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Applying the COM-B Model to Identify Barriers to Bulevirtide Adherence in Chronic Hepatitis D: A Multicenter Italian
Lorenzo Badia1, Alessia Ciancio2, Marco Distefano3
1Infectious Diseases Outpatient Clinic, Azienda USL of Imola, Imola, Italy.
Journal of Viral Hepatitis
|October 11, 2025
Summary
Treatment adherence for Hepatitis D Virus (HDV) patients using bulevirtide (BLV) is crucial. Real-world barriers in Italy, including education and motivation, impact adherence, requiring targeted interventions for better outcomes.
Area of Science:
- Hepatology and Infectious Diseases
- Behavioral Science in Medicine
- Clinical Pharmacy
Background:
- Treatment adherence is vital for managing chronic infectious diseases like Hepatitis D Virus (HDV).
- Bulevirtide (BLV) shows promise, but real-world adherence challenges exist, particularly for migrant populations.
- Understanding adherence barriers is key to optimizing clinical outcomes in HDV management.
Purpose of the Study:
- To investigate factors influencing adherence to bulevirtide (BLV) treatment in real-life settings in Italy.
- To explore behavioral drivers and unmet needs affecting HDV patient adherence using the COM-B model.
- To identify challenges in patient education, medication access, and motivation impacting BLV adherence.
Main Methods:
- Anonymous surveys administered to 83 adult HDV patients on bulevirtide (BLV) and 13 hepatologists in Italy.
- Utilized the COM-B model to systematically analyze adherence determinants.
- Data collected from May to September 2024 across five tertiary centers.
Main Results:
- Key adherence challenges identified include patient education deficits, logistical issues accessing medication, and psychological factors impacting motivation.
- 10% of patients considered discontinuing treatment, and 10% admitted to missing doses.
- Significant barriers to bulevirtide (BLV) adherence were observed in the Italian real-world setting.
Conclusions:
- Real-world adherence to bulevirtide (BLV) in HDV patients is multifactorial, influenced by education, access, and motivation.
- Targeted interventions addressing identified barriers are necessary to enhance adherence.
- Improving adherence can lead to better personalized therapeutic outcomes for HDV patients.
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