Conceptualising access in the direct-acting antiviral era: An integrated framework to inform research and practice in HCV care for people who inject drugs

Høj, Stine Bordier; Jacka, Brendan; Minoyan, Nanor; Artenie, Andreea Adelina; Bruneau, Julie

doi:10.1016/j.drugpo.2019.04.001

Cited by 38 publications

(37 citation statements)

References 186 publications

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“…Finally, health care service disruptions and reorganizations, including longer-term shifts towards telehealth, may disproportionally threaten the overall health of PWUD by setting back efforts to screen for, treat and eliminate hepatitis C virus in this population [ 43 , 44 ], in addition to diagnosing and treating prevalent comorbidities such as mental health disorders, HIV, and other chronic diseases. As was true prior to the pandemic, services should be available in low-threshold settings to counter the marginalization of PWUD, and barriers such as stigmatizing language should be minimized within mainstream services to prevent disengagement from tertiary care [ 45 ].…”

Section: Discussionmentioning

confidence: 99%

Self-reported impacts of the COVID-19 pandemic among people who use drugs: a rapid assessment study in Montreal, Canada

et al. 2022

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Background People who use drugs (PWUD) are at high risk of experiencing indirect harms of measures implemented to curb the spread of COVID-19, given high reliance on services and social networks. This study aimed to document short-term changes in behaviours and health-related indicators among PWUD in Montreal, Canada following declaration of a provincial health emergency in Quebec. Methods We administered a structured rapid assessment questionnaire to members of an existing cohort of PWUD and individuals reporting past-year illicit drug use recruited via community services. Telephone and in-person interviews were conducted in May–June and September–December 2020. Participants were asked to report on events and changes since the start of the health emergency (March 13, 2020). Descriptive analyses were performed. Results A total of 227 participants were included (77% male, median age = 46, 81% Caucasian). 83% and 41% reported past six-month illicit drug use and injection drug use, respectively. 70% of unstably housed participants reported increased difficulty finding shelter since the start of the health emergency. 48% of opioid agonist treatment recipients had discussed strategies to avoid treatment disruptions with providers; 22% had missed at least one dose. Many participants perceived increased difficulty accessing non-addiction health care services. Adverse changes were also noted in indicators pertaining to income, drug markets, drug use frequency, and exposure to violence; however, many participants reported no changes in these areas. Among persons reporting past six-month injection drug use, 79% tried to access needle-syringe programmes during the health emergency; 93% of those obtained services. 45% tried to access supervised injection sites, of whom 71% gained entry. Conclusions This snapshot suggests mixed impacts of the COVID-19 pandemic on PWUD in Montreal in the months following declaration of a provincial health emergency. There were signals of increased exposure to high-risk environments as well as deteriorations in access to health services. Pandemic-related measures may have lasting impacts among vulnerable subgroups; continued monitoring is warranted.

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Section: Discussionmentioning

confidence: 99%

Self-reported impacts of the COVID-19 pandemic among people who use drugs: a rapid assessment study in Montreal, Canada

et al. 2022

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“…Consistent with the integrated theoretical framework of health service utilisation proposed by Høj et al . [29], our findings highlight that access to HCV treatment is negotiated and subject to competing perceptions of candidacy among staff, clients and health service services [29,30]. Global HCV elimination targets and pressures on local health districts to achieve them in set time frames have seen service providers' perceptions of PWID as candidates for DAA treatment shift from suspect (in the time of interferon) to ideal.…”

Section: Discussionmentioning

confidence: 96%

“…Arguably, the factor with the most profound impact on HCV treatment uptake by PWID is what Høj et al . [29] refer to as the recursive nature of candidacy, where negative past experiences with services shape future perceptions of, and engagement with, health care. While it is easy to target OAT service providers as the reason for client distrust and scepticism about HCV treatment, and at times this may be entirely warranted, even the best‐intentioned and non‐judgmental staff member could be deemed unworthy of trust in the face of a client's profound expectations of stigma and discrimination.…”

Section: Discussionmentioning

confidence: 99%

Client resistance to hepatitis C treatment initiation in opioid agonist treatment clinics in Sydney, Australia: A qualitative study

