Barriers and facilitators to hepatitis C screening and treatment for people with lived experience of homelessness: A mixed-methods systematic review.
adult
delivery of health care
hepatitis C
homeless persons
humans
Journal
Health expectations : an international journal of public participation in health care and health policy
ISSN: 1369-7625
Titre abrégé: Health Expect
Pays: England
ID NLM: 9815926
Informations de publication
Date de publication:
02 2022
02 2022
Historique:
revised:
28
10
2021
received:
12
05
2021
accepted:
07
11
2021
pubmed:
5
12
2021
medline:
15
3
2022
entrez:
4
12
2021
Statut:
ppublish
Résumé
People experiencing homelessness have an increased risk of hepatitis C virus (HCV) infection, with rates higher than the general population. However, their access to HCV diagnosis is limited and treatment uptake is low. To identify and describe the barriers and facilitators for HCV screening and treatment for adults with lived experience of homelessness in highly developed countries. Bibliographic databases (Embase, MEDLINE, CINAHL and SocINDEX) and grey literature (Google, EThOS, the Health Foundation, Social Care Online, the World Health Organisation, Shelter, Crisis and Pathway) were searched. Two reviewers independently screened and appraised all studies. The Critical Appraisal Skills Programme tool and the Joanna Briggs Institute checklist were used. The analysis involved a three-stage process: coding, theme generation and theme mapping under Penchansky and Thomas's modified access model. Twelve papers/reports were included in the review. Several interacting factors influence access of people with lived experience of homelessness to HCV testing and treatment. Some mirror those identified for the general population. The precarious conditions associated with the lived experience of homelessness along with the rigidity of hospital settings and lack of awareness emerged as dominant barriers. Flexibility, outreach, effective communication, tailoring and integration of services were found to be important facilitators. Evidence from Black, Asian and minority ethnic groups is limited. People experiencing homelessness face multiple barriers in accessing and completing HCV treatment, relating to both their lived experience and characteristics of health systems. Although some barriers are readily amenable to change, others are more difficult to modify. The facilitators identified could inform future targeted measures to improve HCV diagnosis and treatment for people experiencing homelessness. Research is warranted into successful models to promote screening, diagnosis and treatment. Our team includes a peer advocate, a hepatology nurse and a community volunteer, all with significant experience in promoting and engaging in HCV care and outreach for people experiencing homelessness. They contributed to the protocol, interpretation and reporting of the review findings.
Sections du résumé
BACKGROUND
People experiencing homelessness have an increased risk of hepatitis C virus (HCV) infection, with rates higher than the general population. However, their access to HCV diagnosis is limited and treatment uptake is low.
OBJECTIVES
To identify and describe the barriers and facilitators for HCV screening and treatment for adults with lived experience of homelessness in highly developed countries.
METHODS
Bibliographic databases (Embase, MEDLINE, CINAHL and SocINDEX) and grey literature (Google, EThOS, the Health Foundation, Social Care Online, the World Health Organisation, Shelter, Crisis and Pathway) were searched. Two reviewers independently screened and appraised all studies. The Critical Appraisal Skills Programme tool and the Joanna Briggs Institute checklist were used. The analysis involved a three-stage process: coding, theme generation and theme mapping under Penchansky and Thomas's modified access model.
RESULTS
Twelve papers/reports were included in the review. Several interacting factors influence access of people with lived experience of homelessness to HCV testing and treatment. Some mirror those identified for the general population. The precarious conditions associated with the lived experience of homelessness along with the rigidity of hospital settings and lack of awareness emerged as dominant barriers. Flexibility, outreach, effective communication, tailoring and integration of services were found to be important facilitators. Evidence from Black, Asian and minority ethnic groups is limited.
CONCLUSIONS
People experiencing homelessness face multiple barriers in accessing and completing HCV treatment, relating to both their lived experience and characteristics of health systems. Although some barriers are readily amenable to change, others are more difficult to modify. The facilitators identified could inform future targeted measures to improve HCV diagnosis and treatment for people experiencing homelessness. Research is warranted into successful models to promote screening, diagnosis and treatment.
PATIENT OR PUBLIC CONTRIBUTION
Our team includes a peer advocate, a hepatology nurse and a community volunteer, all with significant experience in promoting and engaging in HCV care and outreach for people experiencing homelessness. They contributed to the protocol, interpretation and reporting of the review findings.
