Sabrina Molinaro1, Giuliano Resce1, Alfredo Alberti2, Massimo Andreoni3, Pietro P F D Egidio4, Claudio Leonardi5, Felice A Nava6, Patrizio Pasqualetti7, Stefano Villa8,9. 1. Institute of Clinical Physiology, National Research Council of Italy (IFC-CNR), Pisa, Italy. 2. Dipartimento di Medicina Molecolare, Università di Padova, Padua, Italy. 3. Clinica Malattie Infettive, Dipartimento di Medicina dei Sistemi, Università di Roma Tor Vergata, Rome, Italy. 4. Presidente FeDerSerD - Federazione Italiana degli Operatori dei Dipartimenti e dei Servizi delle Dipendenze, Como, Italy. 5. UOC Prevenzione e Cura Tossicodipendenze ed Alcolismo, ASL Roma "C", Rome, Italy. 6. Azienda ULSS 16 di Padova, Distretto Socio-Sanitario n. 1, Struttura Semplice Dipartimentale "Sanità Penitenziaria", Padua, Italy. 7. Fondazione Fatebenefratelli per la Ricerca e la Formazione Sanitaria e Sociale, Rome, Italy. 8. Dipartimento di Scienze dell'Economia e della Gestione Aziendale, Università Cattolica del Sacro Cuore, Rome, Italy. 9. CERISMAS (Research Centre in Healthcare Management), Università Cattolica del Sacro Cuore, Milan, Italy.
Abstract
INTRODUCTION AND AIMS: People who inject drugs (PWID) constitute the largest reservoir of hepatitis C virus (HCV). Although effective medications are available and access to care is universal in Italy, the proportion of PWID receiving appropriate care remains low. DESIGN AND METHODS: To identify the major barriers for PWID to HCV treatment we surveyed a large sample of practitioners working in outpatient addiction centres (SerDs). The survey was conducted in two stages and involved 30.3% of SerDs operating in Italy. In the first, SerD physicians completed a questionnaire designed with a Delphi structure. In the second, SerD practitioners completed a targeted questionnaire to identify barriers to four SerD services in HCV management: screening, referral, treatment and harm reduction. RESULTS: The first-stage questionnaire, in which a Delphi and RAND-UCLA method was used, revealed a lack of agreement among the physicians about barriers to health care. The more detailed second-stage questionnaire indicated the barriers to delivering specific SerD services. As regarded the delivery of all four services, the major reasons for treating <50% of patients were: physician and nurse understaffing, technical, economic and logistic issues. In contrast, the practitioners who responded that they follow protocol recommendations often deliver all four services to >50% of patients. DISCUSSION AND CONCLUSIONS: HCV treatment remains out of reach for many PWID attending a drug treatment centre in Italy. To meet the World Health Organisation (WHO) target, there is a need to increase economic, technical and staff support at treatment centres using the protocols and the universal health care already in place.
INTRODUCTION AND AIMS: People who inject drugs (PWID) constitute the largest reservoir of hepatitis C virus (HCV). Although effective medications are available and access to care is universal in Italy, the proportion of PWID receiving appropriate care remains low. DESIGN AND METHODS: To identify the major barriers for PWID to HCV treatment we surveyed a large sample of practitioners working in outpatient addiction centres (SerDs). The survey was conducted in two stages and involved 30.3% of SerDs operating in Italy. In the first, SerD physicians completed a questionnaire designed with a Delphi structure. In the second, SerD practitioners completed a targeted questionnaire to identify barriers to four SerD services in HCV management: screening, referral, treatment and harm reduction. RESULTS: The first-stage questionnaire, in which a Delphi and RAND-UCLA method was used, revealed a lack of agreement among the physicians about barriers to health care. The more detailed second-stage questionnaire indicated the barriers to delivering specific SerD services. As regarded the delivery of all four services, the major reasons for treating <50% of patients were: physician and nurse understaffing, technical, economic and logistic issues. In contrast, the practitioners who responded that they follow protocol recommendations often deliver all four services to >50% of patients. DISCUSSION AND CONCLUSIONS:HCV treatment remains out of reach for many PWID attending a drug treatment centre in Italy. To meet the World Health Organisation (WHO) target, there is a need to increase economic, technical and staff support at treatment centres using the protocols and the universal health care already in place.
Authors: Aliza Monroe-Wise; Loice Mbogo; Brandon Guthrie; David Bukusi; Betsy Sambai; Bhavna Chohan; John Scott; Peter Cherutich; Helgar Musyoki; Rose Bosire; Matthew Dunbar; Paul Macharia; Sarah Masyuko; Eduan Wilkinson; Tulio De Oliveira; Natasha Ludwig-Barron; Bill Sinkele; Joshua Herbeck; Carey Farquhar Journal: BMJ Open Date: 2021-04-24 Impact factor: 2.692