US research has
provided important insights into the factors that motivate and deter people
from starting and completing therapy for hepatitis C virus (HCV) infection.
Published in the online journal BMC
Infectious Diseases, the study showed that expected health problems as a result of
not treating HCV infection encouraged people to start or complete therapy,
while treatment side-effects were discouraging. People living with hepatitis C also reported that
they were more likely to start or complete treatment if they were provided with
test results and other information on the likelihood of treatment success.
“Study findings
suggest that future health problems related to chronic HCV infection and the
expected efficacy and safety profile of HCV therapies are likely to impact on
patients’ decisions on HCV treatment initiation and completion,” comment the
authors. “Such risk-benefit considerations…provide a promising foundation for
those seeking to increase HCV treatment adherence and completion.”
Chronic HCV
infection is an increasingly important cause of serious illness and death in
the US. The infection can be treated and cured, and treatment response rates
have been boosted with the introduction of anti-HCV protease inhibitors.
However, the
factors encouraging or deterring people to start and complete HCV therapy are
poorly understood.
A team of
investigators in Boston therefore designed a study involving 120 people with
HCV with various experiences of treatment. The participants
completed a 60-minute telephone interview answering 33 closed-ended questions
about factors that might influence their decisions about treatment. The
participants were asked to rate these factors on a scale from 1 (not at all
important) to 5 (extremely important).
“Study findings
should inform the development of interventions in support of HCV treatment
initiation and maintenance as new treatment options emerge for this patient
population,” explain the authors.
A quarter of
participants were treatment naive; 30 were currently taking HCV therapy; 30 had
started but then discontinued treatment; and 30 had completed the full course of
HCV therapy.
Participants were
broadly representative of the HCV-infected population in the US. Over half
(56%) were male, 63% were white and their median age was 52 years.
The five most
important factors reported as encouraging people to start treatment were:
- Possible future problems from
not treating HCV infection (mean score: 4.8).
- Willpower to take therapy
(mean score: 4.1).
- Advice from doctor (mean score:
4.1).
- Potential negative impact of
HCV on reaching life goals (mean score: 3.6).
- Ability to obtain information
on likelihood of treatment success (mean score: 3.5).
The five factors
that most discouraged people to start therapy were:
- Overall side-effects of
treatment (mean score: -3.0).
- Fatigue (mean score: - 2.9).
- Flu-like symptoms (mean score:
- 2.6).
- Depression (mean score: - 2.4).
- Need to inject one of the
medications (mean score: -.20).
The most important
factors that encouraged participants to complete treatment were:
- Possible future health problems
(mean score: 4.72).
- Willpower (mean score: 4.32).
- Stage of HCV disease (mean
score: 3.82).
- Emotional support from family,
friends and patient groups (mean score: 3.74).
- Advice from doctor (mean score:
3.82).
The five most
significant factors that discouraged patients to complete a course of treatment
were:
- Fatigue (mean score: -2.78).
- Overall side-effects (mean
score: -2.5).
- Flu-like symptoms (mean score:
-2.09).
- Depression (mean score: -2.06).
- Duration of treatment (mean
score: -1.34).
“Patients want to
be in good health now and in the future but while HCV treatment may provide
future health benefits, side-effects make patients feel poorly in the present,”
comment the investigators. “Participants in our research indicated that
side-effects of treatment were most important both in discouraging treatment
start and in challenging treatment adherence.”
The authors also
believe their findings show the importance of “communication and education” to
overcoming barriers to treatment. They conclude: “understanding potential
motivators and treatment challenges from the patient perspective is an
important means to identify opportunities for education and interventions that
encourage initiation and completion of HCV treatment.”