{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T02:14:25Z","timestamp":1771467265101,"version":"3.50.1"},"reference-count":46,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2021,5,10]],"date-time":"2021-05-10T00:00:00Z","timestamp":1620604800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100006483","name":"AbbVie","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006483","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Despite the availability of highly effective and well-tolerated direct-acting antivirals, not all patients with chronic hepatitis C virus infection receive treatment. This retrospective, multi-centre, noninterventional, case-control study identified patients with chronic hepatitis C virus infection initiating (control) or not initiating (case) treatment at 43 sites in Germany from September 2017 to June 2018. It aimed to compare characteristics of the two patient populations and to identify factors involved in patient\/physician decision to initiate\/not initiate chronic hepatitis C virus treatment, with a particular focus on historical barriers. Overall, 793 patients were identified: 573 (72%) who received treatment and 220 (28%) who did not. In 42% of patients, the reason for not initiating treatment was patient wish, particularly due to fear of treatment (17%) or adverse events (13%). Other frequently observed reasons for not initiating treatment were in accordance with known historical barriers for physicians to initiate therapy, including perceived or expected lack of compliance (14.5%), high patient age (10.9%), comorbidities (15.0%), alcohol abuse (9.1%), hard drug use (7.7%), and opioid substitution therapy (4.5%). Patient wish against therapy was also a frequently reported reason for not initiating treatment in the postponed (35.2%) and not planned (47.0%) subgroups; of note, known historical factors were also common reasons for postponing treatment. Real-world and clinical trial evidence is accumulating, which suggests that such historical barriers do not negatively impact treatment effectiveness. Improved education is key to facilitate progress towards the World Health Organization target of eliminating viral hepatitis as a major public health threat by 2030.<\/jats:p>","DOI":"10.1371\/journal.pone.0250833","type":"journal-article","created":{"date-parts":[[2021,5,10]],"date-time":"2021-05-10T18:12:14Z","timestamp":1620670334000},"page":"e0250833","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":7,"title":["Barriers to initiation of hepatitis C virus therapy in Germany: A retrospective, case-controlled study"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3076-3960","authenticated-orcid":true,"given":"Peter","family":"Buggisch","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hans","family":"Heiken","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefan","family":"Mauss","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bernd","family":"Weber","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria-Christina","family":"Jung","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Herbert","family":"G\u00f6rne","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Renate","family":"Heyne","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Holger","family":"Hinrichsen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dennis","family":"Hidde","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bettina","family":"K\u00f6nig","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana Gabriela","family":"Pires dos Santos","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claus","family":"Niederau","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Berg","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2021,5,10]]},"reference":[{"issue":"2","key":"pone.0250833.ref001","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/S2468-1253(18)30270-X","article-title":"Accelerating the elimination of viral hepatitis: a Lancet Gastroenterology & Hepatology Commission","volume":"4","author":"GS Cooke","year":"2019","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"pone.0250833.ref002","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/j.antiviral.2017.02.014","article-title":"Current therapy for chronic hepatitis C: The role of direct-acting antivirals","volume":"142","author":"G Li","year":"2017","journal-title":"Antiviral Res"},{"key":"pone.0250833.ref003","unstructured":"Gilead Sciences, Inc. EPCLUSA (sofosbuvir\/velpatasvir) Summary of Product Characteristics [cited 2020 May]. Available from: https:\/\/www.ema.europa.eu\/documents\/product-information\/epclusa-epar-product-information_en.pdf."