Abstract
BackgroundHepatitis C virus (HCV) infection is increasingly prevalent among people who inject drugs (PWID) in the context of the current US opioid crisis. Although curative therapy is available and recommended as a public health strategy, few PWID have been treated. We explore PWID narratives that explain why they have not sought HCV treatment or decided against starting it. We then compare these narratives to evidence-based and guideline-concordant information to better enable health, social service, harm reduction providers, PWID, and other stakeholders to dispel misconceptions and improve HCV treatment uptake in this vulnerable population.MethodsWe recruited HIV-uninfected PWID (n = 33) through community-based organizations (CBOs) to participate in semi-structured, in-depth qualitative interviews on topics related to overall health, access to care, and knowledge and interest in specific HIV prevention methods.ResultsIn interviews, HCV transmission and delaying or forgoing HCV treatment emerged as important themes. We identified three predominant narratives relating to delaying or deferring HCV treatment among PWID: (1) lacking concern about HCV being serious or urgent enough to require treatment, (2) recognizing the importance of treatment but nevertheless deciding to delay treatment, and (3) perceiving that clinicians and insurance companies recommend that patients who currently use or inject drugs should delay treatment.ConclusionsOur findings highlight persistent beliefs among PWID that hinder HCV treatment utilization. Given the strong evidence that treatment improves individual health regardless of substance use status while also decreasing HCV transmission in the population, efforts are urgently needed to counter the predominant narratives identified in our study. We provide evidence-based, guideline-adherent information that counters the identified narratives in order to help individuals working with PWID to motivate and facilitate treatment access and uptake. An important strategy to improve HCV treatment initiation among PWID could involve disseminating guideline-concordant counternarratives to PWID and the providers who work with and are trusted by this population.
Highlights
Hepatitis C virus (HCV) infection continues to be endemic among people who inject drugs (PWID) in the United States (US), where the infection prevalence among PWID is estimated at 55.2% [1]
In addition to improving individual health and preventing the onset of costly end-stage disease, public health and medical guidance panels advocate for treating PWID to prevent onward HCV transmission and eliminate HCV in the population [4,5,6,7]
Based on participants’ perceptions of HCV treatment, we identified three predominant treatment-related narratives: (1) lacking concern about HCV being a serious or urgent health threat and being uninterested in treatment; (2) recognizing the importance of treatment, but deciding against initiating it; and (3) perceiving or experiencing that clinicians or insurance companies would recommend against treatment and not taking steps to initiate it
Summary
Hepatitis C virus (HCV) infection continues to be endemic among people who inject drugs (PWID) in the United States (US), where the infection prevalence among PWID is estimated at 55.2% [1]. Intransigent concerns related to poor treatment adherence, drug relapse, and reinfection among substance-using patients, which are not supported by available data, persist [8]. Some of these concerns may stem from recent changes in treatment. We explore PWID narratives that explain why they have not sought HCV treatment or decided against starting it We compare these narratives to evidence-based and guideline-concordant information to better enable health, social service, harm reduction providers, PWID, and other stakeholders to dispel misconceptions and improve HCV treatment uptake in this vulnerable population
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