ViewpointRestrictions on access to direct-acting antivirals for people who inject drugs: The European Hep-CORE study and the role of patient groups in monitoring national HCV responses
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Conflict of interest
No conflicts of interested reported by the authors.
Funding
This work was supported by unrestricted grants from AbbVie Inc., Gilead Sciences Inc., and MSD.
Disclosures
No disclosures reported.
Role of authors
JVL was the Hep-CORE studýs principal investigator. KSH, JVL, MH and SRS drafted the article with input from the co-authors. KSH also served as the Hep-CORE study coordinator and SRS as the data manager. MH, MJR, MM, TR, ES, and JT were part of the Hep-CORE study group and contributed to the development of the original study instrument as well as providing expert input for the article. All authors reviewed and approved the final draft of the article.
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Medical provider stigma experienced by people who use drugs (MPS-PWUD): Development and validation of a scale among people who currently inject drugs in New York City
2021, Drug and Alcohol DependenceCitation Excerpt :Nurses also reported experiencing little motivation and low satisfaction in caring for SUD patients, further perceiving them as emotionally challenging and potentially unsafe (Ford, 2011). As summarized by Goodyear et al. (2020), health care providers have been reluctant to provide Hepatitis C treatment to PWID due to concerns such as questioning PWID’s capacity for adherence to medication regimens (Grebely et al., 2017; Krook et al., 2007), risk of HCV re-infection (Asher et al., 2016; Grebely et al., 2017; Lazarus et al., 2017), a presumed lack of motivation to engage in HCV treatment (Litwin et al., 2019; Treloar et al., 2010), and history of substance use (Boerekamps et al., 2018; Litwin et al., 2019). In turn, this stigma may also impact how PWUD respond to and engage in medical treatment.
“Everybody living with a chronic disease is entitled to be cured”: Challenges and opportunities in scaling up access to direct-acting antiviral hepatitis C virus treatment among people who inject drugs
2020, International Journal of Drug PolicyCitation Excerpt :These ongoing barriers include, for instance, disinclination to seek treatment due to being asymptomatic of HCV, concerns about having to undergo phlebotomy (e.g., due to poor vein health), hesitancy related to treatment side effects, and the prioritization of other health and social concerns over one's HCV status (Harris et al., 2018; Litwin et al., 2019; Madden, Hopwood, Neale, & Treloar, 2018; Marshall et al., 2020). It is also well documented that healthcare providers have historically been overly paternalistic in their approach to providing HCV treatment to PWID, with previous research across Interferon- and DAA-based HCV treatment eras indicating that care providers have raised concerns about: capacity for optimal adherence among PWID (Grebely et al., 2017; Krook, Stokka, Heger, & Nygaard, 2007); the potential for HCV re-infection in the context of costly treatment regimens (Asher et al., 2016; Grebely et al., 2017; Lazarus et al., 2017); a presumed lack of motivation or capacity among PWID living with HCV (Litwin et al., 2019; Treloar, Newland, Rance, & Hopwood, 2010); and the negative impact of co-morbid human immunodeficiency virus (HIV) co-infection (Panagiotoglou et al., 2017; Scott et al., 2009), and past, current, or anticipated substance use (Boerekamps et al., 2018; Litwin et al., 2019). Despite these concerns, a growing body of clinical and behavioural evidence indicates that PWID are able to be successfully cured of HCV with DAAs at rates comparable to other populations (Asher et al., 2016; Chan, Young, Cox, Nitulescu, & Klein, 2018; Harris, 2017).
The removal of DAA restrictions in Europe – One step closer to eliminating HCV as a major public health threat
2018, Journal of HepatologyCitation Excerpt :Testing, diagnosis, linkage to care and treatment uptake must be improved in Europe in order for WHO elimination targets to be achieved. A major barrier to enhancing HCV treatment uptake has been restrictions set by payers, including national governments and others, in response to the initially high list prices of DAA therapies.30–34 This resulted in the prioritisation of DAA therapy based on liver disease stage and may have influenced restrictions based on prescriber type (e.g. limited to prescribing by specialists, typically gastroenterologists, hepatologists, and infectious diseases specialists), and recent drug/alcohol use.
Achieving hepatitis C elimination in Europe – To treatment scale-up and beyond
2018, Journal of HepatologyThe contribution of alcohol use disorder to decompensated cirrhosis among people with hepatitis C: An international study
2018, Journal of HepatologyCitation Excerpt :The WHO HCV elimination strategy has highlighted the need to address alcohol use as a common co-morbidity among people with HCV infection;2 yet, reducing the impact of alcohol is not included among target areas. Restriction of access to DAA treatment on the basis of ongoing alcohol use is present in many settings,5,6 further potentially impacting treatment programmes in WHO regions with higher per capita alcohol consumption.7 Globally, British Columbia, Canada; New South Wales, Australia, and Scotland are among the few settings with established surveillance systems that enable monitoring of people with HCV infection, by linkage between HCV diagnosis databases and hospitalisation records.