Hepatitis C Avoidance in Injection Drug Users: A Typology of Possible Protective Practices

Abstract

IntroductionHepatitis C virus (HCV) represents a serious public health concern. People who inject drugs (PWID) are at particular risk and nearly half (45%) of PWID in England may be infected. HCV prevention interventions have only had moderate impact on the prevalence of HCV in this population. Using qualitative methods, we sought to detail the protective practices potentially linked to HCV avoidance among PWID, and explore the motivations for these.MethodsThe study used a life history approach allowing participants to detail their lived experience both before and during the course of their injecting careers. Thirty-seven participants were recruited from drug services in London, and from referrals within local injecting networks. A baseline and follow-up in-depth qualitative interview was carried out with each participant, and for half, a third interview was also undertaken. All underwent testing for HCV antibody. Analyses focused on developing a descriptive typology of protective practices potentially linked to HCV avoidance.ResultsPractices were deemed to be protective against HCV if they could be expected a priori to reduce the number of overall injections and/or the number of injections using shared injecting equipment. Participants reported engaging in various protective practices which fell into three categories identified through thematic analysis: principles about injecting, preparedness, and flexibility.ConclusionsAll participants engaged in protective practices irrespective of serostatus. It is important to consider the relative importance of different motivations framing protective practices in order to formulate harm reduction interventions which appeal to the situated concerns of PWID, especially given that these protective practices may also help protect against HIV and other blood borne infections.

The impact of methadone maintenance therapy on hepatitis C incidence among illicit drug users

“…Specifically, reviews of harm reduction strategies have shown needle exchange programs to likely be modestly effective in preventing HCV infection , whereas the evidence for opiate substitution treatment [e.g. methadone maintenance treatment (MMT)], behavioral interventions and syringe disinfection is less convincing . Among the reviews of addiction treatments, a recent systematic review and meta‐analysis found that various forms of addiction treatment, including MMT, were not effective in reducing the risk of HCV .…”

Drug preparation, injection, and sharing practices in Tajikistan: a qualitative study in Kulob and Khorog

“…Finally, other authors suggested that in the absence of a needle and syringe, some users might snort or smoke heroin [ 30 ]. However, our results point to injecting as the sole route of administration among drug injectors in Kulob and Khorog.…”

“It’s Not Much of a Life”: The Benefits and Ethics of Using Life History Methods With People Who Inject Drugs in Qualitative Harm Reduction Research

“…London-based findings pertaining to the central study aim have been widely reported. We found that social practices not directly or proximally linked to hepatitis C such as social relations of methadone diversion, stigma avoidance, drug use preparedness, and venous care might, nonetheless, have hepatitis C prevention effects (Harris & Rhodes, 2013a, 2013bHarris, Treloar, & Maher, 2012;McGowan, Harris, & Rhodes, 2013). This article is the first to explore how the life history methods employed informed these findings and the everyday ethical dilemmas encountered in this process.…”

“…and T.R. to develop concept-driven categories and then, with reference to the life-grids, themes with transferable harm reduction utility (see Harris & Rhodes, 2012, 2013a, 2013b; McGowan et al, 2013). Field notes and transcript data pertaining to the methodological process inform analysis presented in this article.…”