Hepatitis C management by addiction medicine physicians: Results from a national survey

Litwin, Alain H.; Kunins, Hillary V.; Berg, Karina M.; Federman, Alex D.; Heavner, Karyn; Gourevitch, Marc N.; Arnsten, Julia H.

doi:10.1016/j.jsat.2006.12.001

Cited by 29 publications

(26 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Finally, providers are often reluctant to provide HCV treatment to active injecting drug users 66,67. One of the clinician-related barriers to treating PWID is fear of relapse into drug injecting and consequent HCV reinfection after successful HCV treatment.…”

Section: Treatment Uptake and Barriersmentioning

confidence: 99%

Factors associated with uptake, adherence, and efficacy of hepatitis C treatment in people who inject drugs: a literature review

Mravčík¹,

Strada²,

Štolfa³

et al. 2013

PPA

View full text Add to dashboard Cite

Introduction and methodsHepatitis C virus (HCV) infections are highly prevalent amongst people who inject drugs (PWID). Despite well documented evidence of its effectiveness, suggested cost-effectiveness, and potential to reduce HCV prevalence rates, the uptake of antiviral HCV treatment by PWID is low. This nonsystematic literature review describes factors associated with the uptake, adherence, and efficacy of HCV treatment among PWID and discusses strategies to increase their uptake of treatment.ResultsLow HCV treatment uptake among PWID is associated with a number of patient-related and provider-related barriers. Beliefs and fears about low efficacy and adverse effects on the patient’s part are common. A substantial number of factors are associated with the chaotic lifestyle and altered social functioning of PWID, which are often associated with decompensation or relapsing into drug addiction. This may lead to perceived low adherence with treatment and low efficacy on the provider’s part too, where lack of support, inadequate management of addiction, and other drug-related problems and poor treatment of side effects have been described. Practical issues such as the accessibility of treatment and finances also play a role. Strategies to improve the HCV treatment rate among PWID involve pretreatment management and assessment, a multidisciplinary approach, management of side effects, and enhanced education and counseling.ConclusionSpecific factors are associated with poorer treatment outcomes in PWID on the side of both the patient and the treatment system. However, given that PWID can achieve treatment adherence and sustained virologic response rates comparable with those in nondrug users, drug use per se should not be considered a criterion for exclusion from treatment. Further development of measures leading to higher uptake of treatment and adherence in PWID and appropriate adaptation of HCV treatment guidelines represent important tools in this regard.

show abstract

Section: Treatment Uptake and Barriersmentioning

confidence: 99%

Factors associated with uptake, adherence, and efficacy of hepatitis C treatment in people who inject drugs: a literature review

Mravčík¹,

Strada²,

Štolfa³

et al. 2013

PPA

View full text Add to dashboard Cite

show abstract

“…Litwin et al found that, although only 1% of primary care physicians were treating CHC, 13% were willing to do so with appropriate training. 21 Novel ways of training primary care staff are emerging. Through Project ECHO (Extension for Community Healthcare Outcomes), the University of New Mexico in the US evaluated a teleconferencing approach whereby primary care clinicians meet weekly with specialists via teleconference.…”

Section: Qualitative Studiesmentioning

confidence: 99%

Can antiviral treatment for hepatitis C be safely and effectively delivered in primary care?

Brew

Butt²,

Wright³

2013

Br J Gen Pract

View full text Add to dashboard Cite

show abstract

“…However concerns have been raised about the quality of management as one study indicated that patients treated in specialized centres in Switzerland were more likely to receive screening for HCV compared to GP's 13 which contrasts results from USA, Australia and the United Kingdom [14][15][16] . We hypothesized that in Switzerland a GP with a high level of commitment but without a special intervention can achieve CHC assessment rates comparable to specialized centres in opioid addicts (with and without a history of IDU) .…”

Section: Introductionmentioning

confidence: 99%

Determinants of successful chronic hepatitis C case finding among patients receiving opioid maintenance treatment in a primary care setting

2009

View full text Add to dashboard Cite

Aims Injection drug users are at high risk for chronic hepatitis C virus infection (CHC). Opioid maintenance treatment (OMT) offers a unique opportunity to screen for CHC. This study proposed the hypothesis that a general practitioner (GP) with special interest in addiction medicine can achieve CHC screening rates comparable to specialized centres and aimed to investigate determinants for a successful CHC case finding in a primary care setting.Design and participants Retrospective medical record analysis of 387 patients who received opioid maintenance therapy between 1 January 2002 and 31 May 2008 in a general practice in Zurich, Switzerland.Measurements Successful CHC assessment was defined as performance of hepatitis C virus (HCV) serology with consecutive polymerase chain reaction‐based RNA and genotype recordings. The association between screening success and patient characteristics was assessed using multiple logistic regression.Findings Median (interquartile range) age and duration of OMT of the 387 (268 males) patients was 38.5 (33.6–44.5) years and 34 (11.3–68.0) months, respectively. Fourteen patients (3.6%) denied HCV testing and informed consent about screening was missing in 13 patients (3.4%). In 327 of 360 patients (90.8%) with informed consent a successful CHC assessment has been performed. Screening for HCV antibodies was positive in 136 cases (41.6%) and in 86 of them (63.2%) a CHC was present. The duration of OMT was an independent determinant of a successful CHC assessment.Conclusions In addicted patients a high CHC assessment rate in a primary care setting in Switzerland is feasible and opioid substitution provides an optimal framework.

show abstract

Hepatitis C management by addiction medicine physicians: Results from a national survey

Cited by 29 publications

References 34 publications

Factors associated with uptake, adherence, and efficacy of hepatitis C treatment in people who inject drugs: a literature review

Factors associated with uptake, adherence, and efficacy of hepatitis C treatment in people who inject drugs: a literature review

Can antiviral treatment for hepatitis C be safely and effectively delivered in primary care?

Determinants of successful chronic hepatitis C case finding among patients receiving opioid maintenance treatment in a primary care setting

Contact Info

Product

Resources

About