Perceived physical health outcomes of direct-acting antiviral treatment for hepatitis C: a qualitative study

Abstract Background Novel health promotion and treatment uptake initiatives will be necessary to ensure Australia meets 2030 hepatitis C elimination targets. Increasing treatment uptake will be assisted by a better understanding of the treatment experience and patient-perceived benefits. This study describes the perceived physical health benefits from direct-acting antiviral (DAA) hepatitis C treatment among people who inject drugs in Melbourne, Australia. Methods Twenty participants were recruited from a community treatment trial and community health clinics. Semi-structured interviews were performed with each participant before, during and following treatment. Interviews focused on treatment experiences, attitudes and motivations. Interviews were recorded, transcribed and thematically analysed. Results Two themes relating to the physical experience of treatment developed; intersection between physical and mental health and “maybe it’s working”. Participants reported various physical benefits, most prominently, reduced fatigue. Reductions in fatigue resulted in instant and meaningful changes in everyday life. Some participants did experience side effects, which they described as mild. Experiencing noticeable physical benefits during treatment was perceived as validation that treatment was working. Conclusion Physical health benefits of DAA treatment may have carry-on effects on cognitive, emotional or social wellbeing and should be incorporated into how treatment is promoted to those who require it.

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Exploring the emotions of patients undergoing therapy for hepatitis C

Gastrointestinal Nursing ◽

10.12968/gasn.2019.17.sup6.s18 ◽

2019 ◽

Vol 17 (Sup6) ◽

pp. S18-S21

Author(s):

Sarah Montague ◽

Kosh Agarwal ◽

Mary Cannon

Keyword(s):

Hepatitis C ◽

Physical Health ◽

Viral Hepatitis ◽

Patient Engagement ◽

Health Benefits ◽

Direct Acting Antiviral ◽

Direct Acting ◽

Positive Outlook ◽

The Impact ◽

Single Question

Background: direct-acting antiviral (DAA) therapy is highly efficacious in the treatment of hepatitis C (HCV). The literature to date has focused primarily on the physical health benefits of viral eradication. Aims: this study explored patient emotions during and after DAA therapy for HCV. Methods: over a 6-month period, 178 patients attending a viral hepatitis clinic for treatment of HCV were posed a single question: ‘How do you feel about your diagnosis of hepatitis C today?’ Responses were transcribed verbatim, thematically coded and visualised using WordArt software. Findings: the images depict the evolution of patients' perceptions of HCV before, during and after DAA therapy. Responses before treatment were predominantly negative, often describing the fear of contagion and feelings of isolation, secrecy and loneliness. After treatment, patients often described feeling positive and more motivated. Conclusions: the results demonstrate that treatment of HCV has a transformative effect on patients' perception of the impact of HCV on their wellbeing. This may promote a more positive outlook and, in turn, facilitate patient engagement with healthcare.

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Exploring the emotions of patients undergoing therapy for hepatitis C

British Journal of Nursing ◽

10.12968/bjon.2019.28.13.824 ◽

2019 ◽

Vol 28 (13) ◽

pp. 824-828 ◽

Cited By ~ 2

Author(s):

Sarah Montague ◽

Kosh Agarwal ◽

Mary Cannon

Keyword(s):

Hepatitis C ◽

Physical Health ◽

Viral Hepatitis ◽

Patient Engagement ◽

Health Benefits ◽

Direct Acting Antiviral ◽

Direct Acting ◽

Positive Outlook ◽

The Impact ◽

Single Question

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Hepatitis C virus testing, liver disease assessment and direct‐acting antiviral treatment uptake and outcomes in a service for people who are homeless in Sydney, Australia: The LiveRLife homelessness study

Journal of Viral Hepatitis ◽

10.1111/jvh.13112 ◽

2019 ◽

Cited By ~ 3

Author(s):

Sahar Bajis ◽

Jason Grebely ◽

Lucy Cooper ◽

Julie Smith ◽

Greg Owen ◽

...

