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

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-naïve 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.