Abstract
BackgroundPeople who inject drugs (PWID) are most at risk of hepatitis C virus infection in Australia. The introduction of transient elastography (TE) (measuring hepatitis fibrosis) and direct acting antiviral medications will likely alter the experience of living with hepatitis C. We aimed to explore positive and negative influences on wellbeing and stress among PWID with hepatitis C.MethodsThe Treatment and Prevention (TAP) study examines the feasibility of treating hepatitis C mono-infected PWID in community settings. Semi-structured interviews were conducted with 16 purposively recruited TAP participants. Participants were aware of their hepatitis C seropositive status and had received fibrosis assessment (measured by TE) prior to interview. Questions were open-ended, focusing on the impact of health status on wellbeing and self-reported stress. Interviews were voice recorded, transcribed verbatim and thematically analysed, guided by Mishel’s (1988) theory of Uncertainty in Illness.ResultsIn line with Mishel’s theory of Uncertainty in Illness all participants reported hepatitis C-related uncertainty, particularly mis-information or a lack of knowledge surrounding liver health and the meaning of TE results. Those with greater fibrosis experienced an extra layer of prognostic uncertainty. Experiences of uncertainty were a key motivation to seek treatment, which was seen as a way to regain some stability in life. Treatment completion alleviated hepatitis C-related stress, and promoted feelings of empowerment and confidence in addressing other life challenges.ConclusionTE scores seemingly provide some certainty. However, when paired with limited knowledge, particularly among people with severe fibrosis, TE may be a source of uncertainty and increased personal stress. This suggests the need for simple education programs and resources on liver health to minimise stress.
Highlights
People who inject drugs (PWID) are most at risk of hepatitis C virus infection in Australia
This study explores how uncertainty in the context of transient elastography (TE) scores and direct acting antiviral (DAA) treatment affects self-reported stress in PWID living with hepatitis C
Participants Participants were recruited from the Treatment and Prevention (TAP) study, which examines the feasibility of treating hepatitis C mono-infected PWID in a community-based setting [29]
Summary
People who inject drugs (PWID) are most at risk of hepatitis C virus infection in Australia. Non-invasive fibrosis assessment tools, such as transient elastography (TE) (an ultrasound like device which determines liver stiffness by measuring wave velocity [9]) and highly effective interferon-free direct acting antiviral (DAA) medications are considered standard of care [10, 11]. These advances have made the elimination of hepatitis C as a public health threat a real possibility, in Australia, where DAAs are widely accessible and heavily subsidised [12, 13]. Such advances may alter the individual experience of living with hepatitis C
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