Identifying barriers and facilitators along the hepatitis C care cascade to inform human-centered design of contextualized treatment protocols for vulnerable populations in Austin, Texas: a qualitative study
Abstract Background Hepatitis C virus (HCV) is a leading cause of liver-related mortality and morbidity. Despite effective direct acting antivirals and a simplified treatment algorithm, limited access to HCV treatment in vulnerable populations, including people experiencing homelessness (PEH) and pe...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-08-01
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| Series: | Implementation Science Communications |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s43058-023-00484-6 |
| _version_ | 1797559375932424192 |
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| author | Anmol Desai Lauren O’Neal Kia Reinis Cristal Brown Michael Stefanowicz Audrey Kuang Deepak Agrawal Darlene Bhavnani Tim Mercer |
| author_facet | Anmol Desai Lauren O’Neal Kia Reinis Cristal Brown Michael Stefanowicz Audrey Kuang Deepak Agrawal Darlene Bhavnani Tim Mercer |
| author_sort | Anmol Desai |
| collection | DOAJ |
| description | Abstract Background Hepatitis C virus (HCV) is a leading cause of liver-related mortality and morbidity. Despite effective direct acting antivirals and a simplified treatment algorithm, limited access to HCV treatment in vulnerable populations, including people experiencing homelessness (PEH) and people who inject drugs (PWID), hinders global elimination. Adapting the evidence-based, simplified HCV treatment algorithm to the organizational and contextual realities of non-traditional clinic settings serving vulnerable populations can help overcome specific barriers to HCV care. The first phase of the Erase Hep C study aimed to identify barriers and facilitators specific to these vulnerable populations to design the site-specific, simplified treatment protocols. Methods Forty-two semi-structured qualitative interviews, guided by the Practical, Robust Implementation and Sustainability Model (PRISM) framework, were conducted with clinic staff, community-based organizations providing screening and linkage to care, and patients diagnosed with HCV, to identify contextual barriers and facilitators to treatment at a local community health center’s Health Care for the Homeless program in Austin, Texas. Audio-recorded interviews were systematically analyzed using thematic analysis informed by the PRISM framework and design thinking, to anchor barriers and facilitators along the HCV care cascade. Findings were fed into human-centered design workshops to co-design, with clinic staff, site-specific, simplified HCV treatment protocols. Results The specific needs of PEH and PWID patient populations informed barriers and facilitators of HCV care. Barriers included tracking patients who miss critical appointments or labs, medication access and adherence, and patient HCV knowledge. Clinical teams leveraged existing facilitators and incorporated solutions to barriers into clinic workflows to improve care coordination and medication access. Actionable solutions included augmenting existing staff roles, employing HCV care navigation throughout the cascade, and standardizing medication adherence counseling. Conclusions Clinic staff identified HCV care facilitators to leverage, and designed actionable solutions to address barriers, to incorporate into site-specific treatment protocols to improve patient HCV outcomes. Methods used to incorporate staff and patient experiential knowledge into the design of contextualized treatment protocols in non-traditional clinic settings could serve as a model for future implementation research. The next phase of the study is protocol implementation and patient enrollment into a single-arm trial to achieve HCV cure. |
| first_indexed | 2024-03-10T17:44:29Z |
| format | Article |
| id | doaj.art-05ca76efa3a74da48476a8af791f907f |
| institution | Directory Open Access Journal |
| issn | 2662-2211 |
| language | English |
| last_indexed | 2024-03-10T17:44:29Z |
| publishDate | 2023-08-01 |
| publisher | BMC |
| record_format | Article |
| series | Implementation Science Communications |
| spelling | doaj.art-05ca76efa3a74da48476a8af791f907f2023-11-20T09:34:45ZengBMCImplementation Science Communications2662-22112023-08-014111710.1186/s43058-023-00484-6Identifying barriers and facilitators along the hepatitis C care cascade to inform human-centered design of contextualized treatment protocols for vulnerable populations in Austin, Texas: a qualitative studyAnmol Desai0Lauren O’Neal1Kia Reinis2Cristal Brown3Michael Stefanowicz4Audrey Kuang5Deepak Agrawal6Darlene Bhavnani7Tim Mercer8Department of Population Health, The University of Texas at Austin Dell Medical SchoolThe University of Texas at Austin Dell Medical SchoolDepartment of Population Health, The University of Texas at Austin Dell Medical SchoolDepartment of Internal Medicine, The University of Texas at Austin Dell Medical SchoolDepartment of Population Health, The University of Texas at Austin Dell Medical SchoolDepartment of Population Health, The University of Texas at