Background
Hepatitis C is curable with direct-acting antivirals (DAAs). However, treatment uptake remains low among marginalized populations such as people who inject drugs. We sought to understand challenges to treatment uptake with DAAs among people living with hepatitis C and compare treatment experiences between people who do and do not inject prescription and/or unregulated drugs.
Methods
We conducted a qualitative study using focus groups with 23 adults aged 18 years and over who completed DAA treatment or were about to begin such treatment at the time of the study. Participants were recruited from hepatitis C treatment clinics across Toronto, Ontario. We drew upon stigma theory to interpret participants’ accounts.
Results
Following analysis and interpretation, we generated five theoretically-informed themes characterizing the experiences of individuals accessing DAAs: “being ‘worthy’ of the cure”, “spatially enacted stigma”, “countering social and structural vulnerability: the importance of peers”, “identity disruption and contagion: attaining a ‘social cure’” and “challenging stigma with population-based screening”. Overall, our findings suggest that structural stigma generated and reproduced through healthcare encounters limits access to DAAs among people who inject drugs. Peer-based programs and population-based screening were proposed by participants as mechanisms for countering stigma within health care settings and ‘normalizing’ hepatitis C among the general population.
Conclusions
Despite the availability of curative therapies, access to such treatment for people who inject drugs is limited by stigma enacted in and structured within healthcare encounters. Developing novel, low-threshold delivery programs that remove power differentials and attend to the social and structural determinants of health and reinfection are needed to facilitate further scale up of DAAs and support the goal of eradicating hepatitis C as a public health threat.
A Learning History approach was used to study the processes and outcomes of West Virginia University's inaugural (2013) Solar Decathlon team as it planned and executed its entry to the competition. In this competition, the product must be a house that meets several standards for sustainable management of material and energy resources. This study conceives of the human resources required to produce an entry as a complementary valuable resource that also can be managed more or less sustainably. Applying principles of sustainable management to evaluate the team's process and the transmission of knowledge to future teams, analysis of the experiences and perspectives of five disciplinary team leaders point to changes that could produce a more sustainably managed competition process for future teams. iii ACKNOWLEDGMENTS Valerie Edwards-Robeson-For tireless and patient guidance, support, advisement, and mentorship. Very sincere gratitude, I can't thank you enough for your help.
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