1
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McKeever A, O'Donovan D, Kee F. Factors influencing compliance with Hepatitis C treatment in patients transitioning from prison to community-A summary scoping review. J Viral Hepat 2023; 30:278-282. [PMID: 36636765 DOI: 10.1111/jvh.13801] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 11/23/2022] [Accepted: 12/16/2022] [Indexed: 01/14/2023]
Abstract
It is well-established that prevalence of Hepatitis C (HCV) infection in prisoners is disproportionately higher than in the general population. While developments in screening and treatment for HCV have enabled greater detection and treatment in prison, release is a high-risk time for HCV infected prisoners returning to the challenges of community living. A scoping review was conducted to examine the evidence on individual, provider and system level factors that influence compliance with HCV treatment in patients transitioning from prison to community. Retrieved articles were screened and those eligible were selected for data extraction. Quantitative and qualitative studies were included. Electronic peer-reviewed databases were searched in February 2022: 140 articles were initially identified of which seven were included in the final review. Six key themes characterized the literature: education, case management and discharge planning, hepatology in-reach nurses, transition clinics, primary care providers and system wide approach. This summary scoping review highlights the paucity of research in this area. There is a need for experimental research to investigate specific interventions, and to understand HCV care-specific barriers and facilitators. A multi-pronged approach is needed to address barriers to healthcare services in general but also specific barriers relating to HCV. Factors that facilitate compliance should also be recognized and amplified across regional HCV elimination strategies.
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Affiliation(s)
- Anna McKeever
- School of Medicine, Dentistry and Biomedical Sciences, Centre for Public Health, QUB, Belfast, UK
| | - Diarmuid O'Donovan
- School of Medicine, Dentistry and Biomedical Sciences, Centre for Public Health, QUB, Belfast, UK
| | - Frank Kee
- School of Medicine, Dentistry and Biomedical Sciences, Centre for Public Health, QUB, Belfast, UK
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2
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Doshi RK, Ruben M, Drezner K, Lachmann A, Kuo I, Chanes-Mora P, Varga L, Saafir-Callaway B, Visconti A, Kharfen M. Knowledge, Attitudes, and Behaviors Related to Hepatitis C Screening and Treatment among Health Care Providers in Washington, DC. J Community Health 2021; 45:785-794. [PMID: 32125591 DOI: 10.1007/s10900-020-00794-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Elimination of chronic hepatitis C (HCV) will require scaling up treatment, including possible HCV treatment by primary care providers. The District of Columbia (DC) has a substantial population living with untreated hepatitis C, and treatment expansion would benefit the resident population. The aim of this study was to assess the knowledge, attitudes, and behaviors of primary care providers and specialists related to hepatitis C screening and treatment. We conducted a prospective, online survey of physicians and nurse practitioners (n = 153) in DC on their knowledge, attitudes, and behaviors related to hepatitis C screening and treatment, as well as referral patterns, interest in learning, and preferred learning modalities. We compared responses by provider type. Key findings indicated that HCV screening and treatment knowledge was higher among specialty physicians as compared to primary care providers. The most common reported facilitators of HCV screening included a prompt in the electronic medical record (63%), patient education (57%), and support staff (41%). While 71% reported that HCV treatment was important in the community they serve, only 26% indicated that access to HCV specialist expertise and consultation was a major area of need. Additionally, 59% reported that they refer all HCV patients to specialists for treatment. Primary care providers in DC had moderate interest in learning how to treat chronic hepatitis C, but they need additional training. Patients are typically referred to gastroenterology, infectious diseases, and hepatology specialists who may have limited capacity to expand treatment.
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Affiliation(s)
- Rupali Kotwal Doshi
- District of Columbia Department of Health, HIV/AIDS, Hepatitis, STD and TB Administration, 899 N. Capitol Street NE, Washington, DC, 20002, USA. .,George Washington University, 950 New Hampshire Avenue NW, Washington, DC, 20052, USA.
