Perceptions Towards HCV Treatment with Direct Acting Antivirals (DAAs): A Qualitative Analysis with Persons with HIV/HCV Co-infection Who Delay or Refuse Treatment

Abstract

In the United States, approximately 25% of people with HIV (PWH) are co-infected with hepatitis C (HCV). Since 2014, highly effective and well-tolerated direct-acting antivirals (DAAs) have revolutionized HCV treatment. Uptake of DAAs by people with HIV/HCV co-infection has improved but remains suboptimal due to system, provider, and patient-level barriers. To explore patient-level issues by better understanding their attitudes towards DAA treatment, we conducted qualitative interviews with 21 persons with HIV/HCV co-infection who did not consent to DAA treatment or delayed treatment for at least 1 year after diagnosis. We found PWH perceived DAA treatment barriers and facilitators on multiple levels of the social-ecological environment: the individual (HCV disease and treatment literacy), interpersonal (peer influence), institutional (media and healthcare provider relationship), and structural levels (treatment cost and adherence support). Recommendations to improve DAA treatment uptake include HCV-treatment adherence support, HCV disease and treatment literacy training (particularly for substance use and DAA treatment interactions), and encouraging PWH who have successfully completed DAA treatment to speak with their peers.

Real‐world economic burden of hepatitis C and impact of direct‐acting antivirals in France: A nationwide claims data analysis

“…A previous study investigating the barriers to DAA initiation among patients with chronic HCV infection in the United States identified various factors, including fear of adverse events, belief in the need for alcohol abstinence before DAA initiation and lower prioritization of chronic HCV infection compared to other illnesses. 29 In France, alcohol use disorders and the low density of HCV specialists at the regional level have been identified as factors delaying the initiation of DAAs in people who use drugs. 30,31 Our study has several strengths.…”

“…The significant percentage of patients with chronic HCV infection still not being treated with DAAs by the end of 2021 highlights the need for future efforts to identify better the social and structural barriers to care for this population. A previous study investigating the barriers to DAA initiation among patients with chronic HCV infection in the United States identified various factors, including fear of adverse events, belief in the need for alcohol abstinence before DAA initiation and lower prioritization of chronic HCV infection compared to other illnesses 29 . In France, alcohol use disorders and the low density of HCV specialists at the regional level have been identified as factors delaying the initiation of DAAs in people who use drugs 30,31 …”

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

“…We hypothesize that single interventions are not enough for all individuals with HIV/HCV coinfection, and it is important to address co-existing barriers specifically identified by patients. These may include additional issues such as provider trust, presence of competing priorities, and health literacy issues (Brothers et al, 2022; DiDomizio et al, 2023).…”

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.…”

“…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.…”