Keyword(s):

Hepatitis C Virus ◽

Liver Disease ◽

Hepatitis C ◽

Antiviral Treatment ◽

Disease Assessment ◽

Direct Acting Antiviral ◽

Treatment Uptake ◽

Direct Acting ◽

Virus Testing ◽

Sydney Australia

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Uptake and predictors of direct-acting antiviral treatment for hepatitis C among people receiving opioid agonist therapy in Sweden and Norway: a drug utilization study from 2014 to 2017

10.21203/rs.3.rs-18790/v2 ◽

2020 ◽

Author(s):

Christer F. Aas ◽

Jørn Henrik Vold ◽

Svetlana Skurtveit ◽

Ingvild Odsbu ◽

Fatemeh Chalabianloo ◽

...

Keyword(s):

Hepatitis C ◽

Antiviral Treatment ◽

Prescription Database ◽

Agonist Therapy ◽

Hcv Treatment ◽

Opioid Agonist ◽

Direct Acting Antiviral ◽

Opioid Agonist Therapy ◽

Treatment Uptake ◽

Direct Acting

Abstract Background: Treatment with direct-acting antiviral agents (DAAs) offers an opportunity to eliminate hepatitis C virus (HCV) endemic among people who inject drugs (PWID) and people enrolled in opioid agonist therapy (OAT) programs. The objective of this study was to estimate and to compare HCV treatment uptake after the introduction of DAAs among patients receiving OAT in Sweden and Norway. We also aimed to evaluate predictors of DAAs treatment among OAT patients in both countries.Methods: This observational study was conducted with data from The Swedish Prescribed Drug Register and The Norwegian Prescription Database. We studied dispensed medications to calculate HCV treatment among OAT patients from 2014 to 2017 in Sweden and Norway. HCV prevalence was estimated from primary and secondary sources. Dispensations of medicines from different therapeutic areas, which served as proxy for co-morbidities in 2017, were conditionally adjusted for age, gender, and OAT medications. Logistic regression was used to evaluate these parameters. Results: In total 3,529 individuals were identified with dispensed OAT in the Swedish cohort and 7,739 individuals in the Norwegian cohort. HCV treatment was utilized by 407 persons in Sweden and 920 in Norway during the study period. Annual HCV and DAA treatment uptake increased in both countries. The estimated cumulative HCV treatment uptake at the end of 2017 was 31% in Norway and 28% in Sweden. DAA treatment was associated with increased age (aOR 1.8; 95% CI 1.0-3.2) and the dispensation of drugs used for diabetes (aOR 3.2; 95% CI 1.8-5.7) in Sweden. In Norway, lipid modifying agents and antibacterials were associated with decreased odds (aOR 0.4; 95%CI 0.2-0.9, aOR 0.8; 95%CI 0.6-1.0).Conclusions: An increase in DAA treatment and HCV treatment uptake was observed among Swedish and Norwegian OAT patients whilst introducing new direct-acting antiviral treatment regimens. However, more than two thirds of the OAT population in Norway and Sweden were untreated at the beginning of 2018. A further scale-up is crucial in order to control and eliminate the HCV endemic among OAT patients.

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Estimated uptake of hepatitis C direct-acting antiviral treatment among individuals with HIV co-infection in Australia: a retrospective cohort study

Sexual Health ◽

10.1071/sh19101 ◽

2020 ◽

Vol 17 (3) ◽

pp. 223 ◽

Cited By ~ 3

Author(s):

Nima Iranpour ◽

Gregory J. Dore ◽

Marianne Martinello ◽

Gail V. Matthews ◽

Jason Grebely ◽

...

