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Provider Perceptions of Hepatitis C Treatment Adherence and Initiation

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Abstract

Background

Significant disparities in hepatitis C (HCV) treatment existed in the interferon treatment era, such that patients with mental health and substance use disorders were less likely to be treated. We aimed to evaluate whether these perceptions continue to influence HCV treatment decisions.

Methods

We e-mailed HCV providers a survey to assess their perceptions of barriers to HCV treatment adherence and initiation. We assessed the frequency of perceived barriers and willingness to initiate HCV treatment in patients with these barriers. We identified a group of providers more willing to treat patients with perceived barriers to adherence and determined the associated provider characteristics using Spearman’s rho and Wilcoxon rank-sum tests.

Results

A total of 103 providers (29%) responded to the survey. The most commonly endorsed perceived barriers to adherence were homelessness (65%), ongoing drug (58%), and ongoing alcohol use (33%). However, 90%, 68%, and 90% of providers were still willing to treat patients with these comorbidities, respectively. Ongoing drug use was the most common reason providers were never or rarely willing to initiate HCV treatment. Providers who were less willing to initiate treatment more frequently endorsed patient-related determinants of adherence, while providers who were more willing to initiate treatment more frequently endorsed provider-based barriers to adherence (e.g., communication).

Conclusions

Most responding providers were willing to initiate HCV treatment in all patients, despite the presence of perceived barriers to adherence or previous contraindications to interferon-based treatments. Ongoing substance use remains the most prominent influencer in the decision not to treat.

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References

  1. Rosenberg ES, Rosenthal EM, Hall EW, et al. Prevalence of hepatitis C virus infection in US states and the district of Columbia, 2013 to 2016. JAMA Netw Open. 2018;1:e186371.

    Article  Google Scholar 

  2. Dominitz JA, Boyko EJ, Koepsell TD, et al. Elevated prevalence of hepatitis C infection in users of United States veterans medical centers. Hepatology. 2005;41:88–96.

    Article  Google Scholar 

  3. Lam BP, Jeffers T, Younoszai Z, Fazel Y, Younossi ZM. The changing landscape of hepatitis C virus therapy: focus on interferon-free treatment. Ther Adv Gastroenterol. 2015;8:298–312.

    Article  CAS  Google Scholar 

  4. Chainuvati S, Khalid SK, Kancir S, et al. Comparison of hepatitis C treatment patterns in patients with and without psychiatric and/or substance use disorders. J Viral Hepat. 2006;13:235–241.

    Article  CAS  Google Scholar 

  5. Feld JJ, Jacobson IM, Hezode C, et al. Sofosbuvir and velpatasvir for HCV genotype 1, 2, 4, 5, and 6 infection. N Engl J Med. 2015;373:2599–2607.

    Article  CAS  Google Scholar 

  6. Poordad F, Hezode C, Trinh R, et al. ABT-450/r-ombitasvir and dasabuvir with ribavirin for hepatitis C with cirrhosis. N Engl J Med. 2014;370:1973–1982.

    Article  CAS  Google Scholar 

  7. Sulkowski MS, Gardiner DF, Rodriguez-Torres M, et al. Daclatasvir plus sofosbuvir for previously treated or untreated chronic HCV infection. N Engl J Med. 2014;370:211–221.

    Article  CAS  Google Scholar 

  8. Zeuzem S, Ghalib R, Reddy KR, et al. Grazoprevir–elbasvir combination therapy for treatment-naive cirrhotic and noncirrhotic patients with chronic hepatitis C virus genotype 1, 4, or 6 infection: a randomized trial. Ann Intern Med. 2015;163:1–13.

    Article  Google Scholar 

  9. Afdhal N, Reddy KR, Nelson DR, et al. Ledipasvir and sofosbuvir for previously treated HCV genotype 1 infection. N Engl J Med. 2014;370:1483–1493.

    Article  CAS  Google Scholar 

  10. Sustained virologic response in veterans in VHA care starting DAA therapy in 2014 or later for the Nation. Accessed January 6, 2019.

  11. World Health Organization. Combating hepatitis B and C to reach elimination by 2030: advocacy brief. 2016; http://www.who.int/iris/handle/10665/206453. Accessed March 14, 2019.