| | - Max Ruben
- George Washington University, 950 New Hampshire Avenue NW, Washington, DC, 20052, USA
| | - Kate Drezner
- District of Columbia Department of Health, HIV/AIDS, Hepatitis, STD and TB Administration, 899 N. Capitol Street NE, Washington, DC, 20002, USA
| | - Alexandra Lachmann
- District of Columbia Department of Health, HIV/AIDS, Hepatitis, STD and TB Administration, 899 N. Capitol Street NE, Washington, DC, 20002, USA
| | - Irene Kuo
- George Washington University, 950 New Hampshire Avenue NW, Washington, DC, 20052, USA
| | - Paola Chanes-Mora
- District of Columbia Department of Health, HIV/AIDS, Hepatitis, STD and TB Administration, 899 N. Capitol Street NE, Washington, DC, 20002, USA
| | - Leah Varga
- District of Columbia Department of Health, HIV/AIDS, Hepatitis, STD and TB Administration, 899 N. Capitol Street NE, Washington, DC, 20002, USA.,George Washington University, 950 New Hampshire Avenue NW, Washington, DC, 20052, USA
| | - Brittani Saafir-Callaway
- District of Columbia Department of Health, HIV/AIDS, Hepatitis, STD and TB Administration, 899 N. Capitol Street NE, Washington, DC, 20002, USA
| | - Adam Visconti
- District of Columbia Department of Health, HIV/AIDS, Hepatitis, STD and TB Administration, 899 N. Capitol Street NE, Washington, DC, 20002, USA
| | - Michael Kharfen
- District of Columbia Department of Health, HIV/AIDS, Hepatitis, STD and TB Administration, 899 N. Capitol Street NE, Washington, DC, 20002, USA
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3
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Impact of Behavioral Health Consultation on Hepatitis C Treatment Outcomes at a Federally Qualified Health Center; Philadelphia, PA. J Prim Prev 2021; 42:203-215. [PMID: 33733379 DOI: 10.1007/s10935-021-00627-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2021] [Indexed: 10/21/2022]
Abstract
Hepatitis C virus (HCV) infection is a public health issue that claims the lives of 350,000 individuals globally every year. Primary care providers are increasingly prescribing HCV medications with more modern, simplified administrations. Individuals with HCV are disproportionately affected by behavioral health challenges and substance use disorders. Integrated behavioral health providers can work in concert with their patients' primary care teams to provide innovative treatment programs to help support the needs of HCV care. We used simple and multivariable logistic regression to determine the association between receipt of behavioral health consultation and two outcomes on the care continuum: insurance approval for treatment and initiated HCV treatment regimen. These models were fitted using theoretically hypothesized variables and multivariable regression models included age, sex, and race/ethnicity as potential confounders. From January 2015 to May 2017, 189 patients at health centers were referred for onsite HCV primary care treatment. Of these, 142 were approved for participation, and 132 started treatment. Simple regression revealed a significant association between behavioral health consultation and treatment approval; however, behavioral health consultation was non-significant in the multivariable model for treatment approval. For initiating HCV treatment, onsite behavioral health consultation was significantly associated in both the unadjusted and adjusted regression models. Integrating behavioral health services for patients seeking HCV treatment may improve movement across the care continuum, optimizing patient's HCV health outcomes. Behavioral health consultation in primary care settings should be studied further to improve HCV treatment outcomes for patients with behavioral health and substance use disorders.
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4
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Connoley D, Francis-Graham S, Storer M, Ekeke N, Smith C, Macdonald D, Rosenberg W. Detection, stratification and treatment of hepatitis C-positive prisoners in the United Kingdom prison estate: Development of a pathway of care to facilitate the elimination of hepatitis C in a London prison. J Viral Hepat 2020; 27:987-995. [PMID: 32449969 DOI: 10.1111/jvh.13336] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 03/29/2020] [Accepted: 04/20/2020] [Indexed: 12/26/2022]
Abstract
The United Kingdom is committed to eliminating hepatitis C virus (HCV) infection by 2025. The prison estate provides an opportunity to identify and treat HCV-positive individuals in a high-prevalence environment. We designed and implemented a pathway of care within a London prison to diagnose, stratify and link HCV-positive prisoners into care. This study was a two-phase case study of a HCV care pathway. New arrivals to the prison were offered blood-borne virus screening with dried blood spot testing at their secondary health check. Those with active infection completed disease stratification tests and were reviewed at a weekly hospital-based multidisciplinary team meeting to determine management. In Phase-2, the pathway was redesigned to improve testing and the referral of HCV-positive prisoners into treatment. Over the 30-month evaluation period, 12,946 people were received in the prison. During Phase-1, 19.6% of new arrivals completed blood-borne virus testing, with 7.3% identified as HCV-positive. Just 8.3% of HCV-positive individuals were treated or referred for treatment in Phase-1. During Phase-2, 30% of new receptions completed BBV testing and 3.9% were identified as HCV-positive. Linkage into care was improved, with 38.9% treated or referred during the second phase. Poor access to testing and referral to treatment limit the effectiveness of care provision for prisoners with HCV. Elimination of HCV in prisons requires local service configuration to ensure high uptake of testing, with all HCV-positive cases then offered treatment during custody or referral on to treatment after release.
