Barriers and facilitators to engagement in Hepatitis C care in the greater New Orleans area
An estimated 2.4 million people are living with chronic Hepatitis C (HCV) in the United States. HCV has become a major topic of discussion due to recent increases in new infections attributed to injection drug users’ transition from prescription opioid use to heroin use and increased treatment costs among older people living with HCV. New direct-acting antiviral (DAA) therapy has improved HCV cure rates, even among the hardest to treat. Nonetheless, Americans living with chronic HCV are not adequately engaged in care. Furthermore, there is a critical knowledge gap about factors influencing engagement in HCV care, especially related to DAA treatment. This explorative study aimed to understand these factors better to develop more effective care models and interventions that facilitate engagement in care. Increasing engagement in care and HCV treatment will help mitigate HCV incidence, morbidity, and mortality in the United States. This study was conducted in three parts: 1) a systematic review of best practices for facilitating linkage and retention in HCV care in the United States 2) a qualitative analysis of factors that influence engagement in HCV care as perceived by patients in the Greater New Orleans area (GNO), and 3) a qualitative analysis of factors that influence engagement in HCV care as perceived by providers in the GNO area. A systematic review of best practices for facilitating linkage and retention in HCV care yielded 15 articles. The identified best practices were classified using the social-ecological model as a framework. The most common practices included patient-level (i.e., patient outreach, financial incentives), provider level (i.e., ECHO, task-shifting), health care system level (i.e., care integration, pharmacist-led teams). Data analysis of semi-structured interviews with HCV-positive individuals and HCV care providers revealed significant barriers to HCV care stemming from the patient, provider, health care system, and structural-related factors. The barriers commonly discussed by patients included current drug use, lack of provider education, stigmatizing attitudes, and lack of widespread HCV awareness. In addition, providers mentioned that mental illness, drug use, and discrimination made it challenging for patients to engage in HCV care. Facilitators of engagement in care mentioned by both providers and patients included providing supportive services, patient education, and coverage for treatment costs. This study revealed that significant barriers to engagement in HCV care persist during the DAA treatment era. Interventions to improve engagement in HCV care must address barriers at multiple levels. Additionally, the study highlighted gaps in intervention research on linkage and retention in HCV care during the DAA treatment era. Additional research is needed to identify and implement optimal strategies for engaging and retaining HCV-positive individuals in treatment in the United States.