Implicit bias from providers inhibits hepatitis C treatment in people with HIV, study finds

A recent study reveals significant insights into the challenges that can occur for hepatitis C virus (HCV) micro-elimination efforts in people with HIV (PWH). Due to the opioid epidemic, the prevalence of co-infection with HIV and HCV has been increasing. If left untreated, HCV infection can lead to liver damage, cancer, and death. Although HIV requires lifelong therapy, HCV can be cured with a few months of oral medications.

To understand the barriers in providing hepatitis C care, the authors conducted a mixed-methods analysis that involved conducting focus groups with 14 health care providers across 11 clinics. Practitioners interviewed in the study identified several barriers to micro-elimination, with housing instability, medication nonadherence concerns, and inability to motivate patients being the most prioritized.

Importantly, the researchers found that implicit biases pervaded a majority of the responses offered by providers. As a result, the authors assert that overcoming barriers to treatment may require addressing the stigma health care practitioners can hold toward patients.

The findings are published in the journal Health Promotion Practice.

"Given that there are deeply ingrained biases toward people who use drugs, biases that are especially hard to change, we need to instead redesign the way we manage such patients to reduce opportunities for stigma-inducing interactions as we cannot reliably expect every clinician to be absent of implicit bias," said Frederick Altice, MD, MA, professor of medicine (infectious diseases), Yale School of Medicine, and of epidemiology (microbial diseases), Yale School of Public Health.