scholarly journals Barriers to Hepatitis C Virus Treatment in a Canadian HIV-Hepatitis C Virus Coinfection Tertiary Care Clinic

2008 ◽  
Vol 22 (2) ◽  
pp. 133-137 ◽  
Author(s):  
Meaghan McLaren ◽  
Gary Garber ◽  
Curtis Cooper
Keyword(s):  
Health Care ◽  
Substance Abuse ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Care Delivery ◽  
Tertiary Care ◽  
Hcv Treatment ◽  
Care Clinic ◽  
Hcv Therapy

BACKGROUND: Despite demonstrated efficacy in HIV-hepatitis C virus (HCV) coinfection, not all patients initiate, complete or achieve success with HCV antiviral therapy.PATIENTS AND METHODS: All HIV-HCV coinfected patient consults received at The Ottawa Hospital Viral Hepatitis Clinic (Ottawa, Ontario) between June 2000 and September 2006 were identified using a clinical database. A descriptive analysis of primary and contributing factors accounting for why patients did not initiate HCV therapy, as well as the therapeutic outcomes of treated patients, was conducted.RESULTS: One hundred two consults were received. Sixty-seven per cent of patients did not initiate HCV therapy. The key primary reasons included: HIV therapy was more urgently needed (22%), loss to follow-up (12%), patients were deemed unlikely to progress to advanced liver disease (18%) and patient refusal (12%). Many patients had secondary factors contributing to the decision not to treat, including substance abuse (23%) and psychiatric illness (14%). Overall, 59% of untreated patients (40 of 68) were eventually lost to follow-up. Thirty-three per cent of referred patients started HCV therapy. Twenty-seven of 42 courses (64%) were interrupted prematurely for reasons such as virological nonresponse (48%), psychiatric complications (10%) and physical side effects (7%). Of all treatment recipients, 12 of 42 full courses of therapy were completed and three remained on HCV medication. Overall, eight of the 102 coinfected patients studied (8%) achieved a sustained virological response.DISCUSSION: Not all HIV-HCV coinfected patients who are deemed to be in need of HCV treatment are initiating therapy. Only a minority of patients who do receive treatment achieve success. Implementation of HIV treatment, patient retention, attention to substance abuse and mental health care should be the focus of efforts designed to increase HCV treatment uptake and success. This can be best achieved within a multidisciplinary model of health care delivery.

scholarly journals Evaluation of Oral Cannabinoid-Containing Medications for the Management of Interferon and Ribavirin-Induced Anorexia, Nausea and Weight Loss in Patients Treated for Chronic Hepatitis C Virus

2008 ◽  
Vol 22 (4) ◽  
pp. 376-380 ◽  
Author(s):  
Cecilia T Costiniuk ◽  
Edward Mills ◽  
Curtis L Cooper
Keyword(s):  
Weight Loss ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Side Effects ◽  
Cohort Analysis ◽  
Smoking History ◽  
Hcv Treatment ◽  
Hcv Therapy ◽  
Median Weight Loss ◽  
Dose Reductions

