Primary Care and Hepatology Provider-Perceived Barriers to and Facilitators of Hepatitis C Treatment Candidacy and Adherence.
BACKGROUND
Provider perceptions regarding barriers to and facilitators of hepatitis C (HCV) treatment initiation and adherence have not been fully evaluated in the interferon-free treatment era. New treatments have provided opportunities for non-specialists to treat HCV, underscoring the importance of understanding primary care provider (PCP) and specialist perspectives.


METHODS
Based on qualitative sampling principles, 12 PCPs and 12 hepatology providers (HPs) from the VA Pittsburgh Healthcare System completed audio-recorded semi-structured interviews. Qualitative analysts coded perceived barriers and facilitators from the interviews with 100% double coding. Codes were thematized and analyzed using Atlas.ti.


RESULTS
Key barriers to treatment described by HPs and PCPs included patients' substance use disorders, mental health, transportation availability, history of non-adherence, and concern about side effects. PCPs also focused on medication cost as a system-based barrier. The main facilitators of treatment initiation and adherence described by both HPs and PCPs were provider education and encouragement. HPs focused almost exclusively on provider-based facilitators, while PCPs noted patient-based facilitators including past adherence, media exposure to information about HCV medications, a desire to clear the virus, and positive feedback regarding treatment response.


CONCLUSIONS
Providers generally focused on perceived patient-level barriers to HCV treatment initiation and adherence, as well as provider-level facilitators; PCPs additionally noted patient preferences and system-level issues that guide decision making regarding treatment initiation. While HPs focused almost exclusively on provider-level facilitators, PCPs additionally focused on patient-level facilitators of treatment. These data provide novel insights and suggest focusing on patient, provider, and system-level strategies to further improve HCV treatment initiation and adherence.
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D000328:Adult D001291:Attitude of Health Personnel D005260:Female D005762:Gastroenterology D019983:Guideline Adherence D007722:Health Knowledge, Attitudes, Practice D006282:Health Personnel D006526:Hepatitis C D006703:Homeless Persons D006801:Humans D008297:Male D001523:Mental Disorders D008875:Middle Aged D010349:Patient Compliance D057240:Patient Preference D018579:Patient Selection D010465:Perception D011320:Primary Health Care D036301:Qualitative Research D013038:Specialization D019966:Substance-Related Disorders
Mental health Addiction Compliance Direct-acting antivirals Interferon-free medications