Hepatitis C Care among People with HIV in Puerto Rico: A Mixed-Methods Study

A significant proportion of people with HIV are coinfected with the hepatitis C virus (HCV). Many of these individuals who are chronically infected with HCV will develop complications. Effective treatments are available to cure HCV infection and reduce morbidity and mortality, but most people with HCV do not receive them. The present study aimed to describe a sample of people co-infected with HIV and HCV and explore barriers and facilitators to HCV care in Puerto Rico. Using a mixed-method design, we reviewed n = 113 randomly selected medical records of people with HIV and HCV coinfection. Then, we conducted 12 qualitative interviews with a purposive sample of HCV treatment stakeholders (e.g., physicians and pharmacists). Findings indicate that coinfected individuals have been living with HIV for an average of 16.6 ± 7.7 years, 41.6% received HCV treatment, and the average time since the latest HCV treatment was 3.9 ± 4.5 years. The most common HCV genotype was 1a (26.5%; n = 30), 40.7% of the participants were treated with direct-acting antivirals, and 42 (91%) achieved a sustained virologic response. Interview findings suggest that access to HCV treatment is limited mainly due to costs, lack of insurance coverage, limited number of providers, stigma, and challenges to engagement in HIV care. A significant proportion of participants received treatment for HCV infection, and, of those, most achieved sustained virological response. Expanding coverage and increasing the number of physicians who could prescribe HCV treatment might reduce the gaps in HCV treatment accessibility and use among people coinfected with HIV and facilitate HCV elimination. Culturally appropriate interventions remain needed to address low HCV disease awareness and stigma.