Fear of future health problems encourage people to start and complete HCV therapy but concern about side-effects is a deterrent

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US research has provided important insights into the factors that motivate and deter people from starting and completing therapy for hepatitis C virus (HCV) infection. Published in the online journal BMC Infectious Diseases, the study showed that expected health problems as a result of not treating HCV infection encouraged people to start or complete therapy, while treatment side-effects were discouraging. Patients also reported that they were more likely to start or complete treatment if they were provided with test results and other information on the likelihood of treatment success.

“Study findings suggest that future health problems related to chronic HCV infection and the expected efficacy and safety profile of HCV therapies are likely to impact on patients’ decisions on HCV treatment initiation and completion,” comment the authors. “Such risk-benefit considerations…provide a promising foundation for those seeking to increase HCV treatment adherence and completion.”

Chronic HCV infection is an increasingly important cause of serious illness and death in the US. The infection can be treated and cured, and treatment response rates have been boosted with the introduction of anti-HCV protease inhibitors.



Tiredness, often severe (exhaustion).



A mental health problem causing long-lasting low mood that interferes with everyday life.

representative sample

Studies aim to give information that will be applicable to a large group of people (e.g. adults with diagnosed HIV in the UK). Because it is impractical to conduct a study with such a large group, only a sub-group (a sample) takes part in a study. This isn’t a problem as long as the characteristics of the sample are similar to those of the wider group (e.g. in terms of age, gender, CD4 count and years since diagnosis).


A person who has never taken treatment for a condition.


In HIV, an individual who is ‘treatment naive’ has never taken anti-HIV treatment before.

However, the factors encouraging or deterring people to start and complete HCV therapy are poorly understood.

A team of investigators in Boston therefore designed a study involving 120 people with HCV mono-infection with various experiences of treatment. The participants completed a 60-minute telephone interview answering 33 closed-ended questions about factors that might influence their decisions about treatment. The participants were asked to rate these factors on a scale from 1 (not at all important) to 5 (extremely important).

“Study findings should inform the development of interventions in support of HCV treatment initiation and maintenance as new treatment options emerge for this patient population,” explain the authors.

A quarter of participants were treatment naive; 30 were currently taking HCV therapy; 30 had started but then discontinued treatment; and 30 had completed the full course of HCV therapy.

Participants were broadly representative of the HCV-infected population in the US. Over half (56%) were male, 63% were white and their median age was 52 years.

The five most important factors reported as encouraging people to start treatment were:

1.     Possible future problems from not treating HCV infection (mean score: 4.8).

2.     Willpower to take therapy (mean score: 4.1).

3.     Advice from doctor (mean score: 4.1).

4.     Potential negative impact of HCV on reaching life goals (mean score: 3.6).

5.     Ability to obtain information on likelihood of treatment success (mean score: 3.5).

The five factors that most discouraged people to start therapy were:

1.     Overall side-effects of treatment (mean score: -3.0).

2.     Fatigue (mean score: - 2.9).

3.     Flu-like symptoms (mean score: - 2.6).

4.     Depression (mean score: - 2.4).

5.     Need to inject one of the medications (mean score: -.20).

The most important factors that encouraged participants to complete treatment were:

1.     Possible future health problems (mean score: 4.72).

2.     Willpower (mean score: 4.32).

3.     Stage of HCV disease (mean score: 3.82).

4.     Emotional support from family, friends and patient groups (mean score: 3.74).

5.     Advice from doctor (mean score: 3.82).

The five most significant factors that discouraged patients to complete a course of treatment were:

1.     Fatigue (mean score: -2.78).

2.     Overall side-effects (mean score: -2.5).

3.     Flu-like symptoms (mean score: -2.09).

4.     Depression (mean score: -2.06).

5.     Duration of treatment (mean score: -1.34).

“Patients want to be in good health now and in the future but while HCV treatment may provide future health benefits, side-effects make patients feel poorly in the present,” comment the investigators. “Participants in our research indicated that side-effects of treatment were most important both in discouraging treatment start and in challenging treatment adherence.”

The authors also believe their findings show the importance of “communication and education” to overcoming barrier to treatment. They conclude: “understanding potential motivators and treatment challenges from the patient perspective is an important means to identify opportunities for education and interventions that encourage initiation and completion of HCV treatment.”


Fusfeld L et al. Assessment of motivating factors associated with the initiation and completion of treatment for chronic hepatitis C virus (HCV) infection. BMC Infectious Diseases, 13: 324, 2013.