Exploring patient characteristics and barriers to Hepatitis C treatment in patients on opioid substitution treatment attending a community based fibro-scanning clinic

Crowley, Des; Cullen, William R.; Laird, Éamon; Lambert, John S.; Hugh, Tina Mc; Murphy, Catherine; Hout, Marie Claire Van

doi:10.1515/jtim-2017-0017

Cited by 23 publications

(30 citation statements)

References 62 publications

(99 reference statements)

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“…20 Liver biopsy, which is an invasive method with pain as the most common complication, has been previously used to assess the stage of liver fibrosis, and fear of such procedure has been identified as one of the patient-identified barriers to HCV care. 21 among PWID with opioid dependency has been shown when combining antiviral therapy with opioid substitution therapy and needle and syringe exchange programs (ie treatment as prevention). 8,28 The strength of the study is the nationwide coverage with large One drawback of this study is the lack of data for visits to primary care.…”

Section: Discussionmentioning

confidence: 99%

“…The reason for the high rate of patients LTFU after HCV diagnosis could be multifactorial.The most common route of transmission of HCV is intravenous drug use in the Western world, with frequent drug dependency or psychiatric co-morbidity in this population 20. A chaotic social situation with high unemployment, homelessness, criminalization, or fear of stigma may affect the compliance to subsequent clinical visits 21. So far, most studies, including ours, have investigated patients LTFU during the IFN era, before the introduction of modern DAA therapies.…”

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confidence: 99%

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Frequent loss to follow‐up after diagnosis of hepatitis C virus infection: A barrier towards the elimination of hepatitis C virus

Aleman

Söderholm

Büsch

et al. 2020

Liver International

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Frequent loss to follow‐up after diagnosis of hepatitis C virus infection: A barrier towards the elimination of hepatitis C virus

Aleman

Söderholm

Büsch

et al. 2020

Liver International

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“…However, while studies have shown that community‐based interventions result in an increase in HCV treatment, overall treatment uptake remains low . This could be partly related to lack of co‐location of HCV screening and treatment, inflexible clinic timings and not involving peer mentors . ITTREAT provided an integrated test and treat service with ‘drop in clinics’ where PWID engaged with the same nurse.…”

Section: Discussionmentioning

confidence: 99%

Improving access to care for people who inject drugs: Qualitative evaluation of project ITTREAT—An integrated community hepatitis C service

Phillips

Schulkind

O’Sullivan

et al. 2019

Journal of Viral Hepatitis

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Achieving hepatitis C virus (HCV) elimination by 2030 requires an increased linkage to care for people who inject drugs (PWID). Project ITTREAT was established to mitigate barriers to HCV care by providing an integrated service within a local drug and alcohol treatment centre. This study aimed to explore the experiences of clients and staff involved in Project ITTREAT and assess the facilitators and barriers to a community-based HCV service. Between October 2014 and April 2016, drug and alcohol treatment attendees were interviewed using one-to-one semi-structured interviews.Drug and alcohol treatment staff took part in focus groups. All data were recorded, transcribed verbatim and analysed using thematic content analysis. Fifteen drug and alcohol treatment attendees with current/previous HCV infection were interviewed, and 15 staff members contributed across two focus groups. Drug and alcohol treatment staff and attendees reported that Project ITTREAT facilitated access to HCV care by mitigating previous negative hospital-based experiences. Other key facilitators were positive narratives around HCV care, and drug and alcohol treatment attendees being well engaged in their drug/alcohol recovery. Barriers included a lack of stability in drug and alcohol treatment attendees, negative discourse around testing/ treatment and stigma associated with attending the drug and alcohol treatment to access HCV treatment in some who had successfully achieved drug rehabilitation.Our findings indicate the positive impact of an integrated and personalized community-based service delivered by a dedicated hepatitis nurse. This played a crucial role in reducing barriers to HCV care for PWID. Our work also highlights areas for future investment including non-DAT-based community services and increasing awareness of new treatments amongst this cohort. K E Y W O R D S barriers, community HCV service, facilitators, hepatitis C virus, staff/client experience, substance misuse | 177 PHILLIPS et aL.

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“…Those with advanced fibrosis are in need of immediate treatment for HCV to prevent further disease progression and also need to be included in hepatocellular carcinoma (HCC) screening programmes. Assessment with LSM has been well received in PWID, and is reasonably effective in identifying advanced fibrosis [23,24]. A need for reliable diagnosis of advanced Figure 2.…”

Section: Discussionmentioning

confidence: 99%

Hepatitis C virus (HCV) related liver fibrosis in people who inject drugs (PWID) at the Stockholm Needle Exchange – evaluated with liver elasticity

Kåberg

Edgren

Hammarberg

et al. 2019

Scandinavian Journal of Gastroenterology

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Background and aims: Sharing of unsterile injection equipment among people who inject drugs (PWID) is the major transmission-route for hepatitis C (HCV). HCV is highly prevalent in PWID in the Stockholm needle exchange programme (NEP). The frequency of advanced liver fibrosis among the participants is, however, unknown. Methods: From December 2016 to April 2018, all participants with chronic hepatitis C infection (CHC) were offered liver fibrosis evaluation at the Stockholm NEP, including liver stiffness measurement (LSM), a medical history and expanded blood tests to evaluate APRI and FIB-4 scores. Results: A total of 2037 individuals were enrolled of whom 964 (47.3%) had CHC. LSM was performed in 203 (21.1%) of eligible participants of whom 85% had mild fibrosis (LSM 9.4 kPa) and 15% advanced fibrosis (LSM 9.5 kPa). APRI >1 and FIB-4 > 3.25 only identified 30% of participants with advanced fibrosis. However, all 31(100%) participants with advanced fibrosis were detected when APRI >1 was combined with an age of 40 years and an injection drug use (IDU) duration of 15 years. Conclusions: We found that the diagnostic work-up for advanced fibrosis can be simplified with this combination of easily available factors. This allows identification of PWID in need of immediate HCV treatment to prevent further disease progression. Furthermore, LSM can be avoided among PWID with mild fibrosis, identified by age <40 years combined with IDU duration of <15 years and APRI score <1. This strategy enhances the HCV care cascade where LSM is not easily available, and will thus facilitate HCV treatment initiation.

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Exploring patient characteristics and barriers to Hepatitis C treatment in patients on opioid substitution treatment attending a community based fibro-scanning clinic

Abstract: The study highlights the usefulness of community fibroscanning. Identifying barriers to treatment in this cohort affords an opportunity to increase the treatment uptake. The availability of afternoon clinics and enhanced prison linkage are warranted.

Cited by 23 publications

References 62 publications

Frequent loss to follow‐up after diagnosis of hepatitis C virus infection: A barrier towards the elimination of hepatitis C virus

Frequent loss to follow‐up after diagnosis of hepatitis C virus infection: A barrier towards the elimination of hepatitis C virus

Improving access to care for people who inject drugs: Qualitative evaluation of project ITTREAT—An integrated community hepatitis C service

Hepatitis C virus (HCV) related liver fibrosis in people who inject drugs (PWID) at the Stockholm Needle Exchange – evaluated with liver elasticity

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