Abstract
BackgroundEvidence documents successful hepatitis C virus (HCV) treatment outcomes for people who inject drugs (PWID) and interest in HCV treatment among this population. Maximising HCV treatment for PWID can be an effective HCV preventative measure. Yet HCV treatment among PWID remains suboptimal. This review seeks to map social factors mediating HCV treatment access.MethodWe undertook a review of the social science and public health literature pertaining to HCV treatment for PWID, with a focus on barriers to treatment access, uptake and completion. Medline and Scopus databases were searched, supplemented by manual and grey literature searches. A two step search was taken, with the first step pertaining to literature on HCV treatment for PWID and the second focusing on social structural factors. In total, 596 references were screened, with 165 articles and reports selected to inform the review.ResultsClinical and individual level barriers to HCV treatment among PWID are well evidenced. These include patient and provider concerns regarding co-morbidities, adherence, and side effect management. Social factors affecting treatment access are less well evidenced. In attempting to map these, key barriers fall into the following domains: social stigma, housing, criminalisation, health care systems, and gender. Key facilitating factors to treatment access include: combination intervention approaches encompassing social as well as biomedical interventions, low threshold access to opiate substitution therapy, and integrated delivery of multidisciplinary care.ConclusionCombination intervention approaches need to encompass social interventions in relation to housing, stigma reduction and systemic changes in policy and health care delivery. Future research needs to better delineate social factors affecting treatment access.
Highlights
Evidence documents successful hepatitis C virus (HCV) treatment outcomes for people who inject drugs (PWID) and interest in HCV treatment among this population
A recent systematic review, for instance, identified countries where HCV antibody prevalence in PWID ranged from 40–60%, countries with a range of 60-80% (USA, Canada, Germany) and 12 (Mexico, Thailand, Russia, the Netherlands) where prevalence was 80% or higher [3]
Research indicates that HCV treatment fears, or disinterest, at the level of individual PWID can be exacerbated by: low patient and provider treatment literacy [9,27,41,42,43]; fear of medical investigations, involving biopsy and phlebotomy [37,40,44,45]; concerns about potential relapse to, or exacerbation of, injecting drug use [31]; communication problems with providers [36,46]; and previous stigmatising and negative experiences with health care systems and providers [27,40,45,47,48]
Summary
We undertook a review of the social science and public health literature pertaining to HCV treatment for PWID, with a focus on barriers to treatment access, uptake and completion. A two step search was taken, with the first step pertaining to literature on HCV treatment for PWID and the second focusing on social structural factors. Step 1 The Medline database was searched using a combination of indexed subject headings: (hepatitis C) AND (Interferons OR treatment mp.) AND (methadone OR Opiate Substitution Treatment OR substance abuse, intravenous). The Scopus database search, using the combination of keywords: (hepatitis C OR HCV) AND (interferon OR treatment) AND (methadone OR opiate substitution therapy OR inject* OR intravenous), yielded 77 articles. Where multiple articles drew on data from the same research cohort and reported similar findings, the most relevant article was selected This screening process resulted in 113 articles which were read in full and analysed for data specific to HCV treatment barriers and facilitators (Figure 1)
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