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Affiliation(s)
- Declan Connoley
- Monash University, Clayton, Vic., Australia.,Division of Medicine, Institute for Liver and Digestive Health, University College London, London, UK.,Royal Free London NHS Foundation Trust, London, UK.,Monash Health Australia, Clayton, Vic., Australia
| | - Seth Francis-Graham
- Division of Medicine, Institute for Liver and Digestive Health, University College London, London, UK.,Royal Free London NHS Foundation Trust, London, UK
| | | | - Nnenna Ekeke
- Division of Medicine, Institute for Liver and Digestive Health, University College London, London, UK.,Royal Free London NHS Foundation Trust, London, UK
| | - Claire Smith
- Division of Medicine, Institute for Liver and Digestive Health, University College London, London, UK.,Royal Free London NHS Foundation Trust, London, UK
| | - Douglas Macdonald
- Division of Medicine, Institute for Liver and Digestive Health, University College London, London, UK.,Royal Free London NHS Foundation Trust, London, UK
| | - William Rosenberg
- Division of Medicine, Institute for Liver and Digestive Health, University College London, London, UK.,Royal Free London NHS Foundation Trust, London, UK
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5
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Dieterich DT. A Simplified Algorithm for the Management of Hepatitis C Infection. Gastroenterol Hepatol (N Y) 2019; 15:1-12. [PMID: 31641341 PMCID: PMC6799873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Elimination of hepatitis C virus (HCV) infection as a public health threat is a goal of the World Health Organization. Official treatment guidelines are comprehensive and may be most appropriate for experienced treaters of HCV; however, global elimination of HCV infection will require the engagement of frontline health care providers (HCPs) to increase the capacity to treat patients. Thus, a simplified treatment algorithm is needed to provide guidance to non-HCV specialists. To accomplish this, a panel of 13 HCV specialists held a consensus meeting in September 2018 to create an easy-to-use, effective, safe, and scalable algorithm for the management and treatment of HCV infection through discussion and collective decision-making. The algorithm begins with universal HCV screening and diagnosis by testing for HCV antibody with reflex to polymerase chain reaction to detect HCV RNA. The pretreatment evaluation uses platelet-based stratification to initially assess fibrosis, and the pan-genotypic regimens glecaprevir/pibrentasvir or sofosbuvir/velpatasvir are recommended for treatment. Unless clinically indicated, on-treatment monitoring is optional. Confirmation of cure (undetectable HCV RNA 12 weeks posttreatment) is followed by harm-reduction measures, as well as surveillance for hepatocellular carcinoma every 6 months in patients with advanced fibrosis/cirrhosis. This algorithm provides guidance for management of uncomplicated cases of HCV by frontline HCPs and indicates when referral to an HCV specialist is warranted. The algorithm was created to enable more HCPs to screen for and manage HCV infection, and thus contribute to its elimination.
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6
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Wong WCW, Lo YR, Jiang S, Peng M, Zhu S, Kidd MR, Wang XC, Chan PL, Ong JJ. Improving the hepatitis cascade: assessing hepatitis testing and its management in primary health care in China. Fam Pract 2018; 35:731-737. [PMID: 29741661 DOI: 10.1093/fampra/cmy032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE The study aimed to decentralize hepatitis testing and management services to primary care in China. METHODS A nationwide representative provider survey amongst community health centres (CHCs) using randomized stratified sampling methods was conducted between September and December 2015. One hundred and eighty CHCs and frontline primary care practitioners from 20 cities across three administrative regions of Western, Central and Eastern China were invited to participate. RESULTS One hundred and forty-nine clinicians-in-charge (79%), 1734 doctors and 1846 nurses participated (86%). Majority of CHCs (80%, 95% CI: 74-87) offered hepatitis B testing, but just over half (55%, 95% CI: 46-65) offered hepatitis C testing. The majority of doctors (87%) and nurses (85%) felt that there were benefits for providing hepatitis testing at CHCs. The major barriers for not offering hepatitis testing were lack of training (54%) and financial support (23%). Multivariate analysis showed that the major determinants for CHCs to offer hepatitis B and C testing were the number of nurses (AOR 1.1) and written policies for hepatitis B diagnosis (AOR 12.7-27.1), and for hepatitis B the availability of reproductive health service. CONCLUSIONS Primary care providers in China could play a pivotal role in screening, diagnosing and treating millions of people with chronic hepatitis B and C in China.
