The Psychosocial Readiness Evaluation and Preparation for Hepatitis C Treatment (PREP-C) has been developed to provide an initial assessment of a patient’s psychosocial readiness to begin HCV treatment.
The lack of clear guidelines, standardized criteria, or a systematic approach to screening patients for psychosocial readiness for HCV treatment can be either a significant barrier to HCV treatment initiation or conversely can result in HCV treatment being started before patients have been optimally prepared. The PREP-C was developed to provide a standardized method for assessing a patient’s readiness to begin HCV treatment.
By identifying psychosocial factors that can potentially interfere with treatment adherence prior to treatment initiation, healthcare providers have the opportunity to intervene in order to improve these areas of functioning prior to starting treatment. The goal of conducting adequate assessment and intervention to improve psychosocial functioning prior to HCV treatment initiation through use of the PREP-C is to optimize treatment adherence and the achievement of sustained virologic response (‘cure’).
The PREP-C is meant to be used with patients who are in the process of being medically evaluated or ‘worked up’ for HCV treatment. The parallel psychosocial work-up also provides support for patients to complete their medical work-up.
The PREP-C is a structured clinical interview. It allows for the opportunity to provide education to the patient about chronic HCV infection and HCV treatment during the interview.
The PREP-C assesses nine areas of psychosocial functioning that are most relevant to people going on HCV treatment. These areas frequently relate to HCV treatment adherence, early treatment discontinuation, and treatment outcome.
PREP-C Assessment Areas
- Motivation: Reasons client wants to begin HCV treatment, concerns about treatment, and importance of treatment.
- Information: Knowledge about HCV treatment and one’s own HCV disease status.
- Medication Adherence: Current prescribed medications and adherence to them in prior month.
- Self-Efficacy: Self-confidence about adhering to HCV treatment.
- Social Support and Stability: Stability of financial, housing, and social support resources.
- Alcohol and Substance Use: Alcohol and substance use behaviors and current treatment.
- Psychiatric Stability: Current psychiatric status, previous and current treatment.
- Energy Level: Sleep and fatigue.
- Cognitive Functioning: Perceived difficulty with communication in health care setting, problem-solving ability, and memory.
The PREP-C should be used:
- To identify areas of psychosocial functioning that can be improved before a patient begins HCV treatment to ensure that treatment will be successful.
- To identify areas that will need increased monitoring and attention while a patient is on HCV treatment.
The PREP-C should not be used to decide that a patient is inappropriate or ineligible for treatment - or to “screen people out” of treatment. It should be used to identify patient needs and to put proper supports in place before beginning treatment to ensure successful treatment for all who medically need it, especially those who are psychosocially vulnerable.
The PREP-C can be administered by healthcare providers from diverse disciplines, including: medical, mental health, substance use, social work, case management, and health education. It is recommended that professionals complete the online training at www.prepc.org before administering the PREP-C.
After the evaluation has been completed, the interviewer should take time to review and score the patient’s responses. Based on the responses, each of the 9 areas can be scored as: Could Be Improved or Satisfactory or Needs Further Evaluation
For areas in which a patient is rated Could Be Improved, it is strongly recommended that:
Steps be taken to improve functioning in this area before starting HCV treatment
- The interviewer can decide to make immediate interventions, provide the patient with resources, and/or make referrals for further evaluation or treatment.
A treatment adherence or support plan should be put into place before starting HCV treatment
- To compensate for areas of functioning which are not rated as Satisfactory.
- Areas that are not rated as Satisfactory should be routinely reassessed during the course of HCV treatment to monitor change and intervene as needed.
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