented in computerized prescriber order-entry systems and digital tools in smartphones. External validation of this tool in a study including a larger number of patients with diseases associated with low medication adherence is required to confirm its use in analyzing and assessing the complexity of medication adherence.
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Affiliation(s)
- Virginie Korb-Savoldelli
- Pharmacy Department, Hôpital européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris (APHP), Paris Cedex 15, France
- Clinical Pharmacy Department, Faculty of Pharmacy, Paris-Saclay University, Orsay, France
| | - Yohann Tran
- Clinical Research Unit, Université Paris Cité, Hôpital européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
- Clinical Investigation Center (CIC) 1418 Clinical Epidemiology, Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Germain Perrin
- Pharmacy Department, Hôpital européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris (APHP), Paris Cedex 15, France
- Health data- and model- driven Knowledge Acquisition (HeKA) Team, Institut National de la Santé et de la Recherche Médicale (INSERM) - (Institut National de Recherche en Informatique et en Automatique (INRIA), PariSanté Campus, Paris, France
| | - Justine Touchard
- Pharmacy Department, Hôpital européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris (APHP), Paris Cedex 15, France
| | - Jean Pastre
- Pulmonary Medecine and Intensive Care Department, Hôpital européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | - Adrien Borowik
- Pharmacy Department, Hôpital européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris (APHP), Paris Cedex 15, France
| | - Corine Schwartz
- Pharmacy Department, Hôpital européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris (APHP), Paris Cedex 15, France
| | - Aymeric Chastel
- Pharmacy Department, Hôpital européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris (APHP), Paris Cedex 15, France
| | - Eric Thervet
- Nephrology Department, Hôpital européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
- Institut National de la Santé et de la Recherche Médicale (INSERM) - Unité Mixte de Recherche (UMR) 970 - Team 8, Paris Cardiovascular Research Center (PARCC), Hôpital européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Michel Azizi
- Clinical Investigation Center (CIC) 1418 Clinical Epidemiology, Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
- Hypertension Department, Reference Centre for Rare Vascular Disease, Hôpital européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | - Laurence Amar
- Clinical Investigation Center (CIC) 1418 Clinical Epidemiology, Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
- Hypertension Department, Reference Centre for Rare Vascular Disease, Hôpital européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | - Benjamin Kably
- Clinical Investigation Center (CIC) 1418 Clinical Epidemiology, Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
- Pharmacology Unit, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | - Armelle Arnoux
- Clinical Research Unit, Université Paris Cité, Hôpital européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
- Clinical Investigation Center (CIC) 1418 Clinical Epidemiology, Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
- Health data- and model- driven Knowledge Acquisition (HeKA) Team, Institut National de la Santé et de la Recherche Médicale (INSERM) - (Institut National de Recherche en Informatique et en Automatique (INRIA), PariSanté Campus, Paris, France
| | - Brigitte Sabatier
- Pharmacy Department, Hôpital européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris (APHP), Paris Cedex 15, France
- Clinical Pharmacy Department, Faculty of Pharmacy, Paris-Saclay University, Orsay, France
- Health data- and model- driven Knowledge Acquisition (HeKA) Team, Institut National de la Santé et de la Recherche Médicale (INSERM) - (Institut National de Recherche en Informatique et en Automatique (INRIA), PariSanté Campus, Paris, France
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2
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Côco LT, Silva GF, Romeiro FG, Cerqueira ATDAR. Factors associated with hepatitis C treatment adherence: an integrative review. CIENCIA & SAUDE COLETIVA 2022; 27:1359-1376. [PMID: 35475818 DOI: 10.1590/1413-81232022274.06942021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 05/13/2021] [Indexed: 11/21/2022] Open
Abstract
This integrative review examined factors associated with hepatitis C treatment adherence. The articles included were published in English, Spanish and Portuguese in the Lilacs, Medline, PsycINFO, Web of Science, Scopus and CINAHL databases, between 2000 and 2019. Initially, 540 publications were found and, after applying the study inclusion criteria, 22 articles were selected. Percentage non-adherence to treatment ranged from 12% to 32%. The variables identified as facilitating adherence were: receiving treatment for psychiatric disorders identified during treatment; knowing about medications and disease; receiving less complex treatment with greater likelihood of cure; fewer adverse events; social support; doctor-patient communication; and/or being in relationships. Barriers to adherence identified were: presence of depressive symptoms and other mental disorders; abuse of alcohol and psychoactive substances; education; age; ethnicity; unemployment; not having a steady partner; stigma; distance from health services; and the complexity and adverse effects of treatment. This review identified gaps in research on adherence.
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Affiliation(s)
- Layla Tatiane Côco
- Departamento de Neurologia, Psicologia e Psiquiatria, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista Júlio de Mesquita Filho (UNESP). Av. Prof. Mário Rubens Guimarães Montenegro s/n, Distrito de Rubião Júnior. 18618-970 Botucatu SP Brasil.
| | - Giovanni Faria Silva
- Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, UNESP. Botucatu SP Brasil
| | - Fernando Gomes Romeiro
- Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, UNESP. Botucatu SP Brasil
| | - Ana Teresa de Abreu Ramos Cerqueira
- Departamento de Neurologia, Psicologia e Psiquiatria, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista Júlio de Mesquita Filho (UNESP). Av. Prof. Mário Rubens Guimarães Montenegro s/n, Distrito de Rubião Júnior. 18618-970 Botucatu SP Brasil.
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Jia K, Venkateshan H, Burke M. Qualitative analysis of the barriers and facilitators influencing uptake of direct-acting antiviral therapy for hepatitis C in a primary healthcare environment. Aust J Prim Health 2022; 28:247-254. [PMID: 35264282 DOI: 10.1071/py21180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 12/01/2021] [Indexed: 11/23/2022]
Abstract
Historical interferon and ribavirin therapies for hepatitis C virus have been replaced by modern treatments with improved efficacy and tolerability. Despite the availability of direct-acting antiviral therapy, evidence demonstrates poor uptake in Australia. Presently, the barriers and facilitators influencing uptake of direct-acting antiviral therapy are not fully understood, especially in a primary healthcare environment. Our study aimed to discover methods of improving uptake of treatment in the community. We conducted 15 semi-structured, face-to-face interviews in a metropolitan, primary healthcare clinic in Australia. Interviews were recorded, transcribed and subsequently analysed using thematic content analysis. We identified patient-related and healthcare system-related barriers and facilitators to commencing treatment. This included established themes from current literature, and novel themes unique to direct-acting antiviral therapy and primary care. Overall, our study reinforces the importance of public health campaigns to promote community awareness and emphasises the concomitant role of mental health in fostering treatment uptake. Informed by our findings, we suggest further research on an integrated model of care, focused on the domains of disease awareness, patient engagement and treatment adherence. Hence, a community-oriented approach, driven by primary healthcare, ultimately underpins a successful public strategy to improve outcomes for patients affected by hepatitis C.
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Affiliation(s)
- Kevin Jia
- Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia; and School of Medicine, Western Sydney University, Sydney, NSW 2560, Australia
| | - Harsha Venkateshan
- School of Medicine, Western Sydney University, Sydney, NSW 2560, Australia
| | - Michael Burke
- School of Medicine, Western Sydney University, Sydney, NSW 2560, Australia; and Kildare Road Medical Centre, Blacktown, NSW 2148, Australia
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Bhimla A, Zhu L, Lu W, Golub S, Enemchukwu C, Handorf E, Tan Y, Yeh MC, Nguyen MT, Wang MQ, Ma GX. Factors Associated with Hepatitis B Medication Adherence and Persistence among Underserved Chinese and Vietnamese Americans. J Clin Med 2022; 11:870. [PMID: 35160319 PMCID: PMC8837110 DOI: 10.3390/jcm11030870] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/21/2022] [Accepted: 01/28/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Hepatitis B virus (HBV) infection disproportionately affects Asian Americans in the United States, while this population faces low adherence to HBV treatment. Using the information-motivation-behavioral skills model (IMB), the study aims to examine medication adherence and persistence among Chinese and Vietnamese people with HBV. METHODOLOGY Study participants were recruited between March 2019 and March 2020 and were enrolled through multiple recruitment approaches in the Greater Philadelphia Area and New York City. The study is an assessment of the baseline data on medication adherence, HBV-related knowledge, motivation of HBV medication treatment, self-efficacy about HBV medication treatment, and socioeconomic status. RESULTS Among 165 participants, 77.6% were Chinese and 22.4% were Vietnamese Americans. HBV-related knowledge/information, motivation, and self-efficacy were all positively associated with having medium/high medication adherence. Multilevel mixed-effects generalized linear regression revealed that living more than 10 years in the U.S. (OR = 4.24; p = 0.028) and greater information-knowledge about HBV (OR = 1.46; p = 0.004) were statistically associated with higher odds of medium/high medication adherence. Moreover, greater HBV-related knowledge/information (OR = 1.49; p = 0.023) and greater motivation towards HBV treatment adherence (OR = 1.10; p = 0.036) were both associated with a higher likelihood of medication persistence. CONCLUSION Our findings provided significant implications in designing behavioral interventions focused on self-efficacy, information, and motivation to promote better medication adherence among Asian Americans living with HBV.
