Abstract
BACKGROUND AND AIMS: The prevalence of hepatitis delta virus (HDV), which causes more severe liver disease than infection with hepatitis B virus alone, has risen in the United States and globally. However, the true burden of HDV is poorly understood due to low screening rates. Both patient- and provider-level factors may contribute to low HDV screening; however, our understanding of such factors is limited. The purpose of our study was to gain a comprehensive understanding of the perceived barriers and facilitators to HDV screening and treatment from the perspective of healthcare providers. METHODS: We recruited participants who were members of the American College of Gastroenterology, the American Association for the Study of Liver Diseases, and/or the Gastroenterology and Hepatology Advanced Practice Providers organization. We conducted in-depth, qualitative interviews with 46 racially diverse providers practicing in practice environments throughout North America. RESULTS: The interviews revealed six themes related to barriers to screening, including (1) limited knowledge and awareness, (2) lack of clear guidelines, (3) operational challenges, (4) cost and insurance, (5) provider-related factors, and (6) patient-related factors. Recommendations for increasing screening included (1) provider education and awareness, (2) advocacy for universal screening, (3) improved guidelines, (4) streamlined testing process, (5) increased access to screening tests, (6) public awareness campaigns, (7) more research on HDV, (8) financial assistance, and (9) accountability measures. CONCLUSION: Identification of gaps in knowledge and barriers to HDV screening are critical toward implementation of successful screening programs, essential for accurately estimating HDV prevalence and connecting patients with HDV infection to appropriate, individualized care.