Author information
1Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA. cjg7003@med.cornell.edu.
2Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, USA.
3Cornell Jeb E. Brooks School of Public Policy and Department of Communication, Cornell University, Ithaca, NY, USA.
4Division of Gastroenterology, Hepatology and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
5Department of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA.
6Department of Health Studies & Applied Educational Psychology, Columbia University, New York, NY, USA.
7Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
8Department of Psychology, College of Human Ecology, Cornell University, Ithaca, NY, USA.
9Department of Sociology, College of Arts and Sciences, Cornell University, Ithaca, NY, USA.
Abstract
Background: Hepatitis C (HCV) is a curable chronic infection, but lack of treatment uptake contributes to ongoing morbidity and mortality. State and national strategies for HCV elimination emphasize the pressing need for people with HCV to receive treatment.
Objective: To identify provider-perceived barriers that hinder the initiation of curative HCV treatment and elimination of HCV in the USA.
Approach: Qualitative semi-structured interviews with 36 healthcare providers who have evaluated patients with HCV in New York City, Western/Central New York, and Alabama. Interviews, conducted between 9/2021 and 9/2022, explored providers' experiences, perceptions, and approaches to HCV treatment initiation. Transcripts were analyzed using hybrid inductive and deductive thematic analysis informed by established health services and implementation frameworks.
Key results: We revealed four major themes: (1) Providers encounter professional challenges with treatment provision, including limited experience with treatment and perceptions that it is beyond their scope, but are also motivated to learn to provide treatment; (2) providers work toward building streamlined and inclusive practice settings-leveraging partnerships with experts, optimizing efficiency through increased access, adopting inclusive cultures, and advocating for integrated care; (3) although at times overwhelmed by patients facing socioeconomic adversity, increases in public awareness and improvements in treatment policies create a favorable context for providers to treat; and (4) providers are familiar with the relative advantages of improved HCV treatments, but the reputation of past treatments continues to deter elimination.
Conclusions: To address the remaining barriers and facilitators providers experience in initiating HCV treatment, strategies will need to expand educational initiatives for primary care providers, further support local infrastructures and integrated care systems, promote public awareness campaigns, remove prior authorization requirements and treatment limitations, and address the negative reputation of outdated HCV treatments. Addressing these issues should be considered priorities for HCV elimination approaches at the state and national levels.