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Goutzamanis S, Doyle JS, Horyniak D, Higgs P, Hellard M. "Like a pickle that's been unpickled": Emotional, identity and behavioural transformations throughout hepatitis C treatment. PLoS One 2022; 17:e0272401. [PMID: 36508406 PMCID: PMC9744280 DOI: 10.1371/journal.pone.0272401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 07/19/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Little is known about the emotional experience and benefits of undertaking direct acting antiviral (DAA) treatment for hepatitis C. A better understanding of individual treatment outcomes can inform acceptable treatment delivery and promotion. We aimed to explore participant-perceived emotional benefits and transformations throughout DAA treatment among people who inject drugs, who were initiating treatment. METHODS Participants were recruited from either a community based clinical trial or community health clinics. Semi structured interviews were conducted with each participant before, during and following treatment. Interviews focussed on treatment perceptions, physical and mental wellbeing and modifiable health behaviours. Interviews were recorded, transcribed verbatim and thematically analysed. Participant and cohort matrices were produced to assess at which time point themes were present and whether themes changed or remained stable over time. RESULTS This paper presents analysis from 19 participants interviewed between 2017-2019. Most participants were male, with no or mild fibrosis. At baseline, all but one participant had injected drugs in the past month. Three themes relating to the emotional wellbeing and behaviour change described a common treatment experience; 'hopes for better wellbeing', 'lifting the weight' and 'closing the chapter'. Participants were hopeful treatment would improve their emotional wellbeing. Hopes were actualised during treatment as participants began to feel uncertainty and stress easing. Completing treatment improved some participants perceptions of self. Some participants consciously changed their injecting behaviours during treatment. CONCLUSION Undertaking and completing treatment was an emotionally and behaviourally transformative period. Participant perceived benefits should be used to inform how treatment benefit is conceptualised and how treatment is promoted in primary care settings.
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Affiliation(s)
- Stelliana Goutzamanis
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Joseph S Doyle
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Victoria, Australia
| | - Danielle Horyniak
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Behaviour and Health Risks Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Peter Higgs
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- Department of Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Margaret Hellard
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Victoria, Australia
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Nascimento YDA, Silva LD, Ramalho de Oliveira D. The Lived Experience of Patients Utilizing Second-Generation Direct-Acting Antiviral for Treatment of Chronic Hepatitis C Virus Infection: A Phenomenological Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12540. [PMID: 36231842 PMCID: PMC9566709 DOI: 10.3390/ijerph191912540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/28/2022] [Accepted: 09/29/2022] [Indexed: 06/16/2023]
Abstract
Hepatitis C is a global public health problem, and the aim of this study was to understand the experiences of patients with hepatitis C using second-generation antivirals. In-depth interviews were conducted with ten outpatients, cognitively capable of reporting their experience, followed up at a university clinic. Field diaries kept during the interviews were also used. The researchers carried out a thematic analysis to identify the ways in which individuals experienced their medication; then, these ways were reorganized to encompass the essential structures of the experience. The patients experienced the use of DAAs as providing resolution and it was permeated by: the experience of time-stagnant time, waiting for medication and the cure; the experience of spaces, understood as necessary and imposed spaces; the experience of relationships with others, personified by the support provided by healthcare professionals; the experience of sexuality, when patients developed several coping strategies to deal with the challenges imposed by the treatment. To conclude, increasing the knowledge about the patients' experiences can contribute to improve the healthcare model for hepatitis C, since several patients have severe hepatic impairment, and the eradication of the virus is only one of the stages of patients' treatments.
