![Sample our Medicine, Dentistry, Nursing & Allied Health journals, sign in here to start your FREE access for 14 days]({"type":"image" , "src" : "/sda/5944/TOC-Subject-Sample-2021-Medicine-Dentistry-Nursing-Allied-Health.jpg"})
ABSTRACT
Background: Direct-acting antivirals (DAAs) are curative in most persons with chronic hepatitis C virus (HCV) infection. However, high cost and concerns about adherence and reinfection may present continued barriers to treatment, particularly for people who inject drugs (PWID). Objective: To understand changes in assessments of treatment candidacy, given advances in treatment. Methods: Clinicians attending the Liver Meeting® in 2014 who reported prescribing HCV treatment in the past three years were invited to complete a survey regarding HCV treatment decisions. Participants assessed their likelihood to treat HCV in PWID in association with time of abstinence from injection drug use and what impacts their decision to provide treatment using interferon and DAAs. Results: 108 clinicians completed the survey; 10% were willing to treat an active PWID (last injection within 30 days) using interferon-containing regimens, and 15% with all-oral regimens. For each increasing time interval of injection abstinence, there was an increase in the odds of a clinician reporting willingness to treat with DAAs (Odds Ratio (OR) 2.57, 95% CI 2.18, 3.03) and with interferon-based treatment (OR 2.22 (95% CI 1.90, 2.61), Reinfection and medication cost were cited as most important concerns when determining candidacy. Conclusions: A cure is now the norm in HCV treatment, and there is an increasing need to address the barriers to treating PWID, the population with the highest burden of infection. Understanding treatment candidacy assessments is essential to improving uptake. This study provides insight into how clinicians view treatment candidacy in this era of DAAs and can help identify supportive treatment environments and concurrent programs.
Glossary
Direct-acting antivirals: Medications that interfere with specific steps in the HCV replication cycle through a direct interaction with the HCV genome, polyprotein, or its polyprotein cleavage products.
Sustained viral response:Undetectable HCV RNA using a highly sensitive assay 24 weeks following the end of HCV treatment. Used as a surrogate marker for HCV cure after completion of antiviral therapy.
Declaration of interest
The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.
Funding
This work was supported by the UCSF Graduate Dean's Health Sciences Fellowship.
Additional information
Notes on contributors
Alice K. Asher
Dr. Alice K. Asher is currently an Epidemiologist in the Division of Viral Hepatitis, Epidemiology and Surveillance Branch; this work was done as a doctoral student at the University of California San Francisco.
Carmen J. Portillo
Dr. Carmen J. Portillo is Professor & Chairperson of the Department of Community Health Systems at the University of California, San Francisco and conducts research on nursing workforce issues, and quality of life among people living with HIV/AIDS.
Bruce A. Cooper
Dr. Bruce A. Cooper is Senior Statistician and Associate Adjunct Professor in the School of Nursing at University of California, San Francisco, and has participated in a large body of research, particularly focused on symptom management among cancer patients.
Carol Dawson-Rose
Dr. Carol Dawson-Rose is a professor of Nursing at the University of California, San Francisco, and has conducted research for over 20 years with substance users, primarily People who are living with HIV, to capture and increase our understanding of their experience of care.
David Vlahov
Dr. David Vlahov is Dean and Professor at the University of California, San Francisco School of Nursing and brings over 20 years research expertise in epidemiology, infectious diseases, substance abuse and mental health.
Kimberly A. Page
Dr. Kimberly A. Page is the Chief of Epidemiology, Biostatistics and Preventive Medicine at the University of New Mexico Health Sciences Center (UNM HSC), and an infectious disease epidemiologist working with populations at high risk of HIV and hepatitis C virus (HCV) infections.