OBJECTIVES: The systemic and cognitive side effects of hepatitis C virus (HCV) therapy may be incapacitating, necessitating dose reductions or abandonment of therapy. Oral cannabinoid-containing medications (OCs) ameliorate chemotherapy-induced nausea and vomiting, as well as AIDS wasting syndrome. The efficacy of OCs in managing HCV treatment-related side effects is unknown.METHODS: All patients who initiated interferon-ribavirin therapy at The Ottawa Hospital Viral Hepatitis Clinic (Ottawa, Ontario) between August 2003 and January 2007 were identified using a computerized clinical database. The baseline characteristics of OC recipients were compared with those of nonrecipients. The treatment-related side effect response to OC was assessed by χ2analysis. The key therapeutic outcomes related to weight, interferon dose reduction and treatment outcomes were assessed by Student’sttest and χ2analysis.RESULTS: Twenty-five of 191 patients (13%) initiated OC use. Recipients had similar characteristics to nonrecipients, aside from prior marijuana smoking history (24% versus 10%, respectively; P=0.04). The median time to OC initiation was seven weeks. The most common indications for initiation of OC were anorexia (72%) and nausea (32%). Sixty-four per cent of all patients who received OC experienced subjective improvement in symptoms. The median weight loss before OC initiation was 4.5 kg. A trend toward greater median weight loss was noted at week 4 in patients eventually initiating OC use (−1.4 kg), compared with those who did not (−1.0 kg). Weight loss stabilized one month after OC initiation (median 0.5 kg additional loss). Interferon dose reductions were rare and did not differ by OC use (8% of OC recipients versus 5% of nonrecipients). The proportions of patients completing a full course of HCV therapy and achieving a sustained virological response were greater in OC recipients.CONCLUSIONS: The present retrospective cohort analysis found that OC use is often effective in managing HCV treatment-related symptoms that contribute to weight loss, and may stabilize weight decline once initiated.

scholarly journals Client Satisfaction among the clients attending tertiary care centers in Mangalore, South India

2017 ◽  
Vol 07 (03) ◽  
pp. 003-006
Author(s):  
Usha Rani S. P. ◽  
Rashmi Kundapur ◽  
Anusha Rashmi ◽  
Harsha Acharya
Keyword(s):  
Health Care ◽  
Sample Size ◽  
Waiting Time ◽  
Client Satisfaction ◽  
Care Delivery ◽  
Tertiary Care ◽  
Teaching Hospitals ◽  
Cross Sectional ◽  
Tertiary Care Centers

Abstract Background: Provision of services in line with the wishes and needs of patients is central to a human health care system .The hospital market has today as changed from a seller's market to a buyer's market and there is a need to improve the quality in the health care delivery. Client satisfaction is a key determinant of quality of care provided in health care centers. Objectives: To determine the client satisfaction among the patients attending tertiary care centers in Mangalore. Materials and Methodology: The study was a cross sectional study which was conducted among the clients attending five teaching hospitals in Mangalore. With 60% of client satisfaction obtained in our pilot study, the sample size was 384 and adding 20% for dropouts the total sample size came up to 462.The clients were selected randomly from each hospital. A pretested Proforma was used outside the hospital with strict confidentiality. Results: In our study we found that,87.6% of the clients felt that the clinic hours at health facility were adequate,79.3% felt health care was easily accessible,89.2% were happy with hygiene and comfort of waiting area. Average waiting time was 116mins.Only 45.4% could meet the same service provider in follow up visit and only 51.5% availed similar services as in the first visit in the follow up. Satisfaction with provider's skill and ability was seen in 82.5% of the clients. Only 69.2% of the clients were satisfied with the cost of services available. Conclusion: Our study revealed that waiting time was a major concern for the client's satisfaction.

Management of HIV Infection in Persons Co-infected With Hepatitis

2005 ◽  
Vol 18 (4) ◽  
pp. 295-309
Author(s):  
Naomi S. Boston ◽  
Judianne C. Slish
Keyword(s):  
Health Care ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Hepatitis B Virus ◽  
Hiv Infection ◽  
Health Care Providers ◽  
Antiretroviral Treatment ◽  
Care Providers ◽  
Hcv Treatment ◽  
B Virus

Co-infection with hepatitis C virus (HCV) and/or hepatitis B virus (HBV) is becoming a rampant disparity in HIV-infected patients. The advent of antiretroviral therapy has led to agents that are effective for suppression of both HIV and HBV; however, this can not be extrapolated to patients who are coinfected with HCV. Treatment of HCV disease is often strenuous and can lead to untoward adverse effects. Co-infection with HIV often leads to higher rates of cirrhosis and liver failure in patients with HBV or HCV, compromising antiretroviral treatment in this patient population due to the hepatotoxicity of these agents. The purpose of this review is to familiarize health care providers to the management of HIV infection in patients who are also co-infected with HBV or HCV.