},{"key":"pone.0250833.ref004","unstructured":"Gilead Sciences, Inc. VOSEVI (sofosbuvir\/velpatasvir\/voxilaprevir) Summary of Product Characteristics [cited 2020 May]. Available from: https:\/\/www.ema.europa.eu\/documents\/product-information\/vosevi-epar-product-information_en.pdf."},{"key":"pone.0250833.ref005","unstructured":"AbbVie, Inc. MAVIRET (glecaprevir\/pibrentasvir) Summary of Product Characteristics [cited 2020 May]. Available from: https:\/\/www.ema.europa.eu\/documents\/product-information\/maviret-epar-product-information_en.pdf."},{"issue":"3","key":"pone.0250833.ref006","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1016\/j.cgh.2017.09.027","article-title":"Efficacy of glecaprevir\/pibrentasvir for 8 or 12 weeks in patients with hepatitis C virus genotype 2, 4, 5, or 6 infection without cirrhosis","volume":"16","author":"T Asselah","year":"2018","journal-title":"Clin Gastroenterol Hepatol"},{"issue":"8","key":"pone.0250833.ref007","doi-asserted-by":"crossref","first-page":"1052","DOI":"10.1111\/apt.15222","article-title":"Real-world effectiveness and safety of glecaprevir\/pibrentasvir for the treatment of chronic hepatitis C infection: data from the German Hepatitis C-Registry","volume":"49","author":"T Berg","year":"2019","journal-title":"Aliment Pharmacol Ther"},{"key":"pone.0250833.ref008","unstructured":"Federal Ministry of Health. Integrated strategy for HIV, hepatitis B and C, and other sexually transmitted infections 2019 [October 2019]. Available from: http:\/\/www.emcdda.europa.eu\/system\/files\/attachments\/9470\/5%20DE_Integrated%20Strategy_HIV_HEP_STI.pdf."},{"key":"pone.0250833.ref009","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.antiviral.2017.12.001","article-title":"Availability of hepatitis C diagnostics and therapeutics in European and Eurasia countries","volume":"150","author":"H Leblebicioglu","year":"2018","journal-title":"Antiviral Res"},{"issue":"2","key":"pone.0250833.ref010","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1016\/j.jhep.2018.03.007","article-title":"High SVR12 with 8-week and 12-week glecaprevir\/pibrentasvir therapy: an integrated analysis of HCV genotype 1\u20136 patients without cirrhosis","volume":"69","author":"M Puoti","year":"2018","journal-title":"J Hepatol"},{"key":"pone.0250833.ref011","article-title":"Global timing of hepatitis C virus elimination in high-income countries: an updated analysis","author":"H Razavi","year":"2020","journal-title":"Presented at EASL 2020"},{"issue":"4","key":"pone.0250833.ref012","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1056\/NEJMoa1702417","article-title":"Glecaprevir-pibrentasvir for 8 or 12 weeks in HCV genotype 1 or 3 infection","volume":"378","author":"S Zeuzem","year":"2018","journal-title":"N Engl J Med"},{"issue":"1","key":"pone.0250833.ref013","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/j.jhep.2016.09.001","article-title":"EASL recommendations on treatment of hepatitis C 2016","volume":"66","year":"2017","journal-title":"J Hepatol"},{"key":"pone.0250833.ref014","unstructured":"AASLD-IDSA. HCV guidance: Recommendations for testing, managing, and treating hepatitis C. Available at: http:\/\/www.hcvguidelines.org. Accessed May 2020."},{"issue":"2","key":"pone.0250833.ref015","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1016\/j.jhep.2019.03.027","article-title":"Direct-acting antivirals after successful treatment of early hepatocellular carcinoma improve survival in HCV-cirrhotic patients","volume":"71","author":"on behalf of Rete Sicilia Selezione Terapia\u2013HCV (RESIST-HCV) and Italian Liver Cancer (ITA.LI.CA.) Group","year":"2019","journal-title":"J Hepatol"},{"issue":"4","key":"pone.0250833.ref016","doi-asserted-by":"crossref","first-page":"996","DOI":"10.1053\/j.gastro.2017.06.012","article-title":"Risk of hepatocellular cancer in HCV patients treated with direct-acting antiviral agents","volume":"153","author":"F Kanwal","year":"2017","journal-title":"Gastroenterology"},{"issue":"3","key":"pone.0250833.ref017","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1111\/jvh.13039","article-title":"Improved liver transplant waitlist mortality and lower risk of disease progression among chronic hepatitis C patients awaiting liver transplantation after the introduction of direct-acting antiviral therapies in the United States","volume":"26","author":"K Young","year":"2019","journal-title":"J Viral Hepat"},{"key":"pone.0250833.ref018","volume-title":"Global Hepatitis Report 2017","author":"World Health Organization (WHO)","year":"2017"},{"key":"pone.0250833.ref019","unstructured":"World Health Organization. Global health sector strategy on viral hepatitis, 2016\u20132021 2016 [May 2020]. Available from: https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/246177\/WHO-HIV-2016.06-eng.pdf;jsessionid=B789DC827B02AF7A18F792AB221CF0D5?sequence=1."