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Affiliation(s)
- William C W Wong
- University of Hong Kong-Shenzhen Hospital, Shenzhen, China.,Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong
| | - Ying-Ru Lo
- Head of Mission and WHO Representative to Malaysia, Brunei Darussalam and Singapore
| | - Sunfang Jiang
- Department of General Practice, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Minghui Peng
- Department of General Practice, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shanzhu Zhu
- Department of General Practice, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Michael R Kidd
- Department of Family and Community Medicine, University of Toronto, Canada.,Southgate Institute for Health, Equity and Society, Flinders University, Australia
| | - Xia-Chun Wang
- National Center for AIDS/STD Prevention and Control, China Center for Disease Control and Prevention, Beijing, China
| | - Po-Lin Chan
- World Health Organization, Office of the Representative to China
| | - Jason J Ong
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, UK.,Central Clinical School, Monash University, Melbourne, Australia
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7
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Nouch S, Gallagher L, Erickson M, Elbaharia R, Zhang W, Wang L, Bacani N, Kason D, Kleban H, Knebel L, Hall D, Barrios R, Hull M. Factors associated with lost to follow-up after hepatitis C treatment delivered by primary care teams in an inner-city multi-site program, Vancouver, Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 59:76-84. [DOI: 10.1016/j.drugpo.2018.06.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 06/27/2018] [Accepted: 06/29/2018] [Indexed: 12/12/2022]
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8
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Sokol R, Early J, Barner A, Gottfried S, Gumpert R, Libaridian L, Morrison V, Santamaria A, Shipton L. Implementation of a multidisciplinary, team-based model to treat chronic hepatitis C in the primary care setting: Lessons learned. Healthcare (Basel) 2018; 6:205-209. [DOI: 10.1016/j.hjdsi.2017.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 09/20/2017] [Accepted: 09/29/2017] [Indexed: 10/18/2022] Open
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9
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Ragusa R, Bertino G, Bruno A, Frazzetto E, Cicciu F, Giorgianni G, Lupo L. Evaluation of health status in patients with hepatitis c treated with and without interferon. Health Qual Life Outcomes 2018; 16:17. [PMID: 29343250 PMCID: PMC5773186 DOI: 10.1186/s12955-018-0842-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 01/05/2018] [Indexed: 12/15/2022] Open
Abstract
Background The evolution of technology in healthcare has increased the health care’s costs and, the universal healthcare systems, in developed countries, need to ensure proper allocation of resources. Thus, the major issue is assessing the effectiveness of new medical technologies. The evaluation of quality of life in response to new treatments has become a key indicator in chronic conditions for which medical interventions are evaluated not only in terms of increasing the number of expected life years but also in terms of increasing quality of life. The aim of this observational study was to verify whether a simple instrument (EQ-5D-5 L) can capture variations in health-related quality of life (HRQoL) and allow us to evaluate the impact of different drug treatment protocols in patients with hepatitis C virus (HCV) on daily activities. Methods Sixty six patients with HCV were consecutively enrolled in the Hepatology Unit at the University Hospital of Catania “G. Rodolico”. Sixteen patients received new direct-acting-antiviral agents (DAAs) plus pegylated alpha interferon (Peg-α-IFN) protocol (Group A) and 50 DAAs IFN free protocol (Group B). The EQ-5D-5 L® questionnaire and visual analog scale (VAS) were given to both groups to calculate coefficient’s utility. We used the EQ-5D-5 L Crosswalk Index Value Calculator to obtain the utility EQIndex and both parametric and non parametric tests for the statistical analysis. Results The biopsy taken at the beginning of treatment showed comparable cell damage in both groups. The difference in the VAS results was negative for patients who received protocols containing IFN (indicating decreased quality of life),whereas it was positive in patients treated with IFN-free protocols. The baseline EQIndex did not reveal any differences between the two treatment groups. The post-treatment EQIndex was statistically better in the groups that received IFN-free therapy. Conclusions When innovative treatments are introduced into clinical practice, assessing quality of life is mandatory to determine their benefits. The instruments used in the present study are effective in detecting the areas in which improvement has occurred. These instruments can be easily managed by general practitioners for follow up of progression of the disease and referred to the specialist.
