Theme: Clinical Research Year: 2015
Historically, the myriad of side effects of interferon-based HCV therapy has been managed by a multi-disciplinary team for our marginalized population. DAA therapy has significantly less side effects and higher sustained virologic response (SVR) rates. However, there is a real potential to lessen the gains in overall personal well-being of patients with this change in paradigm, unless deliberate steps are taken.
For fifteen years, our HCV program at CUPS has linked patients with housing, mental health services, addictions counselling, and ongoing nursing support in order to facilitate their ability to tolerate HCV treatment. SVR rates are comparable to those in registration trials. Medication adherence is facilitated markedly by patient engagement . Our patients can self-refer. The nurse can be seen on a walk-in basis. The infectious diseases specialist is on-site.
DAAs are covered by insurance through the social welfare net or indigenous affairs, provided there is stage 2 fibrosis or greater. Because we no longer have a lengthy relationship with the patient, we have developed a three part series of group medical visits to be completed before starting treatment. The first session is basic background on HCV, the second on the medications, and the third on empowerment and maintenance of positive lifestyle changes. Feedback is sought so that this is an iterative process. The goal of the group visits is medication adherence and the engagement of people in reaching out to other affected individuals from a position of strength and knowledge to reduce the stigma and barriers. An informal empowering peer support network is emerging through the group visits.
The challenge to engage the whole patient in the era of directly acting antiviral (DAA) therapy for hepatitis C virus (HCV) infections can be addressed by a paradigm shift to group-based education and support sessions.