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Affiliation(s)
- Aisha Bhimla
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, 3440 N. Broad St., Philadelphia, PA 19140, USA; (A.B.); (L.Z.); (W.L.); (Y.T.)
| | - Lin Zhu
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, 3440 N. Broad St., Philadelphia, PA 19140, USA; (A.B.); (L.Z.); (W.L.); (Y.T.)
- Department of Urban Health and Population Science, Lewis Katz School of Medicine, Temple University, 3440 N. Broad St., Philadelphia, PA 19140, USA
| | - Wenyue Lu
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, 3440 N. Broad St., Philadelphia, PA 19140, USA; (A.B.); (L.Z.); (W.L.); (Y.T.)
| | - Sarit Golub
- Department of Psychology, Hunter College, City University of New York, 695 Park Ave., New York, NY 10065, USA; (S.G.); (C.E.)
| | - Chibuzo Enemchukwu
- Department of Psychology, Hunter College, City University of New York, 695 Park Ave., New York, NY 10065, USA; (S.G.); (C.E.)
| | - Elizabeth Handorf
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Temple University Health System, 3401 N. Broad St., Philadelphia, PA 19140, USA;
| | - Yin Tan
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, 3440 N. Broad St., Philadelphia, PA 19140, USA; (A.B.); (L.Z.); (W.L.); (Y.T.)
| | - Ming-Chin Yeh
- Nutrition Program, Hunter College, City University of New York, 695 Park Ave., New York, NY 10065, USA;
| | - Minhhuyen T. Nguyen
- Department of Medicine, Section of Gastroenterology, Fox Chase Cancer Center, Temple University Health System, 3401 N. Broad St., Philadelphia, PA 19140, USA;
| | - Min Qi Wang
- School of Public Health, University of Maryland, 4200 Valley Dr., College Park, MD 20742, USA;
| | - Grace X. Ma
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, 3440 N. Broad St., Philadelphia, PA 19140, USA; (A.B.); (L.Z.); (W.L.); (Y.T.)
- Department of Urban Health and Population Science, Lewis Katz School of Medicine, Temple University, 3440 N. Broad St., Philadelphia, PA 19140, USA
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Miller SJ, Harrison SE, Sanasi-Bhola K. A Scoping Review Investigating Relationships between Depression, Anxiety, and the PrEP Care Continuum in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111431. [PMID: 34769945 PMCID: PMC8583073 DOI: 10.3390/ijerph182111431] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/25/2021] [Accepted: 10/26/2021] [Indexed: 01/04/2023]
Abstract
Men who have sex with men and transgender women in the United States are at increased risk for HIV and may benefit from pre-exposure prophylaxis (PrEP), a once-a-day pill to prevent HIV. Due to stigma and discrimination, sexual and gender minority (SGM) populations are also at risk for depression and anxiety. This scoping review sought to identify literature addressing relationships between the PrEP care continuum, depression, and anxiety among SGM individuals and others at high risk for HIV. We conducted a systematic review of four databases (i.e., PubMed, PsycInfo, Web of Science, Google Scholar) and identified 692 unique articles that were screened for inclusion criteria, with 51 articles meeting the final inclusion criteria. Data were extracted for key study criteria (e.g., geographic location, participant demographics, study design, main findings). Results suggest that while depression and anxiety are not associated with PrEP awareness or willingness to use, they can be barriers to seeking care and to PrEP adherence. However, empirical studies show that taking PrEP is associated with reductions in anxiety. Findings suggest the need to implement mental health screenings in PrEP clinical care. In addition, addressing systemic and structural issues that contribute to mental health disorders, as well as PrEP-related barriers, is critical.
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Affiliation(s)
- Sarah J. Miller
- Department of Psychology, College of Arts and Sciences, University of South Carolina, Columbia, SC 29208, USA;
| | - Sayward E. Harrison
- Department of Psychology, College of Arts and Sciences, University of South Carolina, Columbia, SC 29208, USA;
- South Carolina Smart State Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
- Correspondence:
| | - Kamla Sanasi-Bhola
- Department of Internal Medicine, School of Medicine, University of South Carolina, Columbia, SC 29203, USA;
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Kvarnström K, Westerholm A, Airaksinen M, Liira H. Factors Contributing to Medication Adherence in Patients with a Chronic Condition: A Scoping Review of Qualitative Research. Pharmaceutics 2021; 13:pharmaceutics13071100. [PMID: 34371791 PMCID: PMC8309154 DOI: 10.3390/pharmaceutics13071100] [Citation(s) in RCA: 95] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/16/2021] [Accepted: 07/15/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction: Medication adherence continues to be a significant challenge in healthcare, and there is a shortage of effective interventions in this area. This scoping review studied the patient-related factors of medication adherence. Methods: We searched Medline Ovid, Scopus, and Cochrane Library from January 2009 to June 2021 to find the most recent original qualitative studies or systematic reviews that addressed the patient-related factors of medication adherence in treating chronic conditions. We used the PRISMA-ScR checklist to ensure the quality of the study. Results: The initial search revealed 4404 studies, of which we included 89 qualitative studies in the scoping review. We inductively organized the patient-related factors causing barriers, as well as the facilitators to medication adherence. The studies more often dealt with barriers than facilitators. We classified the factors as patient-specific, illness-specific, medication-related, healthcare and system-related, sociocultural, as well as logistical and financial factors. Information and knowledge of diseases and their treatment, communication, trust in patient-provider relationships, support, and adequate resources appeared to be the critical facilitators in medication adherence from the patient perspective. Discussion and conclusions: Patients are willing to discuss their concerns about medications. Better communication and better information on medicines appear to be among the critical factors for patients. The findings of this scoping review may help those who plan further interventions to improve medication adherence.
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Affiliation(s)
- Kirsi Kvarnström
- HUS Pharmacy, University of Helsinki and Helsinki University Hospital, 00290 Helsinki, Finland
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, 00014 Helsinki, Finland; (A.W.); (M.A.)
- Correspondence:
| | - Aleksi Westerholm
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, 00014 Helsinki, Finland; (A.W.); (M.A.)
| | - Marja Airaksinen
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, 00014 Helsinki, Finland; (A.W.); (M.A.)
| | - Helena Liira
- Department of General Practice, University of Helsinki, 00290 Helsinki, Finland;
- Unit of Primary Health Care, University of Helsinki and Helsinki University Hospital, 00290 Helsinki, Finland
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7
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Tofighi B, Lee JD, Sindhu SS, Chemi C, Leonard NR. Engagement in the Hepatitis C care continuum among people who use drugs. JOURNAL OF SUBSTANCE USE 2020; 25:343-349. [PMID: 33041652 DOI: 10.1080/14659891.2019.1704076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Despite high rates of Hepatitis C virus (HCV) infection among people who use drugs (PWUDs), access to the HCV care continuum combined with the receipt of medications for addiction treatment in primary care settings remains suboptimal. A qualitative study was conducted among adults admitted for inpatient detoxification for opioid use disorder (OUD) in New York City (n=23) to assess barriers and facilitators with HCV prevention, screening, treatment, interactions with primary care providers, and experiences with integrated care approaches. Study findings yielded six major themes related to HCV care. Major gaps persist in knowledge regarding HCV harm reduction strategies, voluntary HCV testing services, and eligibility for HCV treatment. Treatment coordination challenges reinforce the importance of enhancing linkages to HCV care in key access-points utilized by PWUDs (e.g., emergency rooms, specialty addiction treatment settings). Peer networks combined with frequent patient-physician communication were elicited as important factors in facilitating linkage to HCV care. Additional care coordination needs in primary care settings included access to integrated treatment of HCV and OUD, and administrative support for enrollment in Medicaid, subsidized housing, and access to transportation vouchers.
