Reported Barriers to Hepatitis C Treatment among Pregnant and Early-Parenting Mothers Undergoing Substance Use Disorder Treatment in One U.S. State

Nationwide, the prevalence of the hepatitis C virus (HCV) has risen in recent years. At least 90% of infected persons must be treated to achieve global elimination targets. The current study aimed to explore barriers to, and facilitators of, direct-acting antiviral (DAA) HCV treatment uptake amongst pregnant and early-parenting women undergoing comprehensive substance use treatment. Twenty participants with documented HCV antibody positivity were recruited from two substance use treatment centers in central Kentucky. Semi-structured interviews were conducted to explore knowledge about HCV, previous experiences, and intentions to seek care. Themes were extracted using an inductive analytical approach. Most participants were aware of the dangers posed by HCV infection. However, there was a high degree of misinformation about transmission mechanisms and treatment eligibility requirements. Low priority for HCV treatment also surfaced as a barrier to treatment uptake. Participants reported being unable to seek care due to time and resource limitations in the presence of a highly demanding treatment process. Findings from the current study suggest that more work is needed to eliminate residual barriers that limit access to HCV treatment among pregnant and early-parenting women in treatment for substance use disorder.

A Social Media Website (Supporting Our Valued Adolescents) to Support Treatment Uptake for Adolescents with Depression or Anxiety: Outcomes From a Pilot Randomized Controlled Trial (Preprint)

BACKGROUND Adolescents with depression or anxiety initiate mental health treatment in low numbers due to multiple factors, with a top reason being negative attitudes towards treatment. We developed a peer-support website intervention, Supporting Our Valued Adolescents (SOVA), for adolescents seen in primary care settings and their parents with the goal of increasing treatment uptake through changing negative health beliefs, enhancing knowledge, offering peer emotional support, and increasing parent-adolescent communication about mental health. OBJECTIVE The aim of this pilot study was to refine recruitment and retention strategies, document intervention fidelity, and explore change in study outcomes (primary outcome being treatment uptake). METHODS We conducted a two-group, single blind, pilot randomized controlled trial in a single adolescent medicine clinic. Participants were aged 12 to 19 with clinician-identified symptoms of depression or anxiety for which a health care provider recommends treatment. The patient and parent, if interested, were randomized to receive the SOVA websites and Enhanced Usual Care (EUC) compared to EUC alone. Baseline, 6-week, and 3-month measures were collected by web-based self-report survey and blinded electronic health record review. Main pilot outcomes assessed were feasibility of recruitment and retention strategies. Implementation outcomes, intervention fidelity, missingness, and adequacy of safety protocols were documented. Descriptive statistics were used to summarize mental health service use, and target measures (examine change in health beliefs and knowledge, emotional support, and parent-adolescent communication) using 2-sample t tests to compare differences between arms. RESULTS A little under half of adolescents offered patient education material (195/461; 42%) were referred by their clinician to the study. Of 146 adolescents meeting inclusion criteria, 38 completed the baseline survey, qualifying them for randomization, and 25 (66%; 95% CI 51 - 81%) completed 6-week measures. There was limited engagement in the treatment arm with (5/11) 45% of adolescents who completed 6-week measures reporting accessing SOVA, mostly citing forgetting. Changes were found in target factors at 6-weeks, but not in per protocol analyses. Despite this, at 12 weeks, 15/18 (83%) adolescents randomized to SOVA received mental health treatment as compared to 10/20 (50%) adolescents randomized to EUC (P=.03), where receipt of treatment was measured by combined adolescent or parent self-report and a blinded manual EHR extraction. CONCLUSIONS In this pilot trial of a peer-support website intervention for adolescents with depression or anxiety we found lower than expected study enrollment post recruitment. While generalizability may be enhanced by not requiring parental permission for adolescent participation in trials of mental health interventions, this may limit study recruitment and retention. We found implementing patient education introducing the study into provider workflow was feasible and acceptable, resulting in almost 500 study referrals. Lastly, we found preliminary evidence that the SOVA intervention may increase uptake of mental health treatment as compared to usual care. CLINICALTRIAL ClinicalTrials.gov NCT03318666; https://clinicaltrials.gov/ct2/show/NCT03318666 INTERNATIONAL REGISTERED REPORT RR2-10.2196/12117

Potential interventions to support HCV treatment uptake among HIV co-infected people in Canada: Perceptions of patients and health care providers

