Factors affecting hepatitis C treatment intentions among Aboriginal people in Western Australia: a mixed-methods study

Abstract

ObjectiveThe aim of this study was to identify the hepatitis C treatment intentions of Aboriginal people living with hepatitis C virus (HCV) in Western Australia. MethodsThis study used a mixed-methods design. In the cross-sectional survey, 123 Aboriginal people who inject drugs and self-report as living with hepatitis C completed a purpose-designed questionnaire. In the qualitative phase, 10 participants were interviewed about the factors influencing their future intentions to undertake hepatitis C treatment. ResultsAnalysis of the survey data revealed significant associations between an intention to undertake hepatitis C treatment and support, community attachment, stable housing and stigma. In addition, there was a high overall level of expressed intention to undertake HCV treatment, with 54% of participants responding positively. Analysis of the qualitative data supported quantitative findings, revealing concerns about stigma, lack of social support and unstable housing as factors affecting the intention to undertake hepatitis C treatment. ConclusionThis mixed methods study with Aboriginal people living with self-reported HCV indicates interventions focused on reducing stigma and unstable housing could positively affect hepatitis C treatment intentions. These findings have implications for developing holistic programs to promote and support people on hepatitis C treatment. What is known about the topic?Substantial knowledge gaps need to be resolved if HCV elimination among Aboriginal Australians is to be achieved. Current research has prioritised non-Aboriginal communities. What does this paper add?This study found that stigma and unstable housing require attention if Aboriginal Australians are to obtain the full benefits of direct acting antiviral (DAA) hepatitis C treatment. What are the implications for practitioners?Reducing stigma (in the primary healthcare setting) and providing access to stable housing are vital components of supportive, non-judgemental and culturally appropriate care for Aboriginal people. This study highlights the importance of education for nurses and other primary care providers to increase engagement in the hepatitis cascade of care. To achieve this, scaling-up of HCV treatment engagement, trained Aboriginal community healthcare workers and HCV treatment advocates must mobilise and support Aboriginal people to avoid the negative effects of stigma, build positive and enabling relationships and reinforce positive attitudes towards DAA hepatitis C treatment.

Timely Hepatitis C RNA Testing and Treatment in the Era of Direct-Acting Antiviral Therapy among People with Hepatitis C in New South Wales, Australia

“…A lower HCV treatment initiation among those with Aboriginal ethnicity and among those born outside of Australia is concerning, particularly given evidence of higher ongoing infection rates in the former population [ 28 ]. The provision of culturally appropriate care, interpreters, stable housing, trained Aboriginal and non-Australian born healthcare workers as treatment advocates/community mobilizers, and reducing stigma in the primary healthcare settings, are some of the interventions to build positive, enabling relationships and enhance the HCV care cascade among those with Aboriginal ethnicity and those born outside of Australia [ 30 ].…”

Hepatitis C care cascade before and during the direct‐acting antiviral eras in New South Wales, Australia: A population‐based linkage study

“…Of further concern is higher ongoing HCV infection rates among Aboriginal people 22 . Expanded efforts including the implementation of contextual and culturally appropriate strategies, promotion of community‐based services, peer‐led outreach, and flexible models of care are recommended to improve HCV care cascade resulting in higher treatment uptake among Aboriginal people 23–25 …”

“…and flexible models of care are recommended to improve HCV care cascade resulting in higher treatment uptake among Aboriginal people. [23][24][25] People born overseas had equivalent HCV treatment uptake to the Australian-born population during the pre-DAA era, but a gap has emerged in the DAA era with lower treatment uptake in this group. A previous Australian study reported lower DAA treatment rates in areas with higher proportions of people born overseas.…”

Hepatitis C treatment outcomes for Australian First Nations Peoples: equivalent SVR rate but higher rates of loss to follow-up

“…general practice, community health clinics, sexual health and drug and alcohol services, and prison). Hospital-based care is more difficult for First Nations Peoples to attend regularly, and there are opportunities to address barriers already cited such as racism in health care [ 20 ], structural barriers to access care (e.g. access to a suitable transport service) [ 21 , 22 ], and communication between First Nations Peoples and health professionals [ 20 , 23 ].…”

“…Hospital-based care is more difficult for First Nations Peoples to attend regularly, and there are opportunities to address barriers already cited such as racism in health care [ 20 ], structural barriers to access care (e.g. access to a suitable transport service) [ 21 , 22 ], and communication between First Nations Peoples and health professionals [ 20 , 23 ]. In our study, LTFU was 2.5-fold higher among First Nations Peoples than non-Indigenous Australians, and in MVA restricted to First Nations Peoples, younger age, treatment initiation in 2018–2019 versus 2016, and those with less liver fibrosis were predictors of LTFU.…”