P138 Exploring the underlying causes of disengagement from hepatitis C care

<h3></h3> Despite established hepatitis C test-to-cure pathways in the community, some people have been unable to engage with treatment. We undertook an interview-based exploration of the barriers and enablers to hepatitis C direct-acting antiviral (DAA) treatment initiation in a key population of people who had delayed treatment. We conducted semi-structured interviews with individuals who had delayed (for at least six months with one appointment missed) or declined DAA therapy, as well as service providers. Participants were identified using peer support and outreach networks. The topic guide was informed by a systematic review of barriers and enablers to treatment initiation. Responses were structured within the Capability, Opportunity, Motivation, Behaviour (COM-B) model by reflexive thematic analysis. Fourteen participants with hepatitis C (two women) were interviewed at drug treatment services, in their place of residence or clinical settings between November 2022 and January 2023. They were aged between 32–66 and diagnosed with hepatitis C between 1–30 (median 7) years ago. Nine participants were of White ethnicity and UK-born, 13 had a mental health diagnosis or concern and 11 had physical comorbidity, five of whom had severely reduced mobility. Six were currently homeless. Ten providers (clinical and allied health professionals, peer advocates and outreach team members) were interviewed in person or online. We identified four themes. ‘Once bitten, twice shy’: negative earlier life experiences and interactions with health and social care were barriers to subsequent engagement with DAA treatment (Opportunity). Previous difficulty navigating the healthcare system and experiencing enacted stigma led to the expectation of poor care again next time, with resultant avoidance. ‘This is a relief’: positive interactions with services, however, had the potential to repair damaged relationships and build trust through addressing the individual’s priorities first (Capability, Opportunity). ‘You can’t make plans’: lack of service adaptability and patient-provider ‘fit’ was a barrier to accessing treatment when life circumstances were unpredictable (Capability, Opportunity). ‘Stepping stones’: stability (individually defined) was needed to enable treatment uptake (Capability, Opportunity and Motivation). Most participants wanted treatment but felt a strong aversion to the possibility of ‘failing’ therapy and so deferred until they felt ready to complete it. These themes provide a useful starting point and guide for exploring individual beliefs and behaviours surrounding hepatitis C treatment. Understanding the underlying capability, opportunity and motivational causes beneath apparently ‘chaotic’ interactions with care providers might facilitate tailored intervention and support through treatment. <h3>References</h3> O’Sullivan M, Jones AM, Gage H,<i> et al</i>. ITTREAT (Integrated Community Test - Stage - TREAT) Hepatitis C service for people who use drugs: real-world outcomes. <i>Liver International</i> 2020;<b>40</b>:1021–31. Bajis S, Grebely J, Hajarizadeh B, <i>et al</i>. Hepatitis C virus testing, liver disease assessment and treatment uptake among people who inject drugs pre‐ and post‐universal access to direct‐acting antiviral treatment in Australia: The LiveRLife study. <i>Journal of Viral Hepatitis</i> 2020;<b>27</b>:281–93. Bryce K, Smith C, Rodger A, Macdonald D. Falling treatment uptake in the hepatitis C care cascade is a growing threat to achieving elimination.<i>J Viral Hepat</i>. 2023;<b>30</b>:46–55. Michie S, Van Stralen MM, West R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. <i>Implementation Science</i> 2011;<b>6</b>:42. Cane J, O’Connor D, Michie S. Validation of the theoretical domains framework for use in behaviour change and implementation research. <i>Implementation Science</i> 2012;<b>7</b>:37.