Patients’ access to and acceptance of community-based hepatitis C testing and treatment in Myanmar: A mixed-method study

Abstract

Hepatitis C (HCV) infection elimination in low- and middle-income countries requires decentralised HCV services to increase testing and linkage to care. The CT2 Study investigated patients’ views of access to and acceptance of two community-based HCV care models in Myanmar using a mixed-methods approach. Point-of-care HCV testing and general practitioner-initiated HCV treatment were provided at two community clinics in Yangon, Myanmar–the Burnet Institute’s (BI) clinic focused on people who inject drugs (PWID), and the Myanmar Liver Foundation’s (MLF) clinic focused on people with liver-related diseases. Study staff administered quantitative questionnaires to 633 participants receiving anti-HCV antibody testing. Purposive sampling was used to recruit 29 participants receiving direct-acting antiviral treatment for qualitative interviews. Among participants completing quantitative questionnaires, almost all reported the clinic location was convenient (447/463, 97%), waiting time was acceptable (455/463, 98%), and HCV antibody and RNA testing methods were acceptable (617/632, 98% and 592/605, 97% respectively). Nearly all participants were satisfied with their clinic’s services (444/463, 96%) and preferred same-day test results (589/632, 93%). BI clinic participants were more confident that they understood HCV antibody and RNA results; MLF clinic participants were more comfortable disclosing their risk behaviour to staff and had slightly higher satisfaction with the overall care, privacy and secure storage of their information. In qualitative interviews, participants reported that flexible appointment scheduling, short wait times and rapid return of results increased the clinic’s accessibility. The simplified point-of-care testing and treatment procedures and supportive healthcare providers contributed to participants’ acceptance of the HCV care model. This decentralised community-based HCV testing and treatment model was highly accessible and acceptable to CT2 participants. Prioritizing patient-centred care, rapid provision of results, flexible appointments and convenient clinic locations can promote accessible and acceptable services which may in turn help accelerate progress in reaching HCV elimination targets.

Patients’ experience of accessing hepatitis C treatment through the Myanmar national hepatitis C treatment program: a qualitative evaluation

“…This can easily be resolved in any future expanded roll-out, and confirmed through annual audits of patient experience at each site. The likely barrier of cost to starting treatment is supported by qualitative findings on acceptability and accessibility of a community-based hepatitis C testing and treatment program in Yangon, where participants described their reluctance to access treatment previously as they had been told by their networks of high treatment costs at both public and private health centres in Yangon and elsewhere in Myanmar [ 20 ].…”

“…Recent qualitative work from Vietnam outlined the various barriers to seeking care for viral hepatitis, including limited and/or incorrect understanding of how they acquired hepatitis C, lack of trust in the local healthcare system to provide appropriate treatment, difficulty reaching care in centralised hospitals, challenges navigating insurance schemes to cover treatment, and cost of testing and treatment [ 19 ]. In addition, recent qualitative work assessing the acceptability of a community-based model of care in Yangon, Myanmar found that flexible appointment scheduling, short wait times and rapid return of results increased the clinic’s accessibility [ 20 ].…”