Exploring and understanding HCV patient journeys- HEPCARE Europe project

Abstract

Background Hepatitis C Virus (HCV) is a leading cause for chronic liver diseases worldwide. The European Union and World Health Organization aspire to eliminate HCV by 2030. However, among at-risk populations, including, homeless people, prisoners and People Who Inject Drugs, access to diagnosis and treatment is challenging. Hepcare Europe is an integrated model of care developed to address this by assessing potential reasons for these restrictions and determining measures needed to improve HCV diagnosis, treatment and access to care within different communities. Objectives HepCare Europe is an EU-supported project involving collaboration between five institutions in: Ireland, United Kingdom, Spain and Romania. We aim to explore the journey of care experienced by those living with HCV with a focus on previous care disruptions (loss to follow up) and the new HepCare Europe Programme. Methods Research teams conducted semi-structured interviews with patients who accessed services through HepCare Europe thus, patients were recruited by purposeful sampling. Patients interviewed had received, or were in the final weeks of receiving, treatment. The interviews were audio recorded, transcribed and translated into English, and sent to the Dublin team for inductive thematic analysis. Researchers from the HepCare Europe research team coded the data separately, then together. Results Common themes are introduced to present similarities, following individual site themes to highlight the importance of tailored interventions for each country. Key themes are: 1) Hepatitis C patients lost to follow up 2) HepCare improved access to treatment and 3) the need for improved HCV education. Individual themes also emerged for each site. These are: Ireland: New opportunities associated with achieving Sustained Virologic Responses (SVR). Romania: HCV is comparatively less crucial in light of Human Immunodeficiency Viruses (HIV) coinfections. UK: Patients desire support to overcome social barriers and Spain: Improved awareness of HCV, treatment and alcohol use. Conclusion This study identified how the tailored HepCare interventions enabled improved HCV testing and linkage to care outcomes for these patients. Tailored interventions that targeted the needs of patients, increased the acceptability and success of treatment by patients. HepCare demonstrated the need for flexibility in treatment delivery, and provided additional supports to keep patients engaged and educated on new treatment therapies.

Aspects that facilitate access to care for viral hepatitis: An evaluative research

“… 44 Personalization of attention to the users’ problem strengthens monitoring and increases the acceptability of treatment. 45 …”

Hepatitis C virus point-of-care microelimination approach in a vulnerable population in the South of Spain

“…Several barriers that hinder access to treatments in these populations have been described [ 20 , 26 , 27 ]. Social stigma, complex lifestyles, HCV not being a priority, unawareness of available effective antiviral treatments, and the need for multiple appointments and analytical tests to access HCV treatment can make the usual healthcare process difficult.…”

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“…39 We observed a three-fold higher HCV seroprevalence in those currently homeless vs those currently in stable accommodation, confirming that PWAH remains the most vulnerable of people who inject drugs (PWIDS). 40,41 Though studies show that the highest absolute rate of disease in homeless individuals is for hepatitis C, 7,42,43 it is imperative that alcohol use be concurrently addressed. Alcohol acts synergistically with HCV resulting in a more than three-fold higher risk for liver disease progression, 39 maybe by enhancing HCV replication.…”