Determinants of stigma among patients with hepatitis C virus infection

Abstract

Stigma around hepatitis C virus (HCV) infection is an important and understudied barrier to HCV treatment and elimination. The determinants of HCV-related stigma, including the impacts of stage of HCV treatment (ie spontaneously cleared; diagnosed, untreated; previously treated, not cured; currently being treated; and treated, cured) and coinfection with human immunodeficiency virus (HIV), remain unknown. To address these gaps, we conducted a cross-sectional study among patients with a history of HCV infection (n = 270) at outpatient clinics in Philadelphia from July 2018 to May 2019. We evaluated stigma using the validated HCV Stigma Scale, adapted from the Berger HIV Stigma Scale. Associations among HCV-related stigma and hypothesized demographic, behavioural, and clinical risk factors were evaluated by multivariable linear regression. Most participants (95.5%) experienced HCV-related stigma. Mean stigma scores did not differ significantly between HCV-monoinfected and HIV/HCVcoinfected participants (P = .574). However, we observed significant interactions between HIV status and multiple determinants; therefore, we stratified analyses by HIV status. Among HIV/HCV-coinfected participants, previous HCV treatment without cure, female gender, Hispanic/Latinx ethnicity and some college education were significantly associated with higher HCV-stigma scores. An annual income of $10 000-$40 000 was associated with significantly lower stigma scores. No significant associations were observed among HCV-monoinfected participants. We found that most participants experienced stigma associated with HCV diagnosis. While stigma scores were similar between HCV-monoinfected and HIV/HCV-coinfected participants, the determinants associated with HCV stigma differed by HIV status.

Fitting health care to people: understanding and adapting to the epidemiology and health literacy of people affected by viral hepatitis from culturally and linguistically diverse migrant backgrounds

“…Social and cultural stigma in many migrant communities needs to be breached to better understand injection drug use as a major risk factor for HCV transmission. The presence of stigma and discrimination in the community harms the utilization of needle and syringe programs and the uptake of antiviral prophylaxis for the prevention of HBV mother to child transmission [21,22]. Stigma and discrimination in persons with VH affect the possibility of early diagnosis, and treatment adherence, which may be associated with a presentation with advanced liver disease, increased hospital re-admissions, increased healthcare costs and higher mortality rates [23].…”

The impact of disease-related knowledge on perceptions of stigma among patients with Hepatitis C Virus (HCV) infection

“…All participants provided verbal informed consent before participating in the study. The study setting, participant recruitment, and procedures have been previously described [ 5 , 9 ]. This study was approved by the Institutional Review Boards of the University of Pennsylvania and Philadelphia FIGHT.…”

“…However, high drug costs, heterogeneity in prior authorization approvals across insurances and state-based Medicaid programs, and experiences of stigma in healthcare continue to be barriers to HCV treatment [14][15][16]. Most patients with HCV experience some degree of HCV-related stigma [5]. For many patients, reduction of stigma is a motivator to undergo HCV treatment [17,18]; however, experiences of stigma may persist beyond completion of treatment and achievement of cure [5,17].…”

“…Most patients with HCV experience some degree of HCV-related stigma [5]. For many patients, reduction of stigma is a motivator to undergo HCV treatment [17,18]; however, experiences of stigma may persist beyond completion of treatment and achievement of cure [5,17]. Therefore, psychosocial approaches must complement biological interventions if the public health threat of HCV is to be eliminated.…”

“…Stigma has been identified as an important mediator of health behaviors, such as disease disclosure, treatment uptake, and medication adherence [1][2][3][4]. Previously, we found that 95.5% of patients with hepatitis C virus (HCV) infection experience some degree of perceived disease-related stigma from others [5]. Significant HCVrelated misconceptions and knowledge gaps are prevalent among persons with HCV infection [6][7][8].…”