BACKGROUND: Increasing direct-acting antiviral (DAA) treatment uptake is key to eliminating HCV infection as a public health threat in Canada. People living with human immunodeficiency virus (HIV) and hepatitis C (HCV) co-infection face barriers to HCV treatment initiation. We sought to identify interventions that could support HCV treatment initiation based on patient and HCV care provider perspectives. METHODS: Eleven people living with HIV with a history of HCV infection and 12 HCV care providers were recruited for this qualitative descriptive study. Participants created ranked-ordered lists of potential interventions during nominal groups ( n = 4) and individual interviews ( n = 6). Following the nominal group technique, transcripts and intervention lists underwent thematic analysis and ranking scores were merged to create consolidated and prioritized lists from patient and provider perspectives. RESULTS: Patient participants identified a total of eight interventions. The highest-ranked interventions were multidisciplinary clinics, HCV awareness campaigns and patient education, nurse- or pharmacist-led care, peer involvement, and more and better-prepared health professionals. Provider participants identified 11 interventions. The highest-ranked were mobile outreach, DAA initiation at pharmacies, a simplified process of DAA prescription, integration of primary and specialist care, and patient-centred approaches. CONCLUSION: Participants proposed alternatives to hospital-based specialist HCV care, which require increasing capacity for nurses, pharmacists, primary care providers, and peers to have more direct roles in HCV treatment provision. They also identified the need for structural changes and educational initiatives. In addition to optimizing HCV care, these interventions might result in broader benefits for the health of HIV–HCV co-infected people.

Gambling behaviours and treatment uptake among vulnerable populations during COVID-19 crisis

This study aimed to explore changes in gambling behaviours and gambling disorder (GD) treatment uptake during the COVID-19 pandemic among those with a heightened vulnerability to gambling-related harm. This was a single-center, cross-sectional, retrospective case series study assessing gambling behaviours and GD counselling participation among a vulnerable population sector following the COVID-19 shutdown. The clinical records of clients at a community substance use disorder (SUD) treatment center were explored (N = 67). Eight clients (n = 8) had satisfied the objective criteria, and were qualified for data exploration and analysis of gambling activities and GD treatment participation following the COVID-19 shutdown. All clients in the study belonged to subgroups at an elevated risk for gambling-related harm, with a mean duration of gambling problems of 9.5 years. Following the COVID-19 shutdown, an increase in gambling activities was noted in five cases. Migration to online gambling was noted in three cases. In two cases, no change in gambling activities was noted, and a reduction of gambling activities was noted in one case. In seven cases, no screening for gambling problems prior to current SUD program was noted. None had a history of, nor were currently engaged in counselling for gambling problems. The COVID-19 crisis and associated increase in gambling participation, coupled with a diminutive gambling counselling uptake during the pandemic, present an opportunity to rethink current behavioural addictions service delivery model for those with an increased vulnerability to gambling-related harm. Further investigation of the changes in gambling participation, and a closer look at optimizing GD service delivery among vulnerable population sectors during the COVID-19 crisis is warranted.

Australia could miss the WHO hepatitis C virus elimination targets due to declining treatment uptake and ongoing burden of advanced liver disease complications

Australia was one of the first countries to introduce government-funded unrestricted access to direct-acting antiviral (DAA) therapy, with 88,790 treated since March 2016. However, treatment uptake is declining which could potentially undermine Australia’s progress towards the WHO HCV elimination targets. Using mathematical modelling, we updated estimates for those living with chronic HCV in Australia, new cases of decompensated cirrhosis (DC), hepatocellular carcinoma (HCC), and liver-related mortality among the HCV-cured and viraemic populations from 2015 to 2030. We considered various DAA treatment scenarios incorporating annual treatment numbers to 2020, and subsequent uptake per year of 6,790 (pessimistic), 8,100 (intermediate), and 11,310 (optimistic). We incorporated the effects of excess alcohol consumption and reduction in progression to DC and HCC among cirrhosis-cured versus viraemic individuals. At the end of 2020, we estimated 117,810 Australians were living with chronic HCV. New cases per year of DC, HCC, and liver-related mortality among the HCV viraemic population decreased rapidly from 2015 (almost eliminated by 2030). In contrast, the growing population size of those cured with advanced liver disease meant DC, HCC, and liver-related mortality declined slowly. The estimated reduction in liver-related mortality from 2015 to 2030 in the combined HCV viraemic and cured population is 25% in the intermediate scenario. With declining HCV treatment uptake and ongoing individual-level risk of advanced liver disease complications, including among cirrhosis-cured individuals, Australia is unlikely to achieve all WHO HCV elimination targets by 2030.

Management of demographic equality of access to family intervention for psychosis in specialist community mental healthcare teams

Background/Aims UK mental health services must provide evidence-based psychological treatments, including family intervention, to every service user diagnosed with psychosis. Although healthcare managers are required to ensure equitable delivery of prescribed core treatments, in practice equality of access remains debatable. This study investigates equality of access to family intervention for psychosis. Subsequent treatment uptake and engagement are also examined. The role of healthcare records in equality management is considered. Methods Retrospective analysis of electronic medical records of 244 service users across four specialist early intervention teams in London in 2018 was undertaken using binary logistic regression and multiple linear regression. Bonferroni adjustment was applied to control for type 1 errors. Results Participants were found to have equal access to the nationally endorsed treatment across all demographic variables. Likewise, treatment uptake and engagement were equally distributed. Conclusions An overall compliance with national policies was shown, demonstrating that equal provision of core treatment for psychosis is achievable. As discrepancies in record keeping were shown to impede the data extraction process, suggestions were made for the management of electronic medical records in mental healthcare services.

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

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.