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. 2021 Mar 1:220:108526.
doi: 10.1016/j.drugalcdep.2021.108526. Epub 2021 Jan 11.

Patients at a drug detoxification center share perspectives on how to increase hepatitis C treatment uptake: A qualitative study

Sabrina A Assoumou  1 , Carlos R Sian  2 , Christina M Gebel  3 , Benjamin P Linas  4 , Jeffrey H Samet  5 , Judith A Bernstein  6
Affiliations

Patients at a drug detoxification center share perspectives on how to increase hepatitis C treatment uptake: A qualitative study

Sabrina A Assoumou et al. Drug Alcohol Depend. .

Abstract

Background: The US opioid crisis is associated with a surge in hepatitis C virus (HCV) infections among persons who inject drugs (PWID), and yet the uptake of HCV curative therapy among PWID is low.

Purpose: To explore potential solutions to overcome barriers to HCV treatment uptake among individuals at a drug detoxification center.

Methods: Qualitative study with in-depth interviews and thematic analysis of coded data.

Results: Patients (N = 24) had the following characteristics: mean age 37 years; 67 % White, 13 % Black, 8 % Latinx, 4 % Native Hawaiian/Pacific Islander, 8 % other; 71 % with a history of injecting drugs. Most patients with a positive HCV test had not pursued treatment due to few perceived immediate consequences from a positive test and possible complications arising in a distant poorly imagined future. Active substance use was a major barrier to HCV treatment uptake because of disruptions to routine activities. In addition, re-infection after treatment was perceived as inevitable. Patients had suggestions to improve HCV treatment uptake: high-intensity wraparound care characterized by frequent interactions with supportive services; same-day/walk-in options; low-barrier access to substance use treatment; assistance with navigating the health care system; attention to immediate needs, such as housing; and the opportunity to select an approach that best fits individual circumstances.

Conclusions: Active substance use was a major barrier to treatment initiation. To improve uptake, affected individuals recommended that HCV treatment be integrated within substance use treatment programs. Such a model should incorporate patient education within low-barrier, high-intensity wraparound care, tailored to patients' needs and priorities.

Keywords: Access to care; Hepatitis C; Linkage to care; Medications for opioid use disorder; Persons who inject drugs.

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Conflict of interest statement

Conflict of interest: The authors have no conflicts of interest to declare.

Figures

Figure 1.
Figure 1.
Conceptual model of hepatitis C treatment initiation mechanisms of action adapting Fisher et al.’s Information-Motivation-Behavioral (IMB) skills theoretical model. HCV=hepatitis C
See this image and copyright information in PMC

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