Health Disparities in Hepatitis D Virus Management: A Case Series on Improving Patient Access to Bulevirtide Therapy.

Background and Aims: Migrants and those from marginalized backgrounds with hepatitis D virus (HDV) often face social or health challenges that can impair access to care and adherence to treatment. This case series seeks to highlight that such challenges can be overcome and should not be seen as insurmountable barriers to the initiation of bulevirtide for HDV. Methods: Four consenting, anonymized patients were retrospectively identified from UK centers by a multidisciplinary authorship group. Results: Identified patients represented 4 different social circumstances that may impair treatment adherence: patient 1 had a history of mental health issues and was recently evicted; patient 2 was living in a homeless shelter, without access to a fridge or to a safe, confidential space for bulevirtide administration and disposal; patient 3 had a history of illicit drug use and previously failed to engage with care; and patient 4 failed to maintain injections following an unplanned trip to Africa. Each patient achieved positive results with bulevirtide therapy-demonstrating a reduced viral load and improvements in key measures of hepatic function-with adjustments made to their care to account for their unique needs. This included initiating therapy at a time that accommodated their personal circumstances, pausing treatment as needed, and working with third-party services to provide practical support that could address medication storage and logistical challenges. Conclusion: By shifting the perception that social circumstances are barriers to adherence, healthcare providers can promote a more inclusive approach to initiating, maintaining, and, where necessary, restarting bulevirtide therapy, ultimately improving health outcomes for patients with HDV.