Anticipated Barriers to Follow-up Care: Perspectives of Patients Receiving Hepatitis C Testing at a Sexual Health Clinic

Background: Half of patients who screen positive for hepatitis C do not receive any follow-up care, despite newly-developed medications capable of curing the infection. Data on the barriers to comprehensive hepatitis C follow-up could inform interventions to more effectively link patients to care.

Methods: In an ongoing study, we conducted surveys with 78 individuals receiving hepatitis C testing in the sexual health clinic at our city's health department. Using descriptive statistics, we characterized 1) factors that would prevent participants from accessing further hepatitis C care in the event of a positive screening test and 2) participant perspectives of potential linkage-to-care interventions.

Results: Most participants anticipated that they would feel very concerned in the event of a positive hepatitis C test (79%) and would seek further care immediately (95%). Prior to testing, all participants had heard of hepatitis C, however, most (90%) reported one or more incorrect belief(s) regarding hepatitis C prevention, transmission, or treatment. Participants predicted that financial concerns (60%) and insurance concerns (50%) would present barriers to follow-up care. Many reported that they would be more likely to seek further care if an individual with hepatitis C shared his or her experience with treatment (74%) or if someone else reminded them of their appointment and coordinated their transportation to the appointment (67%). Only 42% reported that a small cash voucher would further motivate them to seek follow-up care.

Conclusions: Financial and insurance barriers as well as incorrect beliefs regarding hepatitis C prevention, transmission, and treatment may impact follow-up rates in this patient population. Linkage to care interventions that provide 1) opportunities for newly-diagnosed patients to hear from individuals who have successfully completed care (e.g. via a short video), and 2) reminders for follow-up appointments and assistance with coordinating transportation to the clinic could be particularly effective in this setting.