Physicians’ Attitudes and Practice Toward Treating Injection Drug Users Infected with Hepatitis C Virus: Results from a National Specialist Survey in Canada

Myles, Angelique Helena; Mugford, Gerald; Zhao, Jing; Krahn, Murray; Wang, Peter

doi:10.1155/2011/810108

Cited by 62 publications

(43 citation statements)

References 34 publications

(29 reference statements)

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“…Conversely, infectious diseases specialists manage fewer patients with autoimmune/cholestatic disease. This practice profile reflects a subspecialty in the management of CLDs that has been already observed in other Canadian studies (32,33).…”

Section: Discussionsupporting

confidence: 70%

Physicians’ Practices for Diagnosing Liver Fibrosis in Chronic Liver Diseases: A Nationwide, Canadian Survey

Sebastiani

Ghali

Wong

et al. 2014

Canadian Journal of Gastroenterology and Hepatology

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OBJECTIVE: To determine practices among physicians in Canada for the assessment of liver fibrosis in patients with chronic liver diseases.METHODS: Hepatologists, gastroenterologists, infectious diseases specialists, members of the Canadian Gastroenterology Association and/or the Canadian HIV Trials Network who manage patients with liver diseases were invited to participate in a web-based, national survey.RESULTS: Of the 237 physicians invited, 104 (43.9%) completed the survey. Routine assessment of liver fibrosis was requested by the surveyed physicians mostly for chronic hepatitis C (76.5%), followed by autoimmune/cholestatic liver disease (59.6%) and chronic hepatitis B (52.9%). Liver biopsy was the main diagnostic tool for 46.2% of the respondents, Fibroscan (Echosens, France) for 39.4% and Fibrotest (LabCorp, USA) for 7.7%. Etiology-specific differences were observed: noninvasive methods were mostly used for hepatitis C (63% versus 37% liver biopsy) and hepatitis B (62.9% versus 37.1% liver biopsy). For 42.7% of respondents, the use of noninvasive methods reduced the need for liver biopsy by >50%. Physicians’ characteristics associated with higher use of noninvasive methods were older age and being based at a university hospital or in private practice versus community hospital. Physicians’ main concerns regarding noninvasive fibrosis assessment methods were access/availability (42.3%), lack of guidelines for clinical use (26.9%) and cost/lack of reimbursement (14.4%).CONCLUSIONS: Physicians who manage patients with chronic liver diseases in Canada require routine assessment of liver fibrosis stage. Although biopsy remains the primary diagnostic tool for almost one-half of respondents, noninvasive methods, particularly Fibroscan, have significantly reduced the need for liver biopsy in Canada. Limitations in access to and availability of the noninvasive methods represent a significant barrier. Finally, there is a need for clinical guidelines and a better reimbursement policy to implement noninvasive tools to assess liver fibrosis.

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Section: Discussionsupporting

confidence: 70%

Physicians’ Practices for Diagnosing Liver Fibrosis in Chronic Liver Diseases: A Nationwide, Canadian Survey

Sebastiani

Ghali

Wong

et al. 2014

Canadian Journal of Gastroenterology and Hepatology

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“…35 Programs designed to increase the uptake of HCV treatment among injection drug users are being introduced in Canada, 36 although it is not clear how best to improve the unacceptably low rate of uptake in this key patient population. 13 Community-based primary care, peer support groups and multidisciplinary care are all approaches that may help. [37][38][39] Patientrelated barriers to treatment uptake are important but difficult to overcome.…”

Section: Resultsmentioning

confidence: 99%

“…Training and continuing medical education programs have been recommended to widen the pool of clinicians comfortable treating HCV, 40 but even specialists can be reluctant to provide treatment to injection drug users. 13 Qualitative research is needed to explore whether certain patients would receive HCV treatment in some centres but not in others and, if so, why that is the case. Our results also suggest that there is an urgent need for updated HCV treatment and management guidelines for patients with HIV-HCV coinfection, and that these guidelines need to be disseminated to and adopted by both primary care givers and consultants.…”

Section: Resultsmentioning

confidence: 99%

“…11,12 In a recent survey, 80% of Canadian physicians who specialize in HCV said that they were not likely to provide HCV treatment to active injection drug users. 13 Injection drug users are often considered ineligible for treatment because of poor adherence to care, psychiatric illness or ongoing use of drugs or alcohol. 14,15 Even if eligible, patients with HCV may be reluctant to start treatment.…”

