Donna M Evon1, Hannah P Kim2, Angela Edwards3, Jessica Carda-Auten4, Bryce B Reeve5, Carol E Golin6, Michael W Fried7. 1. Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, Burnett-Womack Building CB #7584, Chapel Hill, NC, 27599, USA. donna_evon@med.unc.edu. 2. Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, 130 Mason Farm Road, Bioinformatics Building CB #7080, Chapel Hill, NC, 27599, USA. 3. Division of Global Health and Infectious Disease, Department of Medicine, University of North Carolina, 130 Mason Farm Road, Bioinformatics Building, Chapel Hill, NC, 27599, USA. 4. Institute for Global Health and Infectious Diseases, Connected Health Applications and Interventions Core, University of North Carolina, 130 Mason Farm Road, Bioinformatics Building CB #7030, Chapel Hill, NC, 27599, USA. 5. Department of Population Health Sciences and Department of Pediatrics, Duke University School of Medicine, 215 Morris Street, Suite 230 DUMC 104023, Durham, NC, 27701, USA. 6. Division of General Medicine and Clinical Epidemiology, Department of Medicine, Department of Health Behaviors, University of North Carolina, 135 Dauer Drive CB #7440, Chapel Hill, NC, 27599, USA. 7. Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, Burnett-Womack Building CB #7584, Chapel Hill, NC, 27599, USA.
Abstract
BACKGROUND: Patients' motivations for undergoing direct-acting antiviral (DAA) therapy for chronic hepatitis C may include anticipation of treatment benefits not well described in the literature. AIMS: Evaluate patients' anticipated and actualized improvements in several domains of functioning before and after viral cure. METHODS: Pre-post-study utilizing in-depth interviews with 28 patients prior to, and several months after, DAA therapy. Interviews were audio-recorded, transcribed, coded, and analyzed by two qualitative experts. RESULTS: Patients had a median age of 54 years, 43% were male, 57% white, 25% had cirrhosis, and 71% were treated with sofosbuvir/ledipasvir. Pre-treatment, patients hoped for improvements in several domains including psychological, emotional, physical, social, and occupational functioning. After viral cure, increased energy and less fear of transmission were pathways to better quality of life. Psychological and emotional improvements positively affected physical, social, and occupational functioning. Social improvements were due to better mood and motivation, fewer symptoms, and reduced fear of stigma and transmission. Occupational benefits were linked to increased stamina, self-confidence, and less pain, anxiety, and stigma. Reduced fear of stigma had a pervasive impact on all life improvements after cure. Patient characteristics such as the presence of cirrhosis or psychiatric issues influence treatment motivations. Qualitative data correspond with change in pre-post-survey scores. CONCLUSIONS: Tremendous hope is placed on the ability of DAA therapy to bring about substantial improvements in life functioning after viral cure. Highly interconnected effects on quality of life worked synergistically through improved physical and psychological well-being. Stakeholders should appreciate the multi-dimensional benefits that viral eradication bestows upon individuals and society.
BACKGROUND: Patients' motivations for undergoing direct-acting antiviral (DAA) therapy for chronic hepatitis C may include anticipation of treatment benefits not well described in the literature. AIMS: Evaluate patients' anticipated and actualized improvements in several domains of functioning before and after viral cure. METHODS: Pre-post-study utilizing in-depth interviews with 28 patients prior to, and several months after, DAA therapy. Interviews were audio-recorded, transcribed, coded, and analyzed by two qualitative experts. RESULTS: Patients had a median age of 54 years, 43% were male, 57% white, 25% had cirrhosis, and 71% were treated with sofosbuvir/ledipasvir. Pre-treatment, patients hoped for improvements in several domains including psychological, emotional, physical, social, and occupational functioning. After viral cure, increased energy and less fear of transmission were pathways to better quality of life. Psychological and emotional improvements positively affected physical, social, and occupational functioning. Social improvements were due to better mood and motivation, fewer symptoms, and reduced fear of stigma and transmission. Occupational benefits were linked to increased stamina, self-confidence, and less pain, anxiety, and stigma. Reduced fear of stigma had a pervasive impact on all life improvements after cure. Patient characteristics such as the presence of cirrhosis or psychiatric issues influence treatment motivations. Qualitative data correspond with change in pre-post-survey scores. CONCLUSIONS: Tremendous hope is placed on the ability of DAA therapy to bring about substantial improvements in life functioning after viral cure. Highly interconnected effects on quality of life worked synergistically through improved physical and psychological well-being. Stakeholders should appreciate the multi-dimensional benefits that viral eradication bestows upon individuals and society.
Authors: Dinesh Khanna; Ron D Hays; Andrew B Shreiner; Gil Y Melmed; Lin Chang; Puja P Khanna; Roger Bolus; Cynthia Whitman; Sylvia H Paz; Tonya Hays; Steven P Reise; Brennan Spiegel Journal: Dig Dis Sci Date: 2017-03-01 Impact factor: 3.199