Patients' experience of accessing hepatitis C treatment through the Myanmar national hepatitis C treatment program: a qualitative evaluation.
Barriers
Enablers
Hepatitis C
Hospital
Low and middle-income countries
Myanmar
National program
Patient experience
Journal
BMC health services research
ISSN: 1472-6963
Titre abrégé: BMC Health Serv Res
Pays: England
ID NLM: 101088677
Informations de publication
Date de publication:
16 Jan 2024
16 Jan 2024
Historique:
received:
06
05
2022
accepted:
07
12
2023
medline:
17
1
2024
pubmed:
17
1
2024
entrez:
16
1
2024
Statut:
epublish
Résumé
Globally, 56.8 million people are living with hepatitis C and over three-quarters of those reside in low and middle-income countries (LMICs). Barriers and enablers to hepatitis C care among people who inject drugs in high-income countries are well documented. However, there is scant literature describing the patient experience in LMICs. Understanding the barriers and enablers to care from the patient perspective is important to inform service refinements to improve accessibility and acceptability of hepatitis C care. We conducted a qualitative evaluation of the patient experience of accessing the national hepatitis C program at eight hospital sites in Myanmar. Semi-structured interviews were conducted with four to five participants per site. Interview data were analysed thematically, with deductive codes from Levesque et al.'s (2013) Framework on patient-centred access to healthcare. Across the eight sites, 38 participants who had completed treatment were interviewed. Barriers to accessing care were mostly related to attending for care and included travel time and costs, multiple appointments, and wait times. Some participants described how they did not receive adequate information on hepatitis C, particularly its transmission routes, and on the level of cirrhosis of their liver and what they were required to do after treatment (i.e. reduce alcohol consumption, liver cirrhosis monitoring). Many participants commented that they had few or no opportunities to ask questions. Provision of treatment at no cost was essential to accessibility, and gratitude for free treatment led to high acceptability of care, even when accessing care was inconvenient. These findings highlight the importance of streamlining and decentralising health services, adequate human resourcing and training, and affordable treatment in maximising the accessibility and acceptability of hepatitis C care in LMICs. Findings from this work will inform future service delivery refinements for national program and other decentralised programs to improve accessibility and acceptability of hepatitis C care in Myanmar.
Sections du résumé
BACKGROUND
BACKGROUND
Globally, 56.8 million people are living with hepatitis C and over three-quarters of those reside in low and middle-income countries (LMICs). Barriers and enablers to hepatitis C care among people who inject drugs in high-income countries are well documented. However, there is scant literature describing the patient experience in LMICs. Understanding the barriers and enablers to care from the patient perspective is important to inform service refinements to improve accessibility and acceptability of hepatitis C care.
METHODS
METHODS
We conducted a qualitative evaluation of the patient experience of accessing the national hepatitis C program at eight hospital sites in Myanmar. Semi-structured interviews were conducted with four to five participants per site. Interview data were analysed thematically, with deductive codes from Levesque et al.'s (2013) Framework on patient-centred access to healthcare.
RESULTS
RESULTS
Across the eight sites, 38 participants who had completed treatment were interviewed. Barriers to accessing care were mostly related to attending for care and included travel time and costs, multiple appointments, and wait times. Some participants described how they did not receive adequate information on hepatitis C, particularly its transmission routes, and on the level of cirrhosis of their liver and what they were required to do after treatment (i.e. reduce alcohol consumption, liver cirrhosis monitoring). Many participants commented that they had few or no opportunities to ask questions. Provision of treatment at no cost was essential to accessibility, and gratitude for free treatment led to high acceptability of care, even when accessing care was inconvenient.
CONCLUSIONS
CONCLUSIONS
These findings highlight the importance of streamlining and decentralising health services, adequate human resourcing and training, and affordable treatment in maximising the accessibility and acceptability of hepatitis C care in LMICs. Findings from this work will inform future service delivery refinements for national program and other decentralised programs to improve accessibility and acceptability of hepatitis C care in Myanmar.
Identifiants
pubmed: 38229074
doi: 10.1186/s12913-023-10456-0
pii: 10.1186/s12913-023-10456-0
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
80Informations de copyright
© 2024. The Author(s).
Références
Blach S, Terrault NA, Tacke F, Gamkrelidze I, Craxi A, Tanaka J, et al. Global change in Hepatitis C virus prevalence and cascade of care between 2015 and 2020: a modelling study. Lancet Gastroenterol Hepatol. 2022;7(5):396–415.
doi: 10.1016/S2468-1253(21)00472-6
World Health Organization (WHO). Global progress report on HIV, viral hepatitis and sexually transmitted Infections, 2021. Accountability for the global health sector strategies 2016–2021: actions for impact. Geneva; 2021.
