Barriers to Hepatitis C Medication Adherence

Raising awareness about proper treatment adherence is one method of working toward eliminating hepatitis C.

Research has identified 3 main prongs for low medication adherence among hepatitis C patients, including low awareness of the importance of adherence, according to a paper published in the Journal of Primary Care & Community Health.

Investigators from Cairo retrospectively analyzed the health data for 496 hepatitis C patients in order to assess adherence rates and reasons for noncompliance in patients with hepatitis C who receive interferon-free treatment regimens. The investigators noted the records were completed between August 2014 and October 2019 and they then categorized the patients into 2 groups: adherent (432 patients) and non-adherence (64 patients).

Adherence was assessed by follow up phone calls, and defined as taking all prescribed medications. Many methods to assess medication adherence have been developed, including patient self-reporting, but it is not always accurate. It remains the most common assessment tool for adherence in Egyptian health care, though.

It is a known factor that there is poor adherence among hepatitis C patients using interferon-based therapies, the study authors said, but that direct-acting antivirals (DAAs) are orally administered and have higher efficacy against hepatitis C. The adherence to DAAs is expected to improve, they said, and evaluating this adherence is crucial to assessing the ability of achieving hepatitis elimination.

The study authors noted there were no statistical differences between the groups regarding gender, service availability, treatment history, treatment type, treatment duration, liver function tests, or liver imaging. They did find that the non-adherent group had a significantly higher BMI when compared to the adherent group.

The patients in the adherent group achieved 100 percent sustained virologic response (SVR) after 12 weeks.

Through asking patients in follow-up phone calls why they did not adhere to their medication regimen, the study authors organized the most common reasons, including the following:

Low awareness (44%). The study authors said that educational interventions diagnosed with hepatitis C are important to increasing the adherence rate for the treatment, and that type of medication and how it is administered can also be barriers to adherence. Awareness should be a cooperative, multidisciplinary effort that involves the hepatologist, family physician, and psychiatrist.

Unaffordable cost of follow-up labs (17%), especially for those who missed the date for free follow-up tests. Egyptian programs dispense medications for free which can boost adherence. The patient pays this cost if they miss the free scheduled lab investigators, however. The study authors also noted that other investigations have determined that the use of specialized hepatitis clinics compared to general hepatology centers can raise adherence rates.

Development of complications (12%)

All of these factors require proper evaluation and management, the study authors said. They said that the mean age of the non-adherence group was not significantly higher than the adherent group in their study but noted physical and cognitive dysfunction is considered the main factor for non-adherence in elderly patients.

The investigators also identified 3 mortality cases that they determined were not related to medication, they said.

“Overall, DAAs showed high efficacy, tolerability, and better adherence profile versus Interferon-based therapies in the Egyptian hepatitis C patients,” the study authors concluded. “Low awareness was the main cause of non-adherence in patients receiving DAAs. Raising awareness is mandatory for proper treatment adherence and, subsequently, good clinical outcomes.”