Subspecialty physicians' perspectives on barriers and facilitators of hepatitis C treatment: a qualitative study.
Hepatitis C
Qualitative research
Substance-related disorders
Journal
Harm reduction journal
ISSN: 1477-7517
Titre abrégé: Harm Reduct J
Pays: England
ID NLM: 101153624
Informations de publication
Date de publication:
25 Jul 2024
25 Jul 2024
Historique:
received:
20
03
2024
accepted:
11
07
2024
medline:
26
7
2024
pubmed:
26
7
2024
entrez:
25
7
2024
Statut:
epublish
Résumé
The hepatitis C virus (HCV) causes chronic and curable disease with a substantial burden of morbidity and mortality across the globe. In the United States (US) and other developed countries, incidence of HCV is increasing and people who inject drugs are disproportionately affected. However, HCV treatment rates amongst patients with substance use disorders (SUD) are suboptimal. In this study, we aimed to understand the perspectives of subspecialist physicians who care for substantial numbers of patients with HCV, including addiction medicine, infectious diseases, and hepatology physicians, to better understand barriers and facilitators of HCV treatment. We recruited subspecialty physicians via purposive and snowball sampling and conducted semi-structured interviews with 20 physicians at 12 institutions across the US. We used a mixed deductive and inductive approach to perform qualitative content analysis with a rapid matrix technique. Three major themes emerged: (1) Perceptions of patient complexity; (2) Systemic barriers to care, and (3) Importance of multidisciplinary teams. Within these themes, we elicited subthemes on the effects of patient-level factors, provider-level factors, and insurance-based requirements. Our results suggest that additional strategies are needed to reach the "last mile" untreated patients for HCV care, including decentralization and leverage of telehealth-based interventions to integrate treatment within primary care clinics, SUD treatment facilities, and community harm reduction sites. Such programs are likely to be more successful when multidisciplinary teams including pharmacists and/or peer navigators are involved. However, burdensome regulatory requirements continue to hinder this expansion in care and should be eliminated.
Identifiants
pubmed: 39054530
doi: 10.1186/s12954-024-01057-z
pii: 10.1186/s12954-024-01057-z
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
140Informations de copyright
© 2024. The Author(s).
Références
Polaris Observatory HCV Collaborators. Global prevalence and genotype distribution of hepatitis C virus infection in 2015: a modelling study. Lancet Gastroenterol Hepatol. 2017;2(3):161–76.
doi: 10.1016/S2468-1253(16)30181-9
Hall EW, Schillie S, Vaughan AS, Jones J, Bradley H, Lopman B, et al. County-Level Variation in Hepatitis C Virus Mortality and trends in the United States, 2005–2017. Hepatology. 2021;74(2):582–90.
doi: 10.1002/hep.31756
pubmed: 33609308
Holtzman D, Asher AK, Schillie S. The Changing Epidemiology of Hepatitis C Virus Infection in the United States during the years 2010 to 2018. Am J Public Health. 2021;111(5):949–55.
doi: 10.2105/AJPH.2020.306149
pubmed: 33734844
pmcid: 8034015
Lee DU, Ponder R, Lee KJ, Yoo A, Fan GH, Jung D, et al. The nationwide trends in hospital admissions, deaths, and costs related to Hepatitis C stratified by psychiatric disorders and substance use: an analysis of US hospitals between 2016 and 2019. Eur J Gastroenterol Hepatol. 2023;35(4):402–19.
doi: 10.1097/MEG.0000000000002498
pubmed: 36728850
Grebely J, Collins AB, Artenie AA, Sutherland R, Meyer JP, Barocas JA, et al. Progress and remaining challenges to address hepatitis C, other infectious diseases, and drug-related harms to improve the health of people who use drugs. Int J Drug Policy. 2021;96:103469.
doi: 10.1016/j.drugpo.2021.103469
pubmed: 34610884
Bhattacharya D, Aronsohn A, Price J, Lo Re V, Hepatitis C. Guidance 2023 Update: AASLD-IDSA recommendations for Testing, Managing, and treating Hepatitis C virus infection. Clin Infect Dis. 2023.
