Evaluation Of A Community-Based Hepatitis C Virus Service [Project ITTREAT (Integrated Community Based Test–Stage–Treat) For People Who Inject Drugs (PWID)]

Author: Schulkind J, O’Sullivan M, Verma S, Jones C

Theme: Epidemiology & Public Health Research Year: 2017

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.

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.

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.

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.

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