Taming systems to create enabling environments for HCV treatment: Negotiating trust in the drug and alcohol setting

Harris, Magdalena; Rhodes, Tim; Martin, Anthea

doi:10.1016/j.socscimed.2013.01.031

Cited by 69 publications

(77 citation statements)

References 24 publications

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“…Our formative research adds to the conceptual and implementation science literature around MAT service delivery in limited resource settings (Chawarski, Zhou, & Schottenfeld, 2011; Gu et al, 2013; Rhodes et al, 2015; Tran et al, 2015), delineating the key role that trust/mistrust plays in the treatment enrollment process and how this differs by gender. Literature from other contexts has explored how felt and anticipated stigma shaped mistrust of medical interventions in PWID (Harris, Rhodes, & Martin, 2013; Treloar, Rance, Yates, & Mao, 2015). Our findings identified similar mechanisms underlying weak care engagement in WWID, due to particularly strong social and cultural stigma that generated mistrust of PWID by families and communities and mistrust in PWID of medical settings and outsiders.…”

Section: Discussionmentioning

confidence: 99%

Generating trust: Programmatic strategies to reach women who inject drugs with harm reduction services in Dar es Salaam, Tanzania

Zamudio-Haas

Mahenge

Saleem

et al. 2016

International Journal of Drug Policy

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Background Strong evidence supports the effectiveness of methadone-assisted therapy (MAT) to treat opioid dependence, reduce the risk of HIV transmission, and improve HIV related health outcomes among people who inject drugs (PWID). HIV prevalence reaches 71% in women who inject drugs (WWID) in Dar es Salaam, Tanzania; creating an urgent need for access to MAT. Despite the availability and potential benefits of treatment, few women have enrolled in services. This formative research sought to identify programmatic strategies to increase women’s participation in outreach and their subsequent enrollment in MAT. Methods We conducted twenty-five, in-depth interviews with patients and their providers at a MAT clinic. Open-ended interviews explored enrollment experiences, with a focus on contextual barriers and facilitators unique to women. Ethnographic observations of harm reduction education at outreach sites and the MAT clinic enriched interview data. Trust/mistrust emerged as an overarching theme cross cutting patient and provider accounts of the connective process to enroll PWID in the methadone program. We explore trust and mistrust in relationship to the interrelated themes of family loss, social isolation, vehement discrimination and motivation for treatment. Results Narratives delineated both the generation of mistrust against PWID and the generation of mistrust in PWID against outsiders and medical institutions. In order to enroll PWID in treatment, community base organizations engaged outreach strategies to overcome mistrust and connect eligible patients to care, which varied in their success at recruiting women and men. Greater discrimination against WWID pushed them into hiding, away from outreach teams that focus on outdoor areas where men who inject drugs congregate. Building trust through multiple encounters and making a personal connection facilitated entry into care for women. Only PWID were eligible for MAT, due to resource constraints and the higher risk associated with injection drug use. Many women smoke heroin, yet still face high risk of HIV, resulting from low condom use during sex work to fund drug use. Conclusion Expanding outreach times and locations, by women peers, could increase women’s enrollment in treatment. Allowing women who smoke heroin to enter the program could prevent onward transmission via sex work and reduce the chance of progressing from the lower risk smoking or sniffing to injection drug use.

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Section: Discussionmentioning

confidence: 99%

Generating trust: Programmatic strategies to reach women who inject drugs with harm reduction services in Dar es Salaam, Tanzania

Zamudio-Haas

Mahenge

Saleem

et al. 2016

International Journal of Drug Policy

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“…The specific ways in which OST may be delivered, and in which OST settings are frequently configured in health systems, can be perceived by PWID, and can sometimes be, stigmatizing, controlling and demoralizing. (Bourgois, 2000; Fraser, 2006) The physical and operational separation of OST treatment settings from other aspects health care, embodying the marginalization and stigmatization of drug use and the treatment of opioid dependence, and systems which rely on surveillance, control and power differentials between PWID and staff, (Bourgois, 2000; Fraser, 2006; Harris, Rhodes, & Martin, 2013; Rance, Newland, Hopwood, & Treloar, 2012) have implications for trust, ethics, and use of OST for HCV prevention and care engagement (as well as for HIV prevention, overdose prevention, and the reduction of other adverse consequences of drug use).…”

Section: Introductionmentioning

confidence: 99%

An international perspective on using opioid substitution treatment to improve hepatitis C prevention and care for people who inject drugs: Structural barriers and public health potential

Perlman

Jordan

Uusküla

et al. 2015

International Journal of Drug Policy

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People who inject drugs (PWID) are central to the hepatitis C virus (HCV) epidemic. Opioid substitution treatment (OST) of opioid dependence has the potential to play a significant role in the public health response to HCV by serving as an HCV prevention intervention, by treating non-injection opioid dependent people who might otherwise transition to non-sterile drug injection, and by serving as a platform to engage HCV infected PWID in the HCV care continuum and link them to HCV treatment. This paper examines programmatic, structural and policy considerations for using OST as a platform to improve the HCV prevention and care continuum in 3 countries—the United States, Estonia and Viet Nam. In each country a range of interconnected factors affects the use OST as a component of HCV control. These factors include 1) that OST is not yet provided on the scale needed to adequately address illicit opioid dependence, 2) inconsistent use of OST as a platform for HCV services, 3) high costs of HCV treatment and health insurance policies that affect access to both OST and HCV treatment, and 4) the stigmatization of drug use. We see the following as important for controlling HCV transmission among PWID: 1) maintaining current HIV prevention efforts, 2) expanding efforts to reduce the stigmatization of drug use, 3) expanding use of OST as part of a coordinated public health approach to opioid dependence, HIV prevention, and HCV control efforts, 4) reductions in HCV treatment costs and expanded health system coverage to allow population level HCV treatment as prevention and OST as needed. The global expansion of OST and use of OST as a platform for HCV services should be feasible next steps in the public health response to the HCV epidemic, and is likely to be critical to efforts to eliminate or eradicate HCV.

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“…Barriers to care at the level of the patient, provider and systems levels (Bruggmann & Grebely, 2015;Grebely & Tyndall, 2011;Harris, Rhodes, & Martin, 2013) have resulted in low HCV treatment uptake among PWID in many settings (Alavi et al, 2014;Iversen et al, 2014;Strathdee et al, 2005;Wiessing et al, 2014). However, broadened HCV treatment access in many populations has been limited by criminalisation of drug use, discrimination and stigma in health settings and arduous, poorly tolerated interferon-based therapies.…”

mentioning

confidence: 99%

Expanding access to prevention, care and treatment for hepatitis C virus infection among people who inject drugs

Grebely

Bruggmann

Treloar

et al. 2015

International Journal of Drug Policy

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Taming systems to create enabling environments for HCV treatment: Negotiating trust in the drug and alcohol setting

Cited by 69 publications

References 24 publications

Generating trust: Programmatic strategies to reach women who inject drugs with harm reduction services in Dar es Salaam, Tanzania

Generating trust: Programmatic strategies to reach women who inject drugs with harm reduction services in Dar es Salaam, Tanzania

An international perspective on using opioid substitution treatment to improve hepatitis C prevention and care for people who inject drugs: Structural barriers and public health potential

Expanding access to prevention, care and treatment for hepatitis C virus infection among people who inject drugs

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