• HIV
• People who inject drugs
• antiretroviral therapy
• direct acting antivirals
• hepatitis C
• pre-exposure prophylaxis

• Humans
• Male
• HIV Infections/drug therapy
• HIV Infections/psychology
• Hepatitis C/drug therapy
• Hepatitis C/psychology
• Female
• Adult
• Middle Aged
• Communication
• Health Knowledge, Attitudes, Practice
• Substance Abuse, Intravenous/complications
• Substance Abuse, Intravenous/psychology
• Substance Abuse, Intravenous/epidemiology
• United States/epidemiology
• Substance-Related Disorders
• Qualitative Research
• Interviews as Topic
• Hepacivirus

• K23 DA044085 NIDA NIH HHS
• P30 AI042853 NIAID NIH HHS

• diagnostic errors
• drug users
• global health
• hepatitis C, chronic
• mental health

• Humans
• Hepatitis C, Chronic/psychology
• Hepatitis C, Chronic/drug therapy
• Hepatitis C, Chronic/diagnosis
• Hepatitis C, Chronic/complications
• Substance Abuse, Intravenous/complications
• Substance Abuse, Intravenous/psychology
• Mental Disorders/psychology
• Mental Disorders/diagnosis
• Diagnostic Errors

• Clinical research engagement
• Hepatitis C virus
• Patient and public involvement
• Thematic synthesis

• IHS-1507-31640 Patient-Centered Outcomes Research Institute
• IHS-1507-31640 Patient-Centered Outcomes Research Institute
• IHS-1507-31640 Patient-Centered Outcomes Research Institute
• IHS-1507-31640 Patient-Centered Outcomes Research Institute
• IHS-1507-31640 Patient-Centered Outcomes Research Institute
• IHS-1507-31640 Patient-Centered Outcomes Research Institute
• IHS-1507-31640 Patient-Centered Outcomes Research Institute

Even though substance users have the highest hepatitis C virus (HCV) burden, many lack knowledge about the infection. Lack of knowledge is an important obstacle to pursuing HCV care. Although printed materials are conventionally utilized to disseminate HCV-related knowledge, narrative story-telling videos may be an alternative. Data are extremely limited, however, in the ability of storytelling videos to increase HCV knowledge among substance users. In this study, we hypothesized that a story-telling narrative video would increase substance user’s immediate and 1-month HCV-related knowledge compared to a printed format.

To assess immediate and 1-month HCV-related knowledge retention among substance users comparing education delivered via a storytelling narrative video compared to a printed format.

We conducted a prospective matched, case-control study among substance users actively prescribed buprenorphine enrolled from two sites. The intervention site received the video and the control site, the brochure. Participants (n = 176) were matched on age, gender, and race. We obtained extensive patient and stakeholder input on the video’s design, validated the video’s content, and developed a recruitment plan to guide participant enrollment. Knowledge was assessed by administration of a 25-item instrument immediately before, immediately after, or one month after the intervention. Data were analyzed using nonparametric and generalized linear mixed-effects models.

We recruited a total of 176 substance users, 90 and 86 individuals, from each site, respectively. One-month follow up occurred in 92% and 94% of enrollees in the control and intervention groups, respectively. In comparison with the pre-intervention scores, immediate knowledge recall increased significantly for both the intervention (P < 0.0001) and control (P < 0.0001) groups. Multivariate modeling revealed a significant improvement in HCV-related knowledge and retention (P = 0.033) among participants who viewed the storytelling video.

Storytelling narratives emphasizing HCV education appear to be an effective method to increase HCV-related knowledge among substance users. They should become an educational cornerstone to promote HCV management among this population.

• Hepatitis C virus education
• Hepatitis C Virus
• Hepatitis C virus knowledge
• Persons with opioid use disorder
• Decision-making in healthcare

• Antiviral Agents/therapeutic use
• Hepacivirus
• Hepatitis C/drug therapy
• Hepatitis C, Chronic/drug therapy
• Humans
• Primary Health Care/methods
• Qualitative Research

• Case management
• Methadone
• Opioid-related infectious diseases
• Qualitative research
• Telemedicine

• hepatitis C
• opioid treatment programs
• telemedicine
• telemedicine satisfaction

• Adult
• Antiviral Agents/administration & dosage
• Combined Modality Therapy/methods
• Disease Management
• Female
• Hepatitis C/diagnosis
• Hepatitis C/drug therapy
• Humans
• Male
• Methadone/administration & dosage
• Middle Aged
• Opiate Substitution Treatment/methods
• Opioid-Related Disorders/diagnosis
• Opioid-Related Disorders/drug therapy
• Patient Compliance/statistics & numerical data
• Patient Safety
• Patient Satisfaction/statistics & numerical data
• Pilot Projects
• Risk Assessment
• Surveys and Questionnaires
• Telemedicine/organization & administration
• Treatment Outcome

• AIDS
• health care delivery
• nursing care/interventions
• randomized controlled trials
• social and economic aspects of illness