Tandan M, Dunlea S, Bury G, Hepatitis C. Infection and treatment among injecting drug users attending General Practice: a systematic review and Meta-analysis. Int J Environ Res Public Health. 2023;20(8).
World Health Organization. Global health sector strategy on viral hepatitis 2016–2021: Towards ending viral hepatitis. 2016.
Balsom CR, Farrell A, Kelly DV. Barriers and enablers to testing for hepatitis C virus infection in people who inject drugs - a scoping review of the qualitative evidence. BMC Public Health. 2023;23(1):1038.
doi: 10.1186/s12889-023-16017-8
pubmed: 37259073
pmcid: 10234098
Marshall AD, Grebely J, Dore GJ, Treloar C. Barriers and facilitators to engaging in hepatitis C management and DAA therapy among general practitioners and drug and alcohol specialists-the practitioner experience. Drug Alcohol Depend. 2020;206:107705.
doi: 10.1016/j.drugalcdep.2019.107705
pubmed: 31718924
DiDomizio E, Chandra DK, Nichols L, Villanueva M, Altice FL. Challenges to Achieving HCV Micro-elimination in People with HIV in the United States: provider perspectives and the role of Implicit Bias. Health Promot Pract. 2023;24(5):998–1008.
doi: 10.1177/15248399231169928
pubmed: 37440258
Amoako A, Ortiz-Paredes D, Engler K, Lebouché B, Klein MB. Patient and provider perceived barriers and facilitators to direct acting antiviral hepatitis C treatment among priority populations in high income countries: a knowledge synthesis. Int J Drug Policy. 2021;96:103247.
doi: 10.1016/j.drugpo.2021.103247
pubmed: 33853727
McCreight MS, Rabin BA, Glasgow RE, Ayele RA, Leonard CA, Gilmartin HM, et al. Using the practical, robust implementation and sustainability model (PRISM) to qualitatively assess multilevel contextual factors to help plan, implement, evaluate, and disseminate health services programs. Transl Behav Med. 2019;9(6):1002–11.
doi: 10.1093/tbm/ibz085
pubmed: 31170296
Curtis S, Gesler W, Smith G, Washburn S. Approaches to sampling and case selection in qualitative research: examples in the geography of health. Soc Sci Med. 2000;50(7–8):1001–14.
doi: 10.1016/S0277-9536(99)00350-0
pubmed: 10714922
Valerio MA, Rodriguez N, Winkler P, Lopez J, Dennison M, Liang Y, et al. Comparing two sampling methods to engage hard-to-reach communities in research priority setting. BMC Med Res Methodol. 2016;16(1):146.
doi: 10.1186/s12874-016-0242-z
pubmed: 27793191
pmcid: 5084459
Averill JB. Matrix analysis as a complementary analytic strategy in qualitative inquiry. Qual Health Res. 2002;12(6):855–66.
doi: 10.1177/104973230201200611
pubmed: 12109729
Vindrola-Padros C, Johnson GA. Rapid Techniques in Qualitative Research: a critical review of the literature. Qual Health Res. 2020;30(10):1596–604.
doi: 10.1177/1049732320921835
pubmed: 32667277
Nevedal AL, Reardon CM, Opra Widerquist MA, Jackson GL, Cutrona SL, White BS, et al. Rapid versus traditional qualitative analysis using the Consolidated Framework for Implementation Research (CFIR). Implement Sci. 2021;16(1):67.
doi: 10.1186/s13012-021-01111-5
pubmed: 34215286
pmcid: 8252308
Elo S, Kyngäs H. The qualitative content analysis process. J Adv Nurs. 2008;62(1):107–15.
doi: 10.1111/j.1365-2648.2007.04569.x
pubmed: 18352969
Erlingsson C, Brysiewicz P. A hands-on guide to doing content analysis. Afr J Emerg Med. 2017;7(3):93–9.
