P139 Systematic review and meta-analysis of barriers and enablers to hepatitis C direct-acting antiviral treatment initiation
Notice bibliographique
Résumé
Despite the successes of the direct-acting antiviral (DAA) programme for hepatitis C virus (HCV) infection, many groups still experience challenges to accessing care. We aimed to determine the barriers and enablers associated with hepatitis C DAA initiation and their relative impact. We performed a systematic review and meta-analysis of the barriers and enablers to HCV treatment initiation in the DAA era in high income settings with free universal healthcare. We searched eight bibliographic databases for studies published between 2014 and May 2022 using pre-defined keywords. We included quantitative studies investigating positive or negative associations with DAA treatment initiation. Data were extracted into a standardised form and a random-effects meta-analysis was conducted to pool the effects of variables on treatment initiation. The I2 statistic was used to measure heterogeneity across studies. Of 5198 articles identified, 42 studies conducted in Australia, Canada and Europe were included. Overall quality was ‘fair’ or ‘good’ in 37. Significant negative associations with DAA treatment included: unstable housing (14 studies, pooled odds ratio (OR) 0.48, 95% confidence interval (CI) 0.40–0.58, I2 = 21.1%); active injecting drug use (OR 0.54, CI 0.39–0.74, I2 = 97.5%); low income or socioeconomic status (seven studies, OR 0.75, CI 0.60–0.94, I2 = 73.7%) and female gender (26 studies, 0.78, CI 0.69–0.89, I2 = 89.9%). Positive associations included: increasing age (17 studies, OR 1.76, 95% CI 1.30–2.40, I2 = 95.4%); previous HCV treatment (nine studies, OR 2.20, CI 1.45–3.34, I2 = 85.8%); fibrosis stage (13 studies, OR 1.80, CI 1.15–2.79, I2 = 95.6%) and opioid substitution in people who inject drugs (12 studies, OR 1.54, 95% CI 1.15–2.05, I2 = 65.9%). There was no overall effect of high-risk alcohol use on treatment initiation when compared with lower (or no) alcohol use (13 studies, OR 0.91, 95% CI 0.64–1.27, I2 = 98.3%). The most impactful factors associated with DAA treatment initiation were socioeconomic and fixed demographic or disease characteristics. This should enable pre-emptive identification and intervention in those at risk of disengagement before treatment. Active injecting drug use was the only behavioural characteristic consistently associated with lower treatment initiation but this is significantly mitigated by opiate substitution therapy. References Doyle JS, Scott N, Sacks-Davis R, et al. Treatment access is only the first step to hepatitis C elimination: experience of universal anti-viral treatment access in Australia. Aliment Pharmacol Ther 2019;49:1223–9. Amoako A, Ortiz-Paredes D, Engler K, et al. Patient and provider perceived barriers and facilitators to direct acting antiviral hepatitis C treatment among priority populations in high income countries: a knowledge synthesis. Int J Drug Policy. 2021;96:103247. Hashim A, Macken L, Jones AM, et al. Community-based assessment and treatment of hepatitis C virus-related liver disease, injecting drug and alcohol use amongst people who are homeless: a systematic review and meta-analysis. Int J Drug Policy 2021;96:103342. Paisi M, Crombag N, Burns L, et al. Barriers and facilitators to hepatitis C screening and treatment for people with lived experience of homelessness: A mixed‐methods systematic review. Health Expect 2022;25:48–60.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,016 | 0,059 |
| Méta-épidémiologie (sens strict) | 0,003 | 0,002 |
| Méta-épidémiologie (sens large) | 0,018 | 0,040 |
| Bibliométrie | 0,008 | 0,010 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,005 | 0,003 |
| Science ouverte | 0,003 | 0,002 |
| Intégrité de la recherche | 0,003 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,009 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».