A Qualitative Study Among Injection Drug Using Women in Rhode Island: Attitudes Toward Testing, Treatment, and Vaccination for Hepatitis and HIV

Department of Medicine, Miriam Hospital/Warren Alpert Medical School of Brown University, Providence, Rhode Island 02906, USA.
AIDS patient care and STDs (Impact Factor: 3.5). 02/2008; 22(1):53-64. DOI: 10.1089/apc.2006.0206
Source: PubMed

ABSTRACT HIV and hepatitis C virus infection are serious and prevalent health conditions among many women who inject drugs. Qualitative interviews with 20 injection drug using women at a short term drug treatment center in Rhode Island revealed six primary barriers and facilitators for testing and receiving results and treatment for hepatitis and HIV, as well as for hepatitis vaccination. The primary barriers were prioritization of drug use; low level of disease-specific knowledge; stigmatization; accessibility of testing, results and treatment; and psychological factors. The primary facilitator was interest in promoting one's health. Our findings indicate that injection drug using women experience multiple barriers to HIV and hepatitis testing, results, treatment and vaccination. Methods for improving the motivators for health, facilitating infectious disease prevention, and decreasing unnecessary disease complications of injection drug using women need to be utilized. These methods should include strategies that minimize stigma and facilitate accessibility of health care.

