Insights into Barriers Affecting Access to Hepatitis C Care in Viet Nam

Abstract Introduction: As of 2024 the Ministry of Health of Viet Nam has approved social health insurance reimbursement for testing and treatment for hepatitis C (HCV) at district hospitals to reduce barriers to access to care. However, a significant portion of patients still choose to access medical services at tertiary hospitals. This study sought to understand the barriers to hepatitis access to healthcare faced by adults who tested positive for HCV-RNA at the University Medical Center (UMC) at Ho Chi Minh City, Viet Nam, and to examine attitudes associated with seeking hepatitis care at district hospitals. Methodology: We conducted a cross-sectional study, consecutively recruiting 75 patients aged 18 and over who tested positive for HCV-RNA at the UMC outpatient liver clinic between February 2024 to April 2024. Participants were surveyed about the barriers they faced related to the diagnosis and treatment of HCV, their reasons for seeking care at tertiary hospitals instead of district hospitals, and the distance traveled and wait times to receive hepatitis care. Sociodemographic information, as well as social and behavioral factors, were also documented. The social-ecological model was then applied to understand the barriers to linkage to treatment at the individual, community, environmental, organizational, and political levels. Findings: Seventy five participants with complete data were included in the analysis. Among these participants, 10.7% refused treatment for various reasons, despite physician consultation. The primary barriers to hepatitis C treatment included financial constraints (45.3%), geographical distance (65.3%), and time limitations (57.3%). Conversely, a lack of understanding of their results (18.7%) and fear of side effects (18.7%) were perceived as less significant barriers. When surveying patients on why they chose to seek hepatitis healthcare at tertiary hospitals instead of their district hospitals, the results indicated that 82.7% believed they would receive better hepatitis treatment at tertiary hospitals, 73.3% thought they would receive better overall hepatitis healthcare at tertiary hospitals, 53.3% believed that the tertiary hospital had more comprehensive testing, 45.3% did not trust the hepatitis treatment at their district hospital, and 30.7% were unaware that they could seek treatment at their district hospital. The average wait time at the tertiary clinic was 4.53 hours, and the average distance traveled to seek hepatitis care was 163.79 km. However, 37.3% of patients expressed that they would be open to seeking hepatitis healthcare and treatment at their district hospitals if they could provide the same standard of care as tertiary hospitals. Conclusion Our interviews and surveys reveal that financial constraints, time, and travel distance are the main barriers to seeking hepatitis C treatment at tertiary hospitals. However, a significant minority of patients expressed a willingness to utilize district hospitals, provided these facilities offer comparable standards of care to tertiary hospitals. Our results support the application of decentralization of hepatitis healthcare in Vietnam, which is critical for reaching the targeted goals of HCV elimination.