Engagement in the Hepatitis C care continuum among people who use drugs

Abstract

Despite high rates of Hepatitis C virus (HCV) infection among people who use drugs (PWUDs), access to the HCV care continuum combined with the receipt of medications for addiction treatment in primary care settings remains suboptimal. A qualitative study was conducted among adults admitted for inpatient detoxification for opioid use disorder (OUD) in New York City (n=23) to assess barriers and facilitators with HCV prevention, screening, treatment, interactions with primary care providers, and experiences with integrated care approaches. Study findings yielded six major themes related to HCV care. Major gaps persist in knowledge regarding HCV harm reduction strategies, voluntary HCV testing services, and eligibility for HCV treatment. Treatment coordination challenges reinforce the importance of enhancing linkages to HCV care in key access-points utilized by PWUDs (e.g., emergency rooms, specialty addiction treatment settings). Peer networks combined with frequent patient-physician communication were elicited as important factors in facilitating linkage to HCV care. Additional care coordination needs in primary care settings included access to integrated treatment of HCV and OUD, and administrative support for enrollment in Medicaid, subsidized housing, and access to transportation vouchers.

Barriers and Enablers to Testing for Hepatitis C Infection in People Who Inject Drugs – A Scoping Review of the Qualitative Evidence

“…After screening titles and abstracts, 50 studies were selected for full-text screening. Nine studies ful lled the eligibility criteria and were included (8,9,10,11,12,13,14,13).…”

“…The setting of the studies varied and thus participants in each study may have different motivations or variables in their lives that could impact the barriers they experience and their view of enablers. Although multiple studies are set within the community, either through community engagement or needle syringe exchange programs, To ghi et al (14) interviewed PWID in an inpatient detoxi cation setting. The experiences of these clients may be different since they are enrolled in detoxi cation to stop injecting drugs and don't intend to continue to do so, as is the case in some of the other studies.…”

“…The majority of the participants in each study were male with the exception of Skeer et al (8) which had an equal representation from male and females. Most of the studies had a majority white population with the exception of Ward et al(11) and To ghi et al(14).…”

Community-Based Point-of-Diagnosis Hepatitis C Treatment for Marginalized Populations

“…A study 11 in Seattle, Washington, a city with high levels of HCV testing, found that far fewer PWID and people experiencing homelessness initiated HCV treatment, similar to other US studies. [18][19][20] This finding is unsurprising given that marginalized populations, including PWID, face a myriad of substantial and well-documented 2,11,21,22 systemic-, practitioner-, and individual-level barriers to HCV treatment in clinical care settings. 21 Simplified HCV treatment algorithms have the potential to facilitate DAA treatment by non-HCV specialists (ie, general internal medicine physicians, clinical nurse practitioners, and pharmacists) and streamline the HCV care cascade.…”

“…[18][19][20] This finding is unsurprising given that marginalized populations, including PWID, face a myriad of substantial and well-documented 2,11,21,22 systemic-, practitioner-, and individual-level barriers to HCV treatment in clinical care settings. 21 Simplified HCV treatment algorithms have the potential to facilitate DAA treatment by non-HCV specialists (ie, general internal medicine physicians, clinical nurse practitioners, and pharmacists) and streamline the HCV care cascade. Several innovative approaches have been adopted to address these barriers and lower the threshold for DAA initiation among PWID.…”