World Health Organization (WHO). Progress report on access to hepatitis C treatment: focus on overcoming barriers in low- and middle-income countries. Geneva; 2018.
Clinton Health Access Initiative (CHAI). HCV Market Intelligence Report 2021 and Preliminary HBV Market Insights. 2021.
World Health Organization (WHO). Updated recommendations on treatment of adolescents and children with chronic HCV Infection, and HCV simplified service delivery and diagnostic. Geneva; 2022.
Draper B, Yee WL, Pedrana A, Kyi KP, Qureshi H, Htay H, et al. Reducing liver disease-related deaths in the Asia-Pacific: the important role of decentralised and non-specialist led Hepatitis C treatment for cirrhotic patients. Lancet Reg Health West Pac. 2022;20:100359.
doi: 10.1016/j.lanwpc.2021.100359
pubmed: 35024676
pmcid: 8733182
World Health Organization (WHO). Accelerating access to Hepatitis C diagnostics and treatment: overcoming barriers in low and middle-income countries. Global progress report 2020. Geneva; 2021.
Bajis S, Dore GJ, Hajarizadeh B, Cunningham EB, Maher L, Grebely J. Interventions to enhance testing, linkage to care and treatment uptake for Hepatitis C virus Infection among people who inject Drugs: a systematic review. Int J Drug Policy. 2017;47:34–46.
doi: 10.1016/j.drugpo.2017.07.002
pubmed: 28797498
Bajis S, Applegate TL, Grebely J, Matthews GV, Dore GJ, Novel Hepatitic C, Virus (HCV) Diagnosis and Treatment Delivery Systems, editors. Facilitating HCV Elimination by Thinking Outside the Clinic. J Infect Dis. 2020;222(S9):S758–72.
Grebely J, Applegate TL, Cunningham P, Feld JJ. Hepatitis C point-of-care diagnostics: in search of a single visit diagnosis. Expert Rev Mol Diagn. 2017;17(12):1109–15.
doi: 10.1080/14737159.2017.1400385
pubmed: 29088981
Amoako A, Ortiz-Paredes D, Engler K, Lebouché B, Klein MB. Patient and provider perceived barriers and facilitators to direct acting antiviral Hepatitis C treatment among priority populations in high income countries: a knowledge synthesis. Int J Drug Policy. 2021;96:103247.
doi: 10.1016/j.drugpo.2021.103247
pubmed: 33853727
Gunn J, Draper, Pedrana A, Sacks-Davis R, Keefe O’, Crawford S et al. A mixed-methods systematic review of barriers and enablers to Hepatitis C Care among people who inject Drugs. In: INHSU. 2021.
Degenhardt L, Webb P, Colledge-Frisby S, Ireland J, Wheeler A, Ottaviano S, et al. Epidemiology of injecting drug use, prevalence of injecting-related harm, and exposure to behavioural and environmental risks among people who inject Drugs: a systematic review. Lancet Glob Health. 2023;11(5):e659–e72.
doi: 10.1016/S2214-109X(23)00057-8
pubmed: 36996857
Nelson PK, Mathers BM, Cowie B, Hagan H, Des Jarlais D, Horyniak D, et al. Global epidemiology of Hepatitis B and Hepatitis C in people who inject Drugs: results of systematic reviews. Lancet. 2011;378(9791):571–83.
doi: 10.1016/S0140-6736(11)61097-0
pubmed: 21802134
pmcid: 3285467
Sherbuk JE, Tabackman A, McManus KA, Kemp Knick T, Schexnayder J, Flickinger TE, et al. A qualitative study of perceived barriers to Hepatitis C care among people who did not attend appointments in the non-urban US South. Harm Reduct J. 2020;17(64):1–11.
Litwin AH, Drolet M, Nwankwo C, Torrens M, Kastelic A, Walcher S, et al. Perceived barriers related to testing, management and treatment of HCV Infection among physicians prescribing opioid agonist therapy: the C-SCOPE study. J Viral Hepat. 2019;26(9):1094–104.
doi: 10.1111/jvh.13119
pubmed: 31074167
pmcid: 6771477
Serumondo J, Penkunas MJ, Niyikora J, Ngwije A, Kiromera A, Musabeyezu E et al. Patient and healthcare provider experiences of Hepatitis C treatment with direct-acting antivirals in Rwanda: a qualitative exploration of barriers and facilitators. BMC Public Health. 2020;20(1).
Versfeld A, Versfeld A, McBride A, McBride A, Scheibe A, Scheibe A, et al. Motivations, facilitators and barriers to accessing Hepatitis C treatment among people who inject Drugs in two South African cities. Harm Reduct J. 2020;17(39):1–8.