• Hepatitis C
• Methadone
• Peer
• Peer educator
• Treatment

• Harm reduction
• Hepatitis C
• PWID
• Patient education

• Aboriginal people
• Australia
• health behaviour
• hepatitis C
• knowledge

• Adult
• Australia
• Female
• Health Knowledge, Attitudes, Practice
• Health Promotion
• Hepatitis C/diagnosis
• Hepatitis C/therapy
• Humans
• Life Style
• Male
• Middle Aged
• New South Wales
• Self Report
• Surveys and Questionnaires

• Appointment-keeping behavior
• HCV
• HIV
• Health beliefs

HCV treatment among people who inject drugs (PWID) is low. Education programs may be suitable strategies to improve patients’ knowledge about their condition and to overcome barriers to access treatment.

The Health Educational Program (HEP) consisted of patient workshops and educational videos and leaflets, and healthcare professionals’ workshops. HEP was implemented at seven substance dependence treatment centers (STDC) in Portugal. The study comprised two cross-sectional evaluations conducted before and after HEP. At both evaluations, adult patients with confirmed HCV diagnosis and registered in the STDC were consecutively included. For patients that completed both evaluations, the overall knowledge score were calculated and compared with McNemar test. Linear regression modelling was used to evaluate factors associated with baseline knowledge. Rates of referral and attendance to referral specialist, treatment proposal, initiation and retention at both evaluations were also compared with McNemar test.

Overall, 504 patients with chronic hepatitis C were included: 78 % male, mean age 42.3 ± 6.6 years, 14 % school education ≤ 4 years, disease duration 11.0 ± 6.0 years and 26 % HIV co-infected. A higher baseline knowledge was independently associated with educational level ≥ 10 years (regression coefficient [B] =15.13, p < 0.001), current use of intravenous drugs (B = 7.99, p = 0.038), previous referral for treatment (B = 4.26, p = 0.008) and previous HCV treatment (B = 5.40, p = 0.003). Following HEP, mean knowledge score increased from 69 % to 79 % (p < 0.001). The rate of patient referral to a liver specialist increased from 56.2 % to 67.5 % (p < 0.001).

An HEP conducted at STDCs improved significantly patient knowledge about hepatitis C, even among patients with a high baseline knowledge. The HEP has also increased the rate of referral to the liver specialist and showed a great potential to support healthcare professionals in managing HCV. Education programs may promote treatment access among PWID, a population that represents the majority of HCV infected patients.

The online version of this article (doi:10.1186/s12879-016-1883-6) contains supplementary material, which is available to authorized users.

• Chronic hepatitis C treatment
• Health education program
• Hepatitis C
• People who inject drugs
• Substance abuse
• Treatment access

• Hepatitis C virus
• Injection drug use
• Treatment adherence

• Antiviral Agents/therapeutic use
• Databases, Factual
• Hepatitis C/complications
• Hepatitis C/drug therapy
• Humans
• Patient Compliance
• Social Facilitation
• Substance Abuse, Intravenous/complications

• Doris Duke Charitable Foundation

• discrimination
• health workers
• hepatitis C
• injecting drug use
• stigma
• treatment

New therapies with the potential to eradicate HCV are available. Engagement of infected individuals with care is the major barrier to realising this vision. We describe an enhanced care pathway leading to a sustained increase in indices of engagement.

Background. Engagement of individuals infected with hepatitis C virus (HCV) with care pathways remains a major barrier to realizing the benefits of new and more effective antiviral therapies. After an exploratory study, we have undertaken an evidence-based redesign of care pathways for HCV, including the following: (1) reflex testing of anti-HCV-positive samples for HCV RNA; (2) annotation of laboratory results to recommend referral of actively infected patients to specialist clinics; (3) educational programs for primary care physicians and nurses; and (4) the establishment of needs-driven community clinics in substance misuse services.

Methods. In this study, we conducted a retrospective cohort study of progression through care pathways of individuals with a new diagnosis of HCV infection made between January 2010 and January 2012. We also analyzed patient flow through new care pathways and compared this with our baseline study of identical design.

Results. A total of 28 980 samples were tested for anti-HCV antibody during the study period and yielded 273 unique patients with a new diagnosis of HCV infection. Of these, 38% were tested in general practice, 21% were tested in substance misuse services, 23% were tested in secondary care, and 18% were tested in local prisons. Overall, 80% of patients were referred to specialist clinics, 70% attended for assessment, and 38% commenced treatment, in comparison to 49%, 27%, and 10%, respectively, in the baseline study. Referral rates from all testing sources improved.

Conclusions. This study provides timely evidence that progression through care pathways can be enhanced, and it demonstrates reduction of key barriers to eradication of HCV.

• HCV
• care pathways
• public health

Most hepatitis C virus (HCV) infections in the United States occur following non-sterile injection drug use. However, the majority of people who inject drugs (PWID) with chronic HCV are not currently receiving care.