Outcomes of a Pharmacist-Led Hepatitis C Virus Treatment Program in an Urban Safety-Net Health System, Chicago, 2017-2019

2021 ◽  
pp. 003335492110156
Author(s):  
Bijou R. Hunt ◽  
Hollyn Cetrone ◽  
Sharon Sam ◽  
Nancy R. Glick
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Health System ◽  
Treatment Program ◽  
Safety Net ◽  
The United States ◽  
Hcv Treatment ◽  
Treatment Cascade ◽  
Urban Safety

Objective A recommendation in March 2020 to expand hepatitis C virus (HCV) screening to all adults in the United States will likely increase the need for HCV treatment programs and guidance on how to provide this service for diverse populations. We evaluated a pharmacist-led HCV treatment program within a routine screening program in an urban safety-net health system in Chicago, Illinois. Methods We collected data on all patient treatment applications submitted from January 1, 2017, through June 30, 2019, and assessed outcomes of and patient retention in the treatment cascade. Results During the study period, 203 HCV treatment applications were submitted for 187 patients (>1 application could be submitted per patient): 49% (n = 91) were aged 55-64, 62% (n = 116) were male, 67% (n = 125) were Black, and 15% (n = 28) were Hispanic. Of the 203 HCV treatment applications, 87% (n = 176) of patients were approved for treatment, 91% (n = 161) of whom completed treatment. Of the 161 patients who completed treatment, 81% (n = 131) attended their sustained virologic response (SVR) follow-up visit, 98% (n = 129) of whom reached SVR. The largest drop in the treatment cascade was the 19% decline from receipt of treatment to SVR follow-up visit. Conclusion The pharmacist-led model for HCV treatment was effective in navigating patients through the treatment cascade and achieving SVR. Widespread implementation of pharmacist-led HCV treatment models may help to hasten progress toward 2030 HCV elimination goals.

scholarly journals Sero-epidemiology of Hepatitis C Virus and Malaria (Plasmodium falciparum) Co-infection among pregnant women Attending National Hospital Abuja in Central Nigeria

2019 ◽  
Author(s):  
ASAGA MAC PETER ◽  
HALIMA SALIHU ◽  
AMALI OKWOLI
Keyword(s):  
Health Care ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Pregnant Women ◽  
Health Care Providers ◽  
Care Delivery ◽  
Public Health Problem ◽  
Reproductive Age ◽  
Care Providers ◽  
National Hospital

Abstract Background Hepatitis C virus is an RNA virus of the flaviviridae family and appears to have humans and chimpanzees as the only species susceptible to its infection [1]. Infection is often asymptomatic but once established, chronic infection can lead to scarring of the liver (fibrosis) and advanced scarring (cirrhosis) which is generally apparent after many years [2]. It is a major and growing public health problem that can easily lead to chronic liver disease, cirrhosis and hepatocellular carcinoma [3]. Methods This study was conducted on one hundred and thirty (130) pregnant women of reproductive age (15 – 45 years) who were randomly selected at National hospital Abuja. 5 ml of blood was obtained from study participants for rapid HCV screening and malaria thick films and thin films for parasite densities and parasite species identification. Result The preponderance of HCV was 130 (17.1%), malaria (49.4%) and HCV and malaria co-infection was (10.9%), of the hundred and thirty (130) samples obtained from pregnant women in the Abuja National Hospital. Conclusion The sero-prevalence of HCV infection and its infectivity is high in central Nigeria. This study findings guide the want for routine HCV and malaria screening among pregnant women at some stage in antenatal care within the region and Nigeria. It also form a base for continual education campaign about HCV amongst rural/Urban pregnant mothers/women and food vendors in central states and other parts of Nigeria. Those efforts will guarantee top of the line and better outcome for excellent health care delivery for the expecting mothers and other health care providers in our hospitals.

