Hepatitis C Antiviral Treatment Rates: Understanding Racial Disparities

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ABSTRACT Project Background: HCV is an important health problem within the Veterans Administration (VA). Veterans are more than three times more likely to be infected with HCV than the general population, with the prevalence in African American veterans being three and a half times higher than even that of Caucasian veterans. The disease results in substantial morbidity and mortality, including cirrhosis, hepatocellular carcinoma and death. The current antiviral therapy can achieve a HCV cure rate of 55%, making it the most effective method for reducing the long-term consequences of the disease. Yet despite the higher prevalence, African Americans have significantly lower treatment rates compared to Caucasians. However, no study has addressed this pressing problem within or outside the VA. Project Objectives: (1) Using audio-recoded GI provider-patient clinical encounters, determine whether racial differences exist in providers' recommendations for and patients' interest in initiating antiviral therapy. (2) Using in-depth qualitative interviews with the same cohort of patients, determine whether racial differences exist in patient factors related to initiating antiviral therapy. (3) Using in-depth qualitative interviews with the same cohort of providers, determine whether differences exist in provider factors related to African Americans initiating antiviral therapy. Project Methods: This longitudinal study will enroll patients referred to a Gastroenterology (GI) clinic who are considered eligible for antiviral treatment. Fifty- four African American and fifty-four Caucasians will have their GI provider-patient clinical encounters audio recorded until either the patient starts antiviral therapy or drops out of the treatment initiation process. Patients will participate in a qualitative interview after each clinical encounter. The interview will focus on their satisfaction with the clinical encounter, their concerns, their understanding of HCV treatment, and their facilitators and barriers to treatment. Providers will also participate in a qualitative interview after each clinical encounter. The interview will focus on their recall of patient concerns, their perception of the patient's understanding of HCV treatment, the patient's treatment candidacy, and the perceived level of patient adherence. Qualitative methods will be used to code and analyze the clinical encounter audio recordings, the patient and the provider interviews.