A global view of hepatitis C: Physician knowledge, opinions, and perceived barriers to care§††‡‡§§¶¶

Authors


  • Potential conflict of interest: M.W.F. receives research grants from Merck, Genentech, Vertex, Tibotec/Janssen, Gilead, Bristol Myers Squibb, and Abbott and serves as ad-hoc advisor to Merck, Genentech, Vertex, Tibotec/Janssen, Gilead, Bristol Myers Squibb, and Novartis.

  • Dr. Afdhal provided research support for, consults for, and advises Merck, GlaxoSmithKline, Vertex, and Gilead. He also provided research support for Abbott and Bristol-Myers Squibb. He consults for and advises Echosens, Novartis, Boehringer Ingerlheim, Ligand, and Springbank. He consults for, advises, and owns stock in Medgenics and Kadmon.

  • §

    Dr. Bacon consults for, provides research support for, and is on the speakers' bureau for Merck. He provided research support for Roche and Abbott. He provided research support for, is on the speakers' bureau for, and advises Gilead, Kadmon Pharmaceuticals, Vertex, and ISIS.

  • Dr. Piratvisuth advises, is on the speakers' bureau for, and received grants from Roche and Novartis. He advises and is on the speakers' bureau for MSD. He is also on the speakers' bureau of GlaxoSmithKline. He is on the speakers' bureau for and received grants from Bristol-Myers Squibb.

  • Dr. Mallolas advises and is on the speakers' bureau for Merck and Janssen.

  • ††

    Dr. Poordad advises, is on the speakers bureau for, and received grants from Merck, Vertex, Gilead, and Abbott. He advises and received grants from Janssen. He advises Novartis. He received grants from Achillion and Pharmasset.

  • ‡‡

    Dr. Marcellin advises, is on the speakers' bureau for, and received grants from Roche, Gilead, Janssen, and MSD. He advises and is on the speakers' bureau for Bristol-Myers Squibb, Novartis, Vertex, Boehringer Ingerlheim, Abbott, and Pfizer.

  • §§

    Dr. Zeuzem consults for, advises and is on the speakers' bureau for Merck.

  • ¶¶

    This work was funded by Merck and, in part, by the National Institutes of Health (T32 DK07634, K24 DK066144 [to M.W.F.], and UL1RR025747).

Abstract

Chronic infection with the hepatitis C virus (HCV) is a leading cause of global morbidity and mortality. Although recent advances in antiviral therapy have led to significant improvements in treatment response rates, only a minority of infected patients are treated. Multiple barriers may impede the delivery of HCV therapy. The aim of this study was to identify perceived barriers to care, knowledge, and opinions among a global sample of HCV treatment providers. An international, multidisciplinary survey of HCV treatment providers was conducted. Each physician responded to a series of 214 questions concerning his or her practice characteristics, opinions regarding the state of HCV care, knowledge regarding HCV treatment, and perception of treatment barriers. A total of 697 physicians from 29 countries completed the survey. Overall, physicians viewed patient-level barriers as most significant, including fear of side effects and concerns regarding treatment duration and cost. There were distinct regional variations, with Central and Eastern European physicians citing government barriers as most important. In Latin America, the Middle East, and Africa, payer-level barriers, including lack of treatment coverage, were prominent. Overall, the perception of barriers was strongly associated with physician knowledge, experience, and region of origin, with the fewest barriers reported by Nordic physicians and the most reported by Middle Eastern and African physicians. Globally, physicians demonstrated deficits in basic treatment principles, including the role of viral kinetics and the management of treatment nonresponders. Two thirds of surveyed physicians believed that patients do not have adequate access to providers in their community. Conclusion: Barriers to HCV treatment vary globally, though patient-level factors are viewed as most significant by treating physicians. Efforts to improve awareness, education, and specialist availability are needed. (HEPATOLOGY 2013;57:1325–1332)

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