title: A global view of hepatitis C: physician knowledge, opinions, and perceived barriers to care.
abstract: Chronic infection with the hepatitis C virus (HCV) is a leading cause of global morbidity and mortality. Although recent advances in antiviral therapy have led to significant improvements in treatment response rates, only a minority of infected patients are treated. Multiple barriers may impede the delivery of HCV therapy. The aim of this study was to identify perceived barriers to care, knowledge, and opinions among a global sample of HCV treatment providers. An international, multidisciplinary survey of HCV treatment providers was conducted. Each physician responded to a series of 214 questions concerning his or her practice characteristics, opinions regarding the state of HCV care, knowledge regarding HCV treatment, and perception of treatment barriers. A total of 697 physicians from 29 countries completed the survey. Overall, physicians viewed patient-level barriers as most significant, including fear of side effects and concerns regarding treatment duration and cost. There were distinct regional variations, with Central and Eastern European physicians citing government barriers as most important. In Latin America, the Middle East, and Africa, payer-level barriers, including lack of treatment coverage, were prominent. Overall, the perception of barriers was strongly associated with physician knowledge, experience, and region of origin, with the fewest barriers reported by Nordic physicians and the most reported by Middle Eastern and African physicians. Globally, physicians demonstrated deficits in basic treatment principles, including the role of viral kinetics and the management of treatment nonresponders. Two thirds of surveyed physicians believed that patients do not have adequate access to providers in their community.
  
  
  CONCLUSIONS
  Barriers to HCV treatment vary globally, though patient-level factors are viewed as most significant by treating physicians. Efforts to improve awareness, education, and specialist availability are needed.
authors: UNC Liver Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors: Christopher E
authors: CE
authors: McGowan
authors: Ali
authors: A
authors: Monis
authors: Bruce R
authors: BR
authors: Bacon
authors: Josep
authors: J
authors: Mallolas
authors: Fernando L
authors: FL
authors: Goncales
authors: Ioannis
authors: I
authors: Goulis
authors: Fred
authors: F
authors: Poordad
authors: Nezam
authors: N
authors: Afdhal
authors: Stefan
authors: S
authors: Zeuzem
authors: Teerha
authors: T
authors: Piratvisuth
authors: Patrick
authors: P
authors: Marcellin
authors: Michael W
authors: MW
authors: Fried
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D003625:Data Collection; D003695:Delivery of Health Care; D014943:Global Health; D017048:Health Care Costs; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006526:Hepatitis C / Q000188:drug therapy*; D006801:Humans; D007391:International Cooperation; D010349:Patient Compliance; D010465:Perception; D010820:Physicians / Q000523:psychology*
chemical_list: D000998:Antiviral Agents