Direct-acting antiviral treatment for HIV/HCV patients in safety net settings: patient and provider preferences

ABSTRACT

HIV/HCV coinfected patients are a priority for direct acting antiretroviral (DAA) treatment, yet barriers to treating vulnerable patients persist. This study surveyed safety net clinic patients and providers to quantify their preferences for DAA treatment and prioritize modifiable barriers. Preferences were assessed using best-worst scaling. General linear mixed models were used to determine whether attributes differed in importance and whether patients and providers valued attributes differently. 158 HIV/HCV coinfected patients and 49 providers participated. Patients and providers had strong preferences for treatment within the medical homes where patients receive HIV care. Support such as reminders and advice numbers were also important, but were more important to providers than patients. Providers identified lack of insurance coverage for DAA as the most significant barrier. Providers rated HIV primary care providers as best suited to deliver DAA to HIV+ patients. Addressing structural barriers is essential for increasing DAA treatment in safety net settings.

KEYWORDS:

• HIV
• hepatitis C
• coinfection
• direct-acting antivirals
• preferences
• vulnerable populations

Acknowledgments

The authors wish to thank research assistants, Adriana Martinez, Ada Lin, Barbara Njuguna, Connie Chen, Patrick Lau, Lissa Moran and Jason Storm. We also wish to thank Ward 86 providers for supporting our recruitment efforts, with special thanks to Val Robb, Eva Mureithi, Guy Vandenberg and Mark Jacobson.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the National Institute on Drug Abuse under grants 5UM1AI068636, K24DA039780 and K24DA037034 and the National Institute of Allergy and Infectious Diseases under grants UM1AI106701 and UM1AI069496.