|dc.contributor.author||Sublette, Victoria Anne||-|
|dc.description.abstract||Hepatitis C virus (HCV) is a bloodborne virus that infects the liver, causing significant
morbidity and mortality. It has been declared a global health threat due to its impact on the
lives of 130-150 million people who are chronically infected. For most of the Western world,
HCV is the primary cause of end-stage liver disease, liver cancer, liver transplant, and liverrelated
death. A rise in morbidity and mortality from hepatitis C is expected to peak in the
next decade as complications have a latency of 20-30 years from disease onset, and the first
peak of the hepatitis epidemic occurred in the 1990s among the baby boomer age group.
Adherence and completion of treatment for patients with hepatitis C remains a challenge.
While biomedical (medical and physiological) host determinants explain approximately 50%
of the variance in treatment outcomes, the key psychosocial (psychological and social) factors
have not yet been unequivocally established.
With interferon-based treatments, uptake, adherence, and treatment completion have been
suboptimal. Even in the new era of improved interferon-free treatment regimens, psychosocial
factors could remain a significant barrier to adequate medication adherence, particularly in
difficult to treat populations, such as those with substance abuse problems and unstable
To improve patient outcomes, the aim of this thesis was to identify the key psychosocial
factors that influence patient adherence and completion through the development and testing
of an assessment tool. The purpose of the assessment tool would be to determine patient
readiness for treatment and identify those patients who required psychosocial intervention
before treatment commencement, to improve adherence and likelihood of completion.
To develop the assessment tool, a mixed method research approach was structured in three
stages. In stage one, a systematic review was performed to clarify current knowledge of the
psychosocial factors that influence treatment outcomes for patients with hepatitis C. Stage two
was a qualitative study to gain further insight into the barriers and facilitators of hepatitis C
treatment adherence and completion. This involved in-depth interviews with patients with
hepatitis C and the doctors and nurses who treat them. These studies informed the design of a
psychosocial assessment tool, comprising standardised instruments measuring nine
psychosocial factors. In stage three, this tool was tested in a longitudinal pilot study, to
determine its ability to predict treatment adherence and completion and identify key areas for intervention.
This project has resulted in four published papers and one submitted manuscript, which
provide novel insights into the psychological and social challenges faced by patients with
hepatitis C, the mechanisms they use to cope with a stigmatised disease and difficult treatment
regimen, and the specific barriers and facilitators they experience on their treatment journey.
Based on our findings, I have proposed a model linking key factors that influence treatment
outcomes. Finally, this thesis provides insights into fruitful areas for future research into
treatment adherence among patients with hepatitis C, with potential broader implications for
patients with other chronic diseases||en_AU|
|dc.publisher||University of Sydney||en_AU|
|dc.publisher||Sydney Medical School||en_AU|
|dc.publisher||Westmead Clinical School||en_AU|
|dc.rights||The author retains copyright of this thesis. It may only be used for the purposes of research and study. It must not be used for any other purposes and may not be transmitted or shared with others without prior permission.||en_AU|
|dc.title||Examining psychosocial factors that influence hepatitis C treatment adherence and completion||en_AU|
|dc.type.pubtype||Doctor of Philosophy Ph.D.||en_AU|
|dc.description.disclaimer||Access is restricted to staff and students of the University of Sydney . UniKey credentials are required. Non university access may be obtained by visiting the University of Sydney Library.||en_AU|
|Appears in Collections:||Sydney Digital Theses (University of Sydney Access only)|