This paper presents our protocol for the systematic review and meta-analysis of data on the natural history of HCV among PWID and will inform modeling of the impact and cost-effectiveness of HCV management among this population. This study is conducted as part of the HCV Synthesis Project, which is funded to develop recommendations for HCV control strategies in the United States.

This protocol describes the methods used for a systematic review and meta-analysis of published and unpublished data on the natural history of HCV among PWID including viral clearance, fibrosis progression, and the incidence of compensated cirrhosis (CC), decompensated cirrhosis (DC), hepatocellular carcinoma (HCC), and liver-related mortality.

Final results are anticipated by December 2016.

Methods used for the synthesis of data on disease progression among HCV mono-infected PWID are presented. Data from the systematic review and meta-analysis will be used to inform simulations of the natural history of HCV and to model the effects of prevention and treatment strategies to reduce disease burden and the associated costs to society and individual patients.

• HCV disease progression
• cirrhosis
• fibrosis
• hepatitis C
• hepatocellular carcinoma
• people who inject drugs
• systematic review

• Direct acting antivirals
• Hepatitis C virus
• People who inject drugs
• Treatment

• hepatitis C
• opiate substitution treatment
• qualitative research
• treatment

• Education
• Hepatitis
• Knowledge
• Methadone

This descriptive qualitative study examined the patient, provider, and institutional factors contributing to nonattendance for hepatitis C (HCV) care throughout the disease course. Eighty-four patients and health and social care providers were interviewed. Thematic analysis of the data yielded 6 interrelated nonattendance themes: self-protection, determining the benefits, competing priorities, knowledge gaps, access to services, and restrictive policies. Factors within the themes varied with the disease course, type of provider/service, and patient context. Nonattendance could span months to years and most frequently began at diagnosis where providers either advised that followup was not necessary or did not recommend any followup. The way services were organized (low barrier access) and delivered (nonjudgmental approach) and higher HCV knowledge levels of patients and providers encouraged attendance. This is the first study to explore the reasons for nonattendance for HCV care throughout the disease course and validate them from multiple perspectives. There are missed opportunities for providers to encourage attendance throughout the disease course beginning at diagnosis. Interventions required include development of integrated health and social service delivery models; mechanisms to improve knowledge dissemination of the disease, its management, and treatment; and implementation of standardized followup protocols for liver disease monitoring in primary care.

• hepatitis c
• illicit drug use
• injection drug use
• health care access

• Adult
• Black or African American/psychology
• Attitude to Health
• Counseling
• Early Diagnosis
• Female
• Focus Groups
• Health Services Accessibility
• Hepatitis C, Chronic/complications
• Hepatitis C, Chronic/diagnosis
• Hepatitis C, Chronic/psychology
• Hispanic or Latino/psychology
• Humans
• Male
• Middle Aged
• New York City
• Perception
• Qualitative Research
• Referral and Consultation
• San Francisco
• Substance Abuse, Intravenous/complications

• R01 DA020841 NIDA NIH HHS
• R01 DA020781 NIDA NIH HHS
• P30 DA011041 NIDA NIH HHS
• P50DA009253 NIDA NIH HHS
• P30DA 011041 NIDA NIH HHS
• R01DA020841 NIDA NIH HHS
• U10 DA015815 NIDA NIH HHS
• L60 MD003097 NIMHD NIH HHS
• R01DA020781 NIDA NIH HHS
• U10DA015815 NIDA NIH HHS
• NTC 0035 PHS HHS
• P50 DA009253 NIDA NIH HHS

Infection with hepatitis C virus (HCV) is associated with high morbidity and increased mortality but many patients avoid initiation of treatment or report challenges with treatment completion. The study objective was to identify motivators and barriers for treatment initiation and completion in a community sample of HCV-infected patients in the United States.

Survey methods were employed to identify factors reported by patients as important in their decision to start or complete HCV treatment. Study participants included 120 HCV-infected individuals: 30 had previously completed treatment with pegylated interferon/ribavirin (PR), 30 had discontinued PR, 30 were treated with PR at the time of the survey, and 30 were treatment‒naïve. Telephone interviews occurred between May and August of 2011 and employed a standardized guide. Participants assigned factors a rating from 1 (not at all important) to 5 (extremely important). Trained researchers coded and analyzed interview transcripts.

Of 33 factors, expected health problems from not treating HCV infection was reported as most encouraging for treatment initiation and completion, while treatment side effects was most discouraging. Sixty-nine percent of participants reported that the ability to obtain information during treatment on the likelihood of treatment success (i.e., results of viral load testing) would motivate them to initiate therapy. Median preferred timing for learning about test results was 5 weeks (range: 1–23 weeks).

Understanding challenges and expectations from patients is important in identifying opportunities for education to optimize patient adherence to their HCV treatment regimen.

• IDU
• attitude
• legalisation
• prohibition decriminalisation

• hepatitis c
• hepatitis c education
• vulnerable populations
• hepatitis c knowledge
• disparity of care