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Affiliation(s)
- Babak Tofighi
- New York University School of Medicine, Department of Population Health.,New York University School of Medicine, Division of General Internal Medicine.,Center for Drug Use and HIV Research, NYU College of Global Public Health
| | - Joshua D Lee
- New York University School of Medicine, Department of Population Health.,New York University School of Medicine, Division of General Internal Medicine.,Center for Drug Use and HIV Research, NYU College of Global Public Health
| | - Selena S Sindhu
- New York University School of Medicine, Department of Population Health
| | - Chemi Chemi
- New York University School of Medicine, Department of Population Health
| | - Noelle R Leonard
- Center for Drug Use and HIV Research, NYU College of Global Public Health.,NYU Silver School of Social Work
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Kim HP, Lieber SR, Rogers ME, Moon AM, Loiselle M, Walker J, Assis DN, Safer R, Gomel R, Evon DM. A Systematic Review of Patient-Reported Outcomes in Primary Biliary Cholangitis and Primary Sclerosing Cholangitis. Hepatol Commun 2020; 4:1502-1515. [PMID: 33024919 PMCID: PMC7527768 DOI: 10.1002/hep4.1567] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/03/2020] [Accepted: 06/14/2020] [Indexed: 12/17/2022] Open
Abstract
Primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC) are associated with decreased health-related quality of life and debilitating symptoms. These experiences can be defined as patient-reported outcome (PRO) concepts and measured using PRO instruments. We identified all PRO concepts and instruments used in the PBC and PSC literature. This systematic review identified PBC and/or PSC studies from January 1, 1990, to May 6, 2019, that measured at least one PRO concept. Study population, design, PRO concept, PRO instrument, and validation data for PRO instruments were investigated. We provided descriptive statistics of PRO concepts and instruments used, stratified by population type. Use of PRO concepts and instruments were assessed over time. The search yielded 318 articles (69% in PBC, 18% in PSC, 13% in both, and 24% in drug trials). Forty-nine unique PRO concepts were identified. The five most common PRO concepts included pruritus (25%), fatigue (19%), broad health-related quality of life (16%), gastrointestinal adverse events (6%), and physical adverse events (6%). Only 60% of PRO concepts were measured with a PRO instrument, most of which were nonvalidated visual analogue or numeric rating scales. Only three of 83 PRO instruments were developed with feedback from the target populations (one for PBC, one for PSC, and one for both), and only six documented any psychometric testing in the target populations. Use of PRO instruments increased over time from 30% in the 1990s to 67% by 2019. Conclusion: The overwhelming majority of PRO instruments used in PBC/PSC were nonspecific and lacked patient validation or empirical justification. Significant opportunities exist to use qualitative methods to better understand patient experiences, and translate this knowledge into meaningful, patient-driven study outcomes.
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Affiliation(s)
- Hannah P. Kim
- Division of Gastroenterology and HepatologyDepartment of MedicineUniversity of North CarolinaChapel HillNC
| | - Sarah R. Lieber
- Division of Gastroenterology and HepatologyDepartment of MedicineUniversity of North CarolinaChapel HillNC
| | - Michael E. Rogers
- Division of Pediatric GastroenterologyDepartment of PediatricsUniversity of North CarolinaChapel HillNC
| | - Andrew M. Moon
- Division of Gastroenterology and HepatologyDepartment of MedicineUniversity of North CarolinaChapel HillNC
| | - Marci Loiselle
- Department of Psychiatry and Behavioral SciencesDivision of Behavioral MedicineDuke University Medical CenterDurhamNC
| | - Jennifer Walker
- University of North CarolinaHealth Sciences LibraryChapel HillNC
| | - David N. Assis
- Digestive DiseasesDepartment of MedicineYale School of MedicineNew HavenCT
| | - Ricky Safer
- PSC Partners Seeking a CureGreenwood VillageCO
| | | | - Donna M. Evon
- Division of Gastroenterology and HepatologyDepartment of MedicineUniversity of North CarolinaChapel HillNC
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Falade-Nwulia O, Ward KM, McCormick S, Mehta SH, Pitts SR, Katz S, Chander G, Thomas DL, Sulkowski M, Latkin CA. Network-based recruitment of people who inject drugs for hepatitis C testing and linkage to care. J Viral Hepat 2020; 27:663-670. [PMID: 32045086 PMCID: PMC7299737 DOI: 10.1111/jvh.13274] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 01/15/2020] [Accepted: 01/22/2020] [Indexed: 12/13/2022]
Abstract
Although oral direct-acting agent (DAA) therapies have the potential to reduce the burden of hepatitis C virus (HCV) infection, treatment uptake remains low, particularly among people who inject drugs (PWID). This study examined the feasibility of an innovative peer-based recruitment strategy to engage PWID in HCV testing and treatment. We interviewed an initial set of HCV antibody-positive PWID as 'primary indexes' to gather demographic, drug use, health information and drug network characteristics. Primary indexes were then briefly educated on HCV and its treatment and encouraged to recruit their injection drug 'network members' for HCV testing and linkage to care. Eligible network members were enrolled as 'secondary indexes' and completed the same index study procedures. In sum, 17 of 36 primary indexes initiated the recruitment of 64 network members who were HCV antibody positive and eligible to become indexes. In multivariable analysis, successful recruitment of at least one network member was positively associated with prior HCV treatment (OR 2.80; CI [1.01, 7.72]), daily or more injection drug use (OR 2.38; CI [1.04, 5.47]), and a higher number of injection drug network members (OR 1.20; CI [1.01, 1.42]). Among the 69 participants with chronic HCV not previously linked to HCV care at enrolment, 91% (n = 63) completed a linkage to HCV care appointment, 45% (n = 31) scheduled an appointment with an HCV provider, and 20% (n = 14) initiated HCV therapy. These findings suggest a potential benefit for peer-driven, network-based interventions focused on HCV treatment-experienced PWID as a mechanism to increase HCV linkage to care.
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Affiliation(s)
| | | | - Sean McCormick
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shruti H. Mehta
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Stephanie Katz
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - David L. Thomas
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mark Sulkowski
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carl A. Latkin
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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10
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Mallolas J, Ahumada A, Ampuero J, Blanco JR, Hidalgo Á, Londoño MC, Molina E, Ruiz S. Quality of life in patients with hepatitis C. Importance of treatment. GASTROENTEROLOGIA Y HEPATOLOGIA 2020; 42 Suppl 1:20-25. [PMID: 32560769 DOI: 10.1016/s0210-5705(20)30184-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Chronic hepatitis C virus infection is a systemic disease that impairs the quality of life of affected individuals. The impairment is not only due to physiological factors, such as the non-hepatic manifestations of the disease or certain symptoms such as fatigue, weakness and nausea, but is also due to the substantial psychological impact of the infection. Treatment with direct-acting antivirals (DAA) has been demonstrated to substantially improve patient's quality of life, starting in the initial phases. Supplement information: This article is part of a supplement entitled "The value of simplicity in hepatitis C treatment", which is sponsored by Gilead. © 2019 Elsevier España, S.L.U. All rights reserved.
