Exploring Organizational Barriers and Strategies for Hepatitis C Health Care Among Medically-Underserved Populations in Arizona: A Qualitative Study

Background: Hepatitis C is a major public health concern in the United States, with a particular burden on medically underserved populations (e.g. racially marginalized populations), who experience a disproportionately high mortality risk from the disease. Community-based organizations can help address these disparities by providing accessible healthcare services, however systematic evaluation of these organizations is limited. This study sought to investigate the organizational barriers for HepFreeAZ, a statewide coalition dedicated to eliminating hepatitis C, in providing hepatitis C prevention and treatment to at-risk populations in Arizona. Methods: Semi-structured interviews, guided using the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework, were conducted with members of HepFreeAZ. Inductive thematic analysis was used to identify themes that characterized organizational barriers and facilitators. One researcher independently conducted open coding of all interview transcripts, generating initial codes based on salient patterns in the data. These codes were iteratively refined and organized into thematic clusters. To ensure rigor, an additional research mentor reviewed the coding scheme and participated in consensus meetings to resolve discrepancies. Themes were triangulated with field notes and interview context. Reflexive journaling was employed during analysis to mitigate bias, and a second, independent reviewer not involved in data collection conducted an external audit of the final themes to confirm their credibility and relevance.
Results: Through the study, we identified four key themes and 7 sub-themes for hepatitis C outreach for at-risk populations. The themes included healthcare access, cultural and social perceptions interfering with patient interactions, patient mistrust because of their cultural background bias, and the organization's collaborative and inclusive efforts in healthcare systems.
Conclusion: Our study highlights key organizational challenges and strategies relevant to providing hepatitis C care for at-risk populations. These findings can be generalized to inform other community-based organizations seeking to address diverse health challenges to tailor interventions.