Abstract
Recent advances in the efficacy and tolerability of hepatitis C treatments and the introduction of a universal access scheme for the new Direct Acting Antiviral (DAA) therapies in March 2016, has resulted in a rapid increase in the uptake of hepatitis C treatment in Australia. Despite these positive developments, recent data suggest a plateauing of treatment numbers, indicating that more work may need to be done to identify and address ongoing barriers to hepatitis C treatment access and uptake. This paper aims to contribute to our understanding of the ongoing barriers to DAA therapies, with a focus on people who inject drugs. The paper draws on participant interview data from a qualitative research study based on a participatory research design that included a peer researcher with direct experience of both hepatitis C DAA treatment and injecting drug use at all stages of the research process. The study’s findings show that residual barriers to DAA treatment exist at personal, provider and system levels and include poor venous access, DAA treatments not considered ‘core-business’ by opioid substitution treatment (OST) providers, and patients having to manage multiple health and social priorities that interfere with keeping medical appointments such as childcare and poor access to transport services. Further, efforts to increase access to and uptake of DAA hepatitis C treatment over time will require a focus on reducing stigma and discrimination towards people who inject drugs as this remains as a major barrier to care for many people.
Highlights
With the relatively recent advent of direct acting antiviral (DAA) therapies, hepatitis C (HCV) treatment has taken a significant step forward in efficacy and tolerability [1]
This paper aims to contribute to our understanding of these residual barriers to care in the era of DAA treatments among people who inject drugs
In Australia, surveillance studies of people who inject drugs typically report a gender mix of approximately two-thirds men [17] and monitoring of DAA uptake indicates that two-thirds of people treated were men [11], which is reflected in the sample for this study
Summary
With the relatively recent advent of direct acting antiviral (DAA) therapies, hepatitis C (HCV) treatment has taken a significant step forward in efficacy and tolerability [1]. DAA treatments show higher rates of cure, of shorter duration and with significantly lower side effect profiles than previous longstanding interferon-containing regimens [2, 3]. These advances have given rise to the possibility of the “elimination of HCV as a public health problem”, with the World Health Organisation (WHO) setting the goal of an 90 per cent reduction in HCV incidence at the global level by 2030 [4].
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