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Bédard K, Boisvert I, Rochette M, Racine E, Martel-Laferrière V. Exploring the value and acceptability of a patient navigator program for people who inject drugs and are hospitalized for bacterial infections: patients', community organization and healthcare workers' perspectives. BMC Infect Dis 2025; 25:221. [PMID: 39953410 PMCID: PMC11829365 DOI: 10.1186/s12879-025-10617-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 02/07/2025] [Indexed: 02/17/2025] Open
Abstract
BACKGROUND Hospitalizations for bacterial infections are often difficult for people who inject drugs (PWID) and healthcare workers, in part due to biases and stigma associated with substance use, patients' competing needs, such as pain and withdrawal management, and strict antibiotic treatment protocols. In recent years, peer navigators have been introduced as a strategy to reduce stigma and bridge the gap between patients and healthcare workers, but little is known about their involvement in hospitalization settings. The aim of this study was to assess the value of adding a peer navigator program and to evaluate the elements that key stakeholders identified as essential for the program to be successful. METHODS This was a qualitative study using focus groups. The interview guide was collaboratively developed by ethicists, physicians, and a person with lived experience and validated with a PWID and a community worker. Three two-hour focus groups were conducted in February 2022 with PWID, community organizations and healthcare workers. Descriptive and interpretive thematic analyses were carried out. RESULTS Nineteen people (5 PWID, 6 community organization workers, 8 healthcare workers) participated in the focus groups. The final coding strategy involved 4 main themes: challenges in current care, positive aspects of current care, aspirations for quality care, the contribution of peer navigators as a solution to current challenges and the realization of aspirations. Improvements in the quality of care should focus on an approach centered on patients' values and aspirations; improving the current hospital environment, particularly in terms of training and communication; and encouraging collaborative partnerships with all parties involved. The integration of peer navigators seems to be a promising strategy for improving communication and trust and, consequently, to facilitate shared decision-making and adapted care. CONCLUSIONS Our study showed that any innovative model should be centered on patients' needs and values and therefore co-constructed with them and other parties involved, notably the community organizations offering services to these patients. The inclusion of well-trained and well-supported peer navigators has the potential to improve care and work toward achieving aspirations of quality care.
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Affiliation(s)
- Karine Bédard
- Direction de la qualité, de l'évaluation, de la performance et de l'éthique, Centre hospitalier de l'Université de Montréal, 1000 St-Denis, Montréal, Qc, H2X 0C1, Canada
| | - Isabelle Boisvert
- Centre de recherche du Centre hospitalier de l'Université de Montréal, 900 St-Denis, Montréal, Qc, H2X 0A9, Canada
| | - Marianne Rochette
- Pragmatic Health Ethics Research Unit, Montreal Clinical Research Institute (IRCM), 110 Avenue des Pins Ouest, Montréal, Qc, H2W 1R7, Canada
- Department of Medicine, Department of Social and Preventive Medicine, Université de Montréal, 2900 Bd Édouard-Montpetit, Montréal, Qc, H3T 1J4, Canada
| | - Eric Racine
- Pragmatic Health Ethics Research Unit, Montreal Clinical Research Institute (IRCM), 110 Avenue des Pins Ouest, Montréal, Qc, H2W 1R7, Canada
- Department of Medicine, Department of Social and Preventive Medicine, Université de Montréal, 2900 Bd Édouard-Montpetit, Montréal, Qc, H3T 1J4, Canada
- Department of Neurology and Neurosurgery, Department of Medicine (Program in Clinical and Translational Research), McGill University, 845 rue Sherbrooke Ouest, Montréal, Qc, H3A 0G4, Canada
| | - Valérie Martel-Laferrière
- Centre de recherche du Centre hospitalier de l'Université de Montréal, 900 St-Denis, Montréal, Qc, H2X 0A9, Canada.
- Department of Microbiology, Infectious Diseases and Immunology, Université de Montréal, 2900 Bd Édouard-Montpetit, Montréal, Qc, H3T 1J4, Canada.
