Barriers to HCV care include lack of physical symptoms, treatment side effects

Treloar C. J Viral Hepat. 2013;doi:10.1111/jvh.12183.

  • December 11, 2013

Barriers to hepatitis C care for patients enrolled in opioid substitution treatment included the perception of being physically well and concerns about adverse effects associated with interferon-based hepatitis C virus treatment, according to results from the ETHOS study.

“Integrating treatment for hepatitis C within settings that provide treatment for drug dependence minimizes some of the barriers for clients wishing to undertake hepatitis C treatment,” study researcher Carla Treloar, PhD, deputy director of the Centre for Social Research in Health at the University of New South Wales, Australia, told Infectious Disease News. “However, treatment remains an unattractive option for some patients. Providing ways for those without hepatitis C symptoms to be assessed for liver damage may be important to open up alternative conversations about hepatitis C care.”

Carla Treloar, PhD 

Carla Treloar

Treloar and colleagues conducted in-depth interviews with a subset of 57 patients from the Enhancing Treatment for Hepatitis C in Opioid Substitution Settings (ETHOS) study, which was designed to evaluate an integrative treatment model for the provision of onsite HCV assessment and treatment at addiction care facilities. The subset included patients who self-reported living with HCV infection but did not engage in any HCV care, including assessment; patients who were assessed for HCV infection but did not progress to treatment; and patients who were currently receiving treatment for their infection.

The semi-structured interviews included questions about patients’ attitudes toward HCV diagnosis and management.

Although the integration of HCV and addiction treatment at the same facility eliminates the need for referrals to offsite HCV care, the researchers said certain themes emerged from the interviews related to barriers to care. For patients who had not been assessed for infection, reasons for not engaging in HCV care included the perception that they were physically well and experienced no symptoms. Adverse effects of HCV treatment represented another barrier to care for this group. Among those who were assessed for HCV infection but did not pursue treatment, “family responsibility, unstable housing, and a generalized sense of HCV not being a priority at this point in their life” were common explanations for not committing to treatment.

However, interviewees who did pursue treatment cited common motivations for doing so, including an awareness of the seriousness of the infection, witnessing friends who suffered from the illness and a desire to live more healthy lives. Shared positive experiences of HCV treatment also was a motivating factor for engaging in care.

According to the researchers, patients who were interested in HCV treatment said issues related to the health care setting and provider were important, including the “presence of an engaged clinician, accessible treatment pathway and availability of support.”

“Changing the way in which hepatitis C treatment is spoken about is important, particularly providing opportunities for patients who have had positive treatment experiences to discuss these with their peers,” Treloar said. — John Schoen.

Carla Treloar, PhD, can be reached at

Disclosure: The researchers report no relevant financial disclosures.