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: 3.5). 12/2010; 24(12):753-62. DOI: 10.1089/apc.2010.0142
Source: PubMed


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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    Journal of Dual Diagnosis 04/2015; 11(2):97-106. DOI:10.1080/15504263.2015.1027630 · 0.80 Impact Factor
    • "These include: PWID concerns regarding discrimination and confidentiality breaches in the medical setting, often exacerbated by previous negative experiences (Aitken et al., 2002; Day et al., 2008; Khaw et al., 2007; Lally et al., 2008; Strauss et al., 2008; Swan et al., 2010; Treloar, Hopwood, & Loveday, 2002; Winter et al., 2008); fear of a positive test result and its implications (Aitken et al., 2002; Craine et al., 2004; Day et al., 2008; Khaw et al., 2007; Strauss et al., 2008); limited HCV knowledge – both among PWID and providers (Aitken et al., 2002; Craine et al., 2004; Khaw et al., 2007; Lally et al., 2008; Strauss et al., 2008; Swan et al., 2010); as well as concerns regarding the phlebotomy process, particularly among PWID with damaged and difficult to access veins (Craine et al., 2004; Day et al., 2008; Khaw et al., 2007; Strauss et al., 2008; White et al., 2008; Winter et al., 2008). Testing access issues have also been highlighted, such as: lack of opportunity due to inconvenient testing sites (Lally et al., 2008; Strauss et al., 2008; Swan et al., 2010; Winter et al., 2008); limited offers of pre and post-test counselling (Khaw et al., 2007; Swan et al., 2010), and – in regard to prisons – the need for inmates to fill in testing request forms, and face long waiting times (Khaw et al., 2007). Most published research into barriers to HCV testing has been conducted in Australia (Aitken et al., 2002; Day et al., 2008; White et al., 2008; Winter et al., 2008) and the USA (Lally et al., 2008; Strauss et al., 2008). "
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    • "Though there was no difference in past-year testing, both groups commonly identified access to healthcare professionals as a facilitator to testing. Previous research has noted that continuity of care with a provider has fostered regular screening and, in some cases, adherence to treatment [18]. Our results suggest that PWID are more apt to receive HCV screening when it is offered as a part of routine care, rather than when it is only available “on-demand,” thereby requiring individuals to take initiative for screening themselves. "
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