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

International Journal for Equity in Health

Research

Mieke van Driel¹  Tanya Bain²  Julie Hepworth³ 

[1] Discipline of General Practice, School of Medicine, The University of Queensland, Queensland, Australia;HIV/HCV Education Unit, Discipline of General Practice, School of Medicine, The University of Queensland, Queensland, Australia;School of Public Health and Social Work, Queensland University of Technology, Queensland, Australia;

关键词: Mental Health;    Interferon;    Antiviral Therapy;    Interferon Therapy;    Health Service Delivery;   

DOI  :  10.1186/1475-9276-12-92

 received in 2013-06-06, accepted in 2013-11-12,  发布年份 2013

来源: Springer

【 摘 要 】

IntroductionAccess 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.MethodsWe 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.ResultsThree 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.ConclusionsWhile 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.

【 授权许可】

CC BY   
© Hepworth et al.; licensee BioMed Central Ltd. 2013