Le Nguyen M, Nguyen Thi Hong Y, Dang Trong T, Dung NT, Day J, Phuong LT, et al. Balancing uncertainty and proactivity in care seeking for Hepatitis C: qualitative research with participants enrolled in a treatment trial in Ho Chi Minh City, Vietnam. Int J Qual Stud Health Well-being. 2022;17(1):2126602.
doi: 10.1080/17482631.2022.2126602
Yee WL, Bowring A, Draper B, O’Keefe D, Htay H, Myint KT, et al. Patients’ access to and acceptance of community-based Hepatitis C testing and treatment in Myanmar: a mixed-method study. PLOS Glob Public Health. 2023;3(6):e0000902.
doi: 10.1371/journal.pgph.0000902
pubmed: 37327249
pmcid: 10275420
Lwin AA, Aye KS, Moh Htun M, Kyaw YY, Ko Zaw K, Aung TT, et al. Sero-prevalence of Hepatitis B and C viral Infections in Myanmar: National and Regional Survey in 2015. Myanmar Heal Sci Res J. 2017;29(3):167–75.
Johnston LG, Soe P-M, Aung MY, Ammassari S. Estimating the Population size of males who inject Drugs in Myanmar: methods for obtaining Township and National estimates. AIDS Behav. 2019;23(1):295–301.
doi: 10.1007/s10461-018-2233-z
pubmed: 30046936
Myanmar National Hepatitis Control Program. Myanmar National Strategic Plan on Viral Hepatitis 2016–2020. 2017.
Myanmar National Hepatitis Control Program. Myanmar National Action Plan for Viral Hepatitis Response 2017–2020. 2017.
Ministry of Health and Sports Myanmar. Myanmar National Simplified Treatment Guidelines for Hepatitis C Infection. 2017.
Ministry of Health and Sports Myanmar. Myanmar National Simplified Treatment Guidelines for Hepatitis C Infection - Second Edition, July 2019. 2019.
Min Thaung Y, Chasela CS, Chew KW, Minior T, Lwin AA, Sein YY, et al. Treatment outcomes and costs of a simplified antiviral treatment strategy for Hepatitis C among monoinfected and HIV and/or Hepatitis B virus-co‐infected patients in Myanmar. J Viral Hepat. 2021;28(1):147–58.
doi: 10.1111/jvh.13405
pubmed: 32935438
Myanmar National AIDS. Program. Myanmar Integrated Biological and Behavioural Survey & Population Size Estimates among People Who Inject Drugs (PWID) 2017–2018. 2019.
Boeke CE, Adesigbin C, Agwuocha C, Anartati A, Aung HT, Aung KS, et al. Initial success from a public health approach to Hepatitis C testing, treatment and cure in seven countries: the road to elimination. BMJ Glob Heal. 2020;5(12):e003767.
doi: 10.1136/bmjgh-2020-003767
Neale J. Iterative categorization (IC): a systematic technique for analysing qualitative data. Addiction. 2016;111(6):1096–106.
doi: 10.1111/add.13314
pubmed: 26806155
pmcid: 5069594
Levesque J-F, Harris MF, Russell G. Patient-centred access to health care: conceptualising access at the interface of health systems and populations. Int J Equity Health. 2013;12(1):18.
doi: 10.1186/1475-9276-12-18
pubmed: 23496984
pmcid: 3610159
Myanmar raises minimum. wage to $4.80 a day as economy staggers [Internet]. The Straits Times. 2018 [cited 2022 Mar 11]. Available from: https://www.straitstimes.com/asia/se-asia/myanmar-raises-minimum-wage-to-s480-a-day-as-economy-staggers .
Chikovani I, Ompad DC, Uchaneishvili M, Sulaberidze L, Sikharulidze K, Hagan H, et al. On the way to Hepatitis C elimination in the Republic of Georgia—barriers and facilitators for people who inject Drugs for engaging in the treatment program: a formative qualitative study. PLoS ONE. 2019;14(4):e0216123.
doi: 10.1371/journal.pone.0216123
pubmed: 31034530
pmcid: 6488087
Skeer MR, Ladin K, Wilkins LE, Landy DM, Stopka TJ. Hep C’s like the Common Cold’: understanding barriers along the HCV care continuum among young people who inject Drugs. Drug Alcohol Depend. 2018;190:246–54.
doi: 10.1016/j.drugalcdep.2018.06.013
pubmed: 30071457
pmcid: 6367928
Madden A, Hopwood M, Neale J, Treloar C. Beyond interferon side effects: what residual barriers exist to DAA Hepatitis C treatment for people who inject Drugs? PLoS ONE. 2018;13(11):e0207226.
