1
|
Snow K, MacLachlan JH, Rowe S, Higgins N, Cowie BC. The cascade of care for hepatitis C in Victoria, Australia: a data linkage cohort study. Intern Med J 2024. [PMID: 38504432 DOI: 10.1111/imj.16361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 02/01/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Highly effective hepatitis C therapies are available in Australia. However, people living with hepatitis C face various barriers to accessing care and treatment. AIMS To identify gaps in the cascade of care for hepatitis C and generate estimates of the number living with untreated infection according to population group, using a representative longitudinal study population. METHODS We linked hepatitis C notification data from Victoria to national pathology, prescribing and death registry data. We assessed receipt of key clinical services in a large cohort who tested positive for hepatitis C from 1 January 2000 to 31 December 2016, with follow-up to 30 June 2018. We estimated the number still living with hepatitis C, adjusting for spontaneous clearance and mortality. RESULTS The cohort comprised 45 391 people positive for hepatitis C. Of these, 13 346 (29%) received treatment and an estimated 28% (95% confidence interval (CI): 26-30%) were still living with chronic infection at 30 June 2018, with the remainder still living following spontaneous clearance (30%, 95% CI: 29-32%) or having died (12%, 95% CI: 12-12%). Half (50%) of those still living with hepatitis C were born from 1965 to 1980, and 74% first tested positive before 2011. CONCLUSIONS Despite an enabling policy environment and subsidised therapy, many people in this cohort were not treated. Increased measures may be needed to engage people in care, including those who acquired hepatitis C more than 10 years ago.
Collapse
Affiliation(s)
- Kathryn Snow
- WHO Collaborating Centre for Viral Hepatitis, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Jennifer H MacLachlan
- WHO Collaborating Centre for Viral Hepatitis, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Department of Infectious Diseases, University of Melbourne, Melbourne, Victoria, Australia
| | - Stacey Rowe
- Victorian Government Department of Health, Melbourne, Victoria, Australia
- School of Population Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Nasra Higgins
- Victorian Government Department of Health, Melbourne, Victoria, Australia
| | - Benjamin C Cowie
- WHO Collaborating Centre for Viral Hepatitis, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Department of Infectious Diseases, University of Melbourne, Melbourne, Victoria, Australia
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| |
Collapse
|
2
|
Sutherland R, Peacock A, Crawford S, Holly C, Gava P, Dicka J, Manu G, Byrne J. Information acquisition and dissemination among a sample of people who inject drugs in Australia. Drug Alcohol Rev 2023. [PMID: 37952935 DOI: 10.1111/dar.13765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 09/13/2023] [Accepted: 10/02/2023] [Indexed: 11/14/2023]
Abstract
INTRODUCTION This paper examines the acquisition and dissemination of harm reduction information among people who inject drugs, as well as preferred sources of information. METHODS Data were obtained from 862 people who inject drugs, recruited from Australian capital cities for the 2021 Illicit Drug Reporting System. Multivariable regression analyses were performed to assess potential factors associated with knowledge sharing. RESULTS Almost two-fifths (37%) reported that they had received information about how to keep themselves safe when using drugs within the past 6 months. Reporting on their last occasion of receiving information, participants stated that it was commonly about injecting practices (56%), overdose prevention (26%) and injection-related injuries (22%), and was mostly received from an alcohol and other drug worker (54%), followed by other health professional (24%) and social network (18%). Among those who reported receiving information, 50% shared this information with other people, predominantly with their social network: no factors were found to be significantly associated with sharing information. The majority reported that peer workers and/or people with lived experience would be the first person they would talk to for information about a range of topics (e.g., injecting/harm reduction practices, overdose prevention). DISCUSSION AND CONCLUSIONS Two in five participants had recently obtained information about how to keep themselves safe while using drugs, with half sharing this information with their social network. Peer workers were the preferred source of information, suggesting that the peer educator workforce should be expanded to embrace the capacities and expertise of people who inject drugs.
