Barriers to and Facilitators of Hepatitis C Testing, Management, and Treatment Among Current and Former Injecting Drug Users: A Qualitative Exploration

Centre for Immediate Care Services, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland.
AIDS patient care and STDs (Impact Factor: 3.58). 12/2010; 24(12):753-62. DOI: 10.1089/apc.2010.0142
Source: PubMed

ABSTRACT Hepatitis C (HCV) infection is common among injecting drug users (IDUs), yet accessing of HCV care, particularly HCV treatment, is suboptimal. There has been little in-depth study of IDUs experiences of what enables or prevents them engaging at every level of HCV care, including testing, follow-up, management and treatment processes. This qualitative study aimed to explore these issues with current and former IDUs in the greater Dublin area, Ireland. From September 2007 to September 2008 in-depth interviews were conducted with 36 service-users across a range of primary and secondary care services, including: two addiction clinics, a general practice, a community drop-in center, two hepatology clinics, and an infectious diseases clinic. Interviews were analyzed using a grounded theory approach. Barriers to HCV care included perceptions of HCV infection as relatively benign, fear of investigations and treatment, and feeling well. Perceptions were shaped by the discourse about HCV and "horror stories" about the liver biopsy and treatment within their peer networks. Difficulties accessing HCV care included limited knowledge of testing sites, not being referred for specialist investigations and ineligibility for treatment. Employment, education, and addiction were priorities that competed with HCV care. Relationships with health care providers influenced engagement with care: Trust in providers, concern for the service-user, and continuity of care fostered engagement. Education on HCV infection, investigations, and treatment altered perceptions. Becoming symptomatic, responsibilities for children, and wanting to move on from drug use motivated HCV treatment. In conclusion, IDUs face multiple barriers to HCV care. A range of facilitators were identified that could inform future interventions.

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Available from: Davina Swan, Jun 01, 2014
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    • "Each participating practice had an intensive period of consecutive patient recruitment; this approach was found most effective in previous research in primary care (Swan et al., 2010). The researchers instructed the doctors to recruit 10 consecutive patients who were aged 18 or over, receiving addiction treatment /care (e.g., methadone), and attending a participating general practice for general medical care.. Patients were excluded from the study if they had language difficulties (i.e., unable to speak, read and write English sufficiently well to complete study questionnaires), were acutely intoxicated, and / or were cognitively impaired (including severe mental health illness) to the extent that they were unable to provide informed consent to participate. "
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    • "Research addressing health care among PWID and/or those who live with HIV suggests a positive relationship between health care uptake and trust in providers, the latter influenced by good communication, mutual respect and continuity of care (Carr, 2001; Jauffret-Roustide et al., 2012; Swan et al., 2010). The majority of this research to date focuses on 'patient perspectives' and the factors affecting patiente provider relations, with a dearth of literature focussing on the role of treatment setting or environment in the production of trust relations , and a lack of emphasis on health care providers' accounts. "
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    • "A. Olsen et al. / International Journal of Drug Policy 23 (2012) 312– 318 317 investigations and treatment, lack of knowledge about it, lack of follow-up with appointments, poverty, reluctance of physicians to treat PWID and issues of medical or psychiatric co-morbidity (Dalgard, 2005; Davis & Rodrigue, 2001; Grebely, deVlaming, Duncan, Viljoen, & Conway, 2008; Mehta et al., 2008; Swan et al., 2010; Treloar & Holt, 2008). Policy and practice could more effectively meet the needs of PWID by integrating testing and treatment within health and human service settings such as drug treatment (Birkhead et al., 2007) and peer support programs (Grebely et al., 2007; Winter et al., 2008), as well as community and provider collaborations to inform programme and policy development. "
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