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Affiliation(s)
- Josep Mallolas
- Servicio de Enfermedades Infecciosas, Hospital Clínic de Barcelona, Barcelona, España.
| | - Adriana Ahumada
- Servicio de Aparato Digestivo, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Javier Ampuero
- Servicio de Gastroenterología y Hepatología, Hospital Universitario Virgen del Rocío, Sevilla, España; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas; Instituto de Biomedicina de Sevilla, Sevilla, España; Universidad de Sevilla, Sevilla, España
| | - José Ramón Blanco
- Servicio de Enfermedades Infecciosas, Hospital San Pedro, Logroño, España
| | - Álvaro Hidalgo
- Economista de Salud, Universidad de Castilla-La Mancha, Ciudad Real, España
| | | | - Esther Molina
- Servicio de Aparato Digestivo, Hospital Clínico Universitario de Santiago, A Coruña, España
| | - Salvador Ruiz
- Psiquiatría de Urgencias, Hospital Universitario Príncipe de Asturias, Madrid, España
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11
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Lafferty L, Rance J, Grebely J, Dore GJ, Lloyd AR, Treloar C. Perceptions and concerns of hepatitis C reinfection following prison-wide treatment scale-up: Counterpublic health amid hepatitis C treatment as prevention efforts in the prison setting. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 77:102693. [PMID: 32045828 DOI: 10.1016/j.drugpo.2020.102693] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 01/28/2020] [Accepted: 01/28/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Hepatitis C (HCV) infection is highly prevalent within the prison setting. Direct-acting antiviral (DAA) therapies have changed the HCV treatment landscape, offering simple treatment (with minimal side-effects) and high efficacy. These advances have enabled the first real-world study of HCV treatment as prevention (TasP), the Surveillance and Treatment of Prisoners with hepatitis C (SToP-C) study. This paper draws on data from qualitative interviews completed with SToP-C participants following prison-wide DAA treatment scale-up. METHODS Semi-structured interviews were undertaken with 23 men in prison following HCV treatment completion to identify ongoing risk practices, perceptions of strategies for HCV prevention within the prison setting, experiences of HCV treatment (as prevention), and perceptions of reinfection following cure. Analysis was undertaken using a counterpublic health lens to identify risks and perceptions of reinfection among people treated for HCV within the prison setting. RESULTS Participants identified a number of challenges of meaningful HCV 'cure' in the absence of increased access to prevention strategies (e.g., opioid agonist therapy and prison needle syringe programs) along with concerns that 'cure' was only temporary whilst incarcerated. 'Cure' status included self-perceptions of being "clean", while also imposing responsibility on the individual to maintain their 'cure' status. CONCLUSION HCV DAA treatment is provided somewhat under the guise of 'cure is easy', but fails to address the ongoing risk factors experienced by people who inject drugs in prisons, as well as other people in prison who may be at risk of blood-to-blood exposure. Health messaging regarding HCV treatment and treatment for reinfection should be tailored to ensure patient-centred care. Health interventions in prison must address the whole person and the circumstances in which they live, not just the illness.
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Affiliation(s)
- Lise Lafferty
- Centre for Social Research in Health, UNSW Sydney, Level 2, Goodsell Building, Sydney NSW 2052, Australia.
| | - Jake Rance
- Centre for Social Research in Health, UNSW Sydney, Level 2, Goodsell Building, Sydney NSW 2052, Australia
| | - Jason Grebely
- The Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth Building, Sydney NSW 2052, Australia
| | - Gregory J Dore
- The Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth Building, Sydney NSW 2052, Australia
| | - Andrew R Lloyd
- The Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth Building, Sydney NSW 2052, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Level 2, Goodsell Building, Sydney NSW 2052, Australia
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12
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An J, Lee JS, Sharpsten L, Wilson AK, Cao F, Tran JN. Impact of pill burden on adherence to hepatitis C medication. Curr Med Res Opin 2019; 35:1937-1944. [PMID: 31298592 DOI: 10.1080/03007995.2019.1643160] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objective: To describe pill burden before and after hepatitis C virus (HCV) treatment initiation among patients newly treated for HCV infection, and to evaluate the association between HCV pill burden and gaps in HCV therapy. Methods: This was a retrospective administrative claims study of patients treated with direct-acting antivirals (DAAs) for HCV from 1 November 2013 to 31 July 2016. HCV pill burden was defined as the pill count per day for the index HCV regimen. Mean overall pill burden (HCV medications plus non-HCV medications) was calculated in the 90 days before and after DAA initiation. Gaps in the index HCV regimen were assessed in the 6 months after DAA initiation. Multivariable logistic regression was used to compare the odds of a gap in HCV therapy across HCV pill burden categories (1 pill/day, 2 pills/day, and ≥3 pills/day). Results: Among 9815 patients who met the study criteria, mean overall pill burdens before and after DAA treatment initiation were 5.4 and 7.7, respectively (p < .001). The adjusted odds ratio (OR) of a ≥15-day gap in HCV therapy was 1.75 (95% confidence interval [CI] = 1.38-2.22) for patients with 2 HCV pills/day and 2.11 (95% CI = 1.78-2.51) for patients with ≥3 pills/day, compared with patients with 1 HCV pill/day. Conclusions: Patients with HCV have a substantial pill burden even before initiating HCV treatment. As higher HCV pill burden was associated with lower medication adherence, pill burden should be an important consideration in HCV treatment selection.
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Affiliation(s)
- Jaejin An
- Western University of Health Sciences , Pomona , CA , USA
| | - Janet S Lee
- Gilead Sciences Inc. , Foster City , CA , USA
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13
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Determinants of Hepatitis C Treatment Adherence and Treatment Completion Among Veterans in the Direct Acting Antiviral Era. Dig Dis Sci 2019; 64:3001-3012. [PMID: 30903364 DOI: 10.1007/s10620-019-05590-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 03/12/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Despite the availability of direct acting antiviral medications (DAAs), there are ongoing concerns about adherence to hepatitis C virus (HCV) treatment. We sought to understand the barriers to and facilitators of DAA adherence in the Veteran population. METHODS Patients completed semi-structured interviews focused on barriers to and facilitators of HCV treatment adherence both pre- and post-DAA treatment. Adherence was assessed via provider pill count and self-report. Thematic analyses were conducted in the qualitative software program Atlas.ti in order to understand anticipated barriers to and facilitators of treatment adherence and completion. Charts were reviewed for clinical data and sustained virologic response (SVR12). RESULTS Of 40 patients, 15 had cirrhosis and 10 had prior interferon-based treatment. Pre-treatment interviews revealed anticipated barriers to adherence such as side effects (n = 21) and forgetting pills (n = 11). Most patients (n = 27) reported following provider advice, and others had unique reasons not to (e.g., feeling like a "guinea pig"). Post-treatment interviews uncovered facilitators of treatment including wanting to cure HCV (n = 17), positive results (n = 18), and minimal side effects (n = 15). Three patients (8%) did not complete therapy (whom we further elaborate on) and 6 (15%) missed doses but completed treatment. SVR12 was achieved by all participants who completed therapy (93%). Patients who did not complete therapy or missed doses were all treatment naïve, mostly non-cirrhotic (8 of 9), and often anticipated concerns with forgetting their medications. CONCLUSIONS This qualitative study uncovered several unanticipated determinants of HCV treatment completion and provides rationale for several targeted interventions such as incorporating structured positive reinforcement.
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14
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Voils CI, King HA, Thorpe CT, Blalock DV, Kronish IM, Reeve BB, Boatright C, Gellad ZF. Content Validity and Reliability of a Self-Report Measure of Medication Nonadherence in Hepatitis C Treatment. Dig Dis Sci 2019; 64:2784-2797. [PMID: 31037593 DOI: 10.1007/s10620-019-05621-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 04/08/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND Nonadherence to direct-acting agents (DAAs) for hepatitis C (HCV) decreases viral response. To measure nonadherence to DAAs, a reliable, valid, and easily implemented method is needed. AIMS The goals of this study were to refine a previously validated (in patients with hypertension) self-report measure of extent of nonadherence and reasons for nonadherence in the context of DAAs and to obtain initial evidence of content validity and reliability. METHODS Phase I involved two focus groups with patients with HCV (n = 12) and one focus group with prescribers of HCV medications (n = 6) to establish content validity of reasons for nonadherence. Subsequent cognitive interviews with patients (n = 11) were conducted to refine items. Phase II was a prospective cohort study involving weekly administration of the refined measure by telephone to patients (n = 75) who are prescribed DAAs to evaluate reliability and consistency with viral response. RESULTS In the cohort study, internal consistency ranged from acceptable (α = .69) to very high (α = 1.00) across time points and was quite high on average (α = .91). Across the 75 participants, there were 895 measurement occasions; of those, nonadherence was reported on only 27 occasions (3%), all of which occurred in the first 12 weeks. These 27 occasions represented 19 (26%) different individuals. At 12 weeks, 1 (1%) of patients had a detectable HCV viral load; at 12-24 weeks posttreatment, 4 (5%) had a sustained viral response. Nonadherent patients reported an average of 1.41 reasons for nonadherence. CONCLUSIONS This multi-method study established content validity of reasons for nonadherence and reliability of extent of nonadherence. High rates of adherence and viral response were consistent with previous studies using other nonadherence measurement methods.