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Affiliation(s)
- R Ragusa
- Health Technology Assessment Committee, University Hospital "G. Rodolico", Via Rosso di San Secondo 3, 95128, Catania, Italy.
| | - G Bertino
- Hepatology Unit-Department of clinical and Experimental Medicine, University Hospital "G. Rodolico", Catania, Italy
| | - A Bruno
- Science of Health Professions Technical Diagnostic, University of Catania, Catania, Italy
| | - E Frazzetto
- School of Specialization in Internal Medicine, University of Catania, Catania, Italy
| | - F Cicciu
- School of Specialization in Hygiene, University of Catania, Catania, Italy
| | - G Giorgianni
- School of Specialization in Hygiene, University of Catania, Catania, Italy
| | - L Lupo
- Medical Statistic - Department of Medical and Surgical Sciences and advanced technologies, University of Catania, Catania, Italy
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10
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Williams R, Alexander G, Aspinall R, Bosanquet J, Camps-Walsh G, Cramp M, Day N, Dhawan A, Dillon J, Dyson J, Ferguson J, Foster G, Gardner R, Gilmore SI, Hardman L, Hudson M, Kelly D, Langford A, Liversedge S, Moriarty K, Newsome P, O'Grady J, Pryke R, Rolfe L, Rutter H, Ryder S, Samyn M, Sheron N, Taylor A, Thompson J, Verne J, Yeoman A. New metrics for the Lancet Standing Commission on Liver Disease in the UK. Lancet 2017; 389:2053-2080. [PMID: 27989558 DOI: 10.1016/s0140-6736(16)32234-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 11/02/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Roger Williams
- Institute of Hepatology, Foundation for Liver Research, London, UK.
| | - Graeme Alexander
- British Association for the Study of the Liver, UK; University College London, London, UK; Cambridge University Hospital, Cambridge, UK
| | | | | | | | - Matthew Cramp
- Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - Natalie Day
- Institute of Hepatology, Foundation for Liver Research, London, UK
| | | | - John Dillon
- Medical Research Institute, University of Dundee, Dundee, UK
| | | | | | | | | | | | | | | | | | | | | | | | - Philip Newsome
- NIHR Birmingham Liver Biomedical Research Unit, University Hospital Birmingham, Birmingham, UK
| | | | | | | | - Harry Rutter
- London School of Hygiene & Tropical Medicine, London, UK
| | - Stephen Ryder
- NIHR Biomedical Research Unit in Gastrointestinal and Liver Diseases, Nottingham University NHS Trust and University of Nottingham, Nottingham, UK
| | | | - Nick Sheron
- NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton, UK
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11
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The physical health of people who inject drugs: complexities, challenges, and continuity. Br J Gen Pract 2017; 66:286-7. [PMID: 27231287 DOI: 10.3399/bjgp16x685333] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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12
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Pourmarzi D, Hall L, Rahman T, Lim D, FitzGerald G. Clinical effectiveness, cost-effectiveness and acceptability of community-based management of chronic hepatitis C: a mixed methods systematic review protocol. ACTA ACUST UNITED AC 2017; 15:914-931. [DOI: 10.11124/jbisrir-2016-003103] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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13
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Foster MA, Xing J, Moorman AC, Boscarino J, Gordon SC, Lu M, Rupp L, Schmidt MA, Trinacty CM, Xu F, Holmberg SD, Spradling PR. Frequency of and Factors Associated with Receipt of Liver-Related Specialty Care Among Patients with Hepatitis C in the Chronic Hepatitis Cohort Study. Dig Dis Sci 2016; 61:3469-3477. [PMID: 27510752 DOI: 10.1007/s10620-016-4269-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 07/26/2016] [Indexed: 12/09/2022]
Abstract
BACKGROUND Linking persons with hepatitis C virus (HCV) to care and treatment is critical to reduction in disease burden; typically, this entailed referral to a specialist. However, data regarding the frequency and factors associated with referral among patients in healthcare organizations (HCOs) are lacking. METHODS Among persons in four US HCOs with newly diagnosed HCV during 2006-2011, we determined the frequency of liver-related specialist care after diagnosis. We also identified sociodemographic and clinical characteristics associated with such care by multivariate analysis, adjusted for all variables. RESULTS Among 3592 patients with newly diagnosed HCV, 57 % (range among sites 45-90 %) received specialist care; of these, 57 % received care within 90 