Collapse
Affiliation(s)
- Rachel Sutherland
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Amy Peacock
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
- School of Psychological Sciences, University of Tasmania, Hobart, Australia
| | | | | | - Peta Gava
- Peer Based Harm Reduction WA, Perth, Australia
| | - Jane Dicka
- Harm Reduction Victoria, Melbourne, Australia
| | - Geoff Manu
- Australian Injecting and Illicit Drug Users League, Canberra, Australia
| | - Jude Byrne
- Australian Injecting and Illicit Drug Users League, Canberra, Australia
| |
Collapse
|
3
|
Clay S, Treloar C, Degenhardt L, Grebely J, Christmass M, Gough C, Hayllar J, McDonough M, Henderson C, Crawford S, Farrell M, Marshall A. 'I just thought that was the best thing for me to do at this point': Exploring patient experiences with depot buprenorphine and their motivations to discontinue. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 115:104002. [PMID: 37003194 DOI: 10.1016/j.drugpo.2023.104002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 04/03/2023]
Abstract
INTRODUCTION Long-acting injectable depot buprenorphine is a recent addition to the suite of opioid agonist therapies (OAT) used to treat opioid use disorder (OUD). However, there has been little research that focuses on the lived experience of people receiving depot buprenorphine treatment and reasons for why people decide to discontinue. The aim of this study was to explore what it is like to receive depot buprenorphine and to understand the motivations behind why people discontinue. METHODS Open-ended, semi-structured interviews were conducted between November 2021 and January 2022 with individuals who were either currently receiving depot buprenorphine or had discontinued or were in the process of discontinuing depot buprenorphine. Liberati, et al.'s (2022) adaptation of Dixon-Woods's (2006) candidacy framework was used to analyse the participant experiences. RESULTS 40 participants (26 male, 13 female, 1 undisclosed; mean age 42 years) were interviewed about their experience with depot buprenorphine. At the time of the interview, 21 were currently receiving depot buprenorphine and 19 had discontinued this treatment or were in the process of discontinuing. Participants cited 4 key reasons why they decided to discontinue depot buprenorphine:1) feeling forced into the program, 2) experiencing negative side-effects, 3) finding the treatment ineffective, and 4) wanting to stop depot buprenorphine/OAT to use opioids again or feeling 'cured' and no longer in need of OAT. Participants were ultimately discussing issues related to clinician-patient power relations, agency and bodily autonomy, and the pursuit of well-being. CONCLUSION Depot buprenorphine remains a promising treatment for OUD and offers potential to improve treatment adherence. Instances of restricted OAT choice and consumer concerns regarding a lack of agency must be addressed in order to enhance therapeutic relationships. Clinicians and other healthcare workers in this field also need greater access to information about depot buprenorphine to better address issues patients face during treatment. More research is required to understand patient and treatment choice given the options of these new treatment formulations.
Collapse
Affiliation(s)
- Simon Clay
- National Drug & Alcohol Research Centre, University of New South Wales, Australia.
| | - Carla Treloar
- National Drug & Alcohol Research Centre, University of New South Wales, Australia
| | - Louisa Degenhardt
- National Drug & Alcohol Research Centre, University of New South Wales, Australia
| | - Jason Grebely
- National Drug & Alcohol Research Centre, University of New South Wales, Australia
| | - Michael Christmass
- National Drug & Alcohol Research Centre, University of New South Wales, Australia
| | - Chris Gough
- National Drug & Alcohol Research Centre, University of New South Wales, Australia
| | - Jeremy Hayllar
- National Drug & Alcohol Research Centre, University of New South Wales, Australia
| | - Mike McDonough
- National Drug & Alcohol Research Centre, University of New South Wales, Australia
| | - Charles Henderson
- National Drug & Alcohol Research Centre, University of New South Wales, Australia
| | - Sione Crawford
- National Drug & Alcohol Research Centre, University of New South Wales, Australia
| | - Michael Farrell
- National Drug & Alcohol Research Centre, University of New South Wales, Australia
| | - Alison Marshall
- National Drug & Alcohol Research Centre, University of New South Wales, Australia
| |
Collapse
|
4
|
Goutzamanis S, Horyniak D, Doyle JS, Hellard M, Higgs P. Perceived physical health outcomes of direct-acting antiviral treatment for hepatitis C: a qualitative study. Harm Reduct J 2021; 18:73. [PMID: 34266434 PMCID: PMC8281623 DOI: 10.1186/s12954-021-00516-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 06/16/2021] [Indexed: 12/21/2022] Open
Abstract
Background Novel health promotion and treatment uptake initiatives will be necessary to ensure Australia meets 2030 hepatitis C elimination targets. Increasing treatment uptake will be assisted by a better understanding of the treatment experience and patient-perceived benefits. This study describes the perceived physical health benefits from direct-acting antiviral (DAA) hepatitis C treatment among people who inject drugs in Melbourne, Australia. Methods Twenty participants were recruited from a community treatment trial and community health clinics. Semi-structured interviews were performed with each participant before, during and following treatment. Interviews focused on treatment experiences, attitudes and motivations. Interviews were recorded, transcribed and thematically analysed. Results Two themes relating to the physical experience of treatment developed; intersection between physical and mental health and “maybe it’s working”. Participants reported various physical benefits, most prominently, reduced fatigue. Reductions in fatigue resulted in instant and meaningful changes in everyday life. Some participants did experience side effects, which they described as mild. Experiencing noticeable physical benefits during treatment was perceived as validation that treatment was working. Conclusion Physical health benefits of DAA treatment may have carry-on effects on cognitive, emotional or social wellbeing and should be incorporated into how treatment is promoted to those who require it.