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Affiliation(s)
- Corrine I Voils
- William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI, 53705, USA. .,Department of Surgery, University of Wisconsin School of Medicine and Public Health, K6/100 Clinical Science Center, 600 Highland Ave, Madison, WI, 53792, USA.
| | - Heather A King
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, 411 W. Chapel Hill St., Suite 600, Durham, NC, 27701, USA.,Department of Population and Health Sciences, Duke University Medical Center, Duke Box 104023, 2200 West Main St, Office #771, Durham, NC, 27705, USA.,Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Carolyn T Thorpe
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Dan V Blalock
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, 411 W. Chapel Hill St., Suite 600, Durham, NC, 27701, USA.,Department of Psychiatry, Duke University Medical Center, Durham, NC, USA
| | - Ian M Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 W. 168th Street, PH9-311, New York, NY, 10032, USA
| | - Bryce B Reeve
- Department of Population and Health Sciences, Duke University Medical Center, Duke Box 104023, 2200 West Main St, Office #771, Durham, NC, 27705, USA
| | - Colleen Boatright
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, 411 W. Chapel Hill St., Suite 600, Durham, NC, 27701, USA
| | - Ziad F Gellad
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, 411 W. Chapel Hill St., Suite 600, Durham, NC, 27701, USA.,Duke Clinical Research Institute, 2400 Pratt Street, Rm 0311 Terrace Level, Durham, NC, 27705, USA
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15
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Inglis SK, Beer LJ, Byrne C, Malaguti A, Robinson E, Sharkey C, Gillings K, Stephens B, Dillon JF. Randomised controlled trial conducted in injecting equipment provision sites to compare the effectiveness of different hepatitis C treatment regimens in people who inject drugs: A Direct obserVed therApy versus fortNightly CollEction study for HCV treatment-ADVANCE HCV protocol study. BMJ Open 2019; 9:e029516. [PMID: 31399460 PMCID: PMC6701606 DOI: 10.1136/bmjopen-2019-029516] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 06/17/2019] [Accepted: 07/02/2019] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Hepatitis C is a blood-borne virus (HCV) that can seriously damage the liver and is spread mainly through blood-to-blood contact with an infected person. Over 85% of individuals who have HCV in Scotland became infected following injecting drug use. Since people who inject drugs (PWID) are the main source of new infections, theoretical modelling has suggested that treatment of HCV infection in PWID may effectively reduce HCV prevalence and accomplish elimination. This protocol describes a clinical trial delivering HCV treatment within injecting equipment provision sites (IEPS) in Tayside, Scotland. METHODS AND ANALYSIS PWID attending IEPS are tested for HCV and, if they are chronically infected with HCV and eligible, invited to receive treatment within the IEPS. They are randomised to one of three treatment regimens; daily observed treatment, treatment dispensed every 2 weeks and treatment dispensed every 2 weeks together with an adherence psychological intervention (administered before treatment begins). The primary outcome is comparison of the rate of successful treatment (SVR12) in each treatment group. Secondary analyses include assessment of adherence, reinfection rates, viral resistance to treatment and interaction of the treatment with illicit drugs. ETHICS AND DISSEMINATION The ADVANCE (A Direct obserVed therApy versus fortNightly CollEction) HCV trial was given favourable opinion by East of Scotland Research Ethics Committee (LR/17/ES/0089) prior to commencement. TRIAL REGISTRATION NUMBERS European Clinical Trials Database (EudraCT) (2017-001039-38) and ClinicalTrials.gov (NCT03236506).
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Affiliation(s)
- Sarah K Inglis
- Tayside Clinical Trials Unit, University of Dundee, Dundee, UK
| | - Lewis Jz Beer
- Tayside Clinical Trials Unit, University of Dundee, Dundee, UK
| | | | - Amy Malaguti
- School of Social Sciences (Psychology), University of Dundee, Dundee, UK
| | - Emma Robinson
- Molecular and Clinical Medicine, University of Dundee, Dundee, UK
- Specialist liver service, NHS Tayside, Dundee, UK
| | | | | | | | - John F Dillon
- Molecular and Clinical Medicine, University of Dundee, Dundee, UK
- Specialist liver service, NHS Tayside, Dundee, UK
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Chehl N, Maheshwari A, Yoo H, Cook C, Zhang T, Brown S, Thuluvath PJ. HCV compliance and treatment success rates are higher with DAAs in structured HCV clinics compared to general hepatology clinics. Medicine (Baltimore) 2019; 98:e16242. [PMID: 31305402 PMCID: PMC6641794 DOI: 10.1097/md.0000000000016242] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The real-world cure rates for hepatitis C (HCV) with direct-acting antivirals (DAAs) based on intention-to-treat (ITT) analysis may be lower than reported in the literature because of non-compliance.To determine whether patients treated in a structured outpatient HCV clinic (SHC) had higher compliance and treatment success rates compared to those treated in general hepatology clinics (GHC).In this study, we compared the treatment and compliance success rates of 488 and 840 patients treated in the SHC and GHC, respectively. The SHC required a pre-treatment clinic visit when patients picked up their initial medication, and received detailed education of the treatment plan and follow-up. In the GHC, the medications were delivered to patients' homes, and there was less formal education. Compliance success was defined as a combination of treatment completion and obtaining at least 1 post-treatment viral load at week 4 or 12. Treatment success was defined as either SVR4 or SVR12.Fifty of 488 (10.3%) patients from the SHC and 163 of 840 (19.4%) patients from the GHC were lost to follow-up (P < .0001). sustained virological response (SVR) rates were similar in compliant patients in both the SHC (419/438, 95.6%) and GHC (642/677, 94.8%), but treatment success rates by intention to treat (ITT) (overall 79.9%) were higher in SHC compared to GHC (85.9% vs 76.4%, P < .0001). Multivariate analysis showed that female patients (P = .01), older age (P = .0005), treatment in SHC (OR 1.7, 95% CI 1.2, 2.3, P = .0008), and sofosbuvir/simeprevir compared to sofosbuvir/ledipasvir had higher odds of compliance success; elbasvir/grazoprevir or dasabuvir/ombitasvir/paritaprevir/ritonavir had lower odds of compliance success compared to sofosbuvir/ledipasvir. Female patients (P = .02), older age (P < .0001), previous treatment (P = .03), treatment in SHC (OR 1.7, 95% CI 1.2, 2.3, P = .0008), and sofosbuvir/ledipasvir compared to sofosbuvir/velpatasvir, sofosbuvir, or elbasvir/grazoprevir had higher odds of treatment success. With 1:1 matching, the SHC group still had significantly higher odds than the GHC group of achieving treatment and compliance success.Our study shows that the effectiveness of HCV treatment could be improved by coordinating treatment in a structured HCV clinic.
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17
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Nursing Interventions on Medication Adherence During Hepatitis C Treatment: Application of Self-Regulation Model. Gastroenterol Nurs 2019; 41:525-531. [PMID: 30489409 DOI: 10.1097/sga.0000000000000362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Hepatitis C virus is a common cause of liver disease nationally and globally. Medication adherence to hepatitis C treatment is important for viral eradication and the prevention of chronic disease. The purpose of this article is to identify a nursing middle-range theory to guide research on the impact of nursing interventions on medication adherence during hepatitis C treatment and to apply the theory to practice by providing examples of the theory application. A gap in the literature is identified as the lack of research using theories or models as a guide to investigate nursing interventions and hepatitis C treatment. The lack of theory-based research may contribute to medication nonadherence. The self-regulation model provides the most complete guide for nursing interventions during hepatitis C treatment. Nursing interventions and hepatitis C research, guided by theory, generate knowledge specific for nursing.
