Barriers and Facilitators to Hepatitis C Virus Treatment in Los Angeles County

TL;DR

This study explores what stops people in Los Angeles from getting Hepatitis C treatment and what helps them start it, focusing on underserved communities.

Contribution

The study integrates quantitative and qualitative data to identify both community and individual barriers and facilitators to HCV treatment.

Findings

54% of participants reported barriers like personal issues, provider challenges, insurance problems, and lack of medical access.

Homelessness, incarceration, and drug addiction were identified as major personal barriers to treatment.

Facilitators included personal motivation, family support, trust in providers, and understanding treatment benefits.

Abstract

Diagnosed but untreated chronic Hepatitis C virus (HCV) infection is a major public health problem in Los Angeles (LA) County, particularly among underserved and minority groups. This mixed-methods study (October 2024-January 2025) used de-identified programmatic data from 344 case-residents in a linkage-to-cure program and conducted thematic analysis of semi-structured interviews with ten participants (seven untreated, three treated) from the linkage-to-cure program. By integrating these quantitative and qualitative findings, the study identified community-level and individual barriers and facilitators to HCV treatment. Quantitatively, 54% of case-residents reported barriers, such as personal barriers, provider-specific barriers, insurance barriers, and inadequate access to medical care. Qualitative themes expanded on these findings, identifying homelessness, incarceration, and drug addiction as key personal barriers. Provider-related barriers included language barriers, frustration in navigating the healthcare system, long wait times to see a provider, and participants’ lack of HCV information. Insurance barriers were characterized by cost barriers and inadequate access to medical care due to a lack of transportation. Facilitators of treatment included personal motivation to seek treatment, family and community-based support systems, trust in their medical provider, adequate insurance coverage, understanding the benefits of HCV treatment, and the desire to avoid stigmatization. Eliminating HCV as a public health problem requires equitable interventions that address individual and system-level barriers. These include implementing language support services, leveraging patient navigation and care coordination services, utilizing mobile clinics for the unhoused, ensuring treatment continuity for people re-entering the community from incarceration, and removing insurance restrictions, such as prior authorization requirements.