days of diagnosis. Patient characteristics associated with receipt of specialist care included: affiliation with one of the study sites [adjusted odds ratio (aOR) 4.8 vs. the referent site); having Medicare plus private insurance (aOR 1.6 vs. Medicaid); and having elevated alanine aminotransferase (ALT) (aOR 1.6 vs. normal ALT) or lower platelet values (aOR 1.4 vs. normal platelet level). Specialist care within 90 days of diagnosis was associated with private insurance (aOR 1.5 vs. Medicaid), elevated ALT levels (aOR 1.3-2.3 vs. normal), and having ≥2 comorbid conditions (aOR 1.4 vs. no comorbid conditions). Compared to patients not referred, those referred were more likely to be treated (aOR 3.5). CONCLUSIONS Receipt of specialist care among persons with newly diagnosed HCV varied among HCOs. Clinical evidence of liver disease and having private insurance were associated with prompt receipt of specialist care and HCV treatment.
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Affiliation(s)
- Monique A Foster
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop G-37, Atlanta, GA, 30329, USA.
| | - Jian Xing
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop G-37, Atlanta, GA, 30329, USA
| | - Anne C Moorman
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop G-37, Atlanta, GA, 30329, USA
| | - Joseph Boscarino
- Geisinger Health System, 100 N. Academy Avenue, Danville, PA, 17866, USA
| | - Stuart C Gordon
- Henry Ford Health System, 2799 West Grand Boulevard, Detroit, MI, 48202, USA
| | - Mei Lu
- Henry Ford Health System, 2799 West Grand Boulevard, Detroit, MI, 48202, USA
| | - Loralee Rupp
- Henry Ford Health System, 2799 West Grand Boulevard, Detroit, MI, 48202, USA
| | - Mark A Schmidt
- Kaiser Permanente Health Research, 3800 N. Interstate Avenue, Portland, OR, 97227, USA
| | - Connie M Trinacty
- Kaiser Permanente Health Research, 501 Alakawa Street, Suite 201, Honolulu, HI, 96817, USA
| | - Fujie Xu
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop G-37, Atlanta, GA, 30329, USA
| | - Scott D Holmberg
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop G-37, Atlanta, GA, 30329, USA
| | - Philip R Spradling
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop G-37, Atlanta, GA, 30329, USA
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14
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Whiteley D, Whittaker A, Elliott L, Cunningham-Burley S. The lived experience of interferon-free treatments for hepatitis C: A thematic analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 38:21-28. [PMID: 27842250 DOI: 10.1016/j.drugpo.2016.10.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 10/07/2016] [Accepted: 10/19/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND International discourse concerning the evolution in hepatitis C virus (HCV) therapy has tended to focus on improving outcomes, shortened treatment length and reduced side-effects of interferon-free regimens. How these treatments are being understood and experienced by the people receiving them has so far been overlooked. This study therefore aimed to explore the lived experience of individuals taking interferon-free HCV therapies. METHODS Data were generated through 16 semi-structured interviews with a purposive sample of eight participants, recruited from a university hospital in Scotland. The interviews took place between June 2015 and March 2016, before and after a period of interferon-free HCV treatment. The data were interrogated using a thematic analysis, underpinned by social phenomenological theory. RESULTS Three overriding themes were identified. 'Expectations and realisations' characterised the influence that interferon continued to cast over interferon-free treatment, contrasting the practicalities of taking interferon-free therapy with preconceived notions. 'An honour and a pleasure' portrayed a positive experience of an undemanding therapy, yet among those with a history of drug use, was also positioned as a privilege, associated with feelings of luck and guilt. 'Treatment needs' illustrated the strategies participants used to search for treatment efficacy, and the value those with a significant history of drug use placed on support. One nonconforming case is then discussed to enhance rigour and trustworthiness. CONCLUSION This is the first qualitative exploration of the experience of interferon-free HCV treatment reported globally. The results from this study suggest a cultural lag exists between the pharmacological developments which have been witnessed, and societal understandings of them. This has implications for the way services meet the needs of, and offer therapy to, HCV positive individuals.
