Theme: Models of Care Year: 2019
Background: People who inject drugs (PWID) are disproportionately affected with hepatitis C (HCV).
Many do not engage in HCV care due to structural and social barriers. This qualitative analysis examines
the role of a care coordinator at a syringe exchange program (SEP) in facilitating access and retention in
HCV treatment for active PWID.
Description of model/care: Accessible Care is a strategy being studied in on-going clinical trial to
examine low-threshold HCV care for PWID delivered at a SEP compared to usual referral care. The HCV
care coordinator (HCV-CC), a component of the study intervention, maintains a flexible schedule and an
open-door policy with participants, with the goal of providing a stigma-free environment that adapts to
participant needs. This approach innovatively supports HCV treatment at a SEP while providing a safe
space where the participant can openly address barriers to initiating and completing treatment and
preventing reinfection. This open, stigma-free interaction with HCV-CC is designed to facilitate
adherence to HCV treatment and retention in care.
Effectiveness: Using content analysis conducted by two team researchers, we evaluated the HCV-CC
notes describing 34 interactions with 13 participants. The HCV-CC fosters a non-judgmental relationship
with PWID, in which trust facilitates drug use disclosure, open discussion of treatment interruption,
emotional exchanges of gratitude and hope of cure. The HCV-CC addressed key barriers to retention and
treatment: 1) drug use (open discussion about drug use and its effect on treatment and reinfection); 2)
medication management (delivering and storing medication, addressing adherence); 3) social and
structural barriers to treatment (transportation, homelessness, distress at losing family member).
Conclusion and next steps: The HCV-CC fosters an open, stigma-free relationship supporting PWID in
addressing the multiple barriers that compromise HCV treatment success. The relationship between the
HCV-CC and initiation and retention in HCV treatment will be explored in this study.