Meaning of Adherence in Hepatitis C-Infected Military Veterans.

Among United States (U.S.) veterans, the prevalence of chronic hepatitis C infection is three times that of the general U.S. population. Treatment success is proportionate to the degree of treatment adherence. There has been little research dedicated to the systematic exploration of issues related to treatment adherence. The purpose of this study was to describe factors that influenced adherence in infected military veterans. Phenomenological research emphasizes a rich description. A convenience sample of 21 veterans was recruited from a clinic in north Texas. One-time in-depth interviews explored reasons for remaining in treatment despite difficult side effects. Analysis included immersion, data transformation, thematic analysis, and summary. Cognitive strategies to stay on medication include making a commitment to treatment, "not ready to leave this world," conserving energy and staying busy, looking forward, and starting over. Veterans utilize previously learned military discipline to stay on medications and follow providers' orders. They are not ready to die and have plans for life after treatment. Patient education should focus on side effect management, rather than on genotypes or viral load. Treatment teams should include substance abuse specialists and gastroenterology providers. Future studies need to develop a measurement tool for adherence during antiviral treatment.

Social Support and Adherence for Military Veterans With Hepatitis C.

PURPOSE/OBJECTIVES: The aim of this study was to describe military veterans' experiences of support and how those experiences influence their decisions to be adherent, during hepatitis C virus (HCV) treatment. DESIGN: A qualitative phenomenological design was used. Inclusion criteria were veterans 18 years or older, receiving standard treatment for HCV, able to read, write, and communicate in English. SETTING: A US Veterans Administration facility in Texas. SAMPLE: Convenience sampling was used to obtain a final sample of 21 veterans. METHODS: Data collection consisted of 1-time, in-depth interviews with analysis occurring simultaneously. Follow-up phone calls with participants verified that the themes were accurate reflections of their lived experience. RESULTS: Because of the fear of stigma, veterans make choices about to whom they tell their diagnosis. This limits the circle of friends and coworkers who could provide support. For some veterans, family members provide emotional and practical support, but family can also be a burden. In order to cope with family and treatment demands, some veterans hibernate, whereas others socialize with friends and coworkers. Some veterans found providers to be supportive, but others did not. CONCLUSIONS: Veterans experience both supportive and unsupportive reactions from family, friends, and healthcare providers while receiving HCV treatment. Those reactions either support or frustrate efforts to be adherent to treatment. IMPLICATIONS: In order to support treatment adherence, healthcare providers need to assess sources of support, or burden, experienced by military veterans during HCV treatment. When veterans do not have a supportive network, they need to be encouraged to attend a support group or seek counseling. Support services need to be funded by the Veterans Administration. Providers need to practice empathy and caring in order to support adherence during treatment. Further research is needed on how military veterans manage their health after hepatitis C treatment, contrasting successful versus unsuccessful treatment outcomes.

Effects of recognizing depression with a standardized questionnaire (CES-D) versus patient reporting of depression after a single-standardized question on the outcomes of treatment for hepatitis C with pegylated interferon-α-2b and ribavirin.

BACKGROUND: Depression may worsen during antiviral treatment for hepatitis C virus, resulting in noncompliance treatment. AIM: The aim was to compare the response and compliance rates between the groups of veteran patients using two different methods of identifying depression, either the Centers for Epidemiology Studies for Depression Scale (group A) questionnaire or the report of symptoms of depression after a single-standardized question by the health care provider (group B). METHODS: One hundred and twenty-nine patients were randomly assigned to the two groups before the treatment. RESULTS: No statistical differences were noted in baseline characteristics between the groups. Depression was common in both the groups. No difference between initial Centers for Epidemiologic Studies Depression Scale scores and diagnosis of depression between the two groups was noted. Furthermore, the number of patients diagnosed with depression during the treatment was similar in each group. There were no significant differences between the groups in rates of sustained viral response (30% group A, 35% group B) or in rates of overall compliance with patients receiving more than 90% of prescribed PegIntronA therapy (44% group A, 39% group B), and ribavirin (32% group A and 37% group B). CONCLUSION: The use of the Centers for Epidemiology Studies for Depression Scale questionnaire to recognize depression had no significant advantage over patient reporting of depression symptoms after a single-standardized question on the hepatitis C virus clearance and the treatment compliance rates in veteran populations.