Hepatitis C virus treatment decision-making in the context of HIV co-infection: The role of medical, behavioral and mental health factors in assessing treatment readiness

RAND Corporation, Santa Monica, CA 90407, USA.
AIDS (Impact Factor: 5.55). 11/2005; 19 Suppl 3(Suppl 3):S190-8. DOI: 10.1097/01.aids.0000192089.54130.b6
Source: PubMed


Hepatitis C virus (HCV)-related liver disease is among the leading causes of mortality among HIV patients, yet very few co-infected patients receive pegylated-interferon and ribavirin combination therapy, the standard of care for chronic HCV. Whereas factors related to the provider, patient and clinic setting all contribute to HCV treatment decision-making, the decision of the provider to recommend or defer treatment is perhaps the most critical determinant of whether a patient receives treatment. This paper reviews the literature related to the medical, behavioral and mental health variables that contribute to providers' assessment of treatment readiness, and associations with treatment response, adherence and retention. A greater understanding of the multilevel factors contributing to HCV treatment decision-making, as well as patient characteristics that predict treatment outcome and adherence, can inform the development of interventions aimed at improving HCV care for HIV patients.

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    • "Treatment could be deferred or delayed if the patient exhibited contraindications such as: decompensated liver disease, medical comorbidities which required medical attention (e.g. cardiovascular disease, diabetes, epilepsy, uncontrolled depression), non-adherence to medical visits, or active drug use [13]–[18]. "
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    ABSTRACT: Hepatitis C virus infection (HCV) has a significant global health burden with an estimated 2%-3% of the world's population infected, and more than 350,000 dying annually from HCV-related conditions including liver failure and liver cancer. Prisons potentially offer a relatively stable environment in which to commence treatment as they usually provide good access to health care providers, and are organised around routine and structure. Uptake of treatment of HCV, however, remains low in the community and in prisons. In this study, we explored factors affecting treatment uptake inside prisons and hypothesised that prisoners have unique issues influencing HCV treatment uptake as a consequence of their incarceration which are not experienced in other populations. We undertook a qualitative study exploring prisoners' accounts of why they refused, deferred, delayed or discontinued HCV treatment in prison. Between 2010 and 2013, 116 Australian inmates were interviewed from prisons in New South Wales, Queensland, and Western Australia. Prisoners experienced many factors similar to those which influence treatment uptake of those living with HCV infection in the community. Incarceration, however, provides different circumstances of how these factors are experienced which need to be better understood if the number of prisoners receiving treatment is to be increased. We developed a descriptive model of patient readiness and motivators for HCV treatment inside prisons and discussed how we can improve treatment uptake among prisoners. This study identified a broad and unique range of challenges to treatment of HCV in prison. Some of these are likely to be diminished by improving treatment options and improved models of health care delivery. Other barriers relate to inmate understanding of their illness and stigmatisation by other inmates and custodial staff and generally appear less amenable to change although there is potential for peer-based education to address lack of knowledge and stigma.
    PLoS ONE 02/2014; 9(2):e87564. DOI:10.1371/journal.pone.0087564 · 3.23 Impact Factor
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    • "Coinfected patients' lack of understanding of HCV and misinformation about the effectiveness of IRT have been identified as significant obstacles to motivating them to undergo a liver biopsy to assess disease severity and the need for treatment (Bova et al., 2010; Grebely et al., 2008; Mehta et al, 2008). The recommendation made is to utilize peers to educate patients about both the disease and its treatment (Dore & Thomas, 2005; Wagner & Ryan, 2005). Our findings offer two insights regarding this recommendation . "
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    ABSTRACT: Despite the high prevalence of hepatitis C virus (HCV) infection among injection drug users also infected with human immunodeficiency virus (HIV), and the synergistic adverse effect of the two diseases on patients' health and survival, research on the clinical management of these patients and particularly the low uptake of HCV therapy is limited. We conducted qualitative interviews with 17 HIV providers from two urban public hospitals. We discovered that the limitations of the current state of medical knowledge, the severe side effects of HIV and HCV therapies, and the psychosocial vulnerability of HIV/HCV-coinfected patients combined with their resistance to becoming informed about HCV posed significant challenges for providers. To contend with these challenges, providers incorporated key dimensions of patient-centered medicine in their practice, such as considering their patients' psychosocial profiles and the meaning patients assign to being coinfected, and finding ways to engage their patients in a therapeutic alliance.
    Qualitative Health Research 08/2011; 22(1):54-66. DOI:10.1177/1049732311418248 · 2.19 Impact Factor
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    ABSTRACT: Hepatitis C virus (HCV) infection affects between 150,000 to 300,000 human immunodeficiency (HIV) positive adults in the US (Alter et al., 1999; Sherman, Rouster, Chung, & Rajicic, 2002). The majority of co-infected adults (50%-90%) have acquired HCV through substance abuse (Centers for Disease Control [CDC], 1998; CDC, 2006b). A patient's decision to begin HCV treatment is not straightforward. HCV evaluation and treatment involves a significant amount of time, energy, effort, and compliance on the part of the patient. There is limited information on how adults with HCV mono-infection make decisions about HCV evaluation and treatment (Fraenkel, McGraw, Wongcharatraee, & Garcia-Tsao, 2005). Even less is known about how adults with HIV/HCV co-infection with a history of substance abuse make treatment decisions. The purpose of this study was to describe substance abuse experiences and to explore how these related to patient decision-making about HCV treatment in HIV/HCV co-infected adults. Qualitative descriptive design and secondary data analysis were used to study these phenomena. Data were managed by using NVivo software and analyzed by secondary data analysis and qualitative content analysis. Five major themes with sub-themes emerged during the data analysis. They were: (1) The Evolution of Substance Abuse (with sub-themes: substance abuse initiation, escalation, polysubstance abuse, normalcy: a family of addicts, the enemy within, and transmission and disclosure), (2) Revolving Door: Going Back Out (with sub-themes: specific events as a trigger, emotions as a trigger, alcohol as a trigger, and destructive relationships as a trigger), and (3) Reconstructing Life (with sub-themes: defining moments in substance abuse addiction and maintaining sobriety), (4) HCV Infection Treatment Issues (with sub-themes: HCV treatment: not a priority, fear, and misinformation, and desire to use stimulated during HCV treatment), and (5) Get Clean and Try It. The participants spoke about how their substance abuse evolved from inception to sobriety, and for some it remained a problem. Relapse and recovery were fragile in nature especially in these adults with HIV/HCV co-infection. The decision-making process is influenced by substance abuse experiences, however more research is needed to uncover specific factors influencing these decisions.
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