  12. Rossi C, Young J, Martel-Laferriere V, et al. Direct-acting antiviral treatment failure among hepatitis C and HIV-coinfected patients in clinical care. Open Forum Infect Dis. 2019;6(3):ofz055.

    Article  CAS  Google Scholar 

  13. Soriano V, Vispo E, Poveda E, Labarga P, Barreiro P. Treatment failure with new hepatitis C drugs. Expert Opin Pharmacother. 2012;13:313–323.

    Article  CAS  Google Scholar 

  14. Benitez-Gutierrez L, Barreiro P, Labarga P, et al. Prevention and management of treatment failure to new oral hepatitis C drugs. Expert Opin Pharmacother. 2016;17:1215–1223.

    Article  CAS  Google Scholar 

  15. Buti M, Esteban R. Management of direct antiviral agent failures. Clin Mol Hepatol. 2016;22:432–438.

    Article  Google Scholar 

  16. Rogal SS, McCarthy R, Reid A, et al. Primary care and hepatology provider-perceived barriers to and facilitators of hepatitis C treatment candidacy and adherence. Dig Dis Sci. 2017;62:1933–1943. https://doi.org/10.1007/s10620-017-4608-9.

    Article  PubMed  Google Scholar 

  17. Chesney MA, Ickovics JR, Chambers DB, et al. Self-reported adherence to antiretroviral medications among participants in HIV clinical trials: the AACTG adherence instruments. Patient Care Committee & Adherence Working Group of the Outcomes Committee of the Adult AIDS Clinical Trials Group (AACTG). AIDS Care. 2000;12(3):255–266.

    Article  CAS  Google Scholar 

  18. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42:377–381.

    Article  Google Scholar 

  19. Palmer RE, Carrell DS, Cronkite D, et al. The prevalence of problem opioid use in patients receiving chronic opioid therapy: computer-assisted review of electronic health record clinical notes. Pain. 2015;156:1208–1214.

    Article  Google Scholar 

  20. Grebely J, Alavi M, Micallef M, et al. Treatment for hepatitis C virus infection among people who inject drugs attending opioid substitution treatment and community health clinics: the ETHOS Study. Addiction. 2016;111:311–319.

    Article  Google Scholar 

  21. Grebely J, Dalgard O, Conway B, et al. Sofosbuvir and velpatasvir for hepatitis C virus infection in people with recent injection drug use (SIMPLIFY): an open-label, single-arm, phase 4, multicentre trial. Lancet Gastroenterol Hepatol. 2018;3:153–161.

    Article  Google Scholar 

  22. Read P, Lothian R, Chronister K, et al. Delivering direct acting antiviral therapy for hepatitis C to highly marginalised and current drug injecting populations in a targeted primary health care setting. Int J Drug Policy. 2017;47:209–215.

    Article  Google Scholar 

  23. Zibbell JE, Asher AK, Patel RC, et al. Increases in acute hepatitis C virus infection related to a growing opioid epidemic and associated injection drug use, United States, 2004 to 2014. Am J Public Health. 2018;108:175–181.

    Article  Google Scholar 

  24. Taylor J, Carr-Lopez S, Robinson A, et al. Determinants of treatment eligibility in veterans with hepatitis C viral infection. Clin Ther. 2017;39:130–137.

    Article  Google Scholar 

  25. Tsui JI, Williams EC, Green PK, Berry K, Su F, Ioannou GN. Alcohol use and hepatitis C virus treatment outcomes among patients receiving direct antiviral agents. Drug Alcohol Depend. 2016;169:101–109.

    Article  CAS  Google Scholar 

  26. Rogal SS, Arnold RM, Chapko M, et al. The patient-provider relationship is associated with hepatitis C treatment eligibility: a prospective mixed-methods cohort study. PLoS ONE. 2016;11:e0148596.

    Article  CAS  Google Scholar 

  27. Noska AJ, Belperio PS, Loomis TP, O’Toole TP, Backus LI. Prevalence of human immunodeficiency virus, hepatitis C virus, and hepatitis B virus among homeless and nonhomeless United States veterans. Clin Infect Dis. 2017;65:252–258.

