This descriptive qualitative study examined the patient, provider, and institutional factors contributing to nonattendance for hepatitis C (HCV) care throughout the disease course. Eighty-four patients and health and social care providers were interviewed. Thematic analysis of the data yielded 6 interrelated nonattendance themes: self-protection, determining the benefits, competing priorities, knowledge gaps, access to services, and restrictive policies. Factors within the themes varied with the disease course, type of provider/service, and patient context. Nonattendance could span months to years and most frequently began at diagnosis where providers either advised that followup was not necessary or did not recommend any followup. The way services were organized (low barrier access) and delivered (nonjudgmental approach) and higher HCV knowledge levels of patients and providers encouraged attendance. This is the first study to explore the reasons for nonattendance for HCV care throughout the disease course and validate them from multiple perspectives. There are missed opportunities for providers to encourage attendance throughout the disease course beginning at diagnosis. Interventions required include development of integrated health and social service delivery models; mechanisms to improve knowledge dissemination of the disease, its management, and treatment; and implementation of standardized followup protocols for liver disease monitoring in primary care. 1. Introduction We report the findings from qualitative research to ascertain the patient, provider, and institutional factors that contribute to nonattendance for care for hepatitis C virus (HCV) infection at various points along the disease course. HCV is a chronic infectious disease, spread through blood to blood contact that affects 170 million worldwide, including approximately 250,000 Canadians [1]. Because HCV has a heterogeneous presentation and a slow, unpredictable course of liver inflammation that spans decades, patients require long-term monitoring for signs of progressive liver disease and associated issues such as cirrhosis, end-stage liver disease, liver cancer, HIV coinfection, fatty liver disease, and alcohol overuse [2–8]. Patients receive diagnostic and most followup services in primary care due to the large number affected and the relative shortage of specialists [9]. Specialists provide complex disease management for those with advanced disease including the provision of a 24- to 48-week course of antiviral therapy for those eligible, consenting, and able to tolerate it.
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