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18
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Sullivan KM, Spooner LM, Harris E, Lowe K, Abraham GM. A Bitter Pill to Swallow: Why Medication Safety Is Critical in Hepatitis C Treatment. P & T : A PEER-REVIEWED JOURNAL FOR FORMULARY MANAGEMENT 2018; 43:764-768. [PMID: 30559590 PMCID: PMC6281151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE To provide medication safety tips to optimize the management of patients receiving treatment for chronic hepatitis C virus (HCV) infection. SUMMARY Ensuring safe medication use in patients who receive treatment for HCV infection is a crucial component in providing optimal patient care. Because of the complexity of available treatment options, numerous challenges exist in preventing medication errors with HCV therapies. This article will focus on the selection of appropriate treatment options along with proper dosing and duration, awareness of concomitant disease states and drug interactions, identifying adverse drug reactions (ADRs) and patient counseling points, the provision of adherence counseling and prevention of treatment interruptions, improving communication with patients and between pharmacies, and recognizing the importance of a multidisciplinary approach. CONCLUSION Maintaining awareness of medication safety strategies geared toward HCV pharmacotherapy is critical for providing optimal care for patients while minimizing the opportunity for errors.
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Hepatitis C is an Independent Risk Factor for Perioperative Complications and Nonroutine Discharge in Patients Treated Surgically for Hip Fractures. J Orthop Trauma 2018; 32:565-572. [PMID: 30339646 DOI: 10.1097/bot.0000000000001286] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate the relationship between noncirrhotic hepatitis C virus (HCV) infection, perioperative complications, and discharge status in patients undergoing surgical procedures for hip fractures. METHODS A retrospective epidemiological study was performed, querying the National Hospital Discharge Survey. Patients were selected using the International Classification of Diseases-9 diagnostic codes for hip fracture and primary procedural codes for open reduction internal fixation, hemiarthroplasty, total hip arthroplasty, or internal fixation. Patients with concurrent cirrhosis, HIV, hepatitis A, B, D, or E were excluded. Pearson χ tests, independent-samples t test, and multivariable binary logistic regression were used for data analysis. RESULTS Two cohorts surgically treated for a hip fracture were identified and compared. The first cohort included 5377 patients with a concurrent diagnosis of noncirrhotic HCV infection (HCV+) and the second included 4,712,159 patients without a diagnosis of HCV (HCV-). The HCV+ cohort was younger and had fewer medical comorbidities, yet was found to have a longer length of hospital stay, higher rates of nonroutine discharge, and higher rates of complications than the HCV- cohort. Multivariate regression analysis demonstrated that HCV+ is an independent risk factor for perioperative complications and nonroutine discharge. CONCLUSIONS In conclusion, our study demonstrates a negative association between noncirrhotic HCV infection and hip fracture surgery outcomes. Caution and appropriate preparation should be taken when surgically treating hip fractures in HCV+ patients because of higher risk of perioperative complications and nonroutine discharge. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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The Mexican consensus on the treatment of hepatitis C. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2018. [DOI: 10.1016/j.rgmxen.2017.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
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Aiza-Haddad I, Ballesteros-Amozurrutia A, Borjas-Almaguer OD, Castillo-Barradas M, Castro-Narro G, Chávez-Tapia N, Chirino-Sprung RA, Cisneros-Garza L, Dehesa-Violante M, Flores-Calderón J, Flores-Gaxiola A, García-Juárez I, González-Huezo MS, González-Moreno EI, Higuera-de la Tijera F, Kershenobich-Stalnikowitz D, López-Méndez E, Malé-Velázquez R, Marín-López E, Mata-Marín JA, Méndez-Sánchez N, Monreal-Robles R, Moreno-Alcántar R, Muñoz-Espinosa L, Navarro-Alvarez S, Pavia-Ruz N, Pérez-Ríos AM, Poo-Ramírez JL, Rizo-Robles MT, Sánchez-Ávila JF, Sandoval-Salas R, Torre A, Torres-Ibarra R, Trejo-Estrada R, Velarde-Ruiz Velasco JA, Wolpert-Barraza E, Bosques-Padilla F. The Mexican consensus on the treatment of hepatitis C. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2018; 83:275-324. [PMID: 29803325 DOI: 10.1016/j.rgmx.2017.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 10/17/2017] [Accepted: 11/02/2017] [Indexed: 12/12/2022]
Abstract
The aim of the Mexican Consensus on the Treatment of HepatitisC was to develop clinical practice guidelines applicable to Mexico. The expert opinion of specialists in the following areas was taken into account: gastroenterology, infectious diseases, and hepatology. A search of the medical literature was carried out on the MEDLINE, EMBASE, and CENTRAL databases through keywords related to hepatitisC treatment. The quality of evidence was subsequently evaluated using the GRADE system and the consensus statements were formulated. The statements were then voted upon, using the modified Delphi system, and reviewed and corrected by a panel of 34 voting participants. Finally, the level of agreement was classified for each statement. The present guidelines provide recommendations with an emphasis on the new direct-acting antivirals, to facilitate their use in clinical practice. Each case must be individualized according to the comorbidities involved and patient management must always be multidisciplinary.
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Affiliation(s)
| | | | - O D Borjas-Almaguer
- Hospital Universitario «Dr. José Eleuterio González», Monterrey, Nuevo León, México
| | | | - G Castro-Narro
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | | | | | - L Cisneros-Garza
- Centro de Enfermedades Hepáticas del Hospital San José, Monterrey, Nuevo León, México
| | | | - J Flores-Calderón
- Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Ciudad de México, México
| | | | - I García-Juárez
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | | | - E I González-Moreno
- Hospital Universitario «Dr. José Eleuterio González», Monterrey, Nuevo León, México
| | | | | | - E López-Méndez
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - R Malé-Velázquez
- Instituto de Salud Digestiva y Hepática, Guadalajara, Jalisco, México
| | | | - J A Mata-Marín
- Hospital de Infectología del Centro Médico Nacional «La Raza», Ciudad de México, México
| | | | - R Monreal-Robles
- Hospital Universitario «Dr. José Eleuterio González», Monterrey, Nuevo León, México
| | | | - L Muñoz-Espinosa
- Hospital Universitario «Dr. José Eleuterio González», Monterrey, Nuevo León, México
| | | | - N Pavia-Ruz
- Hospital Infantil de México «Federico Gómez», Ciudad de México, México
| | - A M Pérez-Ríos
- Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, México
| | - J L Poo-Ramírez
- Clínica San Jerónimo de Salud Hepática y Digestiva, Ciudad de México, México
| | | | - J F Sánchez-Ávila
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | | | - A Torre
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
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Burton MJ, Voluse AC, Patel AB, Konkle-Parker D. Measuring Adherence to Hepatitis C Direct-Acting Antiviral Medications: Using the VAS in an HCV Treatment Clinic. South Med J 2018; 111:45-50. [PMID: 29298369 DOI: 10.14423/smj.0000000000000750] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To implement the widespread treatment of hepatitis C virus (HCV), validated self-report measures to assess medication adherence are needed for monitoring patients who are prescribed HCV direct-acting antivirals (DAAs). The Visual Analog Scale (VAS) is an efficient and well-validated tool for measuring adherence to antiretrovirals in human immunodeficiency virus populations. This study compared VAS scores with pill counts and serum levels of HCV RNA in a sample of HCV-infected veterans prescribed DAAs. METHODS Veterans initiating HCV DAAs were offered enrollment in our study. HCV treatment was prescribed in accordance with the standard of care. Follow-up study visits were scheduled every 28 days for a total of 12 weeks. Adherence to DAAs was assessed at weeks 4, 8, and 12 using pill counts and the VAS score. Serum levels of HCV RNA were measured at baseline, week 4 of DAA therapy, and week 12 (Ampliprep/Taqman, lower limit of quantification 43 IU/mL). RESULTS Between May 2013 and December 2014, 30 veterans were enrolled. Mean adherence via pill count at weeks 4, 8, and 12 (96.2%, 95.2%, and 98.2%, respectively) was nearly identical to the mean VAS scores (96.2%, 96.0%, and 98.2%, respectively). Wilcoxon signed rank tests demonstrated no differences between each VAS and pill count pair. The VAS score inversely correlated with HCV viral load 4 weeks after DAA initiation (r -0.98) and at 12 weeks of treatment (r -0.97). CONCLUSIONS The VAS score compared favorably with objective measures of adherence. If future studies confirm our results, then the VAS will provide a simple and reliable method of assessing adherence to HCV DAAs in real-world treatment clinics.
