Department of Family and Community Medicine (von Aesch, Antoniou, Pinto), St. Michael's Hospital; Department of Family and Community Medicine, Faculty of Medicine (von Aesch, Antoniou, Meaney, Pinto), University of Toronto; Upstream Lab, MAP Centre for Urban Health Solutions (Craig-Neil, Pinto), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Francis Family Liver Clinic, University Health Network, Department of Medicine (Shah); Department of Medicine, Faculty of Medicine (Shah); Li Ka Shing Knowledge Institute (Antoniou), St. Michael's Hospital, Toronto, Ont.
CMAJ Open. 2021 Mar 8;9(1):E201-E207. doi: 10.9778/cmajo.20190194. Print 2021 Jan-Mar.
Antivirals for the treatment of hepatitis C virus (HCV) infection are effective, but many patients remain untreated and treatment is not yet routine in primary care. We evaluated the characteristics of patients who engaged in HCV treatment, and clinician perspectives on the barriers and facilitators to treatment.
Our mixed-method, parallel-design study was conducted at a multisite primary care centre in downtown Toronto. In a retrospective chart review, we searched records from 2011 to 2017 to collect quantitative data, including HCV infection status and HCV treatment status. To contextualize the data, we conducted in-depth interviews with select physicians between Aug. 1 and Nov. 1, 2017, and analyzed the transcripts using content analysis.
Of the 40 381 charts reviewed, 727 patients (1.8%, 95% confidence interval [CI] 1.7%-1.9%) were infected with HCV, and 542 (74.6%) had HCV infection requiring treatment. Of those, 255 patients (47.0%) had engaged in treatment. Patients who had engaged in treatment were more likely to be male (odds ratio [OR] 1.63, 95% CI 1.10-2.42), older (OR 1.04 per year increase in age, 95% CI 1.02-1.05) and housed (OR 2.2, 95% CI 1.36-3.75), and they were more likely not to have engaged in injection drug use (OR 1.87, 95% CI 1.33-2.63). Based on interviews with 8 physicians, treatment barriers included a lack of knowledge about HCV treatment, concerns that patients would not adhere to medications and challenges related to medication access. Facilitators of treatment included access to specialist consultation, pharmacist support and primary care treatment guidelines. Common themes that emerged in both quantitative and qualitative components were the roles of unstable housing and intravenous drug use as barriers to engaging in and completing treatment.
Our study captured provider-identified barriers to HCV care and the key factors related to retention in HCV care, including gender, age, housing status and experience with drug use. Successful primary-care-led HCV treatment programs may incorporate specialist and pharmacy support and focus on younger, female, underhoused populations and people who use drugs.
治疗丙型肝炎病毒 (HCV) 感染的抗病毒药物是有效的，但许多患者仍未接受治疗，且治疗在初级保健中尚未常规开展。我们评估了接受 HCV 治疗患者的特征，以及临床医生对治疗障碍和促进因素的看法。
我们的混合方法、平行设计研究在多伦多市中心的一个多地点初级保健中心进行。在回顾性图表审查中，我们检索了 2011 年至 2017 年的记录，以收集包括 HCV 感染状况和 HCV 治疗状况在内的定量数据。为了使数据具有背景，我们于 2017 年 8 月 1 日至 11 月 1 日期间对选定医生进行了深入访谈，并使用内容分析法对转录本进行了分析。
在审查的 40381 份图表中，有 727 名患者（1.8%，95%置信区间[CI] 1.7%-1.9%）感染了 HCV，其中 542 名（74.6%）患有需要治疗的 HCV 感染。在这些患者中，有 255 名（47.0%）接受了治疗。接受治疗的患者更可能为男性（比值比[OR]1.63，95%CI 1.10-2.42）、年龄较大（OR 每年增加 1 岁，95%CI 1.02-1.05）和有住房（OR 2.2，95%CI 1.36-3.75），他们更不可能使用注射毒品（OR 1.87，95%CI 1.33-2.63）。基于对 8 名医生的访谈，治疗障碍包括缺乏对 HCV 治疗的了解、担心患者不会遵守药物治疗以及与药物获取相关的挑战。治疗的促进因素包括获得专科医生咨询、药剂师支持和初级保健治疗指南。在定量和定性部分都出现的共同主题是不稳定的住房和静脉内药物使用作为参与和完成治疗的障碍。
我们的研究捕捉到了提供者确定的 HCV 护理障碍以及与 HCV 护理保留相关的关键因素，包括性别、年龄、住房状况和药物使用经验。成功的以初级保健为基础的 HCV 治疗项目可能会纳入专科医生和药剂师的支持，并关注年轻、女性、住房条件差和使用毒品的人群。
