260310 Patient Perspectives on Barriers to Hepatitis C Treatment in a Coinfected HCV/HIV Population: Qualitative Analysis of Focus Groups

Monday, October 29, 2012 : 4:30 PM - 4:45 PM

Robert Devereaux , The University of Texas Southwestern Medical Center, VA North Texas Health Care System, Dallas, TX
Carol North, MD MPE , VA North Texas Health Care System, The University of Texas Southwestern Medical Center, Dallas, TX
David Pollio, PhD , School of Social Work, University of Alabama, Tuscaloosa, AL
Mamta Jain, MD , UT Southwestern Medical Center, UT Southwestern Medical Center, Dallas, TX
Introduction: Despite promising advances in HCV treatment, it remains unclear how many patients will obtain treatment and achieve optimal outcomes. The research literature has largely focused on physician or system perspectives for understanding treatment barriers that may explain the gap between scientific advances and actual outcomes. Little is known from the patient perspective about the experience of treatment initiation and completion. Even less is known from the perspective of the HCV/HIV coinfected population that experiences barriers related to both diseases. This study aimed to understand the barriers to treatment directly from coinfected patients' perspectives.

Methods: Treatment-na´ve coinfected HCV/HIV patients were recruited from an indigent county hospital's affiliated community HIV clinics. Five focus groups were conducted with 28 participants. Discussions were audiorecorded, transcribed, and reviewed for recurring themes using NVivo software. Two independent raters coded all passages into themes with excellent interrater reliability (kappa=.82, range=.66-1.00).

Results: Seven content themes were identified. The three largest content areas were Treatment (including Treatment Barriers and Desire for Treatment) (42% of passages), Information about HCV/HIV (Lack of Knowledge; Need for Information) (25%), and Social Aspects (Stigma, Isolation) (15%). The remaining passages (18%) were thematically categorized into Coping Methods, Symptoms of HCV/HIV, Changes in Daily Routine, and Prognosis.

Conclusions: Participants were focused on and motivated for treatment, while lacking information about their diseases. Perceived social stigma and feelings of isolation may represent under-appreciated barriers to care among coinfected populations. Innovative approaches are needed to address these barriers, such as psychoeducation groups and public health awareness initiatives.

Learning Areas:
Other professions or practice related to public health
Planning of health education strategies, interventions, and programs
Program planning
Public health or related research
Social and behavioral sciences

Learning Objectives:
Describe barriers to Hepatitis C treatment identified by a co-infected HIV/HCV population.

Keywords: Treatment Patterns, Co-morbid

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I led design of the research methodology and participated in analysis and write-up.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.