},{"key":"pone.0250833.ref020","volume-title":"Global timing of hepatitis C virus elimination: estimating the year countries will achieve the World Health Organization elimination targets","author":"H Razavi","year":"2019"},{"issue":"1","key":"pone.0250833.ref021","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1186\/s12879-017-2908-5","article-title":"Estimating the scale of chronic hepatitis C virus infection in the EU\/EEA: a focus on migrants from anti-HCV endemic countries","volume":"18","author":"AM Falla","year":"2018","journal-title":"BMC Infect Dis"},{"issue":"1","key":"pone.0250833.ref022","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1186\/s12954-019-0338-y","article-title":"High prevalence of hepatitis C virus infection and low level of awareness among people who recently started injecting drugs in a cross-sectional study in Germany, 2011\u20132014: missed opportunities for hepatitis C testing","volume":"17","author":"DRUCK Study group","year":"2020","journal-title":"Harm Reduct J"},{"issue":"1","key":"pone.0250833.ref023","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.jhep.2017.01.024","article-title":"Real-world treatment for chronic hepatitis C infection in Germany: Analyses from drug prescription data, 2010\u20132015","volume":"67","author":"R Zimmermann","year":"2017","journal-title":"J Hepatol"},{"issue":"3","key":"pone.0250833.ref024","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1111\/liv.14011","article-title":"Hepatitis C: is eradication possible?","volume":"39","author":"ESCMID Study Group for Viral Hepatitis (ESGVH)","year":"2019","journal-title":"Liver Int"},{"issue":"8","key":"pone.0250833.ref025","doi-asserted-by":"crossref","first-page":"740","DOI":"10.1055\/s-0042-106731","article-title":"Chronic hepatitis C patients prior to broad access to interferon-free treatments in Germany","volume":"54","author":"D Huppe","year":"2016","journal-title":"Z Gastroenterol"},{"issue":"1","key":"pone.0250833.ref026","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.amj.2006.10.003","article-title":"Research study designs: non-experimental","volume":"26","author":"CB Thompson","year":"2007","journal-title":"Air Medical Journal"},{"key":"pone.0250833.ref027","first-page":"1","article-title":"Identifying barriers to the treatmentof chronic hepatitis C infection","author":"A Al-Khazraji","year":"2019","journal-title":"Dig Dis"},{"issue":"10","key":"pone.0250833.ref028","doi-asserted-by":"crossref","first-page":"992","DOI":"10.1111\/apt.14328","article-title":"Barriers to hepatitis C treatment in the era of direct-acting anti-viral agents","volume":"46","author":"M Lin","year":"2017","journal-title":"Aliment Pharmacol Ther"},{"issue":"9","key":"pone.0250833.ref029","doi-asserted-by":"crossref","first-page":"1094","DOI":"10.1111\/jvh.13119","article-title":"Perceived barriers related to testing, management and treatment of HCV infection among physicians prescribing opioid agonist therapy: the C-SCOPE study","volume":"26","author":"AH Litwin","year":"2019","journal-title":"J Viral Hepat"},{"issue":"2","key":"pone.0250833.ref030","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1016\/j.aohep.2018.06.001","article-title":"Barriers to treatment of chronic hepatitis C with direct acting antivirals in an urban clinic","volume":"18","author":"M Malespin","year":"2019","journal-title":"Ann Hepatol"},{"key":"pone.0250833.ref031","first-page":"1549","author":"A Aghemo","year":"2019"},{"key":"pone.0250833.ref032","first-page":"1178221819835847","article-title":"Registry. Alcohol and cannabis consumption does not diminish cure rates in a real-world cohort of chronic hepatitis C virus infected patients on opioid substitution therapy\u2014data from the German hepatitis C-registry (DHC-R)","volume":"13","author":"German Hepatitis C","year":"2019","journal-title":"Subst Abuse"},{"key":"pone.0250833.ref033","first-page":"THU-125","volume-title":"High real-world efectiveness of elbasvir\/grazoprevir (EBT\/GZR) in PWID on opioid substiturion therapy with HCV genotype 1 (GT1) infection: results from the German