The experience of re-infection among people who inject drugs successfully treated for hepatitis C

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.

Piloting a Flexible Solicited Diary Study With Marginalized Latina Women During the COVID-19 Pandemic

Little is known about the experiences of minority stress among Latina women who have sex with both women and men (WSWM), a sexual and gender minority group situated at the intersection of multiple marginalized identities. The current article presents an exploratory study aimed at addressing this knowledge gap. The research utilized a flexible diary-interview method (DIM) to investigate stress-related experiences among Mexican American WSWM residing in an economically disadvantaged community in the U.S. during the third wave of the COVID-19 pandemic. A detailed description of the study is provided, including information on the background, methodology, participants' experiences, and how the project was managed remotely by a virtual research team. Twenty-one participants were asked to maintain a diary for a 6-week period spanning from March to September 2021. They submitted weekly entries in diverse formats (visual, audio, typed, and handwritten) through a user-friendly website or via mail while communicating regularly with researchers over the phone. Following the diarizing period, in-depth semi-structured interviews were conducted to clarify pertinent information within the entries and validate researchers' preliminary interpretations. Out of the initial 21 enrollees, 14 participants stopped diarizing at different stages, and nine completed the entire study. Despite facing challenges exacerbated by the pandemic, participants reported the diary-keeping process as a positive experience that offered an authentic outlet to share parts of their lives they seldom reveal. The implementation of this study highlights two significant methodological insights. Firstly, it emphasizes the value of employing a DIM to explore intersectional narratives. Secondly, it underscores the importance of adopting a flexible and sensitive approach in qualitative health research, particularly when engaging individuals from minoritized groups.

Cognitive behavioural therapy in virtual reality treatments across mental health conditions: a systematic review

Background

Virtual reality (VR) has been effectively used in the treatment of many mental health disorders.However, significant gaps exist in the literature. There is no treatment framework for researchers to use when developing new VR treatments. One recommended treatment across a range of diagnoses, which may be suitable for use in VR treatments, is Cognitive Behavioural Therapy (CBT). The aim of this systematic review is to investigateCBT treatment methods that utilize VR to treat mental health disorders.

Objectives

To investigate how CBT has been used in VR to treat mental health disorders and to report onthe treatment characteristics (number of sessions, duration, and frequency) that are linked to effective and ineffective trials.

Methods

Studies were included if patients had a mental health diagnosis and their treatment included immersiveVR technology and CBT principles. Data were extracted in relation to treatment characteristics and outcomes,and analysed using narrative synthesis.

Results

Ninety-three studies were analysed. Exposure-based VR treatments were mainly used to treat anxiety related disorders. Treatments generally consisted of eight sessions, once a week for approximately one hour. VR treatments were commonly equal to or more effective than traditional face-to-face methods. No specific treatment characteristics were linked to this effectiveness.

Conclusion

The number, frequency and duration of the VR treatment sessions identified in this review, could be used as a treatment framework by researchers and clinicians. This could potentially save researchers time and money when developing new interventions.

Story Arcs in Serious Illness: Natural Language Processing features of Palliative Care Conversations

OBJECTIVE

Serious illness conversations are complex clinical narratives that remain poorly understood. Natural Language Processing (NLP) offers new approaches for identifying hidden patterns within the lexicon of stories that may reveal insights about the taxonomy of serious illness conversations.

METHODS

We analyzed verbatim transcripts from 354 consultations involving 231 patients and 45 palliative care clinicians from the Palliative Care Communication Research Initiative. We stratified each conversation into deciles of "narrative time" based on word counts. We used standard NLP analyses to examine the frequency and distribution of words and phrases indicating temporal reference, illness terminology, sentiment and modal verbs (indicating possibility/desirability).

RESULTS

Temporal references shifted steadily from talking about the past to talking about the future over deciles of narrative time. Conversations progressed incrementally from "sadder" to "happier" lexicon; reduction in illness terminology accounted substantially for this pattern. We observed the following sequence in peak frequency over narrative time: symptom terms, treatment terms, prognosis terms and modal verbs indicating possibility.

CONCLUSIONS

NLP methods can identify narrative arcs in serious illness conversations.

PRACTICE IMPLICATIONS

Fully automating NLP methods will allow for efficient, large scale and real time measurement of serious illness conversations for research, education and system re-design.

Understanding Through Use: Elderly's Value Identification in a Service Experience

This paper uses a qualitative approach, specifically; narrative analysis, to contextualize user's formulation of an understanding of a personalized meal planning service within the ambient assisted living domain. By focusing on how user's, in this case elderly over 65, formed an understanding of a service, and, what they thought valuable in using the service, based on their understanding. The results indicate how user's compare their initial understanding to their experienced understanding, formed during usage, and how this affects their value formulation of specific service aspects. The paper gives not only provides valuable insight into contextualizing aspects of health and wellness services, but to aspects of importance for implementation, by showing how value aspects of services from a user perspective are important to consider during these processes.