Jeffrey Weiss, PhD, MS
May 13, 2013
Editor's Note: The International Conference on Viral Hepatitis (ICVH) 2013 -- held in New York on March 25-26, 2013, and jointly sponsored by the International Association of Providers of AIDS Care and the Icahn School of Medicine at Mount Sinai -- was designed to update practitioners and scientists on the most recent advances in the management of hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV/hepatitis coinfection.
Jeffrey Weiss, PhD, MS, Associate Professor of Medicine at the Icahn School of Medicine at Mount Sinai, moderated a panel at ICVH 2013 featuring patients discussing barriers to care in hepatitis[1] and comoderated another panel on optimizing outcomes in patients with liver disease.[2] Here, he shares his thoughts on some of the key issues raised during these panel discussions regarding psychosocial issues in patients with HCV.
Two issues raised during ICVH 2013 highlight some of the challenges facing clinicians in managing patients with hepatitis. The Institute of Medicine recommendations for the prevention and control of HBV and HCV noted the need for improved knowledge and awareness about hepatitis among healthcare and social-service providers and the public, especially in at-risk people, as well as the need for improved access to available services.[3] One method raised by the panelists to improve engagement in care was to increase deployment of the peer influence model, which has been used as part of HCV and HIV prevention strategies.[4] Adapting this model to focus on access to and engagement in hepatitis care, peers would go into targeted, hard-to-reach communities to provide education and to connect individuals with testing and treatment opportunities.
Creating tools for primary care physicians to readily educate patients about the importance of effective treatment for hepatitis was also discussed as a potential method for increasing education about and engagement in care. This type of coordinated care has been identified as critical to increasing screening and prevention strategies and may play a key role in improving outcomes in patients with chronic disease.[5]
Yet, engaging patients in care is only a first step toward maximizing treatment benefit in patients with HCV infection. A wide variety of psychosocial factors can influence adherence and treatment effectiveness, particularly among injection drug users, which is a key at-risk population.[6] A structured, integrated approach to ensuring medication adherence in patients with HCV infection is currently lacking at most sites of care,[7] but patients who are given the necessary pretreatment preparation and on-treatment support are more likely to be retained in care and adhere to medication regimens, thus increasing the likelihood for improved outcomes.
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