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Affiliation(s)
- David Whiteley
- Regional Infectious Diseases Unit, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, United Kingdom; School of Health and Social Care, Edinburgh Napier University, Sighthill Campus, Sighthill Court, Edinburgh EH11 4BN, United Kingdom; Substance Misuse Directorate, NHS Lothian, Woodlands House, Astley Ainslie Hospital, 133 Grange Load, Edinburgh EH9 2HL, United Kingdom.
| | - Anne Whittaker
- School of Health and Social Care, Edinburgh Napier University, Sighthill Campus, Sighthill Court, Edinburgh EH11 4BN, United Kingdom; Substance Misuse Directorate, NHS Lothian, Woodlands House, Astley Ainslie Hospital, 133 Grange Load, Edinburgh EH9 2HL, United Kingdom
| | - Lawrie Elliott
- Department of Nursing and Community Health, School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, United Kingdom
| | - Sarah Cunningham-Burley
- School of Molecular, Genetic and Population Health Sciences, University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, United Kingdom
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Primary Care-Based Hepatitis C Treatment Outcomes With First-Generation Direct-Acting Agents. J Addict Med 2016; 9:405-10. [PMID: 26291545 DOI: 10.1097/adm.0000000000000147] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Vulnerable, urban populations with a history of substance use disorders have a high prevalence of hepatitis C virus (HCV). Primary care-based treatment has been proposed to improve access to care. In this study, we present outcomes from our urban, primary care-based HCV treatment program in patients treated with telaprevir or boceprevir in combination with pegylated-interferon and ribavirin ("triple therapy"). METHODS We collected data from 126 consecutive patients with genotype 1 HCV monoinfection seen in our treatment program (2011-2013). Among the 40 who initiated treatment, we analyzed factors associated with achieving a sustained viral response (SVR). RESULTS During the study period, 40 patients initiated triple therapy (32%), 80% with recent or past substance use disorders. Patients initiating treatment were younger than untreated patients (P = 0.002), but otherwise did not differ demographically, or in the severity of their liver fibrosis (P > 0.05). An SVR was achieved in 18 patients (45%) and was less likely in patients with recent or past substance use disorders or psychiatric illness (both P < 0.01). CONCLUSIONS Nearly one third of patients initiated triple therapy with SVR rates comparable to other HCV treatment settings, despite a significant burden of mental illness and substance dependence. Our experience demonstrates that a primary care-based practice can successfully deliver HCV care to a vulnerable population. Additional interventions may be needed to improve outcomes in patients with recent or past substance use disorders or psychiatric illness.
