566 Identifying barriers to the inclusion of pregnant patients in hepatitis C research and treatment programs

Abstract

The rising prevalence of hepatitis C virus (HCV) infection and the availability of direct acting antivirals for HCV treatment has prompted a public health goal of HCV eradication. However, treatment studies and programs have largely excluded pregnant individuals, despite compelling reasons why treatment during pregnancy may be an effective public health strategy. Our objective was to query patient and clinician stakeholders to identify barriers to including pregnant patients in HCV research and treatment programs. This qualitative investigation included obstetricians (ob/gyn specialists and MFM subspecialists) and pregnant and previously-pregnant patients (ages 27-44) with HCV. Participants completed semi-structured individual interviews regarding knowledge of HCV in pregnancy and HCV treatment, perceived barriers to treatment/research during pregnancy, and attitudes toward treatment. Data were analyzed using the constant comparative method to identify themes. Participants (N=18 obstetricians, N=21 patients) addressed multiple perceived barriers to HCV treatment in pregnancy (Table). Obstetrician-specific themes included inadequate evidence base and lack of professional guidelines, perceived patient burdens (e.g. low health literacy), and research roadblocks. Themes shared by obstetricians and patients included cost and access barriers, insufficient provider knowledge, and safety concerns (Figure). Patient-specific themes were provider communication challenges, psychological barriers, and unclear rationale for treatment during pregnancy. Nevertheless, patients were well-informed and largely desirous of treatment. Although cost, safety, and provider knowledge concerns regarding HCV treatment in pregnancy were shared by patients and obstetricians, these groups diverged regarding perceived patient preferences. Importantly, patients did not endorse obstetrician concerns about low health literacy and patient logistical burdens. To ensure appropriate and equitable access to HCV treatment for pregnant individuals, these patient and provider barriers must be addressed.View Large Image Figure ViewerDownload Hi-res image Download (PPT)