Hepatitis C care among people with HIV in Puerto Rico: A mixed-methods study

Abstract Background A significant proportion of people with HIV are coinfected with Hepatitis C Virus (HCV). Many of these individuals who are chronically infected with HCV will develop complications. Effective treatments are available to cure HCV infection and reduce morbidity and mortality, but most people with HCV do not receive it. The present study aimed at describing a sample of people co-infected with HIV and HCV and exploring barriers and facilitators to HCV care in Puerto Rico. Methods Using a mixed-method design, a total of n = 113 randomly selected medical records of people with HIV and HCV coinfection were reviewed. Then, we conducted 12 qualitative interviews with HCV treatment stakeholders (e.g., physicians and pharmacists). Results Findings indicate that coinfected individuals have been living with HIV for an average of 16.6 ± 7.7 years. and the average time since the latest HCV treatment was 3.9 ± 4.5 years. The most common HCV genotype was 1a (26.5%; n = 30), 40.7% of the participants were treated with direct-acting antivirals, and 42 (91%) achieved a sustained virologic response. Interview findings suggest that access to HCV treatment is limited mainly due to costs and lack of insurance coverage and that those engaged in HCV care facilitate access to appropriate services. Conclusions Expanding coverage and increasing the number of physicians who could prescribe HCV treatment might reduce the gaps in HCV treatment accessibility and use among people coinfected with HIV and facilitate HCV elimination. Culturally appropriate interventions remain needed to address low HCV disease awareness and stigma.