“Apparently, you can only be treated once”: A qualitative study exploring perceptions of hepatitis C and access to treatment among people who inject drugs visiting a needle and syringe program

Fontaine, Guillaume; Presseau, Justin; Bruneau, Julie; Patey, Andrea M.; Allen, Zack van; Mortazhejri, Sameh; Høj, Stine Bordier; Hung, Jui-Hsia Cleo; Grimshaw, Jeremy

doi:10.1016/j.drugpo.2023.104124

Cited by 3 publications

(4 citation statements)

References 42 publications

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“…Also aligning with previous research in Australia is the perception of the needle and syringe program as an ideal environment to access HCV testing, with most individuals feeling at home, trusting service providers, and highlighting that it would align with their activities of daily living [16,62,64,65]. Our study expands current knowledge on the intersectional stigma faced by people who inject drugs in traditional healthcare settings, correctional settings and society [59,[66][67][68][69][70][71][72], and how this stigma can compound key barriers related to accessing HCV care. The application of an intersectionality lens offers a nuanced understanding of how multiple facets of stigma related to HCV, behaviors, and identities intersect in the lives of people who inject drugs, leading to cycles of internalization and reinforcement by healthcare teams and the public.…”

Section: Discussionsupporting

confidence: 83%

“…At the time of the study, he was a postdoctoral researcher with expertise in qualitative research and was affiliated with the Ottawa Hospital Research Institute, but had no prior connections to the study setting. For people who inject drugs, this interview was the second of a series of two interviews focusing on HCV infection [59]. The first interview explored perceptions of HCV infection, while the second one explored barriers and enablers to testing.…”

Section: Sample and Recruitmentmentioning

confidence: 99%

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Using an intersectionality lens to explore barriers and enablers to hepatitis C point-of-care testing: a qualitative study among people who inject drugs and service providers

Fontaine,

Presseau,

Bruneau

et al. 2024

Int J Equity Health

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Background Hepatitis C virus (HCV) infection is a significant global health burden, particularly among people who inject drugs. Rapid point-of-care HCV testing has emerged as a promising approach to improve HCV detection and linkage to care in harm reduction organizations such as needle and syringe programs. The objective of this study was to use an intersectionality lens to explore the barriers and enablers to point-of-care HCV testing in a needle and syringe program. Methods A qualitative study was conducted using semi-structured interviews with clients (people who inject drugs) and service providers in a large community organization focused on the prevention of sexually transmitted and blood borne infections and harm reduction in Montreal, Canada. An intersectionality lens was used alongside the Theoretical Domains Framework to guide the formulation of research questions as well as data collection, analysis, and interpretation. Results We interviewed 27 participants (15 clients, 12 providers). For clients, four themes emerged: (1) understanding and perceptions of HCV testing, (2) the role of an accessible and inclusive environment, (3) the interplay of emotions and motivations in decision-making, and (4) the impact of intersectional stigma related to HCV, behaviors, and identities. For providers, five themes emerged: (1) knowledge, skills, and confidence for HCV testing, (2) professional roles and their intersection with identity and lived experience, (3) resources and integration of services, (4) social and emotional factors, and (5) behavioral regulation and incentives for HCV testing. Intersectional stigma amplified access, emotional and informational barriers to HCV care for clients. In contrast, identity and lived experience acted as powerful enablers for providers in the provision of HCV care. Conclusion The application of an intersectionality lens provides a nuanced understanding of multilevel barriers and enablers to point-of-care HCV testing. Findings underscore the need for tailored strategies that address stigma, improve provider roles and communication, and foster an inclusive environment for equitable HCV care. Using an intersectionality lens in implementation research can offer valuable insights, guiding the design of equity-focused implementation strategies.

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Section: Discussionsupporting

confidence: 83%

Section: Sample and Recruitmentmentioning

confidence: 99%

Using an intersectionality lens to explore barriers and enablers to hepatitis C point-of-care testing: a qualitative study among people who inject drugs and service providers

Fontaine,

Presseau,

Bruneau

et al. 2024

Int J Equity Health

Self Cite

View full text Add to dashboard Cite

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“…15,[55][56][57][58] Also aligning with previous research in Australia is the perception of the needle and syringe program as an ideal environment to access HCV testing, with most individuals feeling at home, trusting service providers, and highlighting that it would align with their activities of daily living. 12,57,59,60 Our study expands current knowledge on the intersectional stigma faced by people who inject drugs in traditional healthcare settings and society, 54,[61][62][63][64][65][66] and how this stigma can compound key barriers related to accessing HCV care. The application of an intersectionality lens offers a nuanced understanding of how multiple facets of stigma related to HCV, behaviors, and identities intersect in the lives of people who inject drugs, leading to cycles of internalization and reinforcement by healthcare teams and the public.…”

