Adherence to PEG /ribavirin treatment for chronic hepatitis C: prevalence, patterns, and predictors of missed doses and nonpersistence
Year: 2013
Type: article
Abstract: Adherence to treatment for hepatitis C virus (HCV) maximizes treatment efficacy. Missed doses and failing to persist on treatment are two patient-level processes that are rarely defined or analysed separately from other factors affecting treatment adherence. We evaluated the prevalence and patterns of missed doses and nonpersistence, and identified patient characteristics associated with these outcomes. Missed doses of ribavirin (RBV) and peginterferon (PEG), measured prospectively in Virahep-C using electronic monitoring technology, were analysed using generalized estimating equations. Cox proportional hazards models analysed time to nonpersistence from baseline to week 24 (N = 401) and from week 24 to 48 in Responders (N = 242). Average proportion of PEG- and RBV-missed doses increased over time from 5% to 15% and 7% to 27%, respectively. Patients who were younger, African-American, unemployed, or unmarried were at greater risk of missing PEG from week 0 to 24; higher baseline depression predicted missing PEG from weeks 24 to 48. Patients who were younger or African-American were more likely to miss daily RBV from weeks 0 to 24; and those without private insurance or employment were more likely to miss RBV from weeks 24 to 48. Fifty-two patients failed to persist on treatment for patient-driven deviations. Predictors of nonpersistence from weeks 0 to 24 included younger age, lower education, public or no insurance, or worse baseline headaches. In conclusion, electronic monitoring and the prospective Virahep-C design afforded a unique opportunity to evaluate missing doses and nonpersistence separately, and identify patients at risk of nonadherence. These processes will be important to investigate as the dosing schedules of antiviral regimens become increasingly complex.
Source: Journal of Viral Hepatitis
DOI: 10.1111/jvh.12079
Institution: University of North Carolina at Chapel Hill
Language: English
Subfield: Family Practice
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funders: National Institutes of Health, Centers for Disease Control and Prevention, Center for AIDS Research, University of Washington, National Institute of Allergy and Infectious Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Center for Research Resources, Eunice Kennedy Shriver National Institute of Child Health and Human Development
Awards: Mentoring Junior Faculty: Viral hepatitis Clinical Research, G2230551448, Mentoring Junior Investigators: Comprehensive HIV Prevention, UNC Clinical and Translational Science Award, An Adherence and Depression Intervention for Patients During Hepatitis C Therapy, The University of North Carolina Center for AIDS Research
OpenAlex ID: W2080809577