Characterizing Persons With HIV/HCV Coinfection Who Remain Untreated for Hepatitis C at Four HIV Clinics in Connecticut (CT): Role of Multiple Overlapping Barriers at the Individual and Clinic System Levels

Abstract

Introduction. Direct-acting antiviral medications have made hepatitis C virus (HCV) cure possible for >95% of persons with chronic HCV infection, including those coinfected with HIV. Achieving strategic HCV elimination targets requires an understanding of system, provider, and patient-level barriers to treatment. We explored such barriers among persons with HIV/HCV coinfection who remained untreated for HCV. Methods. Among four primary care HIV clinics in CT with high rates of HCV cure, 25 patients with HIV/HCV coinfection were eligible (no HCV treatment as of March 31, 2021). We conducted retrospective chart reviews of demographics, clinical practice patterns, patient-specific issues such as housing, transportation, food security, and presence of mental health and substance use problems. Results. Among untreated patients, 13 (51%) were female; 17 (68%) were Black; median age was 62 years old. The majority (84%) had injecting drug use (IDU) as HIV transmission risk factor; 14 (56%) were prescribed medication-assisted treatment. Median time since HIV and HCV diagnosis was 25 and 19 years, respectively. Clinic-level barriers were noted in 19 (76%) and included lack of evaluation, treatment not recommended or implemented. Concomitant structural barriers included unstable housing for 11 (44%) and lack of transportation for eight (32%). Most patients had history of illicit substance use (84%) and mental health issues (68%). Many (76%) had multiple potential barriers. Conclusions. Multiple overlapping barriers spanning clinic and patient level domains including social determinants of health were the norm in persons with long-standing HIV/HCV coinfection who have not received HCV treatment. Interventions will require innovative, multi-disciplinary and personalized approaches.

Observational Pilot Using a Data to Care Intervention Strategy to Promote HCV Re-engagement and Cure for Persons with HIV/HCV Co-infection who are Out of Care

“…19,23,39 Other factors such as treatment literacy, media representations, trusted and steady provider relationships, perceived lack of adherence support, concerns for treatment cost, were potential self-identi ed barriers to engagement in another study. 40 Often, patients do not enter HCV treatment due to multiple concurrent barriers, 41 suggesting that the D2C approach using DIS workers which is inherently short-lived and focused on brief educational efforts and motivational interviewing, may not be su cient to overcome such longstanding and complex issues. 34 Additionally, active substance use issues may need to be addressed, which is beyond the scope of DIS.…”

Adapting a Data to Care Approach for HIV to Promote HCV Cure for Persons with HIV/HCV Co-infection

“…19, 36, 37 Other factors such as treatment literacy, media representations, trusted and steady provider relationships, perceived lack of adherence support, concerns for treatment cost, were potential self-identified barriers to engagement in another study. 38 Often, patients do not enter HCV treatment due to multiple concurrent barriers, 39 suggesting that the D2C approach using DIS workers which is inherently short-lived and focused on brief educational efforts and motivational interviewing, may not be sufficient to overcome such longstanding and complex issues. 31 Additionally, active substance use issues may need to be addressed, which is beyond the scope of DIS.…”

HCV Cascade of Care in HIV/HCV Co-Infected Individuals: Missed Opportunities for Micro-Elimination

“…Barriers to care for HIV/HCV co-infected individuals include active intravenous drug use, lack of socioeconomic stability (i.e., homelessness, lack of transportation, unemployment), mental health issues, and younger age [ 13 , 14 ]. In a large US cohort of mono- and co-infected individuals, the authors noted that people of color had greater difficulty accessing care, and women were also less likely to initiate HCV treatment even after three years of continuous HIV care [ 15 ].…”