Original Article

Pretreatment Assessment of Psychosocial Readiness Is Not Associated with Improved Treatment Outcomes in a Safety-Net HCV Treatment Clinic

Authors: Zoë Kopp, MD, Lesley Miller, MD, Sara Turbow, MD, MPH

Abstract

Objectives: Hepatitis C virus (HCV) is highly curable with antiviral therapy, and traditionally, treatment adherence has been critical for treatment success. We sought to determine whether assessing HCV treatment readiness with a structured treatment readiness tool was associated with increased rates of adherence and cure among patients at a safety-net HCV clinic.

Methods: We administered the Psychosocial Readiness Evaluation and Preparation for HCV Treatment (PREP-C) tool to 50 patients and compared them with 50 patients who received the usual care. The outcome measures included achievement of treatment milestones (eg, adherence to treatment, clinic visit attendance) and sustained virologic response (cure).

Results: We found no association between receiving the PREP-C assessment and outcomes, including referral to or starting HCV treatment, adherence to treatment, and HCV cure.

Conclusions: We found that receiving the PREP-C assessment did not improve treatment outcomes, suggesting that targeted pretreatment assessment is unnecessary even in a medically and psychosocially complex population.
Posted in: Gastroenterology53 Infectious Disease136

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References

1. Centers for Disease Control and Prevention. The ABCs of hepatitis-for health professionals. https://www.cdc.gov/hepatitis/resources/professionals/pdfs/abctable.pdf. Updated 2019. Accessed March 10, 2020.
2. American Association for the Study of Liver Diseases, Infectious Diseases Society of America. HCV management: recommendations for testing, managing, and treating hepatitis C. https://www.hcvguidelines.org. Accessed March 10, 2020.
3. Weiss JJ, Brau N, Stivala A, et al. Adherence to medication for chronic hepatitis C-building on the model of human immunodeficiency virus antiretroviral adherence research. Aliment Pharmacol Ther 2009;30:14-27.
4. Gayam V, Tiongson B, Khalid M, et al. Sofosbuvir based regimens in the treatment of chronic hepatitis C genotype 1 infection in African-American patients: a community-based retrospective cohort study. Eur J Gastroenterol Hepatol 2018;30:1200-1207.
5. Mason K, Dodd Z, Guyton M, et al. Understanding real-world adherence in the directly acting antiviral era: a prospective evaluation of adherence among people with a history of drug use at a community-based program in Toronto, Canada. Int J Drug Policy 2017;47:202-208.
6. National Viral Hepatitis Roundtable, Center for Health Law and Policy Innovation, Harvard Law School. Hepatitis C: the state of Medicaid access. https://stateofhepc.org. Published October 2017. Accessed March 10, 2020.
7. Dimova RB, Zeremski M, Jacobson IM, et al. Determinants of hepatitis C virus treatment completion and efficacy in drug users assessed by meta-analysis. Clin Infect Dis 2013;56:806-816.
8. Aspinall EJ, Corson S, Doyle JS, et al. Treatment of hepatitis C virus infection among people who are actively injecting drugs: a systematic review and meta-analysis. Clin Infect Dis 2013;57(suppl 2):S80-S89.
9. Weiss JJ, Alcorn MC, Rabkin JG, et al. The critical role of medication adherence in the success of boceprevir and telaprevir in clinical practice. J Hepatol 2012;56:503-504.
10. Weiss JJ, Aaronson C, Cervantes L, et al. A behavioral intervention improves the rate of hepatitis C treatment initiation among HIV/HCV coinfected patients: results of a randomized controlled trial. J Hepatol 2007;66(1 suppl):S490.
11. Balfour L, Tasca GA, Kowal J, et al. Development and validation of the HIV Medication Readiness Scale. Assessment 2007;14:408-416.
12. Fernández MI, Hosek S, Warren JC, et al. Development of an easy to use tool to assess HIV treatment readiness in adolescent clinical care settings. AIDS Care 2011;23:1492-1499.
13. Gebrekristos HT, Mlisana KP, Karim QA. Patients’ readiness to start highly active antiretroviral treatment for HIV. BMJ 2005;331:772-775.
14. Dupont SC, Fluker SA, Quairoli KM, et al. Improved hepatitis C cure cascade outcomes among urban baby boomers in the direct-acting antiviral era. Public Health Rep 2020;135:107-113.
15. Miller L, Fluker SA, Osborn M, et al. Improving access to hepatitis C care for urban, underserved patients using a primary care-based hepatitis C clinic. J Natl Med Assoc 2012;104:244-250.
16. Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373-383.
17. Beck KR, Kim NJ, Khalili M. Direct acting antivirals improve HCV treatment initiation and adherence among underserved African Americans. Ann Hepatol 2018;17:413-418.
18. Lubega S, Agbim U, Surjadi M, Mahoney M, Khalili M. Formal hepatitis C education enhances HCV care coordination, expedites HCV treatment and improves antiviral response. Liver Int 2013;33:999-1007.
19. Lieveld FI, van Vlerken LG, Siersema PD, et al. Patient adherence to antiviral treatment for chronic hepatitis B and C: a systematic review. Ann Hepatol 2013;12:380-391.
20. Evon DM, Esserman DA, Bonner JE, et al. Adherence to PEG/ribavirin treatment for chronic hepatitis C: prevalence, patterns, and predictors of missed doses and nonpersistence. J Viral Hepat 2013;20:536-549.
21. Bonner JE, Esserman DA, Golin CE, et al. Self-efficacy and adherence to antiviral treatment for chronic hepatitis C. J Clin Gastroenterol 2015;49:76-83.
22. Gowda C, Lott S, Grigorian M, et al. Absolute insurer denial of direct-acting antiviral therapy for hepatitis C: a national specialty pharmacy cohort study. Open Forum Infect Dis 2018;5:ofy076.