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Affiliation(s)
- Mary Jane Burton
- From the G.V. (Sonny) Montgomery VA Medical Center, and the University of Mississippi Medical Center, Jackson
| | - Andrew C Voluse
- From the G.V. (Sonny) Montgomery VA Medical Center, and the University of Mississippi Medical Center, Jackson
| | - Amee B Patel
- From the G.V. (Sonny) Montgomery VA Medical Center, and the University of Mississippi Medical Center, Jackson
| | - Deborah Konkle-Parker
- From the G.V. (Sonny) Montgomery VA Medical Center, and the University of Mississippi Medical Center, Jackson
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23
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Evon DM, Golin CE, Ruffin R, Fried MW. Development and Pilot-Testing of a Cognitive Behavioral Coping Skills Group Intervention for Patients with Chronic Hepatitis C. Contemp Clin Trials Commun 2017; 6:85-96. [PMID: 29082334 PMCID: PMC5654628 DOI: 10.1016/j.conctc.2017.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 03/08/2017] [Accepted: 03/18/2017] [Indexed: 02/08/2023] Open
Abstract
Psychosocial interventions for patients with chronic hepatitis C viral (HCV) infection are needed to attenuate the impact of extrahepatic symptoms, comorbid conditions, and treatment side effects on HCV health outcomes. We adapted empirically-supported interventions for similar patient populations to develop a Cognitive Behavioral Coping Skills group intervention for HCV patients (CBCS-HCV) undergoing treatment. The objectives of this paper are to describe the research activities associated with CBCS-HCV development and pilot testing, including: (1) formative work leading to intervention development; (2) preliminary study protocol; and (3) pilot feasibility testing of the intervention and study design. Formative work included a literature review, qualitative interviews, and adaption, development, and review of study materials. A preliminary study protocol is described. We evaluate the feasibility of conducting a randomized controlled trial (RCT) of the CBCS-HCV with 12 study participants in Wave 1 testing to examine: (a) feasibility of intervention delivery; (b) patient acceptability; (c) recruitment, enrollment, retention; (d) feasibility of conducting a RCT; (d) therapist protocol fidelity; and (e) feasibility of data collection. Numerous lessons were learned. We found very high rates of data collection, participant attendance, engagement, retention and acceptability, and therapist protocol fidelity. We conclude that many aspects of the CBCS-HCV intervention and study protocol were highly feasible. The greatest challenge during this Wave 1 pilot study was efficiency of participant enrollment due to changes in standard of care treatment. These findings informed two additional waves of pilot testing to examine effect sizes and potential improvements in clinical outcomes, with results forthcoming.
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Affiliation(s)
- Donna M. Evon
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, USA
| | - Carol E. Golin
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
- Department of Health Behavior, University of North Carolina, Chapel Hill, NC, USA
| | - Rachel Ruffin
- Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Michael W. Fried
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, USA
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24
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Ward T, Gordon J, Jones B, Bennett H, Webster S, Kalsekar A, Yuan Y, Brenner M, McEwan P. Value of Sustained Virologic Response in Patients with Hepatitis C as a Function of Time to Progression of End-Stage Liver Disease. Clin Drug Investig 2017; 37:61-70. [PMID: 27587071 DOI: 10.1007/s40261-016-0458-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Targeted intervention in patients with hepatitis C virus (HCV) closest to end-stage liver disease (ESLD) progression may offer an approach to treatment prioritisation whilst delivering benefits for patients and the healthcare system. In contrast to previous HCV economic analyses, this study aimed to estimate the health economic value of sustained virologic response (SVR) stratified by the patient's propensity to progress to ESLD. METHODS An HCV natural history model was adapted to estimate the value of avoiding ESLD complications following SVR, assessed as cost offsets and quality-adjusted life year (QALY) gains, as a function of time to ESLD at treatment initiation. These outcomes were used to estimate the financial value of achieving SVR, defined as the maximum investment that could be allocated without exceeding a willingness-to-pay threshold of £20,000/QALY. RESULTS Regardless of time to ESLD onset, achieving SVR was beneficial, resulting in cost offsets and QALY gains, due to avoidance of ESLD complications. The value of achieving SVR was greatest in patients closest to ESLD onset, resulting in increased cost offsets and QALY gains (up to £50,901 and 9.56 QALYs). In patients closest to ESLD onset, the financial value of achieving SVR was £242,051, compared with £127,116 in patients furthest from onset. CONCLUSIONS Standard cost-effectiveness evaluations may underestimate the value of treatment in HCV patients closest to ESLD development. Targeted intervention would promote efficient allocation of limited healthcare resources and reconcile concerns surrounding the affordability of new direct-acting antivirals, by minimising the number-needed-to-treat to maximise health benefit, whilst minimising healthcare expenditure.
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Affiliation(s)
- Thomas Ward
- HEOR, Health Economics and Outcomes Research Ltd, 9 Oak Tree Court, Mulberry Drive, Cardiff Gate Business Park, CF23 8RS, Cardiff, UK.
| | - Jason Gordon
- HEOR, Health Economics and Outcomes Research Ltd, 9 Oak Tree Court, Mulberry Drive, Cardiff Gate Business Park, CF23 8RS, Cardiff, UK.,Department of Public Health, University of Adelaide, Adelaide, Australia
| | - Beverley Jones
- HEOR, Health Economics and Outcomes Research Ltd, 9 Oak Tree Court, Mulberry Drive, Cardiff Gate Business Park, CF23 8RS, Cardiff, UK
| | - Hayley Bennett
- HEOR, Health Economics and Outcomes Research Ltd, 9 Oak Tree Court, Mulberry Drive, Cardiff Gate Business Park, CF23 8RS, Cardiff, UK
| | - Samantha Webster
- HEOR, Health Economics and Outcomes Research Ltd, 9 Oak Tree Court, Mulberry Drive, Cardiff Gate Business Park, CF23 8RS, Cardiff, UK
| | - Anupama Kalsekar
- World Wide Health Economics and Outcomes Research, Bristol-Myers Squibb Pharmaceuticals Ltd, Princeton, USA
| | - Yong Yuan
- World Wide Health Economics and Outcomes Research, Bristol-Myers Squibb Pharmaceuticals Ltd, Princeton, USA
| | - Michael Brenner
- UK HEOR, Bristol-Myers Squibb Pharmaceuticals Ltd, Uxbridge, UK
| | - Phil McEwan
- HEOR, Health Economics and Outcomes Research Ltd, 9 Oak Tree Court, Mulberry Drive, Cardiff Gate Business Park, CF23 8RS, Cardiff, UK.,School of Human and Health Sciences, Swansea University, Swansea, UK
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25
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Sublette VA, Smith SK, George J, McCaffery K, Douglas MW. Listening to both sides: A qualitative comparison between patients with hepatitis C and their healthcare professionals' perceptions of the facilitators and barriers to hepatitis C treatment adherence and completion. J Health Psychol 2016; 23:1720-1731. [PMID: 27682337 DOI: 10.1177/1359105316669858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This qualitative study compares and contrasts the perspectives of healthcare professionals who treat hepatitis C with those of patients in treatment. Comparative analysis of semi-structured interviews with 20 healthcare professionals and 20 patients undergoing treatment for hepatitis C concluded that patients and healthcare professionals disagreed on the source of communication breakdowns, but both felt that individualised clinical information improved adherence. Stigma was recognised as a barrier to treatment adherence by both patients and healthcare professionals. Limitations of the healthcare system, such as patients receiving inconsistent information and long wait times, negatively impacted both patients and providers.
