Department of Sociology, Pennsylvania State University, 316 Oswald Tower, University Park, PA, 16802, USA.
HIV/AIDS Program, Yale University School of Medicine, Section of Infectious Diseases, New Haven, CT, USA.
AIDS Behav. 2023 Jan;27(1):119-133. doi: 10.1007/s10461-022-03749-8. Epub 2022 Jul 1.
In the United States, approximately 25% of people with HIV (PWH) are co-infected with hepatitis C (HCV). Since 2014, highly effective and well-tolerated direct-acting antivirals (DAAs) have revolutionized HCV treatment. Uptake of DAAs by people with HIV/HCV co-infection has improved but remains suboptimal due to system, provider, and patient-level barriers. To explore patient-level issues by better understanding their attitudes towards DAA treatment, we conducted qualitative interviews with 21 persons with HIV/HCV co-infection who did not consent to DAA treatment or delayed treatment for at least 1 year after diagnosis. We found PWH perceived DAA treatment barriers and facilitators on multiple levels of the social-ecological environment: the individual (HCV disease and treatment literacy), interpersonal (peer influence), institutional (media and healthcare provider relationship), and structural levels (treatment cost and adherence support). Recommendations to improve DAA treatment uptake include HCV-treatment adherence support, HCV disease and treatment literacy training (particularly for substance use and DAA treatment interactions), and encouraging PWH who have successfully completed DAA treatment to speak with their peers.
在美国，约有 25%的艾滋病毒感染者（PWH）同时感染丙型肝炎（HCV）。自 2014 年以来，高效且耐受性良好的直接作用抗病毒药物（DAAs）彻底改变了 HCV 的治疗方式。尽管艾滋病毒/HCV 合并感染者对 DAA 的接受程度有所提高，但由于系统、提供者和患者层面的障碍，这一比例仍不理想。为了通过更好地了解他们对 DAA 治疗的态度来探索患者层面的问题，我们对 21 名未同意接受 DAA 治疗或在诊断后至少 1 年内延迟治疗的艾滋病毒/HCV 合并感染者进行了定性访谈。我们发现，PWH 在社会生态环境的多个层面上感知到 DAA 治疗的障碍和促进因素：个人层面（HCV 疾病和治疗知识）、人际层面（同伴影响）、机构层面（媒体和医疗服务提供者关系）和结构层面（治疗费用和依从性支持）。提高 DAA 治疗率的建议包括 HCV 治疗依从性支持、HCV 疾病和治疗知识培训（特别是针对药物使用和 DAA 治疗相互作用），并鼓励成功完成 DAA 治疗的 PWH 与他们的同伴交流。