Keyword(s):

Hepatitis C ◽

Antiviral Treatment ◽

First Year ◽

Treatment Access ◽

Direct Acting Antiviral ◽

Treatment Uptake ◽

Unrestricted Access ◽

High Level ◽

Direct Acting ◽

Pharmaceutical Benefits Scheme

Background Unrestricted access to direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV) infection has been available in Australia since March 2016. Individuals with HIV–HCV co-infection are at a greater risk of liver fibrosis progression. This study estimated DAA treatment uptake among individuals with HIV–HCV co-infection, during the first year of DAA treatment access in Australia. Methods: Pharmaceutical Benefits Scheme (PBS) data on dispensed DAA and antiretroviral therapy (ART) prescriptions from March 2016 to March 2017 were used for analysis. Results: During March 2016 to March 2017, a total of 935 individuals with HIV–HCV co-infection were receiving ART and initiated DAA treatment, with 93% to 97% completing their prescribed course. Estimated DAA treatment uptake in the HIV–HCV-infected population was 41% (935/2290). Most were men (94%). Median age was 50 years. DAA treatment was initiated by specialists in 64% of cases (n = 602), and by general practitioners (GPs) in 25% of cases (n = 238). The proportion of individuals initiated on DAA by GPs increased from 20% in March–April 2016 to 26% in January–March 2017. Most specialists (77%) and GPs (72%) initiated DAA treatment for one to three patients. Among individuals initiated on DAA by GPs, 68% received their ART prescription from the same GP. Conclusions: A high level of DAA treatment uptake and completion was observed among individuals with HIV–HCV co-infection during the first year of DAA treatment access. The proportion of individuals prescribed DAA by GPs increased over time; this is important for broadened access.

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Improved Hepatitis C Cure Cascade Outcomes Among Urban Baby Boomers in the Direct-Acting Antiviral Era

Public Health Reports ◽

10.1177/0033354919888228 ◽

2019 ◽

Vol 135 (1) ◽

pp. 107-113 ◽

Cited By ~ 1

Author(s):

Sarah C. Dupont ◽

Shelly-Ann Fluker ◽

Kristi M. Quairoli ◽

Cameron Body ◽

Ike Okosun ◽

...

Keyword(s):

Hepatitis C ◽

Antiviral Treatment ◽

Linkage To Care ◽

Newly Diagnosed ◽

Screening Programs ◽

Direct Acting Antiviral ◽

Treatment Uptake ◽

Period 2 ◽

Direct Acting ◽

Cure Rates

Objectives: We compared outcomes of the hepatitis C virus (HCV) cure cascade (ie, the path a patient follows from diagnosis to cure), including antiviral treatment outcomes, from 2 HCV screening programs. Our objective was to assess whether treatment uptake and HCV cure rates improved in the cohort screened after the release of all-oral HCV direct-acting antiviral therapies. Methods: We retrospectively compared outcomes of the HCV cure cascade from a cohort of newly diagnosed patients screened during 2012-2014 (period 1) with outcomes from a cohort of newly diagnosed patients screened during 2015-2016 (period 2) at Grady Health System in Atlanta, Georgia. Cure cascade outcomes included HCV antibody (anti-HCV) and RNA testing, linkage to care, antiviral treatment, and sustained virologic response. Results: During period 1, 412 of 5274 (7.8%) persons screened were anti-HCV positive, and 264 (69.3%) of those tested were RNA positive. During period 2, 462 of 7137 (6.5%) persons screened were anti-HCV positive, and 240 (59.3%) of those tested were RNA positive ( P = .003). The percentage of newly diagnosed patients who were treated during period 2 (64.0%) was 3 times that of newly diagnosed patients treated during period 1 (21.2%; P < .001). Both cohorts had similarly high levels of linkage to care (95.8% during period 1, 95.4% during period 2) and cure (92.6% during period 1, 95.5% during period 2). Conclusions: Over time, the prevalence of anti-HCV and HCV RNA positivity declined substantially, and linkage-to-care and cure rates remained high. Treatment uptake increased significantly after the introduction of all-oral direct-acting antiviral therapy. These findings suggest that combining large-scale screening initiatives with treatment programs can speed progress toward HCV elimination.