Section: Cmaj Openmentioning

confidence: 99%

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Variation between Canadian centres in the uptake of treatment for hepatitis C by patients coinfected with HIV: a prospective cohort study

et al. 2013

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Background: Uptake of treatment for hepatitis C virus (HCV) is low in Canada despite its publicly funded health care system. We explored the uptake of HCV treatment within the Canadian Co-infection Cohort to determine if some treatment centres have been more successful than others at starting patients with HIV-HCV coinfection on HCV treatment. Methods:We estimated the variation between 16 centres in the uptake of HCV treatment using a Weibull time-to-event model with adjustment for patient characteristics that are thought likely to influence the uptake of treatment. We asked the principal investigator at each centre about access to hepatitis-related specialists and services and the importance of various criteria when determining if a patient with HIV-HCV coinfection should receive treatment for HCV. Results:Among 681 untreated patients in the Canadian Co-infection Cohort, 163 patients with HIV-HCV coinfection started HCV treatment over a period of 1827 patient-years (9 per 100 patient-years). Even after adjustment for case mix, there was still appreciable variation in treatment uptake between centres, with mean hazard ratios of 0.43 (95% credible interval 0.11-1.3) and 3.6 (95% credible interval 1.7-8.4) for the centres least and most likely to start an average patient with HIV-HCV coinfection on HCV treatment. The most important criteria reported by principal investigators for determining eligibility for treatment were severity of fibrosis, current psychiatric comorbidities, current alcohol intake, past HCV treatment and a history of reinfection with HCV. However, the opinions were wide-ranging: 8 of the 15 criteria elicited both the responses "less important" and "very important." Interpretation:The magnitude of the centre effects and diverse opinions about the importance of treatment eligibility criteria suggest that provider-related barriers to HCV treatment uptake are as important as patient-related barriers. AbstractCMAJ OPEN, 1(3) E107 Research CMAJ OPENare infected with HCV. 11,12 In a recent survey, 80% of Canadian physicians who specialize in HCV said that they were not likely to provide HCV treatment to active injection drug users. 13 Injection drug users are often considered ineligible for treatment because of poor adherence to care, psychiatric illness or ongoing use of drugs or alcohol. 14,15 Even if eligible, patients with HCV may be reluctant to start treatment. 16 In the United States, patients are less likely to be offered and to accept HCV treatment if they are older, male, not white, infected with a difficult-to-treat HCV genotype, have psychiatric illness, or if they use drugs or alcohol. [17][18][19] Many studies have evaluated these patient-related barriers to treatment, 20,21 which are difficult to overcome. Provider and institutional barriers are also important; 17,22 these are perhaps more amenable to intervention. Although having access to an experienced provider is clearly important for the uptake of HCV treatment, [17][18][19] it is not clear what other provider and institutional bar...

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“…Until recently, HCV treatment of active PWID was often withheld by physicians due to concerns about poor adherence, factors associated with concurrent substance use, the risk of reinfection after successful therapy, and comorbid psychiatric diseases that could not be properly addressed [11]. Missed appointments and lack of adherence to HCV treatment regimens are especially problematic in these patients, due to the sociodemographic and cognitive-affective factors that are often present in this population [12,13].…”

Section: Discussionmentioning

confidence: 99%

Analysis of Adherence to AllOral HCV Therapy in a Cohort of People who Inject Drugs (PWID)

Shahi¹,

Kiani²,

Alimohammadi³

et al. 2017

J Hep

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Physicians’ Attitudes and Practice Toward Treating Injection Drug Users Infected with Hepatitis C Virus: Results from a National Specialist Survey in Canada

Cited by 62 publications

References 34 publications

Physicians’ Practices for Diagnosing Liver Fibrosis in Chronic Liver Diseases: A Nationwide, Canadian Survey

Physicians’ Practices for Diagnosing Liver Fibrosis in Chronic Liver Diseases: A Nationwide, Canadian Survey

Variation between Canadian centres in the uptake of treatment for hepatitis C by patients coinfected with HIV: a prospective cohort study

Analysis of Adherence to AllOral HCV Therapy in a Cohort of People who Inject Drugs (PWID)

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