doi: 10.1016/j.afjem.2017.08.001
pubmed: 30456117
pmcid: 6234169
Oru E, Trickey A, Shirali R, Kanters S, Easterbrook P. Decentralisation, integration, and task-shifting in hepatitis C virus infection testing and treatment: a global systematic review and meta-analysis. Lancet Glob Health. 2021;9(4):e431–45.
doi: 10.1016/S2214-109X(20)30505-2
pubmed: 33639097
pmcid: 7966682
Simoncini GM, Koren DE. Hepatitis C update and expanding the role of primary care. J Am Board Fam Med. 2019;32(3):428–30.
doi: 10.3122/jabfm.2019.03.180286
pubmed: 31068409
Alberts R, Zimmermann A, Martinez A. Improving hepatitis C screening and access to treatment. Jaapa. 2022;35(10):17–21.
doi: 10.1097/01.JAA.0000873784.48761.b2
pubmed: 36165543
Castro R, Perazzo H, de Araujo L, Gutierres IG, Grinsztejn B, Veloso VG. Effectiveness of implementing a decentralized delivery of hepatitis C virus treatment with direct-acting antivirals: a systematic review with meta-analysis. PLoS ONE. 2020;15(2):e0229143.
doi: 10.1371/journal.pone.0229143
pubmed: 32084187
pmcid: 7034833
McCrary LM, Roberts KE, Bowman MC, Castillo B, Darling JM, Dunn C, et al. Inpatient Hepatitis C Treatment Coordination and initiation for patients who inject drugs. J Gen Intern Med. 2023;38(15):3428–33.
doi: 10.1007/s11606-023-08386-y
pubmed: 37653211
Kamis KF, Wyles DL, Minturn MS, Scott T, McEwen D, Hurley H, et al. A retrospective, descriptive study of hepatitis C testing, prevalence, and care continuum among adults on probation. Health Justice. 2022;10(1):26.
doi: 10.1186/s40352-022-00191-9
pubmed: 35947313
pmcid: 9363270
Godin A, Kronfli N, Cox J, Alary M, Maheu-Giroux M. The role of prison-based interventions for hepatitis C virus (HCV) micro-elimination among people who inject drugs in Montréal, Canada. Int J Drug Policy. 2021;88:102738.
doi: 10.1016/j.drugpo.2020.102738
pubmed: 32278651
Kilmer G, Hughes E, Hepatitis B, Hepatitis. C among adults on probation or parole in the United States: 2015–2018. J Health Care Poor Underserved. 2021;32(2):671–9.
doi: 10.1353/hpu.2021.0096
pubmed: 34120968
pmcid: 10886909
Morris MD, McDonell C, Luetkemeyer AF, Thawley R, McKinney J, Price JC. Community-based point-of-diagnosis Hepatitis C treatment for marginalized populations: a Nonrandomized Controlled Trial. JAMA Netw Open. 2023;6(10):e2338792.
doi: 10.1001/jamanetworkopen.2023.38792
pubmed: 37862013
pmcid: 10589813
Akiyama MJ, Norton BL, Arnsten JH, Agyemang L, Heo M, Litwin AH. Intensive Models of Hepatitis C Care for people who inject drugs receiving opioid agonist therapy: a Randomized Controlled Trial. Ann Intern Med. 2019;170(9):594–603.
doi: 10.7326/M18-1715
pubmed: 30959528
pmcid: 6868527
Rowan SE, Kamis KF, Beum R, Bryan K, Gawenus L, Colon Sanchez D, et al. Viral Hepatitis and Human Immunodeficiency Virus Testing and linkage to care for individuals enrolled in an opioid treatment program. J Infect Dis. 2020;222(Suppl 5):S384–91.
doi: 10.1093/infdis/jiz694
pubmed: 32877565
Litwin AH, Lum PJ, Taylor LE, Mehta SH, Tsui JI, Feinberg J, et al. Patient-centred models of hepatitis C treatment for people who inject drugs: a multicentre, pragmatic randomised trial. Lancet Gastroenterol Hepatol. 2022;7(12):1112–27.
