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

Abstract

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.