Collapse
Affiliation(s)
- Stelliana Goutzamanis
- Disease Elimination Program, Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia. .,School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia.
| | - Danielle Horyniak
- Disease Elimination Program, Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia.,School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia.,Behaviour and Health Risks Program, Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia
| | - Joseph S Doyle
- Disease Elimination Program, Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia.,Department of Infectious Diseases, The Alfred and Monash University, 85 Commercial Rd, Melbourne, VIC, 3004, Australia
| | - Margaret Hellard
- Disease Elimination Program, Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia.,School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia.,Department of Infectious Diseases, The Alfred and Monash University, 85 Commercial Rd, Melbourne, VIC, 3004, Australia
| | - Peter Higgs
- Disease Elimination Program, Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia.,Department of Public Health, La Trobe University, Plenty Rd and Kingsbury Dr, Bundoora, VIC, 3086, Australia
| | | |
Collapse
|
5
|
Utilising an access to care integrated framework to explore the perceptions of hepatitis C treatment of hospital-based interventions among people who use drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 96:103356. [PMID: 34226111 DOI: 10.1016/j.drugpo.2021.103356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 06/15/2021] [Accepted: 06/16/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Gaps remain in the hepatitis C virus (HCV) care cascade for people who use drugs (PWUD). Acute medical or surgical illnesses requiring hospitalisation are an opportunity to address addiction, but how inpatient strategies could affect HCV care accessibility for PWUD remains unknown. We explored patient perspectives of hospital-based interventions using an integrated framework of access to HCV care. METHODS We conducted a qualitative study of hospitalised adults (n=27) with HCV and addiction admitted to an urban academic medical centre in the United States between June and November 2019. Individual interviews were audio-recorded, transcribed, and dual-coded. We analysed data with coding specific for hospital-based interventions including screening, conducting HCV-related laboratory work-up, starting treatment, connecting with peers, and coordinating outpatient care. We analysed coded data at the semantic level for emergent themes using a framework approach based off an integrated framework of access to HCV care. RESULTS The majority of participants primarily used opioids (78%), were white (85%) and men (67%). Participants frequently reported HCV screening during previous hospitalisation with rare inpatient connection to HCV-related services. Participants expressed willingness to discuss HCV treatment candidacy during hospitalisation; however, lack of inpatient conversations led to perception that "nothing could be done" during admission. Participants expressed interest in completing inpatient HCV work-up to "get the ball rollin'" - consolidating care would enhance outpatient service permeability by reducing barriers. Others resisted HCV care coordination, preferring to focus on "immediate" issues including health conditions and addiction treatment. Participants also expressed openness to engaging with peers about HCV, noting shared drug use experience as critical to a peer relationship when discussing HCV. CONCLUSION Hospitalised PWUD have varied priorities, necessitating adaptable interventions for addressing HCV. Hospitalisation can be an opportunity to address HCV access to care including identification of treatment eligibility, consolidation of care, and facilitation of HCV-related referrals.
Collapse
|