• addiction
• behavioral
• liver
• randomized trial
• treatment

• 5P30 AI064518 NIH HHS
• P30DK034987 NIH HHS
• R01AA021133-01A1 NIH HHS
• 5P30 AI064518 NIH HHS
• P30DK034987 NIH HHS
• R01AA021133-01A1 NIH HHS

• Alcohol related disorder
• Alcoholic liver disease
• Rehabilitation

• Alcoholism
• Humans

• Alcohol use disorder
• alcoholic cirrhosis
• alcoholic liver disease
• anti-craving drugs
• liver transplantation
• psychosocial approach

• Alcoholism/complications
• Alcoholism/diagnosis
• Alcoholism/therapy
• Humans
• Liver Diseases/complications
• Secondary Prevention/methods
• Substance Withdrawal Syndrome/prevention & control

• alcohol use
• coping
• functioning
• hepatitis C
• quality of life

• Addiction
• Alcohol
• Behavioral
• Hepatitis C
• Integrated care
• Therapy

• Humans
• Alcohol Abstinence
• Alcohol Drinking
• Alcoholism/epidemiology
• Alcoholism/therapy
• Carcinoma, Hepatocellular/epidemiology
• Cognitive Behavioral Therapy/methods
• Comorbidity
• Cost-Benefit Analysis
• Hepatitis C, Chronic/epidemiology
• Liver Cirrhosis/epidemiology
• Liver Neoplasms/epidemiology
• Motivational Interviewing/methods
• Psychotherapy, Group
• Quality-Adjusted Life Years
• Randomized Controlled Trials as Topic
• Risk Reduction Behavior
• Multicenter Studies as Topic

• P30 AI064518 NIAID NIH HHS
• R01 AA021133 NIAAA NIH HHS

Alcohol use disorder (AUD) and hepatitis C virus (HCV) infection frequently co-occur. AUD is associated with greater exposure to HCV infection, increased HCV infection persistence, and more extensive liver damage due to interactions between AUD and HCV on immune responses, cytotoxicity, and oxidative stress. Although AUD and HCV infection are associated with increased morbidity and mortality, HCV antiviral therapy is less commonly prescribed in individuals with both conditions. AUD is also common in human immunodeficiency virus (HIV) infection, which negatively impacts proper HIV care and adherence to antiretroviral therapy, and liver disease. In addition, AUD and HCV infection are also frequent within a proportion of patients with HIV infection, which negatively impacts liver disease. This review summarizes the current knowledge regarding pathological interactions of AUD with hepatitis C infection, HIV infection, and HCV/HIV co-infection, as well as relating to AUD treatment interventions in these individuals.

• Hepatitis C virus
• Human immunodeficiency virus
• Hepatitis C virus/human immunodeficiency virus co-infection
• Liver
• Alcohol

There are over 3 million Americans infected with hepatitis C virus (HCV). Despite recent advances in HCV treatment, a major barrier to care remains a limited number of treaters. HCV therapy provision by primary care providers (PCPs) could expand access by increasing the pool of HCV treating clinicians.

To characterize current HCV care practices, willingness and self-efficacy of PCPs to become HCV treaters.

Two hundred and seventy one PCPs were identified from community clinics affiliated with a large academic center and 4 large federally qualified health centers in Baltimore, MD. An internet-based survey was administered to assess provider demographics, clinical practice site and willingness to provide HCV care. Factors associated with willingness to provide HCV care were examined using odds ratios (OR).

Among 129 (48%) PCPs who responded, the majority (70%) had an MD/DO degree and were white (60%). Only a few PCPs, 12 (10%), had treated at least 1 patient for HCV in the prior year. Although only 22% agreed that HCV treatment should be provided by PCPs, 84% were interested in more HCV training. Willingness to provide treatment was strongly linked to having a high proportion of HCV-infected patients (>20% versus <20%; OR 3.9; 95% confidence interval [CI] 1.5–10) and availability of other services at the primary care site including HIV treatment (OR 6.5; 95% CI 2.5–16.5), substance abuse treatment (OR 3.3; 95% CI 1.3–8.4) and mental health services (OR 4.9; 95% CI 2.0–12.1).

These data suggest that efforts to expand HCV medical provider capacity will be most impactful if they initially focus HCV training on PCPs with a high prevalence of HCV among their patients and existing systems to support HCV care.

• Hepatitis C
• Primary care
• Treatment

• Hepatitis C
• liver disease
• medical and clinical social workers
• treatment

• Alcohol Drinking/prevention & control
• Behavior Therapy
• Female
• Hepacivirus/isolation & purification
• Hepatitis C
• Humans
• Male
• Middle Aged
• Social Work

In an attempt to curtail the rising morbidity and mortality from undiagnosed HCV (hepatitis C virus) in the United States, screening guidelines have been expanded to high-risk individuals and persons born 1945–1965. Community-based screening may be one strategy in which to reach such persons; however, the acceptance of HCV testing, when many high-risk individuals may not have access to HCV specific medications, remains unknown.

We set out to assess attitudes about HCV screening and knowledge about HCV disease at several community-based testing sites that serve high-risk populations. This assessment was paired with a brief HCV educational intervention, followed by post-education evaluation.

Participants (n = 140) were surveyed at five sites; two homeless shelters, two drug rehabilitation centers, and a women’s "drop-in" center. Personal acceptance of HCV testing was almost unanimous, and 90% of participants reported that they would still want to be tested even if they were unable to receive HCV treatment. Baseline hepatitis C knowledge was poor; however, the brief educational intervention significantly improved knowledge and increased acceptability of testing when medical access issues were explicitly stated.

Despite inconsistencies in access to care and treatment, high-risk communities want to know their HCV status. Though baseline HCV knowledge was poor in this population, a brief on-site educational intervention improved both knowledge and acceptability of HCV testing and care. These data support the establishment of programs that utilize community-based screening, and also provide initial evidence for acceptance of the implementation of the recently expanded screening guidelines among marginalized communities.

• hcv
• alcohol-related disorders
• delivery of health care

• Adult
• Aged
• Alcoholism/complications
• Alcoholism/therapy
• Counseling
• Female
• Hepatitis C, Chronic/complications
• Hepatitis C, Chronic/drug therapy
• Humans
• Male
• Middle Aged
• Patient Care Team
• Psychotherapy, Group
• Temperance

• P30 AI064518 NIAID NIH HHS
• R01 AA021133 NIAAA NIH HHS
• R21 AA017252 NIAAA NIH HHS
• 1R21AA017252-01A1 NIAAA NIH HHS