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Saich F, Walker S, Hellard M, Stoové M, Seear K. The Application of Australian Rights Protections to the Use of Hepatitis C Notification Data to Engage People 'Lost to Follow Up'. Public Health Ethics 2024; 17:40-52. [PMID: 39005529 PMCID: PMC11245707 DOI: 10.1093/phe/phae006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Indexed: 07/16/2024] Open
Abstract
Hepatitis C is a global public health threat, affecting 56 million people worldwide. The World Health Organization has committed to eliminating hepatitis C by 2030. Although new treatments have revolutionised the treatment and care of people with hepatitis C, treatment uptake has slowed in recent years, drawing attention to the need for innovative approaches to reach elimination targets. One approach involves using existing notifiable disease data to contact people previously diagnosed with hepatitis C. Within these disease surveillance systems, however, competing tensions exist, including protecting individual rights to privacy and autonomy, and broader public health goals. We explore these issues using hepatitis C and Australia's legislative and regulatory frameworks as a case study. We examine emerging uses of notification data to contact people not yet treated, and describe some of the ethical dilemmas associated with the use and non-use of this data and the protections that exist to preserve individual rights and public health. We reveal weaknesses in rights protections and processes under Australian public health and human rights legislation and argue for consultation with and involvement of affected communities in policy and intervention design before notification data is used to increase hepatitis C treatment coverage.
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Affiliation(s)
| | | | - Margaret Hellard
- Burnet Institute; The Alfred Hospital; Monash University; The University of Melbourne
| | - Mark Stoové
- Burnet Institute; Monash University; La Trobe University
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Hassan MRA, Chan HK, Nordin M, Yahya R, Sulaiman WRW, Merican SAA, Lah D, Sem X, Shilton S. Assessing feasibility of a modified same-day test-and-treat model for hepatitis C among rural people who inject drugs. Harm Reduct J 2023; 20:48. [PMID: 37046294 PMCID: PMC10091347 DOI: 10.1186/s12954-023-00780-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/06/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Despite advancements in hepatitis C virus (HCV) treatment, low uptake among hard-to-reach populations remains a global issue. The current study aimed to assess the feasibility of a modified same-day test-and-treat model in improving HCV care for people who inject drugs (PWID) living in resource-constrained rural areas. METHODS A pilot study was conducted in four primary healthcare (PHC) centers in Malaysia. The model's key features included on-site HCV ribonucleic acid (RNA) testing using a shared GeneXpert® system; noninvasive biomarkers for cirrhosis diagnosis; and extended care to PWID referred from nearby PHC centers and outreach programs. The feasibility assessment focused on three aspects of the model: demand (i.e., uptake of HCV RNA testing and treatment), implementation (i.e., achievement of each step in the HCV care cascade), and practicality (i.e., ability to identify PWID with HCV and expedite treatment initiation despite resource constraints). RESULTS A total of 199 anti-HCV-positive PWID were recruited. They demonstrated high demand for HCV care, with a 100% uptake of HCV RNA testing and 97.4% uptake of direct-acting antiviral treatment. The rates of HCV RNA positivity (78.4%) and sustained virologic response (92.2%) were comparable to standard practice, indicating the successful implementation of the model. The model was also practical, as it covered non-opioid-substitution-therapy-receiving individuals and enabled same-day treatment in 71.1% of the participants. CONCLUSIONS The modified same-day test-and-treat model is feasible in improving HCV care for rural PWID. The study finding suggests its potential for wider adoption in HCV care for hard-to-reach populations.
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Affiliation(s)
| | - Huan-Keat Chan
- Clinical Research Center, Sultanah Bahiyah Hospital, 05460, Alor Setar, Kedah, Malaysia.
| | - Mahani Nordin
- Public Health Division, State Health Department, Alor Setar, Kedah, Malaysia
| | | | | | | | - Darisah Lah
- Bukit Tunggal Health Clinic, Kuala Nerus, Terengganu, Malaysia
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Chan HK, Hassali MA, Mohammed NS, Azlan A, Hassan MRA. Barriers to scaling up hepatitis C treatment in Malaysia: a qualitative study with key stakeholders. BMC Public Health 2022; 22:371. [PMID: 35189876 PMCID: PMC8860373 DOI: 10.1186/s12889-022-12786-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 02/15/2022] [Indexed: 11/15/2022] Open
Abstract
Background While the availability of generic direct-acting antivirals (DAAs) opens the door for large-scale treatment, the care for people living with hepatitis C virus (HCV) in Malaysia is shifting toward a tripartite partnership between the public health system, correctional settings and civil society organizations (CSOs). This study aimed to explore the barriers to scaling up HCV treatment in Malaysia from the perspective of key stakeholders. Methods Eighteen focus-group discussions (FGDs) were conducted with 180 individuals, who actively engaged in coordinating, executing or supporting the implementation of the national strategic plan for HCV. An analytical framework was adapted to guide the data collection and thematic analysis. It covered four key aspects of HCV treatment: geographical accessibility, availability, affordability and acceptability. Results Movement restrictions in times of coronavirus disease 2019 (COVID-19) outbreaks and being marginalized translated into barriers to treatment access in people living with HCV. Barriers to treatment initiation in health and correctional settings included limited staffing and capacity; disruption in material supply; silos mentality and unintegrated systems; logistical challenges for laboratory tests; and insufficient knowledge of care providers. Although no-cost health services were in place, concerns over transportation costs and productivity loss also continued to suppress the treatment uptake. Limited disease awareness, along with the disease-related stigma, further lowered the treatment acceptability. Conclusions This study disclosed a series of supply- and demand-side barriers to expanding the treatment coverage among people living with HCV in Malaysia. The findings call for strengthening inter-organizational collaborations to overcome the barriers.
