Hepatitis C, mental health and equity of access to antiviral therapy: a systematic narrative review

Hepworth, Julie, Bain, Tanya and van Driel, Mieke (2013) Hepatitis C, mental health and equity of access to antiviral therapy: a systematic narrative review. International Journal for Equity in Health, 12 1: 92.1-92.8. doi:10.1186/1475-9276-12-92

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Author Hepworth, Julie
Bain, Tanya
van Driel, Mieke
Title Hepatitis C, mental health and equity of access to antiviral therapy: a systematic narrative review
Journal name International Journal for Equity in Health   Check publisher's open access policy
ISSN 1475-9276
Publication date 2013-11-18
Year available 2013
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1186/1475-9276-12-92
Open Access Status DOI
Volume 12
Issue 1
Start page 92.1
End page 92.8
Total pages 8
Place of publication London, United Kingdom
Publisher BioMed Central
Language eng
Formatted abstract
Introduction: Access to hepatitis C (hereafter HCV) antiviral therapy has commonly excluded populations with mental health and substance use disorders because they were considered as having contraindications to treatment, particularly due to the neuropsychiatric effects of interferon that can occur in some patients. In this review we examined access to HCV interferon antiviral therapy by populations with mental health and substance use problems to identify the evidence and reasons for exclusion.

Methods: We searched the following major electronic databases for relevant articles: PsycINFO, Medline, CINAHL, Scopus, Google Scholar. The inclusion criteria comprised studies of adults aged 18 years and older, peer-reviewed articles, date range of (2002–2012) to include articles since the introduction of pegylated interferon with ribarvirin, and English language. The exclusion criteria included articles about HCV populations with medical co-morbidities, such as hepatitis B (hereafter HBV) and human immunodeficiency virus (hereafter HIV), because the clinical treatment, pathways and psychosocial morbidity differ from populations with only HCV. We identified 182 articles, and of these 13 met the eligibility criteria. Using an approach of systematic narrative review we identified major themes in the literature.

Results: Three main themes were identified including: (1) pre-treatment and preparation for antiviral therapy, (2) adherence and treatment completion, and (3) clinical outcomes. Each of these themes was critically discussed in terms of access by patients with mental health and substance use co-morbidities demonstrating that current research evidence clearly demonstrates that people with HCV, mental health and substance use co-morbidities have similar clinical outcomes to those without these co-morbidities.

Conclusions: While research evidence is largely supportive of increased access to interferon by people with HCV, mental health and substance use co-morbidities, there is substantial further work required to translate evidence into clinical practice. Further to this, we conclude that a reconsideration of the appropriateness of the tertiary health service model of care for interferon management is required and exploration of the potential for increased HCV care in primary health care settings.
Keyword Public, Environmental & Occupational Health
Public, Environmental & Occupational Health
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Discipline of General Practice Publications
Official 2014 Collection
School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 2 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 4 times in Scopus Article | Citations
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Created: Tue, 26 Nov 2013, 20:49:49 EST by Shani Lamb on behalf of Discipline of General Practice