Hepatitis C Virus Treatment Status and Barriers among Patients in Methadone Maintenance Treatment Clinics in Guangdong Province, China: A Cross-Sectional, Observational Study

Abstract

We aimed to evaluate the status and barriers related to hepatitis C virus (HCV) treatment among Chinese methadone maintenance treatment (MMT) clients, and the willingness and barriers of patients to accept directly observed treatment (DOT) service and oral direct-acting antivirals (DAAs). We conducted a cross-sectional survey from July to October 2017 in Guangdong Province, China, involving 678 HCV antibody-positive MMT patients. If they reported being infected with HCV, then their HCV treatment experience, willingness to use DOT and DAAs, along with any barriers, were collected. Logistic regression analysis was used to identify the correlates of initiating HCV treatment. Among those reporting HCV infection (54%, 366/678), 39% (144/366) initiated treatment; however, 38% (55/144) interrupted and 55% (79/135) delayed treatment for 15 months. Seventy-five percent (273/366) and 53% (195/366) were willing to use DOT and DAAs, respectively. Unaffordable medical costs and insignificant symptoms were the major barriers to HCV treatment and accepting DOT or DAAs. The lack of a stable residence, being a woman, and having ever injected drugs were all associated with a low probability of initiating treatment (p < 0.05). This study highlights a limited uptake of HCV treatment among MMT patients, and a need to strengthen the popularity of DOT and DAAs and integrate them into Chinese MMT clinics.

Hepatitis C antibody prevalence, correlates and barriers to care among people who inject drugs in Central California

“…Fortunately, there are direct‐acting antiviral (DAA) medications on the market that cure HCV with an efficacy of ~95% for patients with HCV genotype 1 (though effective treatments for HCV genotype 3 are more limited) 21 . Of concern, however, is that many PWID remain untreated for a variety of reasons, including lack of health insurance and/or socioeconomic disadvantage 22 ; healthcare‐related stigma (including “sobriety requirements” or provider reluctance to treat PWID) 23–28 ; fear of medical establishments 23 ; insurances’ prior authorization requirements 29 ; and/or an overall lack of knowledge regarding HCV transmission, symptoms, testing and the availability of DAA (interferon‐free) therapies 26,30,31 …”

“…21 Of concern, however, is that many PWID remain untreated for a variety of reasons, including lack of health insurance and/or socioeconomic disadvantage 22 ; healthcare-related stigma (including "sobriety requirements" or provider reluctance to treat PWID) [23][24][25][26][27][28] ; fear of medical establishments 23 ; insurances' prior authorization requirements 29 ; and/or an overall lack of knowledge regarding HCV transmission, symptoms, testing and the availability of DAA (interferon-free) therapies. 26,30,31 Between 1999 and 2016, nine U.S. states had more than 65,000 people living with HCV, with California (CA) ranking highest at 318,900 people living with HCV infection. 32,33 As of 2018, the CDC reported CA was among the five states with the highest number of newly reported chronic HCV cases.…”

Universal screening for HCV infection in China: An effectiveness and cost-effectiveness analysis

“… 4 Acceptability of treatment after active screening and CHC diagnosis 0.88 (0.85–0.93) Beta (201.8, 27.6) Liu et al. 5 Cost data Anti-HCV test per unit 3.14 (2.35–3.92) Gamma (784.88, 0.004) Heffernan et al. 27 HCV-RNA test per unit 43.95 (32.97–54.94) Gamma (15.1, 2.91) Heffernan et al.…”

“…In the past two decades, the disease burden related to HBV in China has declined significantly, whereas the disease burden related to HCV has remained stable. [3] , [4] , [5] Therefore, with approximately 10 million chronic carriers, HCV infection is still one of the leading public health challenges in China. Considering that China is not a region with high HCV prevalence in a global perspective, with a highly effective health system for disease control and prevention by the government, HCV eradication is highly feasible.…”

“…6 However, owing to its large population, low testing rate and poor linkage to care are barriers to eliminating HCV in China. [3] , [4] , [5] Urgent action is needed to scale up screening and treatment efforts aimed at eliminating hepatitis C. At present, the WHO has recommended and promoted the implementation of HCV screening programs. However, universal HCV screening is still absent in the National Health Program.…”