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Affiliation(s)
- Huan-Keat Chan
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Gelugor, Penang, Malaysia. .,Clinical Research Center, Sultanah Bahiyah Hospital, Alor Setar, 05460, Alor Setar, Kedah, Malaysia.
| | - Mohamed Azmi Hassali
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Gelugor, Penang, Malaysia
| | - Noor Syahireen Mohammed
- Clinical Research Center, Sultanah Bahiyah Hospital, Alor Setar, 05460, Alor Setar, Kedah, Malaysia
| | - Azlina Azlan
- Public Health Division, State Health Department, Alor Setar, Kedah, Malaysia
| | - Muhammad Radzi Abu Hassan
- Clinical Research Center, Sultanah Bahiyah Hospital, Alor Setar, 05460, Alor Setar, Kedah, Malaysia.,Medical Department, Sultanah Bahiyah Hospital, Alor Setar, Kedah, Malaysia
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Martel-Laferrière V, Brissette S, Wartelle-Bladou C, Juteau LC, Popa M, Goyer MÈ, Bruneau J. Impact of an Accelerated Pretreatment Evaluation on Linkage-to-Care for Hepatitis C-infected Persons Who Inject Drugs. Subst Abuse 2022; 16:11782218221119068. [PMID: 35990750 PMCID: PMC9382068 DOI: 10.1177/11782218221119068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 07/25/2022] [Indexed: 11/15/2022]
Abstract
Background: Historically, hepatitis C virus (HCV) pretreatment evaluation has required multiple visits, frequently resulting in loss to follow-up and a delayed initiation of treatment. New technologies can accelerate this process. We investigated the feasibility of a single-day evaluation program and its impact on evaluation completion, treatment eligibility awareness, and treatment initiation among people who inject drugs (PWIDs). Methods: HCV-infected PWID who were unaware if they were eligible for treatment were recruited in a prospective evaluation of an accelerated model of care between 2017 and 2019 and compared to a historical cohort. The patients underwent a medical evaluation, rapid HCV viral load testing, and transient elastography during a single visit, at the end of which they were informed whether they were eligible for treatment. A historical cohort of patients fulfilling the same inclusion criteria and evaluated with the usual standard of care spanning several visits who were examined at the addiction medicine clinic from 2014 to 2016 served as the comparison group. Results: The accelerated and historical cohorts included 99 and 76 patients, respectively. The cohorts did not differ significantly by age and gender, but more patients in the historical cohort were undergoing opioid agonist therapy, while more patients in the accelerated cohort injected drugs in the last month. An accelerated evaluation resulted in a higher rate of evaluation completion (100% vs 67.1%; P < .001). Among those eligible for treatment, the proportion of those initiating treatment was similar between the groups (51/64 (79.7%) vs. 26/37 (70.3%); P = .28). The delay in the initiation of treatment was shorter in the accelerated cohort than in the historical cohort (69 (IQR: 49-106) days vs. 219 (IQR: 141-416) days; P < .001). Conclusions: Accelerated evaluation enhanced the awareness of eligibility and reduced the time to initiation among eligible patients. Trial Registration: This study is registered on www.clinicaltrials.gov (NCT02755402).
