Perceptions of drug users regarding Hepatitis C screening and care: a qualitative study

Abstract

BackgroundIllicit drug users have a high prevalence of HCV and represent the majority of newly infected persons in the U.S. Despite the availability of effective HCV treatment, few drug users have been evaluated or treated for HCV. Racial and ethnic minorities have a higher incidence and prevalence of HCV and higher HCV-related mortality. Factors contributing to poor engagement in care are incompletely understood.MethodsFourteen mixed-gender focus groups of either African American or Latino/a drug users (N = 95) discussed barriers to HCV testing and treatment. Themes were identified through content analysis of focus group discussions.ResultsMany drug users were tested for HCV in settings where they were receiving care. Outside of these settings, most were unaware of voluntary test sites. After testing HCV positive, drug users reported not receiving clear messages regarding the meaning of a positive HCV test, the impact of HCV infection, or appropriate next steps including HCV clinical evaluations. Many drug users perceived treatment as unimportant because they lacked symptoms, healthcare providers minimized the severity of the diagnosis, or providers did not recommend treatment. Mistrust of the motivations of healthcare providers was cited as a barrier to pursuing treatment. Social networks or social interactions were a source of HCV-related information and were influential in shaping drug users perceptions of treatment and its utility.ConclusionDrug users perceived a paucity of settings for self-initiated HCV testing and poor provider-patient communication at test sites and during medical encounters. Notably, drug users reported having an unclear understanding about the meaning of a positive HCV test, the health implications of HCV infection, the importance of clinical evaluations and monitoring, and of treatment options for HCV. Efforts to improve the delivery of clinical messages about HCV infection for drug users at test settings and clinical encounters are needed.

Providing ART to HIV Seropositive Persons Who Use Drugs: Progress in New York City, Prospects for “Ending the Epidemic”

“…These findings are consistent with qualitative data from people who use drug who report ready access to, and frequent use of, HIV testing services [17]. In contrast to national data for all transmission groups where “not knowing one's status” represents a significant gap in the care continuum, HIV testing programs in New York City have been very effective in engaging PWID and NIDU in HIV testing.…”

Inability to access health and social services associated with mental health among people who inject drugs in a Canadian setting

“…However, uptake of HCV treatment among PWID in BC remains low despite therapeutic advances (Alavi et al, 2014, Grebely et al, 2009 and Lima et al, 2015). The low self-reported inability to access services among HCV-positive PWID may be partially explained by the long latency period for the disease, poor tolerability of pegylated interferon-based regimens, and low perceived need for treatment (Doab et al, 2005, Jordan et al, 2013, Mehta et al, 2008 and Swan et al, 2010). Poor coordination between services (Harris and Rhodes, 2013, Hoffman et al, 2004, Krusi et al, 2010 and Nosyk et al, 2014), however, largely compromised access to care among PWID, especially when managing comorbid health conditions.…”

Conceptualizing Care Continua: Lessons from HIV, Hepatitis C Virus, Tuberculosis and Implications for the Development of Improved Care and Prevention Continua

“…Qualitatively, it has been abundantly noted that individuals may complete any given step of a continuum model and for a range of reasons, not proceed to the next clinically logical or desired step, but then at some subsequent point in time become re-engaged at the same or even re-enter at an earlier step in the continuum model (72). Such stalled or backward movement may be the result of various barriers introduced by both providers and patients (e.g., losing health insurance) as part of a “stutter-step” (51).…”