Exploring drug users’ attitudes and decisions regarding hepatitis C (HCV) treatment in the U.S.

Abstract

Individuals with a history of injecting drugs are at the highest risk of becoming infected with the hepatitis C virus (HCV), with studies of patients in methadone maintenance treatment programmes (MMTPs) reporting that 60-90% of intravenous drug users (IDUs) have the virus. Fortunately, HCV therapy has been shown to be effective in 42-82% of all patients with chronic HCV infection, including IDUs. While the decision to start HCV therapy requires significant consideration, little research exists that explores the attitudes of drug users toward HCV therapy. Therefore, this paper examines how drug users perceive the treatment, as well as the processes by which HCV-positive individuals examined the advantages and disadvantages of starting the HCV medications. Interviews were conducted with 164 patients from 14 drug treatment programmes throughout the United States, and both uninfected and HCV-positive drug users described a pipeline of communication among their peers that conveys largely negative messages about the medications that are available to treat HCV. Although many of the HCV-positive individuals said that these messages heightened their anxiety about the side effects and difficulties of treatment, some patients said that their peers helped them to consider and/or initiate HCV treatment. Gaining a better understanding of drug users' perceptions of HCV treatment is important, because so many of them, particularly IDUs, are already infected with HCV and may benefit from support in addressing their HCV treatment needs. In addition, currently uninfected drug users will likely remain at high risk for contracting HCV and may need to make decisions about whether or not to start the HCV medical regimen in the future.

Factors That Influence an HIV Coinfected Patient's Decision to Start Hepatitis C Treatment

“…28 Knowing others who have been on treatment, and their experience with treatment outcomes and side effects, can influence whether a patient decides to accept or refuse treatment. 22 The doctor-patient relationship, the level of trust in one's doctor, and provider attitudes toward the cost-benefit ratio of HCV treatment may also impact a patient's decision to undergo treatment, although only few published studies have explored these relationships. 29 To explore the HCV treatment decision-making process of HIV coinfected patients, we conducted a qualitative study of HCV treatment decision-making in which both providers and patients were administered semistructured interviews.…”

“…4,[16][17][18][19] Not surprisingly, a general fear and apprehension regarding side effects and their impact on quality of life and functioning are common among patients considering treatment. [20][21][22] Despite these side effects and related patient concerns, some recommend early treatment for coinfected patients to prevent more serious disease development. 23 Several psychosocial factors may also contribute to a patient's treatment decisions.…”

Health Beliefs and Co-morbidities Associated with Appointment-Keeping Behavior Among HCV and HIV/HCV Patients

“…One reason could be perceiving HCV infection to not be as significant as HIV infection. Findings from previous studies reveal that co-infected patients admit to being more worried about HIV than HCV, thereby being more reluctant to consult a liver specialist [4,16]. Missing Liver Clinic appointments in co-infected individuals has been linked specifically to denial of having HCV, fear of liver biopsy, and knowledge of complications of end-stage liver disease and exposure to information about debilitating side effects of therapy from fellow patients [13].…”

The Use of Mixed Methods in Drug Discovery

“…There are many examples in the literature of the use of qualitative methodologies to examine the efficacy of pharmacologic therapies (e.g., Munoz-Plaza, Strauss & Astone-Twerell, 2008;Salter et al, 2008). Qualitative methodologies have also been used to gain insight into the subjective experience of participants using study therapies (Chalmers et al, 2007;Phillips & McCann, 2007), as well as their lived experience of the disorders themselves (Mason, Rice & Records, 2005;Michalak et al, 2012).…”