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Cited by 118Hepatitis C virus researchMental Health Treatment and AccessHelicobacter pylori-related gastroenterology studies

Integrated care increases treatment and improves outcomes of patients with chronic hepatitis C virus infection and psychiatric illness or substance abuse

Ho, Samuel B., Bräu, Norbert, Cheung, Ramsey, Liu, Lin, Sanchez, Courtney, Sklar, Marisa, Phelps, Tyler E., Marcus, Sonja G. +7 more·2015·Clinical Gastroenterology and Hepatology
DOI 10.1016/j.cgh.2015.02.022
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Abstract

Background & aims Patients with hepatitis C virus (HCV) infection with psychiatric disorders and/or substance abuse face significant barriers to antiviral treatment. New strategies are needed to improve treatment rates and outcomes. We investigated whether an integrated care (IC) protocol, which includes multidisciplinary care coordination and patient case management, could increase the proportion of patients with chronic HCV infection who receive antiviral treatment (a combination of interferon-based and direct-acting antiviral agents) and achieve a sustained virologic response (SVR).Methods We performed a prospective randomized trial at 3 medical centers in the United States. Participants (n = 363 patients attending HCV clinics) had been screened and tested positive for depression, post-traumatic stress disorder, and/or substance use; they were assigned randomly to groups that received IC or usual care (controls) from March 2009 through February 2011. A midlevel mental health practitioner was placed at each HCV clinic to provide IC with brief mental health interventions and case management, according to formal protocol. The primary end point was SVR.Results Of the study participants, 63% were non-white, 51% were homeless in the past 5 years, 64% had psychiatric illness, 65% were substance abusers within 1 year before enrollment, 57% were at risk for post-traumatic stress disorder, 71% had active depression, 80% were infected with HCV genotype 1, and 23% had advanced fibrosis. Over a mean follow-up period of 28 months, a greater proportion of patients in the IC group began receiving antiviral therapy (31.9% vs 18.8% for controls; P = .005) and achieved a SVR (15.9% vs 7.7% of controls; odds ratio, 2.26; 95% confidence interval, 1.15-4.44; P = .018). There were no differences in serious adverse events between groups.Conclusions Integrated care increases the proportion of patients with HCV infection and psychiatric illness and/or substance abuse who begin antiviral therapy and achieve SVRs, without serious adverse events. ClinicalTrials.gov # NCT00722423.

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Authors
Ho, S. B., Bräu, N., Cheung, R., Liu, L., Sanchez, C., Sklar, M., Phelps, T. E., Marcus, S. G., Wasil, M. M., Tisi, A., Huynh, L., Robinson, S. K., Gifford, A. L., Asch, S. M., & Groessl, E. J.
Affiliations
  • University of California San Diego (US)
  • James J. Peters VA Medical Center (US)
  • VA Palo Alto Health Care System (US)
  • VA San Diego Healthcare System (US)
  • Boston University (US)
Corresponding author
Ho, Samuel B.
ORCID
Venue
Clinical Gastroenterology and Hepatology
Publisher
Elsevier BV
Published
2015-11
Volume
13
Issue
11
Pages
2005-2014.e3
ISSN
1542-3565 (ISSN-L)
DOI
10.1016/j.cgh.2015.02.022
OpenAlex
W2097899475
Cited by
118
References
39
Citations by year
2026: 3 · 2025: 7 · 2024: 6 · 2023: 10 · 2022: 12 · 2021: 17 · 2020: 16 · 2019: 11 · 2018: 9 · 2017: 17 · 2016: 9 · 2015: 1
FWCI
7.13
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • Clinical Gastroenterology and Hepatology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Hepatology › Hepatitis C virus research
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Health Sciences › Medicine › Surgery › Helicobacter pylori-related gastroenterology studies
Keywords
chronic hepatitis C, integrated care, psychiatric comorbidity, depression, post-traumatic stress disorder, substance use disorders, antiviral treatment initiation, sustained virological response, case management, multidisciplinary care coordination, direct-acting antivirals, interferon therapy, homeless patients, barriers to treatment
MeSH terms
Adult, Aged, Mental Disorders, Female, Humans, Male, Middle Aged, Prospective Studies, United States, Treatment Outcome, Delivery of Health Care, Integrated, Case Management, Hepatitis C, Chronic, Substance-Related Disorders

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