doi: 10.1016/S2468-1253(22)00275-8
pubmed: 36370741
Springer SA, Del Rio C. Co-located opioid Use Disorder and Hepatitis C Virus treatment is not only right, but it is also the Smart Thing to do as it improves outcomes! Clin Infect Dis. 2020;71(7):1723–5.
doi: 10.1093/cid/ciaa111
pubmed: 32011653
pmcid: 7583407
Platt L, Minozzi S, Reed J, Vickerman P, Hagan H, French C, et al. Needle syringe programmes and opioid substitution therapy for preventing hepatitis C transmission in people who inject drugs. Cochrane Database Syst Rev. 2017;9(9):Cd012021.
pubmed: 28922449
Rosenthal ES, Silk R, Mathur P, Gross C, Eyasu R, Nussdorf L, et al. Concurrent Initiation of Hepatitis C and Opioid Use Disorder treatment in people who inject drugs. Clin Infect Dis. 2020;71(7):1715–22.
doi: 10.1093/cid/ciaa105
pubmed: 32009165
pmcid: 7755091
Choi S, Healy S, Shapoval L, Forthal S, Neighbors CJ. Hepatitis C Virus Screening among Medicaid-Insured individuals with opioid Use Disorder across Substance Use Disorder Treatment settings. Subst Use Misuse. 2021;56(2):258–63.
doi: 10.1080/10826084.2020.1858106
pubmed: 33345680
Doshi RK, Ruben M, Drezner K, Lachmann A, Kuo I, Chanes-Mora P, et al. Knowledge, attitudes, and behaviors related to Hepatitis C Screening and Treatment among Health Care Providers in Washington, DC. J Community Health. 2020;45(4):785–94.
doi: 10.1007/s10900-020-00794-z
pubmed: 32125591
Terrault NA, Slepin J, Kanner R, Gailloux K, Catalli L, McKinney J, et al. Strategies to increase primary care provider capacity for hepatitis C care: the California ECHO-PLUS study. J Viral Hepat. 2023;30(5):397–405.
doi: 10.1111/jvh.13807
pubmed: 36696286
Talal AH, Markatou M, Liu A, Perumalswami PV, Dinani AM, Tobin JN, et al. Integrated Hepatitis C-Opioid Use Disorder Care through facilitated telemedicine: a Randomized Trial. JAMA. 2024;331(16):1369–78.
doi: 10.1001/jama.2024.2452
pubmed: 38568601
Cunningham EB, Wheeler A, Hajarizadeh B, French CE, Roche R, Marshall AD, et al. Interventions to enhance testing and linkage to treatment for hepatitis C infection for people who inject drugs: a systematic review and meta-analysis. Int J Drug Policy. 2023;111:103917.
doi: 10.1016/j.drugpo.2022.103917
pubmed: 36542883
Marcus JL, Hurley LB, Chamberland S, Champsi JH, Gittleman LC, Korn DG, et al. Disparities in initiation of Direct-Acting Antiviral agents for Hepatitis C virus infection in an Insured Population. Public Health Rep. 2018;133(4):452–60.
doi: 10.1177/0033354918772059
pubmed: 29750893
pmcid: 6055302
Goutzamanis S, Horyniak D, Doyle JS, Hellard M, Higgs P. Perceived physical health outcomes of direct-acting antiviral treatment for hepatitis C: a qualitative study. Harm Reduct J. 2021;18(1):73.
doi: 10.1186/s12954-021-00516-1
pubmed: 34266434
pmcid: 8281623
National Viral Hepatitis Roundtable, Center for health law and policy innovation. Harvard law school. Hepatitis C: The state of medicaid access 2017 National Summary Report. 2017.
National Viral Hepatitis Roundtable, Center for health law and policy innovation. Harvard law school. 2024 National Snapshot Report. 2024.