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. 2024 Jan 16;24(1):80.
doi: 10.1186/s12913-023-10456-0.

Patients' experience of accessing hepatitis C treatment through the Myanmar national hepatitis C treatment program: a qualitative evaluation

Bridget Draper  1   2 , Win Lei Yee  3 , Anna Bowring  4 , Win Naing  5   6 , Khin Pyone Kyi  6 , Hla Htay  3 , Jessica Howell  4   7   8 , Margaret Hellard  4   9   10   11   12 , Alisa Pedrana  4   9   13
Affiliations

Patients' experience of accessing hepatitis C treatment through the Myanmar national hepatitis C treatment program: a qualitative evaluation

Bridget Draper et al. BMC Health Serv Res. .

Abstract

Background: Globally, 56.8 million people are living with hepatitis C and over three-quarters of those reside in low and middle-income countries (LMICs). Barriers and enablers to hepatitis C care among people who inject drugs in high-income countries are well documented. However, there is scant literature describing the patient experience in LMICs. Understanding the barriers and enablers to care from the patient perspective is important to inform service refinements to improve accessibility and acceptability of hepatitis C care.

Methods: We conducted a qualitative evaluation of the patient experience of accessing the national hepatitis C program at eight hospital sites in Myanmar. Semi-structured interviews were conducted with four to five participants per site. Interview data were analysed thematically, with deductive codes from Levesque et al.'s (2013) Framework on patient-centred access to healthcare.

Results: Across the eight sites, 38 participants who had completed treatment were interviewed. Barriers to accessing care were mostly related to attending for care and included travel time and costs, multiple appointments, and wait times. Some participants described how they did not receive adequate information on hepatitis C, particularly its transmission routes, and on the level of cirrhosis of their liver and what they were required to do after treatment (i.e. reduce alcohol consumption, liver cirrhosis monitoring). Many participants commented that they had few or no opportunities to ask questions. Provision of treatment at no cost was essential to accessibility, and gratitude for free treatment led to high acceptability of care, even when accessing care was inconvenient.

Conclusions: These findings highlight the importance of streamlining and decentralising health services, adequate human resourcing and training, and affordable treatment in maximising the accessibility and acceptability of hepatitis C care in LMICs. Findings from this work will inform future service delivery refinements for national program and other decentralised programs to improve accessibility and acceptability of hepatitis C care in Myanmar.

Keywords: Barriers; Enablers; Hepatitis C; Hospital; Low and middle-income countries; Myanmar; National program; Patient experience.

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Conflict of interest statement

MH has received investigator-initiated grant funding from Gilead Sciences and Abbvie for unrelated work. AP has received investigator-initiated grant funding from Gilead Sciences, MSD and Abbvie and speaker fees from Gilead Sciences for unrelated work. JH has received investigator-initiated grant funding and speaker fees from Gilead Sciences for unrelated work. WLY has received Gilead Sciences Fellowship for related work. KPK has received non-financial support from Mylan, Hetero and Royal Ruby. WN has received non-financial support from Mylan and Cipla. All others declare no potential competing interests.

Figures

Fig. 1
Fig. 1
Determinants of accessing care, guided by [31] framework
Fig. 2
Fig. 2
Considerations for service refinement & expanded roll-out
See this image and copyright information in PMC

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