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Karasz A, Merchant K, Singh R, Thomas A, Borsuk C, McKee D, Duryea P, Kim AY, Mehta S, Norton BL, Page K, Pericot-Valverde I, Sedillo S, Stein ES, Taylor LE, Tsui J, Litwin A. The experience of re-infection among people who inject drugs successfully treated for hepatitis C. J Subst Use Addict Treat 2023; 146:208937. [PMID: 36880897 DOI: 10.1016/j.josat.2022.208937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 08/16/2022] [Accepted: 12/30/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Highly effective direct-acting antiviral (DAA) agents have changed the landscape of hepatitis C virus infection (HCV) treatment and have become more available to people who inject drugs (PWID) over the past several years. Although many achieve a sustained virologic response (SVR), a small proportion will become re-infected. This study examined experiences of re-infection among participants in Project HERO, a large multi-site treatment trial designed to test alternative treatment delivery models for DAAs. METHODS Study staff conducted qualitative interviews with twenty-three HERO participants who experienced reinfection following successful treatment for HCV. Interviews focused on life circumstances and experiences with treatment/re-infection. We conducted a thematic analysis, followed by a narrative analysis. RESULTS Participants described challenging life circumstances. The initial experience of cure was joyful, leading participants to feel that they had escaped a defiled, stigmatized identity. Re-infection was very painful. Feelings of shame were common. Participants with fully developed narratives of re-infection described both a strong emotional response as well as a plan for avoiding re-infection during retreatment. Participants who lack such stories showed signs of hopelessness and apathy. CONCLUSION Though the promise of personal transformation through SVR may be motivating for patients, clinicians should be cautious about how they describe the "cure" when educating patients about HCV treatment. Patients should be encouraged to avoid stigmatizing, dichotomizing language of the self, including terms such as "dirty" and "clean." In acknowledging the benefits of HCV cure, clinicians should emphasize that re-infection does not mean failed treatment; and that current treatment guidelines support retreatment of re-infected PWID.
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Affiliation(s)
| | - Krupa Merchant
- University of South Carolina School of Medicine, Greenville, 607 Grove Rd., Greenville, SC 29605, United States of America
| | - Reena Singh
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY 10461, United States of America
| | - Aurielle Thomas
- University of Rhode Island, 80 Washington Street, Rm. 525, Providence, RI 02903, United States of America
| | - Courtney Borsuk
- Johns Hopkins, 615 N. Wolfe St., E6536, Baltimore, MD 21205, United States of America
| | - Diane McKee
- University of Massachusetts School of Medicine 55 Lake Ave. North Worcester, MA 01655
| | - Patrick Duryea
- University of Rhode Island, Burnett Hall 1220 T St., Lincoln, NE 68588, United States of America
| | - Arthur Y Kim
- Harvard Medical School and Massachusetts General Hospital, 55 Fruit Street Cox 5, Boston, MA 02130, United States of America
| | - Shruti Mehta
- Johns Hopkins, 615 N. Wolfe St., E6546, Baltimore, MD 21205, United States of America
| | - Brianna L Norton
- Albert Einstein College of Medicine, Montefiore Medical Center, 3330 Kossuth Ave., Bronx, NY 10467, United States of America
| | - Kimberly Page
- University of New Mexico, Department of Internal Medicine, Division of Epidemiology, Biostatistics, and Preventive Medicine, MSC10 5550 1 University of New Mexico, Albuquerque, NM 87131, United States of America
| | - Irene Pericot-Valverde
- Clemson University, College of Behavioral, Social, and Health Sciences, 605 Grove Rd., Greenville, SC 29605, United States of America
| | - Sandra Sedillo
- University of New Mexico, MSC10 5550 1 University of New Mexico, Albuquerque, NM 87131, United States of America
| | - Ellen S Stein
- University of California, San Francisco, Mission Hall, 550-16th St., Suite 300, San Francisco, CA 94158, United States of America
| | - Lynn E Taylor
- University of Rhode Island, CODAC Behavioral Health, 80 Washington Street, Rm. 525, Providence, RI 02903, United States of America
| | - Judith Tsui
- University of Washington, Box 359780, 325 9th Ave, Seattle, WA 98104, United States of America
| | - Alain Litwin
- Prisma Health/Clemson University, Department of Medicine, Prisma Health Greenville Memorial Hospital Medical Support Tower, 5th Floor 701 Grove Rd., Greenville, SC 29695, United States of America
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Duryea P, Habchi J, Sprecht-Walsh S, Thomas AM, Bratberg J. A Modifiable Barrier to Hepatitis C Virus Elimination in Rhode Island: The Prior Authorization Process for Direct-Acting Antiviral Agents. R I Med J (2013) 2020; 103:41-44. [PMID: 32481779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Hepatitis C virus (HCV) is disproportionately prevalent among different groups of marginalized populations in Rhode Island (RI). Although direct-acting antiviral (DAA) agents are safe and cure HCV, RI payers limit access to these life-saving medications using prior authorizations (PAs). We assessed RI DAA-specific PA criteria. The authors reviewed payers' websites and/or called payers to obtain, describe, and analyze DAA PA forms, and approval and appeal processes. While some information was consistently required, we observed substantial differences among payers' requirements. All PA forms require at least one piece of data that is clinically superfluous for DAA prescription. These include post-treatment laboratory results, prescriber requirements, documentation of co-treatment of substance use disorders, and repeat diagnostic tests. Post-approval barriers also exist; DAA PAs are time-limited, and DAAs can only be obtained from preferred pharmacies. The PA process requires many steps, differing across RI payers, taking 45-120 minutes per patient. To achieve HCV elimination, DAA PA forms and processes should be standardized, streamlined, and ultimately removed.
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