Impact of hepatitis C virus antibody positivity on mortality and causes of death in people living with HIV in Georgia

2019 ◽  
Vol 30 (12) ◽  
pp. 1185-1193
Author(s):  
Nikoloz Chkhartishvili ◽  
Natalia Bolokadze ◽  
Nino Rukhadze ◽  
Natia Dvali ◽  
Akaki Abutidze ◽  
...  
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Proportional Hazards ◽  
Multivariable Analysis ◽  
Cox Proportional Hazards ◽  
People Living With Hiv ◽  
Hcv Therapy ◽  
Living With Hiv ◽  
Related Mortality

Hepatitis C co-infection in people living with HIV (PLWH) is common in Georgia. Antiretroviral therapy (ART) is widely available in the country since 2004, and from 2011, patients have unlimited access to hepatitis C virus (HCV) treatment. A retrospective nationwide cohort study included adult PLWH diagnosed between 2004–2016, who were followed up until 31 December 2017. Predictors of mortality were assessed in Cox proportional hazards regression model. A total of 4560 persons contributed 22,322 person-years (PY) of follow-up, including 2058 (45.1%, 10,676 PY) anti-HCV+ patients. After the median 4.1 years of follow-up, 954 persons died, including 615 anti-HCV+ patients. Persons with HCV had higher overall mortality compared to HIV monoinfection (5.76/100 PY vs. 2.91/100 PY, p < 0.0001). In multivariable analysis, anti-HCV positivity was significantly associated with mortality (adjusted hazard ratio: 1.42, 95% CI: 1.09–1.85). Among anti-HCV+ persons, liver-related mortality due to viral hepatitis before the availability of HCV therapy (2004–2011) was 2.11 cases per 100 PY and this decreased to 0.79 cases per 100 PY after 2011 (p < 0.0001). AIDS remained the leading cause of death prior to and after 2011. Wide availability of ART and anti-HCV therapy translated into a significant decline in mortality including due to liver-related causes. Improving earlier diagnosis will decrease excess AIDS-related mortality among people living with HIV/HCV co-infection.

scholarly journals A piece of the jigsaw of primary care: health professional perceptions of an integrated care model of hepatitis C management in the community

2014 ◽  
Vol 6 (2) ◽  
pp. 129 ◽  
Author(s):  
Carla Treloar ◽  
Rebecca Gray ◽  
Loren Brener
Keyword(s):  
Health Care ◽  
Hepatitis C ◽  
Integrated Care ◽  
Health Care Services ◽  
Service Providers ◽  
Health Resources ◽  
Opinion Leader ◽  
Interprofessional Relations ◽  
Hcv Treatment ◽  
Care Clinic

INTRODUCTION: There is growing interest in increasing uptake of hepatitis C (HCV) treatment. HCV is strongly associated with injecting drug use and is a stigmatised illness. People with HCV may be reluctant to engage with health care services. A community-based, nurse-led integrated care clinic was established in Christchurch, New Zealand with the intention of bridging the health care gap for those unwilling or unable to access mainstream health care. This paper explores the experiences and perceptions of health professionals regarding the implementation of this clinic, with particular attention paid to the interprofessional relationships relevant to the clinic. METHODS: Qualitative, in-depth interviews were conducted with 24 stakeholders, including four staff of the clinic and other service providers with varying relationships to the clinic. FINDINGS: Participants generally endorsed the clinic model and described its operation as easy to access, non-judgmental and non-threatening, and, therefore, able to attract and engage ‘hard-to-reach’ clients. The clinic model was also thought to support more effective use of health resources. Some participants expressed concerns regarding the potential ‘poaching’ of patients from other services (particularly general practice) and indicated a preference for HCV treatment services to be restricted to hospital settings. CONCLUSION: The findings of this study suggest the need to address concerns of general practitioners regarding patient poaching. Key information to disseminate is the clinic’s success in engaging with complex clients and contribution to more efficacious use of health service resources. These activities may require the advocacy of a key local opinion leader acting as ‘knowledge broker’. KEYWORDS: Community health services; hepatitis C; interprofessional relations; primary health care; qualitative research

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