Coupland

Day

Haber

et al. 2021

Drug and Alcohol Review

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Introduction. Opioid agonist treatment (OAT) clinics play a key role in achieving elimination of hepatitis C virus (HCV) globally. Previous research has identified barriers to HCV treatment uptake in OAT clinics; however, most studies were conducted prior to the introduction of direct-acting antiviral treatments (DAA). It remains unclear whether progress has been made in responding to barriers and what challenges persist in this setting. Methods. Semi-structured in-depth interviews were conducted with staff (n = 20) and clients (n = 15) in two OAT clinics in Sydney, Australia. Interviews were transcribed verbatim and analysed using constant comparative methods. Results. Despite progress in integrating hepatitis C care in the clinics, competing priorities, concerns about side-effects, distrust of staff, health problems and difficulties accessing testing and medication persisted as key reasons why clients had not initiated treatment. Most clients preferred to postpone treatment and focus on other priorities and some highlighted lack of medical evidence for urgent treatment. Pressure on services to achieve elimination targets within set time frames was a primary driver of repeated offers of treatment by staff and the framing of clients' preferences for postponing treatment, as a barrier. Discussion and Conclusion. Current timelines for HCV elimination targets may have galvanised services into action but may have also created tensions at the coalface due to disparities between staff and clients' priorities. The involvement of peer workers and mechanisms to ensure continued follow up with clients about DAA treatments is required. Public health timelines for HCV elimination need to be informed by affected communities' priorities.

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“…Peers, people with prior experience with HCV treatment and/or substance use, may be an additional source of patient support, especially in areas where peer services are supported through state Medicaid programs [ 53 ]. However, at this time, results related to the success of peer support programs for HCV care are mixed [ 11 , 31 , 54 ].…”

Section: Discussionmentioning

confidence: 99%

“…Infections with HCV have risen rapidly in this region, particularly among young people [ 2 ], driven by the opioid epidemic and injection drug use [ 3 ]. People who use drugs and those living in rural regions face significant barriers to HCV treatment and limited access to services [ 4–9 ], including in Southwest Virginia [ 10 ], which has resulted in very low HCV treatment uptake among rural Appalachian people who inject drugs (PWID) [ 11 , 12 ].…”

mentioning

confidence: 99%

Development of an Interdisciplinary Telehealth Model of Provider Training and Comprehensive Care for Hepatitis C and Opioid Use Disorder in a High-Burden Region

Sherbuk

Knick

Canan

et al. 2020

The Journal of Infectious Diseases

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Background Hepatitis C virus (HCV) and the opioid epidemic disproportionately affect the Appalachian region. Geographic and financial barriers prevent access to specialty care. Interventions are needed to address the HCV-opioid syndemic in this region. Methods We developed an innovative, collaborative telehealth model in Southwest Virginia featuring bidirectional referrals from and to comprehensive harm reduction (CHR) programs and office-based opioid therapy (OBOT), as well as workforce development through local provider training in HCV management. We aimed to (1) describe the implementation process of provider training and (2) assess the effectiveness of the telehealth model by monitoring patient outcomes in the first year. Results The provider training model moved from a graduated autonomy model with direct specialist supervision to a 1-day workshop with parallel tracks for providers and support staff followed by monthly case conferences. Forty-four providers and support staff attended training. Eight providers have begun treating independently. For the telehealth component, 123 people were referred, with 62% referred from partner OBOT or CHR sites; 103 (84%) attended a visit, 93 (76%) completed the treatment course, and 61 (50%) have achieved sustained virologic response. Rates of sustained virologic response did not differ by receipt of treatment for opioid use disorder. Conclusions Providers demonstrated a preference for an in-person training workshop, though further investigation is needed to determine why only a minority of those trained have begun treating HCV independently. The interdisciplinary nature of this program led to efficient treatment of hepatitis C in a real-world population with a majority of patients referred from OBOTs and CHR programs.

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Conceptualising access in the direct-acting antiviral era: An integrated framework to inform research and practice in HCV care for people who inject drugs

Cited by 38 publications

References 186 publications

Self-reported impacts of the COVID-19 pandemic among people who use drugs: a rapid assessment study in Montreal, Canada

Self-reported impacts of the COVID-19 pandemic among people who use drugs: a rapid assessment study in Montreal, Canada

Client resistance to hepatitis C treatment initiation in opioid agonist treatment clinics in Sydney, Australia: A qualitative study

Development of an Interdisciplinary Telehealth Model of Provider Training and Comprehensive Care for Hepatitis C and Opioid Use Disorder in a High-Burden Region

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