‘Treat my whole person, not just my condition’: qualitative explorations of hepatitis C care delivery preferences among people who inject drugs

Abstract

Background The advent of direct-acting antivirals (DAAs)—a form of hepatitis C (HCV) treatment associated with shorter treatment course and greater efficacy—offers an unprecedented opportunity to eliminate HCV, but only if care delivery systems are developed to extend treatment to people who inject drugs (PWID). To support the design of a community-pharmacy program, we explored perspectives of PWID with chronic HCV with regard to barriers, motivators, preferences, and prior experiences related to HCV treatment and pharmacists. Methods We conducted semi-structured interviews with people living with HCV who reported active injection drug use. Participants were recruited from local community service and clinical organizations in the Seattle, Washington region, and focus groups and interviews were conducted in-person or via phone/video-conference. Rapid Assessment Process was used to analyze qualitative data. Dual coders used structured templates to summarize findings and engaged in iterative review to identify themes. Results Among the 40 participants, 65% were male, 52.5% were white, and 80% were not stably housed. On average, participants had been injecting drugs for 14 years and living with HCV for 6 years. Analyses revealed 3 themes: (1) limited knowledge regarding HCV and DAA treatments; (2) barriers/motivators for receiving treatment included fear of side effects, prior stigmatizing behaviors from physicians, and desire to protect relatives and the PWID community from HCV transmission; and (3) preferences for HCV care delivery, including a need for person-centered, low-barrier, and collaborative treatment integrated with other care (e.g. primary care and addiction treatment) for PWID. Participants were generally receptive to a community-pharmacy model for HCV treatment, but prior interactions with pharmacists were mixed and there were some concerns expressed that care delivered by pharmacists would not be equivalent to that of physicians. Conclusions Even in the direct-acting antivirals era, people who inject drugs still face major barriers to hepatitis C treatment which may be reduced by providing low-barrier points of access for care through pharmacists. Key recommendations for community-pharmacy design included providing care team training to reduce stigma and ensuring care team structures and culture target PWID-specific needs for education and engagement.

Prevalence of social and economic stressors among transgender veterans with alcohol and other drug use disorders

“…Further, though the impact of these social and economic stressors on adverse physical and mental health outcomes has been well-established in the literature ( Adler & Stewart, 2010 ; Braveman, Egerter, & Williams, 2011 ; Marmot & Bell, 2012 ), most healthcare systems do not screen for these stressors and patients’ broader lived experience is rarely addressed in addictions and/or other behavioral interventions in clinical settings. Interventions that address the lived experiences of persons with addictions are in their nascence and should be further developed and tested ( Tsui et al, 2021 ), particularly for transgender individuals ( Austin & Goodman, 2017 ; Blosnich et al, 2013 ; Blosnich, Lehavot, et al, 2017 ; Brown & Jones, 2016 ; Glick et al, 2018 ; Hatzenbuehler et al, 2013 ; Hatzenbuehler & Pachankis, 2016 ; Lehavot & Simoni, 2011 ).…”

Qualitative inquiry into perceptions of HIV pre-exposure prophylaxis among people who inject drugs living with hepatitis C in Seattle, WA, USA

“…Of note PrEP medications are clinically safe to take along with OUD treatments (e.g., buprenorphine and methadone) [ 49 ]. Still, it is recognized that PWID are not a monolith and individuals in this population have varying preferences for care delivery formats [ 29 , 50 ].…”

“…Next, the interviewer asked questions related to community awareness of PrEP, prior experiences with seeking care for HIV prevention, and beliefs about the acceptability of taking PrEP in its current, once-daily format. The interviewer also asked about other aspects of seeking Opioid Use Disorder (OUD) and HCV-related care, which are reported elsewhere [ 29 , 30 ]. Interviews and focus groups were conducted in person in January and February 2020.…”

Indications of food insecurity in the content of telephone calls to a community referral system

“…In Utah, 47% of ZIP Codes are nonmetropolitan areas according to the rural-urban commuting area codes [ 20 ]. Moreover, using a purposive sampling approach [ 21 ], we requested a sample that varied in regard to race and ethnicity similar to the Utah population. 77% of Utah’s population are non-Hispanic white and 14.4% of the population are Hispanic or Latino [ 22 ].…”