Approximately 2.71 million people in the United States are living with chronic hepatitis C virus (HCV), which causes liver inflammation and can lead to liver damage, loss of liver function, liver cancer, and death (Centers for Disease Control and Prevention, 2019; Chhatwal et al., 2019; de Oliveria Andrade et al., 2009; Dowsett et al., 2017; Khatun & Ray, 2019). Alcohol works synergistically with HCV and can continue to compromise the liver after HCV has been cured (Khan & Yatsuhashi, 2000; Llamosas-Falcón et al., 2020; Noda et al., 1996; Peters & Terrault, 2002; Younossi et al., 2013). Healthcare models that integrate physical and behavioral healthcare can improve health outcomes, including in the context of HCV and alcohol use (Farmanova et al., 2019; Kwan & Nease, 2013; Patel et al., 2018). However, the benefits of integrated care have not been found consistently (Abrams, 2015; Farmanova et al., 2019; Nolte, 2021; Vold et al., 2019). In addition, factors that explain integrated care models’ effects are not well understood, in part due to the lack of research on patients’ perspectives in integrated care settings. The current study begins to address this knowledge gap by analyzing interviews collected from 34 participants who participated in a randomized controlled trial of an integrated Hepatitis C-Alcohol Reduction Treatment (HepART) intervention, which led to significant reductions in alcohol use but did not lead to improvements compared to a less-resource intensive fragmented care condition (Proeschold-Bell et al., 2019). Thematic analysis of interview data examined barriers and facilitators to alcohol reduction in fragmented and integrated care settings. Results revealed that key facilitators of alcohol reduction, including enhancing personal readiness to change and compassionate communication during a screening and brief intervention delivered by liver doctors, were present in both conditions. Participants further described social and environmental factors that had the potential to enhance or interfere with alcohol reduction, while physical and behavioral health education was seen as empowering in the alcohol reduction process. Ultimately, factors common across conditions seem to point to key conditions important for alcohol reduction regardless of whether patients are engaged in integrated care versus fragmented care. Findings also have implications for improving efforts to evaluate the effectiveness of integrated care interventions.Keywords: hepatitis C, liver disease, alcohol use, integrated healthcare
