Limited uptake of hepatitis C treatment among injection drug users

Abstract

We characterized hepatitis C virus (HCV) treatment knowledge, experience and barriers in a cohort of community-based injection drug users (IDUs) in Baltimore, MD. In 2005, a questionnaire on HCV treatment knowledge, experience and barriers was administered to HCV-infected IDUs. Self-reported treatment was confirmed from medical records. Of 597 participants, 71% were male, 95% African-American, 31% HIV co-infected and 94% were infected with HCV genotype 1; 70% were aware that treatment was available, but only 22% understood that HCV could be cured. Of 418 who had heard of treatment, 86 (21%) reported an evaluation by a provider that included a discussion of treatment of whom 30 refused treatment, 20 deferred and 36 reported initiating treatment (6% overall). The most common reasons for refusal were related to treatment-related perceptions and a low perceived need of treatment. Compared to those who had discussed treatment with their provider, those who had not were more likely to be injecting drugs, less likely to have health insurance, and less knowledgeable about treatment. Low HCV treatment effectiveness was observed in this IDU population. Comprehensive integrated care strategies that incorporate education, case-management and peer support are needed to improve care and treatment of HCV-infected IDUs.

Figure 1

Conceptual framework of predisposing factors, enabling factors and need for HCV treatment [24]

Figure 2

Flow diagram: Of 597 HCV-infected ALIVE participants, 418 had heard of treatment, 86 had an evaluation by a provider that included a discussion of treatment of whom 56 agreed to initiate treatment, 26 initiated treatment and 5 had a sustained virologic response (SVR). Reasons for refusal, deferral and not being interested in treatment are listed.