Patient perceptions of successful hepatitis C virus treatment adherence in Veterans

Abstract

Background: Treatment adherence remains a potential barrier to achieving population-level hepatitis C virus (HCV) elimination by 2030. We aimed to understand barriers to and facilitators of HCV treatment adherence pre-and post-directacting antiviral (DAA) treatment.Methods: A cohort of US Veterans who were initiating DAA treatment completed pre-and post-treatment surveys assessing demographic information, psychological symptoms and perceived barriers to adherence. DAA adherence was assessed through self-report and pharmacy records. Sustained virologic response (SVR) was evaluated using the medical record. Mann-Whitney U, Fisher's exact tests, and logistic regression were employed to evaluate associations of patient characteristics and survey responses with adherence and SVR.Results: Of 97 participants, the majority were male (98%), white (62%), low-income (less than 35 000/y; 82%), and had a history of self-reported prior substance use (93%). The most common anticipated adherence barrier prior to treatment was having side effects (21%). Over follow-up, 62% of participants missed doses and 84% achieved SVR. Decreased pain (OR 0.32, 95% CI 1.06-1.72), agreeing with 'the medication will improve my health' (OR 4, 95% CI 1.22-15.8) and disagreeing with being 'worried about my liver disease getting worse' (OR 0.2, 95% CI 0.05, 0.59) predicted successfully achieving SVR. After treatment, the most commonly reported barriers to adherence were being busy (13%) and being away from home (13%). Veterans reported non-significantly decreased substance use after treatment (38% vs 28%, P = .18). Conclusion:In this population of Veterans with high rates of substance use, most participants missed doses but still achieved SVR. HCV treatment may also serve as an opportunity for substance use treatment.