Identifiants
pubmed: 34862710
doi: 10.1111/hex.13400
pmc: PMC8849376
doi:
Types de publication
Journal Article
Review
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
48-60Informations de copyright
© 2021 The Authors. Health Expectations published by John Wiley & Sons Ltd.
Références
Harm Reduct J. 2017 Nov 28;14(1):76
pubmed: 29179765
Med Teach. 2020 Aug;42(8):846-854
pubmed: 32356468
Health Expect. 2022 Feb;25(1):48-60
pubmed: 34862710
Int J Evid Based Healthc. 2015 Sep;13(3):121-31
pubmed: 26196082
Int J Drug Policy. 2019 Oct;72:129-137
pubmed: 30962036
AIDS. 2005 Oct;19 Suppl 3:S208-14
pubmed: 16251820
J Health Serv Res Policy. 2005 Jan;10(1):45-53
pubmed: 15667704
Hepatology. 2019 Aug;70(2):476-486
pubmed: 30633811
Sex Transm Dis. 2018 Jul;45(7):494-504
pubmed: 29465661
Public Health Rep. 2018 Jul/Aug;133(4):452-460
pubmed: 29750893
Lancet. 2019 Oct 19;394(10207):1451-1466
pubmed: 31631857
BMC Infect Dis. 2020 May 29;20(1):386
pubmed: 32471376
Med Care. 1981 Feb;19(2):127-40
pubmed: 7206846
Int J Equity Health. 2013 Mar 11;12:18
pubmed: 23496984
Int J Drug Policy. 2008 Dec;19(6):429-35
pubmed: 17962008
J Racial Ethn Health Disparities. 2018 Oct;5(5):1052-1058
pubmed: 29288470
J Gen Intern Med. 2002 Feb;17(2):134-43
pubmed: 11841529
Thorax. 2018 Jun;73(6):557-564
pubmed: 29378859
BMC Infect Dis. 2019 Feb 7;19(1):128
pubmed: 30732573
Soc Sci Med. 2001 Nov;53(9):1149-62
pubmed: 11556606
J Health Serv Res Policy. 2016 Jan;21(1):36-9
pubmed: 26377728
BMC Med Res Methodol. 2012 Nov 27;12:181
pubmed: 23185978
Harm Reduct J. 2018 Dec 11;15(1):62
pubmed: 30538000
Int J Drug Policy. 2017 Sep;47:137-143
pubmed: 28347636
Lancet Public Health. 2021 May;6(5):e309-e323
pubmed: 33780656
J Health Care Poor Underserved. 2014 May;25(2):652-62
pubmed: 24858874
J Viral Hepat. 2020 Feb;27(2):205-220
pubmed: 31638294
Res Sch. 2006 Spring;13(1):29
pubmed: 20098638
BMC Med Res Methodol. 2008 Jul 10;8:45
pubmed: 18616818
Hepatol Commun. 2020 Mar 03;4(5):646-656
pubmed: 32363316
J Health Care Poor Underserved. 2017;28(1):596-606
pubmed: 28239021
Int J Drug Policy. 2019 Oct;72:146-159
pubmed: 31147142
Can Commun Dis Rep. 2018 Jul 05;44(7-8):166-172
pubmed: 31011297
BMC Med. 2019 Apr 1;17(1):71
pubmed: 30929642
Public Health Rep. 2017 Mar/Apr;132(2):136-139
pubmed: 28135425
Lancet Infect Dis. 2012 Nov;12(11):859-70
pubmed: 22914343
BMJ. 2009 Jul 21;339:b2535
pubmed: 19622551
Nat Rev Gastroenterol Hepatol. 2013 Sep;10(9):553-62
pubmed: 23817321
Syst Rev. 2016 Dec 5;5(1):210
pubmed: 27919275
Int J Drug Policy. 2019 Oct;72:138-145
pubmed: 30995968
Lancet. 2008 Nov 8;372(9650):1661-9
pubmed: 18994664
Br J Gen Pract. 2019 Aug;69(685):e537-e545
pubmed: 30745354
Syst Rev. 2018 Apr 18;7(1):61
pubmed: 29669583
J Health Serv Res Policy. 2005 Jul;10 Suppl 1:6-20
pubmed: 16053580
BMC Public Health. 2016 Sep 20;16:994
pubmed: 27645935
Drug Alcohol Depend. 2013 Oct 1;132(3):457-65
pubmed: 23578590
Lancet. 2018 Jan 20;391(10117):241-250
pubmed: 29137869