Section: Discussionmentioning

confidence: 92%

“…For people who inject drugs, this interview was the second of a series of two interviews focusing on HCV infection. 54 The rst interview explored perceptions of HCV infection, while the second one explored barriers and enablers to testing. For service providers, no relationship had been established prior to the interviews.…”

Section: Sample and Recruitmentmentioning

confidence: 99%

Promoting Equity in Hepatitis C Care: A Qualitative Study Using an Intersectionality Lens to Explore Barriers and Facilitators to Point-of-Care Testing Among People Who Inject Drugs and Service Providers

Fontaine,

Presseau,

Bruneau

et al. 2024

Preprint

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Background: Hepatitis C virus (HCV) infection is a significant global health burden, particularly among people who inject drugs. Rapid point-of-care HCV testing has emerged as a promising approach to improve HCV detection and linkage to care in harm reduction organizations such as needle and syringe programs. The objective of this study was to use an intersectionality lens to explore the barriers and enablers to point-of-care HCV testing in a needle and syringe program. Methods: A qualitative study was conducted using semi-structured interviews with clients (people who inject drugs) and service providers in a large community organization focused on the prevention of sexually transmitted and blood borne infections in Montreal, Canada. An intersectionality lens was used alongside the Theoretical Domains Framework to guide the formulation of research questions as well as data collection, analysis, and interpretation. Results: We interviewed 27 participants (15 clients, 12 providers). The intersectional analysis revealed that intersectional stigma amplifies access, emotional and informational barriers to HCV care for people who inject drugs, while identity and lived experience of HCV and drug use represent powerful tools leveraged by providers. There were four themes for clients: (1) understanding and perceptions of HCV testing, (2) an accessible and inclusive environment for HCV testing, (3) the interplay of emotions and motivations in HCV testing decision-making, and (4) the impact of intersectional stigma related to HCV, behaviors (e.g., drug use), and identities (e.g., gender identity). For providers, five themes emerged: (1) knowledge, skills, and confidence for HCV testing, (2) professional roles and their intersection with identity and lived experience, (3) resources and integration of services, (4) social and emotional factors, and (5) behavioral regulation and incentives for HCV testing. Conclusion: The application of an intersectionality lens provides a nuanced understanding of the impact of intersectional stigma in the lives of people who inject drugs, which amplifies barriers to point-of-care HCV testing. Findings underscore the need for tailored strategies that address stigma, improve provider roles and communication, and foster an inclusive environment for equitable HCV care. Integrating an intersectionality lens into implementation research offers valuable insights for more equitable and effective interventions.

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Understanding Perceptions of Hepatitis C and Its Management Among People with Experience of Incarceration in Quebec, Canada: A Qualitative Study Guided by the Common Sense Self-Regulation Model

Mambro,

Mortazhejri,

Ortiz-Paredes

et al. 2024

Viruses

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Hepatitis C virus (HCV) disproportionately affects certain sub-populations, including people with experience of incarceration (PWEI). Little is known about how perceptions of HCV and treatment have changed despite simplifications in testing and treatment in carceral settings. Nineteen semi-structured interviews were conducted with people living with or having a history of HCV infection released from Quebec provincial prison. Interviews were guided by the Common Sense Self-Regulation Model (CS-SRM) and aimed to explore cognitive and emotional representations of HCV and coping strategies. Among the 19 participants, seven (37%) were diagnosed with HCV in prison and 14 (74%) had previously received HCV treatment. Participants’ HCV illness perceptions were influenced by fear (of HCV transmission, death, and the well-being of family) and stigma (related to HCV, injection drug use, and incarceration). While some sought education and social and professional support, others self-isolated or engaged in high-risk behaviors to cope. Despite advances in HCV treatment, PWEI continue to experience various forms of stigma and fear surrounding their HCV diagnosis, resulting in delayed HCV care. These findings provide insights into how prison-based healthcare providers can better utilize HCV illness perceptions to evaluate willingness to engage in HCV care among PWEI.

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“Apparently, you can only be treated once”: A qualitative study exploring perceptions of hepatitis C and access to treatment among people who inject drugs visiting a needle and syringe program

Cited by 3 publications

References 42 publications

Using an intersectionality lens to explore barriers and enablers to hepatitis C point-of-care testing: a qualitative study among people who inject drugs and service providers

Using an intersectionality lens to explore barriers and enablers to hepatitis C point-of-care testing: a qualitative study among people who inject drugs and service providers

Promoting Equity in Hepatitis C Care: A Qualitative Study Using an Intersectionality Lens to Explore Barriers and Facilitators to Point-of-Care Testing Among People Who Inject Drugs and Service Providers

Understanding Perceptions of Hepatitis C and Its Management Among People with Experience of Incarceration in Quebec, Canada: A Qualitative Study Guided by the Common Sense Self-Regulation Model

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