Hepatitis C Registry (DHC-R)","author":"S Christensen","year":"2019"},{"key":"pone.0250833.ref034","first-page":"GS-07","volume-title":"Real-world safety, effectiveness, and patient-reported outcomes in patients with chronic hepatitis C virus infection treated with glecaprevir\/pibrentasvir: data from the German Hepatitis C-Registry","author":"M Cornberg","year":"2019"},{"key":"pone.0250833.ref035","first-page":"1584","volume-title":"Drug use and reinfection during and following HCV treatment with elbasvir\/grazopervir among patients receiving opioid agonist therapy: final result form the CO-STAR study","author":"J Grebely","year":"2019"},{"key":"pone.0250833.ref036","first-page":"1583","volume-title":"Addressing barriers to hepatitis C virus (HCV) elimination: real-world outcomes in historically underserved patients with chronic HCV infection treated with glecaprevir\/pibrentasvir","author":"P Lampertico","year":"2019"},{"issue":"7","key":"pone.0250833.ref037","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1080\/00365521.2018.1467963","article-title":"DANHEP group. Direct acting antiviral treatment of chronic hepatitis C in Denmark: factors associated with and barriers to treatment initiation","volume":"53","author":"C Solund","year":"2018","journal-title":"Scand J Gastroenterol"},{"issue":"12","key":"pone.0250833.ref038","doi-asserted-by":"crossref","first-page":"1339","DOI":"10.3748\/wjg.v18.i12.1339","article-title":"Chronic hepatitis C: treat or wait? Medical decision making in clinical practice","volume":"18","author":"C Niederau","year":"2012","journal-title":"World J Gastroenterol"},{"issue":"8","key":"pone.0250833.ref039","doi-asserted-by":"crossref","first-page":"754","DOI":"10.1111\/j.1525-1497.2005.0161.x","article-title":"Barriers to the treatment of hepatitis C. Patient, provider, and system factors","volume":"20","author":"JA Morrill","year":"2005","journal-title":"J Gen Intern Med"},{"issue":"10","key":"pone.0250833.ref040","doi-asserted-by":"crossref","first-page":"1363","DOI":"10.1016\/S0277-9536(98)00440-7","article-title":"Gender, psychosocial factors and the use of medical services: a longitudinal analysis","volume":"48","author":"CA Green","year":"1999","journal-title":"Soc Sci Med"},{"issue":"6","key":"pone.0250833.ref041","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1023\/A:1007629920752","article-title":"Gender differences of symptom reporting and medical health care utilization in the German population","volume":"16","author":"KH Ladwig","year":"2000","journal-title":"Eur J Epidemiol"},{"key":"pone.0250833.ref042","first-page":"630","volume-title":"Effectiveness of ledipasvir\/sofosbuvir in genotype 1 hepatitis C treatment na\u00efve heavy alcohol drinkers","author":"ME Mailliard","year":"2018"},{"issue":"22","key":"pone.0250833.ref043","doi-asserted-by":"crossref","first-page":"2750","DOI":"10.4103\/0366-6999.218023","article-title":"Patient education improves patient knowledge and acceptance on antiviral therapy of hepatitis C in rural China","volume":"130","author":"M Yang","year":"2017","journal-title":"Chin Med J (Engl)"},{"key":"pone.0250833.ref044","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1016\/j.drugpo.2017.05.041","article-title":"Evaluation of a hepatitis C education intervention with clients enrolled in methadone maintenance and needle\/syringe programs in Malaysia","volume":"47","author":"TI Mukherjee","year":"2017","journal-title":"Int J Drug Policy"},{"issue":"1","key":"pone.0250833.ref045","first-page":"79","article-title":"Hepatitis C virus and hepatocellular carcinoma: a narrative review","volume":"6","author":"P Axley","year":"2018","journal-title":"J Clin Transl Hepatol"},{"issue":"4","key":"pone.0250833.ref046","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1016\/j.gtc.2015.07.003","article-title":"Natural history of hepatitis C","volume":"44","author":"S Lingala","year":"2015","journal-title":"Gastroenterol Clin North Am"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0250833","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,5,10]],"date-time":"2021-05-10T18:13:53Z","timestamp":1620670433000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0250833"}},"subtitle":[],"editor":[{"given":"Chen-Hua","family":"Liu","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2021,5,10]]},"references-count":46,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2021,5,10]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0250833","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,10]]}}}