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. 2022 Jun 24:10:877585.
doi: 10.3389/fpubh.2022.877585. eCollection 2022.

Interventions to Improve Uptake of Direct-Acting Antivirals for Hepatitis C Virus in Priority Populations: A Systematic Review

David Ortiz-Paredes  1 , Afia Amoako  2 , Taline Ekmekjian  3 , Kim Engler  1 , Bertrand Lebouché  1   4   5 , Marina B Klein  5   6
Affiliations

Interventions to Improve Uptake of Direct-Acting Antivirals for Hepatitis C Virus in Priority Populations: A Systematic Review

David Ortiz-Paredes et al. Front Public Health. .

Abstract

Background & objective: Access to Hepatitis C (HCV) care remains suboptimal. This systematic review sought to identify existing interventions designed to improve direct-acting antiviral (DAA) uptake among HCV infected women, people who inject drugs (PWID), men who have sex with men (MSM), and Indigenous peoples.

Methods: Studies published in high- and middle-income countries were retrieved from eight electronic databases and gray literature (e.g., articles, research reports, theses, abstracts) were screened by two independent reviewers. Identified interventions were summarized using textual narrative synthesis.

Results: After screening 3,139 records, 39 studies were included (11 controlled comparative studies; 36 from high-income countries). Three groups of interventions were identified: interventions involving patients; providers; or the healthcare system. Interventions directed to patients included care co-ordination, accelerated DAA initiation, and patient education. Interventions involving providers included provider education, telemedicine, multidisciplinary teams, and general practitioner-led care. System-based interventions comprised DAA universal access policies and offering HCV services in four settings (primary care, secondary care, tertiary care, and community settings). Most studies (30/39) described complex interventions, i.e., those with two or more strategies combined. Most interventions (37/39) were tailored to, or studied among, PWID. Only one study described an intervention that was aimed at women.

Conclusions: Combining multiple interventions is a common approach for supporting DAA initiation. Three main research gaps were identified, specifically, a lack of: (1) controlled trials estimating the individual or combined effects of interventions on DAA uptake; (2) studies in middle-income countries; and (3) interventions tailored to women, MSM, and Indigenous people.

Keywords: Hepatitis C; Indigenous peoples; antiviral agents; people who inject drugs; sexual and gender minorities.

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Conflict of interest statement

This study received funding from the Gilead LEGA-C NoCo Program. The funder had the following involvement with the study: revision of the manuscript. MK reports grants for investigator-initiated studies from ViiV Healthcare, Merck, and Gilead; consulting fees from ViiV Healthcare, Merck, AbbVie and Gilead. She is supported by a Canada Research Chair, Tier 1. BL is the holder of a Canadian Institutes for Health Research, Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials for HIV Care and also supported by a career award, LE 250, from the Quebec's Ministry of Health for researchers in Family Medicine. BL reports grants for investigator-initiated studies from ViiV Healthcare, Merck, and Gilead; consulting fees from ViiV Healthcare, Merck, and Gilead. DO-P, AA, TE, and KE have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
PRISMA flow diagram.
Figure 2
Figure 2
Stakeholder group(s) addressed by the 30 complex interventions.
Figure 3
Figure 3
Number of studies that addressed the populations of interest. MSM, men who have sex with men; PWID, people who inject drugs.
See this image and copyright information in PMC

References

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