Barriers and facilitators to engaging in HCV management and DAA therapy among general practitioners and drug and alcohol specialists – The practitioner experience

Author: Marshall AD, Grebely J, Dore GJ, Treloar C

Theme: Social Science & Policy Research Year: 2019

background: Since the advent of interferon-free direct-acting antiviral (DAA) HCV therapies,
prescriber restrictions have been reduced permitting HCV management outside of tertiary, hospitalbased clinics. To date, there is limited knowledge on the practitioner experience in managing DAA
treatment, particularly among those new to HCV-related care. The aim of this study was to
investigate barriers and facilitators for HCV management among: (1) general practitioners (GPs) who
are opioid agonist therapy (OAT) prescribers; and, (2) drug and alcohol specialists based in Australia.
methods: In-depth, semi-structured interviews via telephone occurred between September 2018
and March 2019. Practitioners were purposively sampled and questioned on barriers and facilitators
(e.g. education/training) to ‘taking on’ HCV management in their clinic(s). Data were coded and
analysed thematically.
results: Thirty practitioners were interviewed. In their clinical experience, high DAA cure rates were
surprising to most practitioners and in turn, many expressed professional fulfillment managing HCV
care. Some practitioners expressed trepidation with liver disease staging and continued frustrations
with implementation barriers, notably, a lack of HCV-related personnel and equipment. Practitioners
with solid mentorship and established referral pathways experienced comparatively fewer obstacles
than practitioners with seemingly less support. Poor venous access and limited onsite phlebotomy
services were elucidated as barriers to HCV testing and subsequently, treatment initiation for people
who inject drugs (PWID). Most practitioners were unsure as to how to galvanise more GPs/OAT
prescribers into HCV care and increase treatment uptake among PWID.
conclusion: To achieve HCV WHO targets by 2030, practitioners require additional implementation
support. As HCV testing remains a substantial barrier to linkage to care, practitioners should be kept
well-informed of diagnostic developments and receive treatment ‘work-up’ assistance (e.g. nurseled care). Findings underscore the importance of initial mentorship, especially for practitioners new
to HCV care with further evidence needed for practitioners based in rural and remote regions.
disclosure of interest statement: This study has received funding from Merck. ADM has nothing to
declare. JG has received research grants, speaker fees, and participated on advisory boards for
AbbVie, Cepheid, Gilead Sciences, and Merck. GJD is a consultant/advisor and has received research
grants from Abbvie, Gilead Sciences and Merck. CT has received speaker fees from Abbvie.

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