Grace Zhang1, Krupa Patel2, Akshata Moghe3, Andrea Reid4, Marina Serper5,6, Linda Calgaro7, Sandra Gibson8, Susan Zickmund9,10, Obaid Shaikh3,7, Shari Rogal11,12,13,14. 1. University of Pittsburgh School of Medicine, Pittsburgh, PA, 15261, USA. 2. Division of General Internal Medicine, University of Pittsburgh School of Medicine, UPMC Montefiore Hospital, Suite W933, 200 Lothrop Street, Pittsburgh, PA, 15213, USA. 3. Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh, Pittsburgh, PA, 15213, USA. 4. Gastroenterology, Hepatology, and Nutrition Section, Washington DC VA Medical Center, 50 Irving Street, NW, Room 3A-149, Washington, DC, 20422, USA. 5. Division of Gastroenterology, Department of Medicine, School of Medicine, University of Pennsylvania, 3400 Spruce Street, Dulles, Philadelphia, PA, 19104, USA. 6. Gastroenterology Section, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, 19104, USA. 7. VA Pittsburgh Healthcare System, Pittsburgh, PA, 15240, USA. 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. 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. 10. Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT, 84132, USA. 11. Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh, Pittsburgh, PA, 15213, USA. rogalss@upmc.edu. 12. VA Pittsburgh Healthcare System, Pittsburgh, PA, 15240, USA. rogalss@upmc.edu. 13. Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Building 30, Room 2A113, University Drive C (151C), Pittsburgh, PA, 15240-1001, USA. rogalss@upmc.edu. 14. Department of Surgery, University of Pittsburgh, Pittsburgh, PA, 15213, USA. rogalss@upmc.edu.
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.
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.
Entities:
Keywords:
Addiction; Attitude of health personnel; Compliance; Direct-acting antiviral agents
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