UNC Liver Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Hepatology. 2013 Apr;57(4):1325-32. doi: 10.1002/hep.26246.
Chronic infection with the hepatitis C virus (HCV) is a leading cause of global morbidity and mortality. Although recent advances in antiviral therapy have led to significant improvements in treatment response rates, only a minority of infected patients are treated. Multiple barriers may impede the delivery of HCV therapy. The aim of this study was to identify perceived barriers to care, knowledge, and opinions among a global sample of HCV treatment providers. An international, multidisciplinary survey of HCV treatment providers was conducted. Each physician responded to a series of 214 questions concerning his or her practice characteristics, opinions regarding the state of HCV care, knowledge regarding HCV treatment, and perception of treatment barriers. A total of 697 physicians from 29 countries completed the survey. Overall, physicians viewed patient-level barriers as most significant, including fear of side effects and concerns regarding treatment duration and cost. There were distinct regional variations, with Central and Eastern European physicians citing government barriers as most important. In Latin America, the Middle East, and Africa, payer-level barriers, including lack of treatment coverage, were prominent. Overall, the perception of barriers was strongly associated with physician knowledge, experience, and region of origin, with the fewest barriers reported by Nordic physicians and the most reported by Middle Eastern and African physicians. Globally, physicians demonstrated deficits in basic treatment principles, including the role of viral kinetics and the management of treatment nonresponders. Two thirds of surveyed physicians believed that patients do not have adequate access to providers in their community.
Barriers to HCV treatment vary globally, though patient-level factors are viewed as most significant by treating physicians. Efforts to improve awareness, education, and specialist availability are needed.
慢性丙型肝炎病毒（HCV）感染是全球发病率和死亡率的主要原因。尽管抗病毒治疗的最新进展使治疗反应率显著提高，但只有少数感染患者得到治疗。多种障碍可能会阻碍 HCV 治疗的实施。本研究的目的是在全球 HCV 治疗提供者样本中确定护理方面的感知障碍、知识和意见。对 HCV 治疗提供者进行了一项国际性的、多学科的调查。每位医生都要回答一系列 214 个问题，内容涉及他们的实践特征、对 HCV 护理现状的看法、对 HCV 治疗的了解以及对治疗障碍的看法。共有来自 29 个国家的 697 名医生完成了这项调查。总的来说，医生认为患者层面的障碍最为重要，包括对副作用的恐惧以及对治疗持续时间和费用的担忧。不同地区存在明显差异，中欧和东欧的医生认为政府障碍最重要。在拉丁美洲、中东和非洲，支付方层面的障碍，包括缺乏治疗覆盖范围，是突出问题。总的来说，对障碍的看法与医生的知识、经验和原籍地区密切相关，北欧医生报告的障碍最少，中东和非洲医生报告的障碍最多。全球范围内，医生在基本治疗原则方面表现出不足，包括病毒动力学的作用以及治疗无应答者的管理。三分之二的被调查医生认为患者在其所在社区无法获得足够的医疗服务提供者。
HCV 治疗的障碍在全球范围内存在差异，但治疗医生认为患者层面的因素最为重要。需要努力提高认识、教育和专家的可用性。
