Author: Weiss JJ, Amory C, Prochno K, Prieto S, Aaronson C, Cervantes L, Miller T, Stivala A, Wyatt B, Perumalswami P

Theme: Clinical Research Year: 2017

Background: Curative and well-tolerated treatment for hepatitis C virus (HCV) infection is now available to all HIV/HCV co-infected patients. Curing HCV has been shown to significantly decrease morbidity and mortality; yet many co-infected patients engaged in HIV care have not been successfully treated for HCV infection.
Methods: The Psychosocial Readiness Evaluation and Preparation for hepatitis C treatment (PREP-C; is a web-based, open-access resource to evaluate the psychosocial barriers faced by patients medically eligible for HCV treatment. PREP-C evaluates nine domains of psychosocial functioning relevant to HCV treatment initiation— motivation, information, medication adherence, self-efficacy, social support, substance use, psychiatric stability, energy level, and cognitive functioning—and rates them as either “satisfactory” or “could be improved” based on patient responses. The PREP-C profiles of 37 HIV co-infected patients with undetectable HIV viral load who are engaged in HIV care but not engaged in HCV care (referred to as “non-engaged”) were compared to those of 210 HCV patients (12.4% coinfected with HIV) being medically evaluated to begin HCV treatment (“engaged”).
Results: The patients were predominantly male (61.9%) and members of minority groups (42.9% black; 42.5% Hispanic), with a mean age of 53.4 years (SD=10.7). The groups did not differ on these characteristics. The non-engaged patients had more domains rated “could be improved” than engaged patients (mean non-engaged=4.32, SD=1.68; mean engaged=3.46, SD=1.96; p=0.012). Specifically, the non-engaged patients had lower motivation than engaged patients (64.9% satisfactory vs. 84.8%, respectively; p=0.004), less knowledge about HCV and its treatment (0% satisfactory vs. 28.6%; p=0.0002), and a higher rate of current alcohol and substance use (56.8% vs. 30.0%; p=0.002). The other six domains did not differ between groups.
Conclusion: In order to improve HCV treatment initiation among HIV/HCV co-infected patients, behavioral interventions should specifically target motivation, disease and treatment information, and current substance use.

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