Barriers and facilitators related to HCV treatment uptake among HIV coinfected populations in Canada: Patient and treatment provider perceptions.

Canadian liver journal Pub Date : 2022-05-09 eCollection Date: 2022-01-01 DOI:10.3138/canlivj-2021-0020
David Ortiz-Paredes, Afia Amoako, David Lessard, Kim Engler, Bertrand Lebouché, Marina B Klein
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Abstract

Background: Direct-acting antiviral (DAA) uptake is challenging across HIV-hepatitis C (HCV) coinfected populations. This study sought to identify barriers and facilitators related to DAA uptake in priority populations in Canada.

Methods: This qualitative descriptive study included 11 people living with HIV with a history of HCV and 15 HCV care providers. Participants were part of either nominal groups (n = 4) or individual interviews (n = 6) in which they identified and ranked barriers and facilitators to DAA uptake. Consolidated lists of barriers and facilitators were identified thematically.

Results: Patient participants highly ranked the following barriers: competing priorities and needs (ie, social instability and mental health), delays in care, lack of adherence, and polypharmacy. Provider participant top barriers were the following: competing priorities and needs (ie, social chaos), delays in care (eg, systemic barriers, difficulties engaging patients, lack of trained HCV providers), and HCV-related stigma. Patient participants identified having a strong network of health care providers, family, and friends, possessing intrinsic motivation, and DAAs being a simple and tolerable oral treatment as important facilitators. Provider participant top-ranked facilitators were having resources to identify hard-to-reach populations (eg, patient navigation, outreach), holistic care and addiction management, provider HCV education, and a strong network of interprofessional collaboration.

Conclusion: The barriers to DAA initiation addressed by patients and providers overlapped, with some nuances. Multidisciplinary care fostering a strong supportive network and intrinsically motivated patients along with HCV education emerged as key facilitators. This study provides insights for developing potential strategies to improve DAA uptake among HIV-HCV coinfected people in Canada.

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加拿大HIV合并感染人群中与HCV治疗相关的障碍和促进因素:患者和治疗提供者的看法。
背景:在hiv - C型肝炎(HCV)合并感染人群中,直接作用抗病毒药物(DAA)的摄取具有挑战性。本研究旨在确定与加拿大重点人群DAA吸收相关的障碍和促进因素。方法:本定性描述性研究包括11名有HCV病史的HIV感染者和15名HCV医护人员。参与者是名义小组(n = 4)或个人访谈(n = 6)的一部分,其中他们确定并排名DAA吸收的障碍和促进因素。按主题确定了障碍和促进因素的综合清单。结果:患者参与者高度评价了以下障碍:竞争优先事项和需求(即社会不稳定和心理健康),护理延误,缺乏依从性和多种药物。提供者参与的主要障碍如下:相互竞争的优先事项和需求(即社会混乱)、护理延误(例如,系统性障碍、难以吸引患者、缺乏训练有素的HCV提供者)以及与HCV相关的污名。患者参与者认为拥有强大的医疗保健提供者、家庭和朋友网络,拥有内在动机,DAAs是一种简单且可耐受的口服治疗,是重要的促进因素。提供者参与者排名靠前的调解人拥有资源来确定难以接触到的人群(例如,患者导航、外展)、整体护理和成瘾管理、提供者丙型肝炎病毒教育以及强大的跨专业合作网络。结论:患者和医疗服务提供者解决的DAA启动障碍重叠,有一些细微差别。多学科护理培养强大的支持网络和内在动机的患者以及HCV教育成为关键的促进因素。本研究为加拿大HIV-HCV合并感染者改善DAA摄取的潜在策略提供了见解。
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