    Article  Google Scholar 

  28. Beste LA, Ioannou GN. Prevalence and treatment of chronic hepatitis C virus infection in the US Department of Veterans Affairs. Epidemiol Rev.. 2015;37:131–143.

    Article  Google Scholar 

  29. Bini EJ, Brau N, Currie S, et al. Prospective multicenter study of eligibility for antiviral therapy among 4,084 U.S. veterans with chronic hepatitis C virus infection. Am J Gastroenterol. 2005;100(8):1772–1779.

    Article  Google Scholar 

  30. Mishra G, Sninsky C, Roswell R, Fitzwilliam S, Hyams KC. Risk factors for hepatitis C virus infection among patients receiving health care in a Department of Veterans Affairs hospital. Dig Dis Sci. 2003;48:815–820. https://doi.org/10.1023/A:1022865515735.

    Article  PubMed  Google Scholar 

  31. Noska AJ, Belperio PS, Loomis TP, O’Toole TP, Backus LI. Engagement in the hepatitis C care cascade among homeless veterans, 2015. Public Health Rep. 2017;132:136–139.

    Article  Google Scholar 

  32. Rich ZC, Chu C, Mao J, et al. Facilitators of HCV treatment adherence among people who inject drugs: a systematic qualitative review and implications for scale up of direct acting antivirals. BMC Public Health. 2016;16:994.

    Article  Google Scholar 

  33. Chaiyachati KH, Hubbard RA, Yeager A, et al. Association of rideshare-based transportation services and missed primary care appointments: a clinical trial. JAMA Intern Med. 2018;178:383–389.

    Article  Google Scholar 

  34. Cunningham CT, Quan H, Hemmelgarn B, et al. Exploring physician specialist response rates to web-based surveys. BMC Med Res Methodol. 2015;15:32.

    Article  Google Scholar 

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Acknowledgments

The contents of this article are the views of the authors alone and do not represent the views of the Department of Veterans Affairs or the United States Government.

Funding

This study was funded by an investigator-initiated research grant from Gilead Sciences to the institution.

Author information

Authors and Affiliations

  1. University of Pittsburgh School of Medicine, Pittsburgh, PA, 15261, USA

    Grace Zhang

  2. Division of General Internal Medicine, University of Pittsburgh School of Medicine, UPMC Montefiore Hospital, Suite W933, 200 Lothrop Street, Pittsburgh, PA, 15213, USA

    Krupa Patel

  3. Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh, Pittsburgh, PA, 15213, USA

    Akshata Moghe, Obaid Shaikh & Shari Rogal

  4. Gastroenterology, Hepatology, and Nutrition Section, Washington DC VA Medical Center, 50 Irving Street, NW, Room 3A-149, Washington, DC, 20422, USA

    Andrea Reid

  5. Division of Gastroenterology, Department of Medicine, School of Medicine, University of Pennsylvania, 3400 Spruce Street, Dulles, Philadelphia, PA, 19104, USA

    Marina Serper

  6. Gastroenterology Section, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, 19104, USA

    Marina Serper

  7. VA Pittsburgh Healthcare System, Pittsburgh, PA, 15240, USA

    Linda Calgaro, Obaid Shaikh & Shari Rogal

  8. Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Building 30, Room 2A113, University Drive C (151C), Pittsburgh, PA, 15240-1001, USA

    Sandra Gibson & Shari Rogal

  9. VA HSR&D IDEAS 2.0 Center of Innovation, VA Salt Lake City Heath Care System, 500 Foothill Drive, Salt Lake City, UT, 84148, USA

    Susan Zickmund

  10. Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT, 84132, USA

    Susan Zickmund

  11. Department of Surgery, University of Pittsburgh, Pittsburgh, PA, 15213, USA

    Shari Rogal

Authors
  1. Grace Zhang
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  2. Krupa Patel
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  3. Akshata Moghe
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Correspondence to Shari Rogal.

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Zhang, G., Patel, K., Moghe, A. et al. Provider Perceptions of Hepatitis C Treatment Adherence and Initiation. Dig Dis Sci 65, 1324–1333 (2020). https://doi.org/10.1007/s10620-019-05877-z

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  • DOI: https://doi.org/10.1007/s10620-019-05877-z

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