doi: 10.1371/journal.pone.0207226
pubmed: 30500863
pmcid: 6267952
McGowan CE, Fried MW. Barriers to Hepatitis C treatment. Liver Int. 2012;32(Suppl 1):151–6.
doi: 10.1111/j.1478-3231.2011.02706.x
pubmed: 22212587
pmcid: 3955982
Khaw F-M, Stobbart L, Murtagh MJ. I just keep thinking I haven’t got it because I’m not yellow: a qualitative study of the factors that influence the uptake of Hepatitis C testing by prisoners. BMC Public Health. 2007;7(1):98.
doi: 10.1186/1471-2458-7-98
pubmed: 17555573
pmcid: 1906754
Talal A, Ding Y-X, Markatou M. Innovations in education: a prospective study of storytelling narratives to enhance Hepatitis C virus knowledge among substance users. World J Hepatol. 2022;14(5):972–83.
doi: 10.4254/wjh.v14.i5.972
pubmed: 35721284
pmcid: 9157714
Sagrestano LM, Clay J, Finerman R, Gooch J, Rapino M. Transportation vulnerability as a barrier to service utilization for HIV-positive individuals. AIDS Care. 2014;26(3):314–9.
doi: 10.1080/09540121.2013.819403
pubmed: 23876086
Kennedy CE, Yeh PT, Atkins K, Fonner VA, Sweat MD, O’Reilly KR et al. Economic compensation interventions to increase uptake of voluntary medical male circumcision for HIV prevention: A systematic review and meta-analysis. Francis JM, editor. PLoS One. 2020;15(1):e0227623.
Thirumurthy H, Masters SH, Rao S, Bronson MA, Lanham M, Omanga E, et al. Effect of providing conditional economic compensation on Uptake of Voluntary Medical Male Circumcision in Kenya. JAMA. 2014;312(7):703.
doi: 10.1001/jama.2014.9087
pubmed: 25042290
pmcid: 4268484
Govindasamy D, Ford N, Kranzer K. Risk factors, barriers and facilitators for linkage to antiretroviral therapy care. AIDS. 2012;26(16):2059–67.
doi: 10.1097/QAD.0b013e3283578b9b
pubmed: 22781227
Oru E, Trickey A, Shirali R, Kanters S, Easterbrook P. Decentralisation, integration, and task-shifting in Hepatitis C virus Infection testing and treatment: a global systematic review and meta-analysis. Lancet Glob Health. 2021;9(4):e431–e45.
doi: 10.1016/S2214-109X(20)30505-2
pubmed: 33639097
pmcid: 7966682
Draper BL, Htay H, Pedrana A, Yee WL, Howell J, Pyone Kyi K, et al. Outcomes of the CT2 study: a ‘one-stop‐shop’ for community‐based Hepatitis C testing and treatment in Yangon, Myanmar. Liver Int. 2021;41(11):2578–89.
doi: 10.1111/liv.14983
pubmed: 34153155
pmcid: 8596916
Draper BL, Yee WL, Shilton S, Bowring A, Htay H, Nwe N, et al. Feasibility of decentralised, task-shifted Hepatitis C testing and treatment services in urban Myanmar: implications for scale-up. BMJ Open. 2022;12(5):e059639.
doi: 10.1136/bmjopen-2021-059639
pubmed: 35504640
pmcid: 9066562
Phan JM, Kim S, Linh ĐTT, Cosimi LA, Pollack TM. Telehealth interventions for HIV in Low- and Middle-Income Countries. Curr HIV/AIDS Rep. 2022;19(6):600–9.
doi: 10.1007/s11904-022-00630-0
pubmed: 36156183
pmcid: 9510721
Zhang M, O’Keefe D, Craig J, Samley K, Bunreth V, Jolivet P, et al. Decentralised Hepatitis C testing and treatment in rural Cambodia: evaluation of a simplified service model integrated in an existing public health system. Lancet Gastroenterol Hepatol. 2021;6(5):371–80.
doi: 10.1016/S2468-1253(21)00012-1
pubmed: 33743883
Walker JG, Mafirakureva N, Iwamoto M, Campbell L, Kim CS, Hastings RA, et al. Cost and cost-effectiveness of a simplified treatment model with direct‐acting antivirals for chronic Hepatitis C in Cambodia. Liver Int. 2020;40(10):2356–66.
doi: 10.1111/liv.14550
pubmed: 32475010
Zhang M, O’Keefe D, Iwamoto M, Sann K, Kien A, Hang V, et al. High sustained viral response rate in patients with Hepatitis C using generic sofosbuvir and daclatasvir in Phnom Penh, Cambodia. J Viral Hepat. 2020;27(9):886–95.
doi: 10.1111/jvh.13311
pubmed: 32358826