Barriers and Facilitators to Hepatitis C Virus Treatment in Los Angeles County

Diagnosed but untreated chronic Hepatitis C virus (HCV) infection is a major public health problem in Los Angeles (LA) County, particularly among underserved and minority groups. This mixed-methods study (October 2024-January 2025) used de-identified programmatic data from 344 case-residents in a linkage-to-cure program and conducted thematic analysis of semi-structured interviews with ten participants (seven untreated, three treated) from the linkage-to-cure program. By integrating these quantitative and qualitative findings, the study identified community-level and individual barriers and facilitators to HCV treatment. Quantitatively, 54% of case-residents reported barriers, such as personal barriers, provider-specific barriers, insurance barriers, and inadequate access to medical care. Qualitative themes expanded on these findings, identifying homelessness, incarceration, and drug addiction as key personal barriers. Provider-related barriers included language barriers, frustration in navigating the healthcare system, long wait times to see a provider, and participants' lack of HCV information. Insurance barriers were characterized by cost barriers and inadequate access to medical care due to a lack of transportation. Facilitators of treatment included personal motivation to seek treatment, family and community-based support systems, trust in their medical provider, adequate insurance coverage, understanding the benefits of HCV treatment, and the desire to avoid stigmatization. Eliminating HCV as a public health problem requires equitable interventions that address individual and system-level barriers. These include implementing language support services, leveraging patient navigation and care coordination services, utilizing mobile clinics for the unhoused, ensuring treatment continuity for people re-entering the community from incarceration, and removing insurance restrictions, such as prior authorization requirements.