What barriers delay treatment in patients with hepatitis C?
EVIDENCE-BASED ANSWER:
Multiple patient-specific and provider-perceived factors delay initiation of treatment in patients with hepatitis C. Patient-specific barriers to initiation of treatment for hepatitis C virus (HCV) include age, race, gender, economic status, insurance status, and comorbidities such as HIV coinfection, psychiatric illness, and other psychosocial factors.
Provider-perceived patient factors include substance abuse history, older age, psychiatric illness, medical comorbidities, treatment adverse effect risks, and factors that might limit adherence (eg, comprehension level).
Study limitations included problems with generalizability of the populations studied and variability in reporting or interpreting data associated with substance or alcohol use disorders
Providers identify similar barriers to treatment of HCV
A 2017 prospective qualitative study (N = 24) from a Veterans Affairs health care system analyzed provider-perceived barriers to initiation of and adherence to HCV treatment.7 The analysis focused on differences by provider specialty. Primary care providers (PCPs; n = 12; 17% with > 40 patients with HCV) and hepatology providers (HPs; n = 12; 83% with > 40 patients with HCV) participated in a semi-structured telephone-based interview, providing their perceptions of patient-level barriers to HCV treatment. Eight patient-level barrier themes were identified; these are outlined in the TABLE7 along with data for both PCPs and HPs.
Editor’s takeaway
These 7 cohort studies show us the factors we consider and the reasons we give to not initiate HCV treatment. Some of the factors seem reasonable, but many do not. We might use this list to remind and challenge ourselves to work through barriers to provide the best possible treatment.
