Hepatitis C Antiviral Treatment Rates: Understanding Racial Disparities

丙型肝炎抗病毒治疗率：了解种族差异

• 批准号: 8195228
• 负责人: MICHAEL K. CHAPKO
• 金额: --
• 依托单位: VA PUGET SOUND HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-05-01 至 2013-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8195228
• 关键词: Address; Affect; African American; Antiviral Agents; Antiviral Therapy; Appointment; Area; Caucasians; Caucasoid Race; Cessation of life; Cirrhosis; Clinic; Clinical; Code; Communities; Complex; Data; Decision Making; Development; Disease; Drops; Enrollment; Epidemiologic Methods; Epidemiologic Studies; Ethnic Origin; Face; Foundations; Future; Gastroenterology; General Population; Goals; Health; Health Personnel; Health Services Research; Hepatitis C; Hepatitis C Antiviral; Hepatitis C Prevalence; Hepatitis C virus; High Prevalence; Intervention; Interview; Investigation; Lead; Longitudinal Studies; Measurable; Methods; Morbidity - disease rate; Outcome Study; Patients; Pattern; Perception; Population; Positioning Attribute; Prevalence; Primary carcinoma of the liver cells; Process; Provider; Qualitative Methods; Race; Recommendation; Research; Research Infrastructure; Resources; Secure; Source; Survey Methodology; Time; United States Department of Veterans Affairs; Veterans; Viral; adverse outcome; base; cohort; compliance behavior; design; experience; health disparity; insight; interest; meetings; mortality; novel; racial difference; research and development; response; satisfaction; sound; success; therapy design

ABSTRACT Project Background: HCV is an important health problem within the Veterans Administration (VA). Veterans are more than three times more likely to be infected with HCV than the general population, with the prevalence in African American veterans being three and a half times higher than even that of Caucasian veterans. The disease results in substantial morbidity and mortality, including cirrhosis, hepatocellular carcinoma and death. The current antiviral therapy can achieve a HCV cure rate of 55%, making it the most effective method for reducing the long-term consequences of the disease. Yet despite the higher prevalence, African Americans have significantly lower treatment rates compared to Caucasians. However, no study has addressed this pressing problem within or outside the VA. Project Objectives: (1) Using audio-recoded GI provider-patient clinical encounters, determine whether racial differences exist in providers' recommendations for and patients' interest in initiating antiviral therapy. (2) Using in-depth qualitative interviews with the same cohort of patients, determine whether racial differences exist in patient factors related to initiating antiviral therapy. (3) Using in-depth qualitative interviews with the same cohort of providers, determine whether differences exist in provider factors related to African Americans initiating antiviral therapy. Project Methods: This longitudinal study will enroll patients referred to a Gastroenterology (GI) clinic who are considered eligible for antiviral treatment. Fifty- four African American and fifty-four Caucasians will have their GI provider-patient clinical encounters audio recorded until either the patient starts antiviral therapy or drops out of the treatment initiation process. Patients will participate in a qualitative interview after each clinical encounter. The interview will focus on their satisfaction with the clinical encounter, their concerns, their understanding of HCV treatment, and their facilitators and barriers to treatment. Providers will also participate in a qualitative interview after each clinical encounter. The interview will focus on their recall of patient concerns, their perception of the patient's understanding of HCV treatment, the patient's treatment candidacy, and the perceived level of patient adherence. Qualitative methods will be used to code and analyze the clinical encounter audio recordings, the patient and the provider interviews.

抽象的 项目背景：HCV 是退伍军人的一个重要健康问题 行政管理（弗吉尼亚州）。退伍军人被感染的可能性是普通人的三倍多 HCV 感染率高于一般人群，非洲裔美国人的患病率 退伍军人的比例甚至比白人退伍军人高出三倍半。 该疾病导致大量发病率和死亡率，包括肝硬化、 肝细胞癌和死亡。目前的抗病毒治疗可以达到HCV 治愈率高达55%，是减少长期疾病最有效的方法 该疾病的后果。然而，尽管患病率较高，非裔美国人 与白人相比，治疗率明显较低。然而没有研究 已经解决了退伍军人管理局内部或外部的这一紧迫问题。 项目目标：(1) 使用音频记录的 GI 提供者与患者的临床接触， 确定提供者的推荐中是否存在种族差异 患者对开始抗病毒治疗的兴趣。 (2) 采用深度定性访谈 与同一组患者一起，确定患者是否存在种族差异 与开始抗病毒治疗相关的因素。 (3) 采用深度定性访谈 对于同一组提供者，确定提供者是否存在差异 与非裔美国人开始抗病毒治疗相关的因素。 项目方法：这项纵向研究将招募转诊至 胃肠病学 (GI) 诊所被认为有资格接受抗病毒治疗。五十- 四名非裔美国人和五十四名白种人将拥有他们的胃肠道提供者-患者 记录临床遭遇的音频，直到患者开始抗病毒治疗或 退出治疗启动过程。患者将参与定性的 每次临床接触后进行访谈。面试将重点关注他们的满意度 临床经历、他们的担忧、他们对 HCV 治疗的理解，以及 他们的治疗的促进因素和障碍。供应商还将参加 每次临床接触后进行定性访谈。采访将重点关注他们 回忆患者关心的问题、患者对 HCV 理解的看法 治疗、患者的治疗候选资格以及患者的感知水平 坚持。将使用定性方法对临床数据进行编码和分析 遇到录音、患者和提供者访谈。