Download full-text


Available from: Michelle Lally, Sep 28, 2015
15 Reads
  • Source
    • "(Morano, et al., 2014; Perlman & Jordan, 2014) Regardless of whether HCV testing is done on site or off site by effective linkage, its potential contribute to HCV control (through primary prevention and through enhancing TasP) would be enhanced by strategies to address identified barriers to, and to utilize identified facilitators of, HCV testing among PWID.(Harris & Rhodes, 2013; Jordan, et al., 2013; Lally, Montstream- Quas, Tanaka, Tedeschi, & Morrow, 2008) Co-located models of HCV care avoid the need for linking infected persons from MMT to other HCV care sites, but given the limited medical infrastructure in most MMT programs M a n u s c r i p t 10 other strategies, such as linkage support or telemedicine, may be more practical ways to leverage OST for HCV care. A recent study showed that a linkage to HCV care intervention for MMT patients can significantly improve linkage to off-site HCV care compared to education and traditional referral only (OR: 4.10; 95% CI: 2.35-7.17). "
    [Show abstract] [Hide abstract]
    ABSTRACT: People who inject drugs (PWID) are central to the hepatitis C virus (HCV) epidemic. Opioid substitution treatment (OST) of opioid dependence has the potential to play a significant role in the public health response to HCV by serving as an HCV prevention intervention, by treating non-injection opioid dependent people who might otherwise transition to non-sterile drug injection, and by serving as a platform to engage HCV infected PWID in the HCV care continuum and link them to HCV treatment. This paper examines programmatic, structural and policy considerations for using OST as a platform to improve the HCV prevention and care continuum in 3 countries-the United States, Estonia and Viet Nam. In each country a range of interconnected factors affects the use OST as a component of HCV control. These factors include (1) that OST is not yet provided on the scale needed to adequately address illicit opioid dependence, (2) inconsistent use of OST as a platform for HCV services, (3) high costs of HCV treatment and health insurance policies that affect access to both OST and HCV treatment, and (4) the stigmatization of drug use. We see the following as important for controlling HCV transmission among PWID: (1) maintaining current HIV prevention efforts, (2) expanding efforts to reduce the stigmatization of drug use, (3) expanding use of OST as part of a coordinated public health approach to opioid dependence, HIV prevention, and HCV control efforts, (4) reductions in HCV treatment costs and expanded health system coverage to allow population level HCV treatment as prevention and OST as needed. The global expansion of OST and use of OST as a platform for HCV services should be feasible next steps in the public health response to the HCV epidemic, and is likely to be critical to efforts to eliminate or eradicate HCV. Copyright © 2015 Elsevier B.V. All rights reserved.
    International Journal of Drug Policy 04/2015; DOI:10.1016/j.drugpo.2015.04.015 · 2.40 Impact Factor
  • Source
    • "Many studies have examined causes for underutilization of health care from the perspective of PWIDs, identifying issues ranging from system deficiencies to personal factors such as PWID favouring the use of addictive substances over seeking medical help [8-14]. PWIDs cite poor interactions with service providers as a main reason for avoiding care and have reported discrimination from a variety of service providers [11,15-17]. In addition, PWIDs maintain that some service providers are unable to provide effective services because service providers lack education regarding issues surrounding injection drug use [9,11,16,18]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: People who inject drugs (PWID) often encounter barriers when attempting to access health care and social services. In our previous study conducted to identify barriers to accessing care from the perspective of PWIDs in Saskatoon, Canada: poverty, lack of personal support, discrimination, and poor knowledge and coordination of service providers among other key barriers were identified. The purpose of the present investigation was to explore what service providers perceive to be the greatest barriers for PWIDs to receive optimal care. This study is an exploratory investigation with a purpose to enrich the literature and to guide community action. Data were collected through focus groups with service providers in Saskatoon. Four focus groups were held with a total of 27 service providers. Data were transcribed and qualitative analysis was performed. As a result, concepts were identified and combined into major themes. Four barriers to care were identified by service providers: inefficient use of resources, stigma and discrimination, inadequate education and the unique and demanding nature of PWIDs. Participants also identified many successful services. The results from this investigation suggest poor utilization of resources, lack of continuing education of health care providers on addictions and coping skills with such demanding population, and social stigma and disparity. We recommend improvements in resource utilization through, for example, case management. In addition, sensitivity training and more comprehensive service centers designed to meet PWID's complex needs may improve care. However, community-wide commitment to addressing injection drug issues will also be required for lasting solutions.
    Substance Abuse Treatment Prevention and Policy 10/2013; 8(1):35. DOI:10.1186/1747-597X-8-35 · 1.16 Impact Factor
  • Source
    • "For people considering treatment, side-effects are a primary concern [9,17,31,36,37], as is lengthy treatment duration and uncertain efficacy [36]. For PWID who need to prioritise acute health and social concerns over preventative health care [27,38], who have caring responsibilities [39], and for whom the effects of living with HCV may be relatively unproblematic [8,37,40], there may be little incentive to commence treatment. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Evidence documents successful hepatitis C virus (HCV) treatment outcomes for people who inject drugs (PWID) and interest in HCV treatment among this population. Maximising HCV treatment for PWID can be an effective HCV preventative measure. Yet HCV treatment among PWID remains suboptimal. This review seeks to map social factors mediating HCV treatment access. Method We undertook a review of the social science and public health literature pertaining to HCV treatment for PWID, with a focus on barriers to treatment access, uptake and completion. Medline and Scopus databases were searched, supplemented by manual and grey literature searches. A two step search was taken, with the first step pertaining to literature on HCV treatment for PWID and the second focusing on social structural factors. In total, 596 references were screened, with 165 articles and reports selected to inform the review. Results Clinical and individual level barriers to HCV treatment among PWID are well evidenced. These include patient and provider concerns regarding co-morbidities, adherence, and side effect management. Social factors affecting treatment access are less well evidenced. In attempting to map these, key barriers fall into the following domains: social stigma, housing, criminalisation, health care systems, and gender. Key facilitating factors to treatment access include: combination intervention approaches encompassing social as well as biomedical interventions, low threshold access to opiate substitution therapy, and integrated delivery of multidisciplinary care. Conclusion Combination intervention approaches need to encompass social interventions in relation to housing, stigma reduction and systemic changes in policy and health care delivery. Future research needs to better delineate social factors affecting treatment access.
    Harm Reduction Journal 05/2013; 10(1):7. DOI:10.1186/1477-7517-10-7 · 1.26 Impact Factor
Show more