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

David Ortiz-Paredes; Afia Amoako; David Lessard; Kim Engler; Bertrand Lebouché; Marina B Klein

doi:10.3138/canlivj-2021-0020

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

Can Liver J. 2022 May 9;5(2):124-143. doi: 10.3138/canlivj-2021-0020. eCollection 2022 Spring.

Authors

David Ortiz-Paredes¹, Afia Amoako², David Lessard¹, Kim Engler¹, Bertrand Lebouché^{1

3

4}, Marina B Klein^{4

4}

Affiliations

¹ Centre for Outcome Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.
² Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada.
³ Department of Family Medicine, McGill University, Montreal, Quebec, Canada.
⁴ Department of Medicine, Division of Infectious Diseases/Chronic Viral Illness Service, Glen site, McGill University Health Centre, Montreal, Quebec, Canada.

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.

Keywords: MSM; direct-acting antivirals uptake; hepatitis C; men who have sex with men; people who inject drugs.

Grants and funding

This research was supported by Gilead Sciences (IN-US-334-4492).