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Affiliation(s)
- Yone de Almeida Nascimento
- College of Pharmacy, Center for Pharmaceutical Care Studies, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil
| | - Luciana Diniz Silva
- College of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil
| | - Djenane Ramalho de Oliveira
- College of Pharmacy, Center for Pharmaceutical Care Studies, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil
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Goutzamanis S, Horyniak D, Doyle JS, Hellard M, Higgs P. Perceived physical health outcomes of direct-acting antiviral treatment for hepatitis C: a qualitative study. Harm Reduct J 2021; 18:73. [PMID: 34266434 PMCID: PMC8281623 DOI: 10.1186/s12954-021-00516-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 06/16/2021] [Indexed: 12/21/2022] Open
Abstract
Background Novel health promotion and treatment uptake initiatives will be necessary to ensure Australia meets 2030 hepatitis C elimination targets. Increasing treatment uptake will be assisted by a better understanding of the treatment experience and patient-perceived benefits. This study describes the perceived physical health benefits from direct-acting antiviral (DAA) hepatitis C treatment among people who inject drugs in Melbourne, Australia. Methods Twenty participants were recruited from a community treatment trial and community health clinics. Semi-structured interviews were performed with each participant before, during and following treatment. Interviews focused on treatment experiences, attitudes and motivations. Interviews were recorded, transcribed and thematically analysed. Results Two themes relating to the physical experience of treatment developed; intersection between physical and mental health and “maybe it’s working”. Participants reported various physical benefits, most prominently, reduced fatigue. Reductions in fatigue resulted in instant and meaningful changes in everyday life. Some participants did experience side effects, which they described as mild. Experiencing noticeable physical benefits during treatment was perceived as validation that treatment was working. Conclusion Physical health benefits of DAA treatment may have carry-on effects on cognitive, emotional or social wellbeing and should be incorporated into how treatment is promoted to those who require it.
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Affiliation(s)
- Stelliana Goutzamanis
- Disease Elimination Program, Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia. .,School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia.
| | - Danielle Horyniak
- Disease Elimination Program, Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia.,School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia.,Behaviour and Health Risks Program, Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia
| | - Joseph S Doyle
- Disease Elimination Program, Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia.,Department of Infectious Diseases, The Alfred and Monash University, 85 Commercial Rd, Melbourne, VIC, 3004, Australia
| | - Margaret Hellard
- Disease Elimination Program, Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia.,School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia.,Department of Infectious Diseases, The Alfred and Monash University, 85 Commercial Rd, Melbourne, VIC, 3004, Australia
| | - Peter Higgs
- Disease Elimination Program, Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia.,Department of Public Health, La Trobe University, Plenty Rd and Kingsbury Dr, Bundoora, VIC, 3086, Australia
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Dantas-Duarte A, Morais-de-Jesus M, Nunes AP, Miranda-Pettersen K, Araújo-de-Freitas L, Netto LR, Santos CT, Codes L, Quarantini LC. Risk-taking behavior and impulsivity among HCV-infected patients. Psychiatry Res 2016; 243:75-80. [PMID: 27371803 DOI: 10.1016/j.psychres.2016.04.114] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 03/02/2016] [Accepted: 04/29/2016] [Indexed: 12/22/2022]
Abstract
The association between risk behaviors and hepatitis C virus (HCV) has been extensively studied. It is also proved that impulsivity is associated with risk behaviors. However, there is a lack of studies investigating the association between HCV and impulsivity, a characteristic that can contribute directly to these risk behaviors. This study aimed to investigate HCV-infected individuals' impulsivity and whether this feature mediates risk behavior. Adult patients with liver diseases (n=269) were divided into two groups: viral group (n=157) - patients with HCV and nonviral group (n=112). Risk behaviors were evaluated by a sociodemographic questionnaire. Impulsivity was assessed through Barratt Impulsiveness Scale - BIS-11. Psychiatric comorbidities were investigated by the Mini International Neuropsychiatric Interview 5.0.0. The viral group patients had higher impulsivity than the nonviral group in all domains: attentional impulsivity, motor impulsivity, and nonplanning. Risk behaviors were also shown to be associated with impulsivity levels. Our results suggest that HCV-infected patients are more impulsive than individuals with other liver diseases, even when analyses are controlled for the presence of comorbid mental disorders. In addition, at-risk behavior was significantly mediated by impulsivity.
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Affiliation(s)
- Adriana Dantas-Duarte
- Programa de Pós-graduação em Medicina e Saúde, Faculdade de Medicina da Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Mychelle Morais-de-Jesus
- Programa de Pós-graduação em Medicina e Saúde, Faculdade de Medicina da Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Ana Paula Nunes
- Programa de Pós-graduação em Medicina e Saúde, Faculdade de Medicina da Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Karine Miranda-Pettersen
- Programa de Pós-graduação em Medicina e Saúde, Faculdade de Medicina da Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Lucas Araújo-de-Freitas
- Programa de Pós-graduação em Medicina e Saúde, Faculdade de Medicina da Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Liana R Netto
- Programa de Pós-graduação em Medicina e Saúde, Faculdade de Medicina da Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Carlos Teles Santos
- Departamento de Ciências Exatas, Universidade Estadual de Feira de Santana, Feira de Santana, Bahia, Brazil; Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Liana Codes
- Hospital Universitário da Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Lucas C Quarantini
- Programa de Pós-graduação em Medicina e Saúde, Faculdade de Medicina da Universidade Federal da Bahia, Salvador, Bahia, Brazil; Hospital Universitário da Universidade Federal da Bahia, Salvador, Bahia, Brazil.