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26
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Herold S, Freudenreich O. Hepatitis C Virus and Schizophrenia: Expanding the Role of the Community Psychiatrist. PSYCHOSOMATICS 2016; 57:634-637. [PMID: 27418108 DOI: 10.1016/j.psym.2016.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 05/17/2016] [Accepted: 05/20/2016] [Indexed: 01/21/2023]
Affiliation(s)
- Sarah Herold
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA; Erich Lindemann Mental Health Center, Boston, MA.
| | - Oliver Freudenreich
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA; Erich Lindemann Mental Health Center, Boston, MA; Harvard Medical School, Boston, MA
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27
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Sublette VA, Smith SK, George J, McCaffery K, Douglas MW. Listening to both sides: A qualitative comparison between patients with hepatitis C and their healthcare professionals' perceptions of the facilitators and barriers to hepatitis C treatment adherence and completion. J Health Psychol 2016; 22:1300-1311. [PMID: 26857543 DOI: 10.1177/1359105315626786] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
This qualitative study compares and contrasts the perspectives of healthcare professionals who treat hepatitis C with those of patients in treatment. Comparative analysis of semi-structured interviews with 20 healthcare professionals and 20 patients undergoing treatment for hepatitis C concluded that patients and healthcare professionals disagreed on the source of communication breakdowns, but both felt that individualised clinical information improved adherence. Stigma was recognised as a barrier to treatment adherence by both patients and healthcare professionals. Limitations of the healthcare system, such as patients receiving inconsistent information and long wait times, negatively impacted both patients and providers.
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Affiliation(s)
- Victoria A Sublette
- 1 The University of Sydney, Australia.,2 The Westmead Institute for Medical Research, Australia.,3 Westmead Hospital, Australia
| | | | - Jacob George
- 1 The University of Sydney, Australia.,2 The Westmead Institute for Medical Research, Australia.,3 Westmead Hospital, Australia
| | | | - Mark W Douglas
- 1 The University of Sydney, Australia.,2 The Westmead Institute for Medical Research, Australia.,3 Westmead Hospital, Australia
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28
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Richmond JA, Sheppard-Law S, Mason S, Warner SL. The Australasian Hepatology Association consensus guidelines for the provision of adherence support to patients with hepatitis C on direct acting antivirals. Patient Prefer Adherence 2016; 10:2479-2489. [PMID: 28008234 PMCID: PMC5171201 DOI: 10.2147/ppa.s117757] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Hepatitis C is a blood-borne virus primarily spread through sharing of drug-injecting equipment. Approximately 150 million people worldwide and 230,000 Australians are living with chronic hepatitis C infection. In March 2016, the Australian government began subsidizing direct acting antivirals (DAAs) for the treatment of hepatitis C, which are highly effective (95% cure rate) and have few side effects. However, there is limited evidence to inform the provision of adherence support to people with hepatitis C on DAAs including the level of medication adherence required to achieve a cure. METHODOLOGY In February 2016, a steering committee comprising four authors convened an expert panel consisting of six hepatology nurses, a hepatologist, a pharmacist, a consumer with hepatitis C and treatment experience, and a consumer advocate. The expert panel focused on the following criteria: barriers and enablers to DAA adherence; assessment and monitoring of DAA adherence; components of a patient-centered approach to DAA adherence; patients that may require additional adherence support; and interventions to support DAA adherence. The resultant guidelines underwent three rounds of consultation with the expert panel, Australasian Hepatology Association (AHA) members (n=12), and key stakeholders (n=7) in June 2016. Feedback was considered by the steering committee and incorporated if consensus was achieved. RESULTS Twenty-four guidelines emerged from the evidence synthesis and expert panel discussion. The guidelines focus on the pretreatment assessment and education, assessment of treatment readiness, and monitoring of medication adherence. The guidelines are embedded in a patient-centered approach which highlights that all patients are at risk of nonadherence. The guidelines recommend implementing interventions focused on identifying patients' memory triggers and hooks; use of nonconfrontational and nonjudgmental language by health professionals; and objectively monitoring adherence. CONCLUSION These are the first guidelines to support patients and health professionals in the delivery of clinical care by identifying practical adherence support interventions for patients taking DAAs.
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Affiliation(s)
- Jacqueline A Richmond
- Australian Research Centre in Sex, Health and Society, La Trobe University
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Melbourne, VIC
- Correspondence: Jacqueline A Richmond, Viral Hepatitis Research Program, Australian Research Centre in Sex, Health and Society, La Trobe University, 215 Franklin Street, Melbourne, VIC 3000, Australia, Tel +61 488 662 268, Email
| | | | - Susan Mason
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, NSW
| | - Sherryne L Warner
- Department of Gastroenterology, Monash Health
- Department of Medicine, Monash University, Melbourne, VIC, Australia
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29
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Sublette VA, Smith SK, George J, McCaffery K, Douglas MW. The Hepatitis C treatment experience: Patients' perceptions of the facilitators of and barriers to uptake, adherence and completion. Psychol Health 2015; 30:987-1004. [PMID: 25622699 DOI: 10.1080/08870446.2015.1012195] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE This study explores the perceptions of patients receiving treatment for Hepatitis C to determine what factors influence their decision to commence treatment, ability to maintain adherence and complete their treatment program. DESIGN Semi-structured interview techniques were used in a qualitative study of 20 patients undergoing treatment for Chronic Hepatitis C (CHC). MAIN OUTCOME MEASURES To explore patients' perceived barriers and facilitators of Hepatitis C treatment adherence and completion. RESULTS Analysis of patient interviews identified four key themes: (1) motivations for commencing CHC treatment - fear of death and ridding themselves of stigma and shame; (2) the influential role of provider communication - patients reported that information and feedback that was personalised to their needs and lifestyles was the most effective for improving adherence to treatment; (3) facilitators of treatment adherence and completion - social, emotional and practical support improved adherence and completion, as did temporarily ceasing employment; (4) barriers to treatment adherence and completion - these included side effects, stigma, a complicated dosing schedule and limitations of the public healthcare system. CONCLUSION To increase treatment adherence and completion rates, a patient-centred approach is required that addresses patients' social, practical, and emotional support needs and adaptive coping strategies.
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30
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Rasi M, Künzler-Heule P, Schmid P, Semela D, Bruggmann P, Fehr J, Saxer S, Nicca D. "Fighting an uphill battle": experience with the HCV triple therapy: a qualitative thematic analysis. BMC Infect Dis 2014; 14:507. [PMID: 25231646 PMCID: PMC4174651 DOI: 10.1186/1471-2334-14-507] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 09/10/2014] [Indexed: 02/08/2023] Open
Abstract
Background Hepatitis C virus (HCV) infections are a severe burden on public health worldwide, causing mortality rates triple that of the general population. Since 2011, for both therapy-naive and therapy-experienced genotype 1 patients, the first generation of direct acting antivirals (DAAs), i.e., the protease-inhibitors (PI) telaprevir and boceprevir have been added to existing dual therapies. The therapeutic effect of the resulting triple therapy is striking; however, treatment regimens are complex and commonly cause side effects. Little is known of how patients implement therapy in their daily lives, or of how they deal with these effects. This study aims to describe HCV patients' experiences with protease-inhibitor-based triple therapy and their support needs. Methods A qualitative design was used. Patients from three outpatient clinics, with ongoing, completed or discontinued PI treatment experience were recruited using a maximum variation sampling approach. Open-ended interviews were conducted and analyzed using thematic analysis according to Braun & Clarke (Qual Res Psychol 3:77-101, 2006). Results Thirteen patients participated in the interviews. All described themselves as highly motivated to undergo treatment, since they saw the new therapy as a “real chance” for a cure. However, all later described the therapy period as a struggle. The constitutive theme–“Fighting an uphill battle”– describes the common existential experience of and negative consequences of coping with side effects. The processes that fostered this common experience followed three sub-themes: “encountering surprises”, “dealing with disruption” and “reaching the limits of systems”. Conclusion HCV patients undergoing outpatient protease-inhibitor-based triple therapy need systematic support in symptom management. This will require specially trained professionals to advise and support them and their families, and to provide rapid responses to their needs throughout this complex course of therapy. As the generation of DAAs for all genotypes, are expected to have less severe side effects, and many HCV patients require treatment, this knowledge can improve treatment support tremendously, especially for patients who are quite difficult to treat. Furthermore, these findings are helpful to illustrate development in HCV treatment. Electronic supplementary material The online version of this article (doi:10.1186/1471-2334-14-507) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | | | | | | | | | - Dunja Nicca
- Cantonal Hospital St, Gallen, Division of Infectious Diseases and Hospital Epidemiology, 9007 St, Gallen, Switzerland.
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