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Edlin BR, Winkelstein ER. Can hepatitis C be eradicated in the United States? Antiviral Res 2014; 110:79-93. [PMID: 25110202 DOI: 10.1016/j.antiviral.2014.07.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 07/18/2014] [Accepted: 07/27/2014] [Indexed: 12/11/2022]
Abstract
The advent of highly effective antiviral regimens will make the eradication of hepatitis C in high-income countries such as the United States technically feasible. But eradicating hepatitis C will require escalating our response to the epidemic in key domains, including surveillance and epidemiology, prevention, screening, care and treatment, policy, research, and advocacy. Surveillance must be nimble enough to quickly assess the magnitude of new transmission patterns as they emerge. Basic prevention strategies - community-based outreach and education, testing and counseling, and access to sterile injection equipment and opioid substitution therapies - must be scaled up and adapted to target groups in which new epidemics are emerging. All adults should be screened for hepatitis C, but special efforts must focus on groups with increased prevalence through community outreach and rapid testing. Government, industry, and payers must work together to assure full access to health services and antiviral drugs for everyone who is infected. Access to the new regimens must not be compromised by excessively high prices or arbitrary payer restrictions. Partnerships must be forged between hepatitis providers and programs that serve people who inject illicit drugs. Healthcare providers and systems, especially primary care practitioners, need education and training in treating hepatitis C and caring for substance-using populations. Services must be provided to the disadvantaged and stigmatized members of society who bear a disproportionate burden of the epidemic. Environments must be created where people who use drugs can receive prevention and treatment services without shame or stigma. Action is needed to end the policy of mass incarceration of people who use drugs, reduce the stigma associated with substance use, support the human rights of people who use drugs, expand social safety net services for the poor and the homeless, remove the legal barriers to hepatitis C prevention, and build public health infrastructure to reach, engage, and serve marginalized populations. Governments must take action to bring about these changes. Public health agencies must work with penal institutions to provide prevention and treatment services, including antiviral therapy, to those in need in jails and prisons or on probation or parole. Research is needed to guide efforts in each of these domains. Strong and sustained political advocacy will be needed to build and sustain support for these measures. Leadership must be provided by physicians, scientists, and the public health community in partnership with community advocates and people living with or at risk for hepatitis C. Eliminating hepatitis C from the United States is possible, but will require a sustained national commitment to reach, test, treat, cure, and prevent every case. With strong political leadership, societal commitment, and community support, hepatitis C can be eradicated in the United States. If this is to happen in our lifetimes, the time for action is now. This article forms part of a symposium in Antiviral Research on "Hepatitis C: next steps toward global eradication."
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Affiliation(s)
- Brian R Edlin
- Weill Cornell Medical College, New York, NY 10065, United States; National Development and Research Institutes, 71 West 23rd St., 4th floor, New York, NY 10010, United States.
| | - Emily R Winkelstein
- National Development and Research Institutes, 71 West 23rd St., 4th floor, New York, NY 10010, United States.
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Mitruka K, Thornton K, Cusick S, Orme C, Moore A, Manch RA, Box T, Carroll C, Holtzman D, Ward JW. Expanding primary care capacity to treat hepatitis C virus infection through an evidence-based care model--Arizona and Utah, 2012-2014. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2014; 63:393-8. [PMID: 24807237 PMCID: PMC5779404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Hepatitis C virus (HCV) infection is the leading reason for liver transplantation and a common cause of hepatocellular carcinoma, the most rapidly increasing cause of cancer-related deaths in the United States. Of the approximately 3 million persons living with HCV infection in the United States, an estimated 38% are linked to care, 11% are treated, and 6% achieve cure. Recent development of highly effective and well-tolerated medications, such as sofosbuvir and simeprevir, to treat chronic HCV infection shows promise in curbing rising HCV-related morbidity and mortality, with the potential to cure >90% of patients. To fully benefit from these new treatments, improvement in linkage to care and treatment is urgently needed.* Lack of provider expertise in HCV treatment and limited access to specialists are well-documented barriers to HCV treatment. In September 2012, CDC funded programs in Utah and Arizona to improve access to primary care providers with the capacity to manage and treat HCV infection. Both programs were modeled on the Extension for Community Healthcare Outcomes (Project ECHO), developed by the University of New Mexico's Health Sciences Center in 2003 to build primary care capacity to treat diseases among rural, underserved populations through videoconferencing and case-based learning in "teleECHO" clinics. To assess the effectiveness of these programs in improving primary care provider capacity and increasing the number of patients initiating treatment, process and patient outcome data for each state program were analyzed. In both states, Project ECHO was successfully implemented, training 66 primary care clinicians, predominantly from rural settings. Nearly all (93%) of the clinicians had no prior experience in care and treatment of HCV infection. In both states combined, 129 (46%) of HCV-infected patients seen in teleECHO clinics received antiviral treatment, more than doubling the proportion of patients expected to receive treatment. These findings demonstrate Project ECHO's ability to expand primary care capacity to treat HCV infection, notably among underserved populations.
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Affiliation(s)
- Kiren Mitruka
- Division of Viral Hepatitis, National Center for National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC,Corresponding author: Kiren Mitruka, , 1-404-639-3488
| | | | | | | | - Ann Moore
- St. Joseph’s Hospital and Medical Center, Phoenix, Arizona
| | | | - Terry Box
- University of Utah School of Medicine
| | | | - Deborah Holtzman
- Division of Viral Hepatitis, National Center for National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC
| | - John W. Ward
- Division of Viral Hepatitis, National Center for National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC
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