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Affiliation(s)
- Valérie Martel-Laferrière
- Université de Montréal, Montreal, QC, Canada
- Centre hospitalier de l’Université de Montréal, Montreal, QC, Canada
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Suzanne Brissette
- Université de Montréal, Montreal, QC, Canada
- Centre hospitalier de l’Université de Montréal, Montreal, QC, Canada
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Claire Wartelle-Bladou
- Université de Montréal, Montreal, QC, Canada
- Centre hospitalier de l’Université de Montréal, Montreal, QC, Canada
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Louis-Christophe Juteau
- Université de Montréal, Montreal, QC, Canada
- Centre hospitalier de l’Université de Montréal, Montreal, QC, Canada
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Maria Popa
- Université de Montréal, Montreal, QC, Canada
| | - Marie-Ève Goyer
- Université de Montréal, Montreal, QC, Canada
- CIUSSS du Centre-Sud de Montréal, Montreal, QC, Canada
| | - Julie Bruneau
- Université de Montréal, Montreal, QC, Canada
- Centre hospitalier de l’Université de Montréal, Montreal, QC, Canada
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montreal, QC, Canada
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Yen HH, Su PY, Liu ILI, Zeng YH, Huang SP, Hsu YC, Hsu PK, Chen YY. Retrieval of lost patients in the system for hepatitis C microelimination: a single-center retrospective study. BMC Gastroenterol 2021; 21:209. [PMID: 33964873 PMCID: PMC8105932 DOI: 10.1186/s12876-021-01792-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 04/23/2021] [Indexed: 02/07/2023] Open
Abstract
Background Hepatitis C virus (HCV) is one of the major causes of chronic liver disease, cirrhosis, and liver cancer. Most of the infected people have no clinical symptoms. The current strategy for HCV elimination includes test and treatment. In this study, we aimed to evaluate the campaign for retrieving patients who were lost to follow-up, for subsequent re-evaluation. Methods From January 2020 to October 2020, patients who had prior tests for positive anti-HCV antibody in 2010–2018 in our hospital were enrolled for our patient callback campaign. Patients who had unknown HCV RNA status or no documented successful antiviral therapy history were selected for anti-HCV therapy re-evaluation. To facilitate patient referral in the hospital, we developed an electronic reminding system and called the candidate patients via telephone during the study period. Results Through the hospital electronic system, 3783 patients with positive anti-HCV antibody documentation were identified. Among them, 1446 (38.22%) had tested negative for HCV RNA or had anti-HCV therapy, thereby excluded. Of the 2337 eligible patients, 1472 (62.99%) were successfully contacted and called back during the study period for subsequent HCV RNA testing and therapy. We found that 42.19% of the patients had positive HCV RNA and 88% received subsequent anti-HCV therapy. Conclusions A significant number of patients with positive HCV serology were lost for HCV confirmatory test or therapy in the hospital. Therefore, this targeted HCV callback approach in the hospital is feasible and effective in achieving microelimination.
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Affiliation(s)
- Hsu-Heng Yen
- Division of Gastroenterology, Department of Internal Medicine, Changhua Christian Hospital, No. 135 Nanhsiao Street, Changhua, Taiwan. .,General Education Center, Chienkuo Technology University, Changhua, Taiwan. .,Department of Electrical Engineering, Chung Yuan Christian University, Taoyuan, Taiwan.
| | - Pei-Yuan Su
- Division of Gastroenterology, Department of Internal Medicine, Changhua Christian Hospital, No. 135 Nanhsiao Street, Changhua, Taiwan
| | - I-L Ing Liu
- Division of Gastroenterology, Department of Internal Medicine, Changhua Christian Hospital, No. 135 Nanhsiao Street, Changhua, Taiwan
| | - Ya-Huei Zeng
- Division of Gastroenterology, Department of Internal Medicine, Changhua Christian Hospital, No. 135 Nanhsiao Street, Changhua, Taiwan
| | - Siou-Ping Huang
- Division of Gastroenterology, Department of Internal Medicine, Changhua Christian Hospital, No. 135 Nanhsiao Street, Changhua, Taiwan
| | - Yu-Chun Hsu
- Division of Gastroenterology, Department of Internal Medicine, Changhua Christian Hospital, No. 135 Nanhsiao Street, Changhua, Taiwan
| | - Po-Ke Hsu
- Division of Gastroenterology, Department of Internal Medicine, Changhua Christian Hospital, No. 135 Nanhsiao Street, Changhua, Taiwan
| | - Yang-Yuan Chen
- Division of Gastroenterology, Department of Internal Medicine, Changhua Christian Hospital, No. 135 Nanhsiao Street, Changhua, Taiwan. .,Department of Hospitality Management, MingDao University, Changhua, Taiwan.
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