Identifying Varying Influences on Eliminating Hepatitis C Across Medical Specialties

Abstract

Objective:To identify specialty-specific influences in administering HCV treatment among primary care, gastroenterology/hepatology, infectious diseases, and addiction specialties, and strategies to potentially eliminate HCV. Study Setting and Design:Qualitative study using remote interviews with healthcare providers in New York and Alabama who treated or screened patients for HCV, purposefully sampling for specialty, clinical setting, and HCV treatment experience. Data sources and Analytic Sample: Interviews occurred 9/2021–8/2022. Transcripts were analyzed using a hybrid inductive-deductive approach; a content analysis identified codes arising uniquely within specialties. Results: Thirty-six providers were interviewed: primary care (n = 9), addiction medicine (n = 12), infectious diseases (n = 9), and gastroenterology/hepatology (n = 6). Distinct challenges and facilitators emerged across specialties. Primary care and addiction providers similarly emphasized the convenience and usual practice of referring patients to specialists for HCV treatment, while infectious disease and gastroenterology noted challenges with patients not completing the referrals. Primary care providers expressed wanting training and peer support related to treatment provision. Addiction providers described structural barriers, such as lacking on-site phlebotomy services and patients' competing health concern prioritization, but highlighted strategies to improve treatment access, including trust-building. Infectious disease providers highlighted using patient navigators to overcome logistical barriers, while gastroenterologists emphasized collaborative relationships, particularly with addiction specialists. Specialty-specific opportunities emerged regarding training, collaboration, navigation, and infrastructure. Conclusions:Eliminating HCV requires addressing specialty-specific concerns for providers managing HCV. Potential opportunities include dissemination of specialty-tailored training, facilitating interdisciplinary care and desired cross-specialty collaborations, and overcoming unique infrastructural needs. Future research should evaluate implementation strategies addressing these specialty-specific needs.