Experiences of alcohol use and hepatitis c among people who inject drugs: implications for treatment services.

EXPERIENCES OF ALCOHOL USE AND HEPATITIS C AMONG PEOPLE WHO INJECT DRUGS: IMPLICATIONS FOR TREATMENT SERVICES.

Evely J1, Hay G1, Frankham J2, Leavey C1

1Centre for Public Health, Faculty of Education, Health and Community, Liverpool John Moores University, 2School of Education, Faculty of Education, Health and Community, Liverpool John Moores University

Background: Hepatitis C (HCV) can cause cirrhosis, end stage liver disease and liver cancer. Drinking alcohol with HCV is associated with a more rapid progression to these liver diseases and guidelines in England recommend abstinence with HCV. In developed countries, sharing drug injection equipment is the main route of HCV transmission, however there is a paucity of research on HCV and alcohol use in people who inject/injected drugs (PWID).

Methods: Interviews using a qualitative life history calendar were used to explore lifetime alcohol use with 21 PWID who have/had HCV. Interviews using vignettes, of hypothetical case studies, were used with staff (n=7) working in drug, alcohol or HCV services, to explore service provision for PWID who have HCV and drink alcohol.

Results: Staff interviews showed excessive alcohol consumption is an exclusion for HCV treatment. All PWID in this study were aware that drinking alcohol with HCV increased the risk of liver damage, however most (N=19) had drank alcohol since being diagnosed with HCV. 7 were dependent drinking and 5 were drinking above recommended limits for the general population (>14 units a week). Of these, 3 had received prescribed medication through a service to reduce the amount of alcohol consumed, others had not accessed a service and used illegal drugs to decrease alcohol consumption. Barriers to accessing alcohol support include; negative impact of previous encounters with services, not realising drinking levels were harmful and not wanting help for drinking.

Conclusion: This is the first qualitative exploration of alcohol use and HCV in PWID in England. In this study excessive alcohol consumption is an exclusion for HCV treatment. Some PWID who drink above recommended limits and have HCV do not access alcohol support, reducing the likelihood of receiving HCV treatment. The role of stigma and ‘othering’ of ‘drinkers’ needs further exploration.

Disclosure of Interest Statement: The research team recognise the contribution that service providers and service users have made towards this study. We also recognise the need for transparency and disclosure of potential conflicts of interest by acknowledging these relationships in publications and presentations.

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