Theme: Epidemiology & Public Health Research Year: 2019
Background: Direct acting antivirals (DAAs) have increased cure rates for HIV-HCV co-infected
patients; however, there are several obstacles to the uptake of HCVs DAAs in vulnerable
populations with high risk of coinfection. We aimed to investigate the patient and provider
perceived barriers and facilitators to DAA treatment with emphasis on key patient subgroups—
people who inject drugs (PWID), men who have sex with men (MSM), and indigenous
Methods: We systematically searched seven databases and conducted a grey literature search
for studies that qualitatively explored provider and patient perceived barriers and facilitators to
DAAs, were published after 2013 in accordance with second generation DAA availability and
included our populations of interest. The titles, abstracts, and subsequently full texts were
screened by two independent reviewers and critically appraised. Themes focusing on barriers
and facilitators to DAA treatment uptake were then extracted from included articles.
Results: 2143 titles and abstracts were identified and screened; 43 full texts were subsequently
reviewed, of which six studies were included. Patient perceived barriers to treatment uptake
included increased stigma concerning drug use or ethnicity, fear of medication side effects, and
lack of counselling and treatment information following diagnosis. Patient-perceived facilitators
to treatment uptake included having supportive and culturally-competent medical practitioners
and receipt of continuous reminders and check-ups during their treatment. Provider-perceived
barriers to DAA treatment provision included high costs, extensive paperwork, and lack of
expertise. Provider perceived facilitators to treatment provision included access to HCV and
addiction training opportunities.
Conclusion: This knowledge synthesis highlights key barriers and facilitators to HCV treatment
uptake and provision from patients’ and providers’ perspectives, which may inform choice and
design of interventions to increase DAA treatment uptake. Helpful interventions can include
culturally sensitive education, and counselling initiatives for patients and training for providers
to increase their confidence in providing DAA treatment.
Disclosure of interest statement: Dr. Klein has received funding from Gilead Sciences, Inc. for
the development of this investigator- initiated study.