Potential interventions to support HCV treatment uptake among HIV co-infected people in Canada: Perceptions of patients and health care providers.

Canadian liver journal Pub Date : 2022-02-04 eCollection Date: 2022-01-01 DOI:10.3138/canlivj-2021-0021
David Ortiz-Paredes, Afia Amoako, David Lessard, Kim Engler, Bertrand Lebouché, Marina B Klein
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引用次数: 3

Abstract

Background: Increasing direct-acting antiviral (DAA) treatment uptake is key to eliminating HCV infection as a public health threat in Canada. People living with human immunodeficiency virus (HIV) and hepatitis C (HCV) co-infection face barriers to HCV treatment initiation. We sought to identify interventions that could support HCV treatment initiation based on patient and HCV care provider perspectives.

Methods: Eleven people living with HIV with a history of HCV infection and 12 HCV care providers were recruited for this qualitative descriptive study. Participants created ranked-ordered lists of potential interventions during nominal groups (n = 4) and individual interviews (n = 6). Following the nominal group technique, transcripts and intervention lists underwent thematic analysis and ranking scores were merged to create consolidated and prioritized lists from patient and provider perspectives.

Results: Patient participants identified a total of eight interventions. The highest-ranked interventions were multidisciplinary clinics, HCV awareness campaigns and patient education, nurse- or pharmacist-led care, peer involvement, and more and better-prepared health professionals. Provider participants identified 11 interventions. The highest-ranked were mobile outreach, DAA initiation at pharmacies, a simplified process of DAA prescription, integration of primary and specialist care, and patient-centred approaches.

Conclusion: Participants proposed alternatives to hospital-based specialist HCV care, which require increasing capacity for nurses, pharmacists, primary care providers, and peers to have more direct roles in HCV treatment provision. They also identified the need for structural changes and educational initiatives. In addition to optimizing HCV care, these interventions might result in broader benefits for the health of HIV-HCV co-infected people.

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支持加拿大HIV合并感染者接受HCV治疗的潜在干预措施:患者和卫生保健提供者的看法
背景:在加拿大,增加直接抗病毒药物(DAA)治疗是消除HCV感染这一公共卫生威胁的关键。人类免疫缺陷病毒(HIV)和丙型肝炎(HCV)合并感染的患者在开始HCV治疗时面临障碍。我们试图从患者和HCV护理提供者的角度确定可以支持HCV治疗开始的干预措施。方法:本定性描述性研究招募了11名有HCV感染史的HIV感染者和12名HCV医护人员。参与者在名义小组(n = 4)和个人访谈(n = 6)期间创建了潜在干预措施的排序列表。按照名义小组技术,成绩单和干预列表进行了主题分析,并合并了排名分数,从患者和提供者的角度创建了统一的优先级列表。结果:患者参与者确定了总共8种干预措施。排名最高的干预措施是多学科诊所、丙型肝炎病毒宣传运动和患者教育、护士或药剂师主导的护理、同伴参与以及更多和准备更充分的卫生专业人员。提供者参与者确定了11项干预措施。排名最高的是移动推广、在药店启动DAA、简化DAA处方流程、初级保健和专科保健的整合以及以患者为中心的方法。结论:参与者提出了以医院为基础的丙型肝炎专科治疗的替代方案,这需要增加护士、药剂师、初级保健提供者和同行在丙型肝炎治疗提供中发挥更直接作用的能力。他们还确定了结构改革和教育倡议的必要性。除了优化HCV护理外,这些干预措施可能会对HIV-HCV合并感染者的健康产生更广泛的益处。
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