1
|
Bredenberg E, Callister C, Dafoe A, Holliman BD, Rowan SE, Calcaterra SL. Subspecialty physicians' perspectives on barriers and facilitators of hepatitis C treatment: a qualitative study. Harm Reduct J 2024; 21:140. [PMID: 39054530 PMCID: PMC11271208 DOI: 10.1186/s12954-024-01057-z] [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: 03/20/2024] [Accepted: 07/11/2024] [Indexed: 07/27/2024] Open
Abstract
INTRODUCTION The hepatitis C virus (HCV) causes chronic and curable disease with a substantial burden of morbidity and mortality across the globe. In the United States (US) and other developed countries, incidence of HCV is increasing and people who inject drugs are disproportionately affected. However, HCV treatment rates amongst patients with substance use disorders (SUD) are suboptimal. In this study, we aimed to understand the perspectives of subspecialist physicians who care for substantial numbers of patients with HCV, including addiction medicine, infectious diseases, and hepatology physicians, to better understand barriers and facilitators of HCV treatment. METHODS We recruited subspecialty physicians via purposive and snowball sampling and conducted semi-structured interviews with 20 physicians at 12 institutions across the US. We used a mixed deductive and inductive approach to perform qualitative content analysis with a rapid matrix technique. RESULTS Three major themes emerged: (1) Perceptions of patient complexity; (2) Systemic barriers to care, and (3) Importance of multidisciplinary teams. Within these themes, we elicited subthemes on the effects of patient-level factors, provider-level factors, and insurance-based requirements. CONCLUSION Our results suggest that additional strategies are needed to reach the "last mile" untreated patients for HCV care, including decentralization and leverage of telehealth-based interventions to integrate treatment within primary care clinics, SUD treatment facilities, and community harm reduction sites. Such programs are likely to be more successful when multidisciplinary teams including pharmacists and/or peer navigators are involved. However, burdensome regulatory requirements continue to hinder this expansion in care and should be eliminated.
Collapse
Affiliation(s)
- Erin Bredenberg
- Division of Hospital Medicine, University of Colorado School of Medicine, 4th Floor, Leprino Building 12401 E 17th Ave, Aurora, CO, 80045, USA.
| | - Catherine Callister
- Division of Hospital Medicine, University of Colorado School of Medicine, 4th Floor, Leprino Building 12401 E 17th Ave, Aurora, CO, 80045, USA
| | - Ashley Dafoe
- Adult and Child Center for Health Outcomes Research and Delivery Science, Aurora, CO, USA
| | - Brooke Dorsey Holliman
- Adult and Child Center for Health Outcomes Research and Delivery Science, Aurora, CO, USA
| | - Sarah E Rowan
- Denver Health and Hospital Authority, Denver, CO, USA
- Division of Infectious Diseases, University of Colorado, Aurora, CO, USA
| | - Susan L Calcaterra
- Division of Hospital Medicine, University of Colorado School of Medicine, 4th Floor, Leprino Building 12401 E 17th Ave, Aurora, CO, 80045, USA
- Adult and Child Center for Health Outcomes Research and Delivery Science, Aurora, CO, USA
- Division of General Internal Medicine, University of Colorado, Aurora, CO, USA
| |
Collapse
|
2
|
Winter RJ, Griffin S, Sheehan Y, Nguyen W, Stoové M, Lloyd AR, Thompson AJ. People in community corrections are a population with unmet need for viral hepatitis care. EClinicalMedicine 2024; 70:102548. [PMID: 38516104 PMCID: PMC10955648 DOI: 10.1016/j.eclinm.2024.102548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/29/2024] [Accepted: 02/29/2024] [Indexed: 03/23/2024] Open
Abstract
To reach World Health Organization elimination targets for hepatitis C, different strategies are needed to reach people who have not yet been diagnosed and treated. In the context of declining treatment initiation rates, innovation in service design and delivery is necessary: testing and treatment needs to be offered to people in non-traditional settings. The community corrections (probation and parole) population is larger than the prison population, which has high prevalence of hepatitis C and-in some countries-established diagnosis and treatment programs. In this Viewpoint we identify a gap in hepatitis C care for people under community correctional supervision, a group who have either never been imprisoned or need continuity of healthcare provided in prison. We propose that offering hepatitis C screening and treatment would benefit this population, and accelerate progress to hepatitis C elimination.
Collapse
Affiliation(s)
- Rebecca J. Winter
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Samara Griffin
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Yumi Sheehan
- Viral Immunology Systems Program, The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | | | - Mark Stoové
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, VIC, Australia
| | - Andrew R. Lloyd
- Viral Immunology Systems Program, The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Alexander J. Thompson
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - National Prisons Hepatitis Network
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Viral Immunology Systems Program, The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
- Hepatitis Queensland, Brisbane, QLD, Australia
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, VIC, Australia
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| |
Collapse
|
3
|
Jacka BP, Bazerman LB, Dickerson C, Moody M, Martin J, Patry E, Cady T, Compere H, Boudreau M, Beckwith CG. Feasibility of hepatitis C virus testing and linkage in community supervision offices: Great potential but persistent challenges. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 103:103668. [PMID: 35367903 PMCID: PMC9070602 DOI: 10.1016/j.drugpo.2022.103668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 03/16/2022] [Accepted: 03/18/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Persons involved with the justice system have an elevated risk of hepatitis C virus (HCV) yet remain marginalized from treatment. Efforts to eliminate HCV will require targeted interventions within the justice system effective at providing diagnosis and treatment. METHODS We implemented a novel HCV screening and treatment intervention for persons under community supervision in Rhode Island, USA during April 2018--March 2020. Participants received rapid point-of-care HCV antibody testing onsite and referral to community laboratory and treatment services as indicated. We assessed the HCV care cascade to identify areas for improvement. RESULTS Overall, 483 individuals were screened for HCV antibody; 85 (18%) were positive. A minority of participants with positive HCV antibody tests (n=25/85, 29%) presented to community laboratories for confirmatory testing. Among participants that received HCV viral load results and linked to a treatment provider (n=12), four initiated treatment, three had record of completing treatment, and two were confirmed to have achieved cure. CONCLUSION Linkage to HCV viral load testing and treatment was challenging in this community supervision population, with substantial loss to follow-up at each step of the HCV cascade. Community supervision remains an important venue for case identification but substantial barriers to accessing HCV treatment exist. Innovative HCV diagnosis and treatment strategies are needed for community supervision populations.
Collapse
Affiliation(s)
- Brendan P Jacka
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Laurie B Bazerman
- Division of Infectious Diseases, The Miriam Hospital, Providence, Rhode Island, USA
| | - Collin Dickerson
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Marc Moody
- Rhode Island Department of Corrections, Pawtucket, Rhode Island, USA
| | - Johanna Martin
- Division of Infectious Diseases, The Miriam Hospital, Providence, Rhode Island, USA
| | - Emily Patry
- Division of Infectious Diseases, The Miriam Hospital, Providence, Rhode Island, USA
| | - Treniece Cady
- Division of Infectious Diseases, The Miriam Hospital, Providence, Rhode Island, USA
| | - Hacheming Compere
- Division of Infectious Diseases, The Miriam Hospital, Providence, Rhode Island, USA
| | - Matthew Boudreau
- Division of Infectious Diseases, The Miriam Hospital, Providence, Rhode Island, USA
| | - Curt G Beckwith
- Division of Infectious Diseases, The Miriam Hospital, Providence, Rhode Island, USA; The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
| |
Collapse
|