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Exploring the emotions of patients undergoing therapy for hepatitis C

British Journal of Healthcare Assistants ◽

10.12968/bjha.2019.13.11.544 ◽

2019 ◽

Vol 13 (11) ◽

pp. 544-548

Author(s):

Sarah Montague ◽

Kosh Agarwal ◽

Mary Cannon

Keyword(s):

Hepatitis C ◽

Physical Health ◽

Viral Hepatitis ◽

Patient Engagement ◽

Health Benefits ◽

Direct Acting Antiviral ◽

Direct Acting ◽

Positive Outlook ◽

The Impact ◽

Single Question

Background: Direct-acting antiviral (DAA) therapy is highly efficacious in the treatment of hepatitis C (HCV). The literature to date has focused primarily on the physical health benefits of viral eradication. Aims: This study explored patient emotions during and after DAA therapy for HCV. Methods: Over a 6-month period, 178 patients attending a viral hepatitis clinic for treatment of HCV were posed a single question: ‘How do you feel about your diagnosis of hepatitis C today?’ Responses were transcribed verbatim, thematically coded and visualised using WordArt software. Findings: The images depict the evolution of patients' perceptions of HCV before, during and after DAA therapy. Responses before treatment were predominantly negative, often describing the fear of contagion and feelings of isolation, secrecy and loneliness. After treatment, patients often described feeling positive and more motivated. Conclusions: The results demonstrate that treatment of HCV has a transformative effect on patients' perception of the impact of HCV on their wellbeing. This may promote a more positive outlook and, in turn, facilitate patient engagement with healthcare.

Download Full-text

Uptake and predictors of direct-acting antiviral treatment for hepatitis C among people receiving opioid agonist therapy in Sweden and Norway: a drug utilization study from 2014 to 2017

10.21203/rs.3.rs-18790/v1 ◽

2020 ◽

Author(s):

Christer F. Aas ◽

Jørn Henrik Vold ◽

Svetlana Skurtveit ◽

Ingvild Odsbu ◽

Fatemeh Chalabianloo ◽

...

Keyword(s):

Hepatitis C ◽

Antiviral Treatment ◽

Prescription Database ◽

Agonist Therapy ◽

Hcv Treatment ◽

Opioid Agonist ◽

Direct Acting Antiviral ◽

Opioid Agonist Therapy ◽

Treatment Uptake ◽

Direct Acting

Abstract Background Treatment with direct-acting antiviral agents (DAAs) offers an opportunity to eliminate hepatitis C virus (HCV) endemic among people who inject drugs (PWID) and people enrolled in opioid agonist therapy (OAT) programs. The objective of this study was to estimate and to compare HCV treatment uptake after the introduction of DAAs among patients receiving OAT in Sweden and Norway. We also aimed to evaluate predictors of DAAs treatment among OAT patients in both countries. Methods This observational study was conducted with data from The Swedish Prescribed Drug Register and The Norwegian Prescription Database. We studied dispensed medications to calculate HCV treatment among OAT patients from 2014 to 2017 in Sweden and Norway. HCV prevalence was estimated from primary and secondary sources. Dispensations of medicines from different therapeutic areas, which served as proxy for co-morbidities in 2017, were conditionally adjusted for age, gender, and OAT medications. Logistic regression was used to evaluate these parameters. Results In total 3,529 individuals were identified with dispensed OAT in the Swedish cohort and 7,739 individuals in the Norwegian cohort. HCV treatment was utilized by 407 persons in Sweden and 920 in Norway during the study period. Annual HCV and DAA treatment uptake increased in both countries. The estimated cumulative HCV treatment uptake at the end of 2017 was 31% in Norway and 28% in Sweden. DAA treatment was associated with increased age (aOR 1.8; 95% CI 1.0-3.2) and dispensation of drugs used for diabetes (aOR 3.2; 95% CI 1.8-5.7) in Sweden. In Norway, lipid modifying agents and antibacterials were associated with decreased odds (aOR 0.4; 95%CI 0.2-0.9, aOR 0.8; 95%CI 0.6-1.0). Conclusions An increase in DAA treatment and HCV treatment uptake was observed among Swedish and Norwegian OAT patients during the introduction period of new direct-acting treatment regimens. However, more than two thirds of the OAT population in Norway and Sweden were untreated at the beginning of 2018. A further scale-up is crucial to be able to control and eliminate the HCV endemic among OAT patients.

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