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


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.

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    • "(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). "
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    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.
    Full-text · Article · Apr 2015 · International Journal of Drug Policy
    • "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). Research focused on HCV testing in the UK comprises three quantitative investigations of testing uptake (Craine, Parry, O'Toole, D'Arcy, & Lyons, 2009; Hickman et al., 2008; Kirwan, Evans, & Brant, 2011), and two qualitative studies – one exploring post-test risk behaviour (Craine et al., 2004), the other, barriers to HCV testing in the prison setting (Khaw et al., 2007). "
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    ABSTRACT: Background: Hepatitis C virus (HCV) related morbidity and mortality will continue to rise unless HCV testing and treatment uptake increases. People who inject drugs constitute those at highest risk for HCV in the UK, yet over a third who access drug and alcohol services have never received an HCV test. Method: We conducted qualitative life history research with people who have injected drugs for over six years to explore the social conditions of long-term HCV avoidance. In order to ascertain previous HCV exposure, participants were required to have an HCV antibody test at a recruiting service. We concentrate here on analyses of participant accounts in relation to HCV testing, and specifically, barriers to uptake. Thirty-seven participants were interviewed two to three times over three months. Data were analyzed according to grounded theory principles. Results: Participants had injected an average of nine years before their first HCV test. Key themes in participant accounts included: concerns regarding the process of HCV testing, including phlebotomy practices; concerns regarding the impacts of HCV diagnosis, exacerbated by confusion regarding test results and HCV effects, and fears of concomitant HIV diagnosis; optimism that testing was unnecessary given HCV risk potentials; and institutional mistrust, often internalized as felt stigma, especially in hospital settings. Conclusions: To maximize HCV testing uptake among people who inject drugs, we emphasize the need for: testing at community-based drug services; on-site skilled and non-judgemental phlebotomists; the decoupling of HCV and HIV testing; and peer-supported testing interventions.
    No preview · Article · Mar 2014 · Drugs Education Prevention & Policy
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    • "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]. "
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    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.
    Full-text · Article · Oct 2013 · Substance Abuse Treatment Prevention and Policy
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