Factors that influence an HIV coinfected patient's decision to start hepatitis C treatment.

Liver disease is a leading cause of morbidity and mortality among patients coinfected with HIV and hepatitis C (HCV), yet few HIV coinfected patients actually receive HCV treatment. Providers must first be willing to prescribe treatment, but the patient ultimately makes the decision to accept or decline a treatment recommendation. We used a process model framework to explore the factors influencing patients' treatment decision-making. We conducted semistructured interviews with 35 HIV coinfected patients and 11 primary care providers at three HIV clinics in Los Angeles, California. Patients reported that stability of HIV disease, perceived need for HCV treatment, treatment readiness, willingness to deal with side effects, absence of substance abuse, and stability of mental health and overall life circumstances are key factors influencing treatment decision-making. Patients also spoke of the influence of the trusting relationship that many had with their provider, and providers acknowledged an awareness of the influence of how they present the risks and benefits of HCV treatment and the overall tone of their recommendation (encouraging, dissuasive, or neutral). These results speak to a social decision-making process between the patient and provider-a partnership that involves sequential interactions whereby both the patient and provider may influence the other's evaluation of the patient's readiness for treatment, with treatment initiation dependent on both agreeing on the need for treatment and the patient's readiness for treatment.