Theme: Epidemiology & Public Health Research Year: 2017
Introduction:
Despite discovery of direct acting antiviral agents (DAA), a two- threefold increase in hepatitis C virus (HCV) detection and treatment is necessary to reduce the HCV burden in England. Our primary aim was to assess feasibility of Project ITTREAT: Integrated- Test- stage- Treat hepatitis C service for people who inject drugs; a “one-stop” service based at a substance misuse service (SMS) in SE England. Our secondary aim was to evaluate this service via qualitative interviews. Here we present our qualitative results, quantitative data being presented separately.
Methods:
Fifteen participants currently engaged in the service were recruited and two staff focus groups were conducted. Interviews were semi-structured, exploring barriers and motivators to HCV testing/treatment. Interviews were analysed using thematic content analysis.
Results:
The interviews identified multiple interrelated barriers to HCV care at the individual-, provider- and system-level. At the individual level lack of stability, poor health seeking behaviour and fear of treatment side effects and liver biopsy emerged as key barriers. Overall, hospital services appeared ill-adapted to meet the needs of this vulnerable population; the bureaucratic and impersonal hospital environment coalesced to create a mistrust of secondary care. Participants expressed distinct and contrasting attitudes towards the community-based service. Though a number preferred an integrated service, for some the stigma attached to the SMS acted as an important barrier. Despite multiple obstacles a number of facilitators to engaging in HCV care emerged, most notably a trusting client-provider relationship, a non-invasive method to detect hepatic fibrosis (Fibroscan) and desire to regain one’s health following addiction recovery.
Conclusion:
Findings from this qualitative study confirm multiple barriers to HCV treatment at all levels of healthcare. However a strong client-provider relationship and community fibroscan appeared to be powerful facilitators for engagement. These may have important implications for linking this complex cohort into care.