Adherence to treatment
Adherence to treatment is important, and managing any condition or circumstance that may affect adherence to treatment is recommended before commencing DAA therapy for HCV. People with stable psychiatric conditions and/or stable injecting drug use are candidates for DAA treatment. People with no cirrhosis may continue to drink alcohol at low risk levels during treatment (no more than two standard drinks on any day28). Complete abstinence from alcohol is recommended for people with cirrhosis or people with alcohol dependence. People with high-risk alcohol use should be considered for management for alcohol dependence before DAA therapy.
The Australasian Hepatology Association (AHA) has recently released the AHA consensus guidelines for the provision of adherence support to patients with hepatitis C on direct acting antivirals.29 The guidelines consist of 24 consensus recommendations that promote a patient-centred approach, asserting that all patients are at risk of medication non-adherence. “Treatment readiness” is a pivotal concept that influences subsequent adherent behaviour. The AHA guidelines recommend supporting DAA adherence through implementing interventions focused on the patient, such as identifying memory triggers and hooks; and linguistic advice for health professionals, including using non-confrontational and non-judgemental language. See the AHA website (www.hepatologyassociation.com.au) for further information.30