If the mountain won't come to Mohammed, then Mohammed must go to the mountain: Decentralisation of hepatitis C care for people who use drugs

Hoff, Daan W. Von den; Berden, Floor A. C.; Schellekens, Arnt

doi:10.1002/ueg2.12167

Cited by 2 publications

(4 citation statements)

References 7 publications

(8 reference statements)

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“…These reflections resonate with recommendations from research that favours offering hepatitis C care in needs-tailored and/or specific community settings, in ways that are peer-led or informed and co-delivered with or linked to other relevant services, including harm reduction strategies (e.g., Biondi & Feld, 2020;Richmond & Wallace, 2018;Von den Hoff, et al, 2021).…”

Section: Hepatitis C Normalisationmentioning

confidence: 80%

“…Treatment improvements have ushered in a new era in the medical and social history of hepatitis C. A gathering of techno‐scientific, economic, political and bureaucratic forces is understood to have brought about a new phase in the history of hepatitis C that is imagined to be the disease’s ‘final’ chapter. Within this global project of viral elimination, models of care organised around the normalisation of hepatitis C testing and treatment are, as we discussed earlier, emerging as a new set of practice norms (e.g., Knight & Ti, 2019; Oru et al., 2021; Von den Hoff, et al., 2021). The take‐up of DAA treatments was initially strong but has since declined (MacLachlan et al., 2020), stimulating concern among policymakers and others about the factors surrounding ‘non‐uptake’ (see Fraser et al., 2022).…”

Section: Discussionmentioning

confidence: 99%

“…These Australian developments reflect changes in the landscape of hepatitis C care internationally. For example, researchers in Canada recently called for the decentralisation of hepatitis C care, integrating it into primary, ‘generalist’ and preventative health care (e.g., general practice) (Knight & Ti, 2019, p. 377), and researchers in Europe recommend ‘care decentralisation’, such as making treatment available in specialised community‐based contexts, such as alcohol and other drug treatment facilities, correctional facilities, opioid pharmacotherapy settings and dispensing pharmacies (Von den Hoff, et al., 2021). A recent Lancet meta‐analysis of ‘decentralisation, integration, and task‐shifting’ in hepatitis C testing and treatment that synthesised 142 studies across 34 countries found ‘a robust evidence base’ for expanding and decentralising treatment and for ‘task‐shifting to primary‐care physicians and nurses’ (Oru et al., 2021, p. e443).…”

Section: Introductionmentioning

confidence: 99%

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The trouble with normalisation: Transformations to hepatitis C health care and stigma in an era of viral elimination

Kagan

Seear

Lenton

et al. 2023

Sociology Health & Illness

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Modern health‐care systems have customarily approached hepatitis C in ways that resemble the public health approach to HIV/AIDS known as ‘HIV exceptionalism’. HIV exceptionalism describes the unusual emphasis on privacy, confidentiality and consent in approaches to HIV and was partly developed to address HIV/AIDS‐related stigma. In the case of hepatitis C, exceptionalist approaches have included diagnosis and treatment by specialist physicians and other ‘boutique’ public health strategies. The recent availability of highly effective, direct‐acting antivirals alongside goals to eliminate hepatitis C have heralded dramatic changes to hepatitis C health care, including calls for its ‘normalisation’. The corollary to exceptionalism, normalisation aims to bring hepatitis C into routine, mainstream health care. This article draws on interviews with stakeholders (n = 30) who work with hepatitis C‐affected communities in policy, community, legal and advocacy settings in Australia, alongside Fraser et al.’s (2017, International Journal of Drug Policy, 44, 192–201) theorisation of stigma, and Rosenbrock et al.’s (1999, The AIDS policy cycle in Western Europe: from exceptionalism to normalisation. WZB Discussion Paper, No. P 99‐202) critique of normalisation to consider the perceived effects of hepatitis C normalisation. Stakeholders described normalisation as a stigma‐reducing process. However, they also expressed concerns about the ongoing stigma and discrimination that is not ameliorated by normalisation. We suggest that in centring normalisation, changes in health care may exaggerate the power of technological solutions to transform the meanings of hepatitis C.

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Section: Hepatitis C Normalisationmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The trouble with normalisation: Transformations to hepatitis C health care and stigma in an era of viral elimination

Kagan

Seear

Lenton

et al. 2023

Sociology Health & Illness

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“…Treatment uptake rate showed similar results [ 11 ]. Successful implementation of decentralized pathways are therefore the next step in achieving HCV elimination in PWUD [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

Implementation of a decentralized hepatitis C care pathway for people who use drugs in Dutch addiction care. Study protocol for the Hepatitis C: chain of addiction care (CAC) project

Hoff

Berden

Drenth

et al. 2022

Addict Sci Clin Pract

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Background People who use drugs (PWUD) are at high risk for hepatitis C virus (HCV) infection and its complications. Given the high prevalence rate of HCV in PWUD, the World Health Organization (WHO) emphasizes PWUD as a target population for HCV elimination. The introduction of pangenotypic direct acting antivirals (DAAs) greatly simplifies HCV treatment, which encourages integration of HCV treatment in primary care. Facilitating low threshold HCV care for PWUD by implementing decentralized models is crucial for HCV elimination. Aims With this study we aim to (1) eliminate 90% of identified HCV infections in Dutch addiction care, using a decentralized PWUD-HCV care model, and (2) identify facilitators and barriers for successful implementation of the model using interviews. Methods We will perform a multicenter mixed-method study on HCV treatment in addiction care. In a prospective observational study we will examine HCV-related outcomes in PWUD receiving HCV treatment as part of addiction care. The primary outcome is viral elimination, defined as percentage of identified HCV positive patients cured with DAAs. In parallel, we will perform a qualitative study to explore facilitators and barriers for implementation of fully decentralized HCV-PWUD care. We will interview addiction care professionals and board members about their experience with HCV-care as part of addiction care. Discussion This study will show effectiveness of integration of HCV care within addiction care, and provide insight in facilitators and barriers to implement integrated HCV-addiction care. The results will provide recommendations for implementation and maintenance of the decentralized HCV pathway, which can facilitate scaling-up to contribute to reaching WHO HCV elimination goals. Trial registration NCT05401136.

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If the mountain won't come to Mohammed, then Mohammed must go to the mountain: Decentralisation of hepatitis C care for people who use drugs

Cited by 2 publications

References 7 publications

The trouble with normalisation: Transformations to hepatitis C health care and stigma in an era of viral elimination

The trouble with normalisation: Transformations to hepatitis C health care and stigma in an era of viral elimination

Implementation of a decentralized hepatitis C care pathway for people who use drugs in Dutch addiction care. Study protocol for the Hepatitis C: chain of addiction care (CAC) project

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