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Recent advances in the treatment of hepatitis C virus (HCV) infection have produced highly effective all-oral direct-acting antivirals (DAA) therapies with minimal side effects and short treatment duration. This is encouraging news for the 71 million persons estimated to be chronically infected with HCV worldwide.1 From a public health perspective, HCV prevalence shall be eliminated if available treatment is also targeted to those who most likely transmit the virus. Despite this scientific breakthrough, a systematic review from the USA described that of 43% of patients are aware of their HCV diagnosis, only 16% had begun treatment.2 Evidently, long-standing barriers to treatment need to be addressed for these effective therapies to be delivered. Therefore, in the DAA era, where treatment efficacy, side effects and duration are not a problem, identification of barriers that prevent the delivery of HCV care is an important issue that remains pending. Historically, multiple-layered barriers related to a patient, provider and structural factors may effectively prevent HCV linkage to care (figure 1):
Patient-related factors are a common source of treatment deferral and limited awareness, poor adherence to physician recommendations and treatment fears. Patient unawareness of HCV infection represents one of the greatest obstacles to treatment. Efforts to scale up HCV diagnosis must include community education and stigma issues. Confusion about disease complications and modes of transmission is also common. Once HCV diagnosis is established, patients frequently fail to seek treatment probably because they may not recognise the urgency to treat this asymptomatic infection. In some regions, patients with HCV are more likely to be uninsured when compared with persons without HCV. Uninsured individuals are less likely to have regular visits with healthcare professionals, reducing the probability of diagnosis and treatment. …
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