Austin Dell Medical SchoolDepartment of Internal Medicine, The University of Texas at Austin Dell Medical SchoolDepartment of Population Health, The University of Texas at Austin Dell Medical SchoolDepartment of Population Health, The University of Texas at Austin Dell Medical SchoolAbstract Background Hepatitis C virus (HCV) is a leading cause of liver-related mortality and morbidity. Despite effective direct acting antivirals and a simplified treatment algorithm, limited access to HCV treatment in vulnerable populations, including people experiencing homelessness (PEH) and people who inject drugs (PWID), hinders global elimination. Adapting the evidence-based, simplified HCV treatment algorithm to the organizational and contextual realities of non-traditional clinic settings serving vulnerable populations can help overcome specific barriers to HCV care. The first phase of the Erase Hep C study aimed to identify barriers and facilitators specific to these vulnerable populations to design the site-specific, simplified treatment protocols. Methods Forty-two semi-structured qualitative interviews, guided by the Practical, Robust Implementation and Sustainability Model (PRISM) framework, were conducted with clinic staff, community-based organizations providing screening and linkage to care, and patients diagnosed with HCV, to identify contextual barriers and facilitators to treatment at a local community health center’s Health Care for the Homeless program in Austin, Texas. Audio-recorded interviews were systematically analyzed using thematic analysis informed by the PRISM framework and design thinking, to anchor barriers and facilitators along the HCV care cascade. Findings were fed into human-centered design workshops to co-design, with clinic staff, site-specific, simplified HCV treatment protocols. Results The specific needs of PEH and PWID patient populations informed barriers and facilitators of HCV care. Barriers included tracking patients who miss critical appointments or labs, medication access and adherence, and patient HCV knowledge. Clinical teams leveraged existing facilitators and incorporated solutions to barriers into clinic workflows to improve care coordination and medication access. Actionable solutions included augmenting existing staff roles, employing HCV care navigation throughout the cascade, and standardizing medication adherence counseling. Conclusions Clinic staff identified HCV care facilitators to leverage, and designed actionable solutions to address barriers, to incorporate into site-specific treatment protocols to improve patient HCV outcomes. Methods used to incorporate staff and patient experiential knowledge into the design of contextualized treatment protocols in non-traditional clinic settings could serve as a model for future implementation research. The next phase of the study is protocol implementation and patient enrollment into a single-arm trial to achieve HCV cure.https://doi.org/10.1186/s43058-023-00484-6Hepatitis CHomelessnessIntravenous drug useQualitative researchHuman-centered designImplementation research |
| spellingShingle | Anmol Desai Lauren O’Neal Kia Reinis Cristal Brown Michael Stefanowicz Audrey Kuang Deepak Agrawal Darlene Bhavnani Tim Mercer Identifying barriers and facilitators along the hepatitis C care cascade to inform human-centered design of contextualized treatment protocols for vulnerable populations in Austin, Texas: a qualitative study Implementation Science Communications Hepatitis C Homelessness Intravenous drug use Qualitative research Human-centered design Implementation research |
| title | Identifying barriers and facilitators along the hepatitis C care cascade to inform human-centered design of contextualized treatment protocols for vulnerable populations in Austin, Texas: a qualitative study |
| title_full | Identifying barriers and facilitators along the hepatitis C care cascade to inform human-centered design of contextualized treatment protocols for vulnerable populations in Austin, Texas: a qualitative study |
| title_fullStr | Identifying barriers and facilitators along the hepatitis C care cascade to inform human-centered design of contextualized treatment protocols for vulnerable populations in Austin, Texas: a qualitative study |
| title_full_unstemmed | Identifying barriers and facilitators along the hepatitis C care cascade to inform human-centered design of contextualized treatment protocols for vulnerable populations in Austin, Texas: a qualitative study |
| title_short | Identifying barriers and facilitators along the hepatitis C care cascade to inform human-centered design of contextualized treatment protocols for vulnerable populations in Austin, Texas: a qualitative study |
| title_sort | identifying barriers and facilitators along the hepatitis c care cascade to inform human centered design of contextualized treatment protocols for vulnerable populations in austin texas a qualitative study |
| topic | Hepatitis C Homelessness Intravenous drug use Qualitative research Human-centered design Implementation research |
| url | https://doi.org/10.1186/s43058-023-00484-6 |
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