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Facilitators of HCV treatment adherence among people who inject drugs: a systematic qualitative review and implications for scale up of direct acting antivirals. BMC Public Health 2016; 16:994. [PMID: 27645935 PMCID: PMC5029046 DOI: 10.1186/s12889-016-3671-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 09/15/2016] [Indexed: 01/16/2023] Open
Abstract
Background While the public health benefits of new HCV treatments depend on treatment adherence, particularly among people who inject drugs (PWID), several social and medical factors can jeopardize treatment adherence. The aim of this study is to examine the qualitative literature on facilitators to HCV treatment adherence among PWID. Methods We searched six databases to identify qualitative research studies on HCV treatment adherence facilitators among PWID. Two reviewers independently extracted and analyzed data using PRISMA guidelines and the CASP tool to evaluate study quality. Results From ten studies representing data from 525 participants, three major themes emerged across studies: logistical facilitators within health systems enhanced HCV treatment adherence, positive social interactions between PWID and staff provided positive feedback during treatment, and HCV treatment may complicate the addiction recovery process. Conclusions Although PWID face several barriers to adherence, we identified treatment adherence facilitators that could be incorporated into clinical practice. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3671-z) contains supplementary material, which is available to authorized users.
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Health-Related Quality of Life for individuals with hepatitis C: A narrative review. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 26:936-49. [DOI: 10.1016/j.drugpo.2015.04.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 03/10/2015] [Accepted: 04/24/2015] [Indexed: 02/06/2023]
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Safo SA, Batchelder A, Peyser D, Litwin AH. The common sense model applied to hepatitis C: a qualitative analysis of the impact of disease comparison and witnessed death on hepatitis C illness perception. Harm Reduct J 2015; 12:20. [PMID: 26092261 PMCID: PMC4477484 DOI: 10.1186/s12954-015-0054-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 06/14/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) accounts for 15,000 deaths in the United States yearly because people living with HCV are not identified in time to seek treatment, are ineligible for or refuse treatment, or face structural impediments to obtaining treatment such as lack of access to health care or lack of insurance. People who inject drugs (PWID) comprise a large proportion-estimates of up to 60-70%-of current and new HCV infected individuals and face many barriers to completing HCV treatment. METHODS We conducted 30 qualitative semi-structured interviews of current and former PWID seeking HCV treatment at an opioid-agonist treatment facility in New York City. We used thematic analysis, informed by grounded theory, to examine perceptions of HCV and decisions to initiate HCV treatment. We analyzed the themes that emerged via the common sense model (CSM) of illness perception theoretical framework. RESULTS Using thematic analyses, two major themes emerged related to engagement in HCV treatment. First, participants independently compared HCV to HIV, and in so doing, emphasized the potential fatality of HCV and the need for treatment. Second, participants described witnessing others suffer or die from untreated HCV and expressed how these recollections impacted their desire to undergo treatment themselves. Together, these themes contributed to the way participants perceived HCV and informed their decisions to initiate treatment. Both themes reflect the CSM's "self-regulation" process, which posits that understanding the causes and consequences of an illness impacts one's ability to seek treatment to overcome this illness state. CONCLUSIONS This paper offers insight into how clinicians can better understand and utilize HCV illness perceptions to evaluate willingness to engage in HCV treatment among PWID considering antiviral treatment modalities.
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Affiliation(s)
- Stella A Safo
- Department of General Internal Medicine, Albert Einstein College of Medicine, 111 East 210 St., Bronx, NY, 10467, USA.
| | - Abigail Batchelder
- Department of General Internal Medicine, Albert Einstein College of Medicine, 111 East 210 St., Bronx, NY, 10467, USA. .,University of California, San Francisco, CA, USA.
| | - Deena Peyser
- Department of General Internal Medicine, Albert Einstein College of Medicine, 111 East 210 St., Bronx, NY, 10467, USA. .,Rutgers University, Newark, NJ, USA.
| | - Alain H Litwin
- Department of General Internal Medicine, Albert Einstein College of Medicine, 111 East 210 St., Bronx, NY, 10467, USA.
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