Improving access to care for people who inject drugs: Qualitative evaluation of project ITTREAT—An integrated community hepatitis C service

Abstract

Achieving hepatitis C virus (HCV) elimination by 2030 requires an increased linkage to care for people who inject drugs (PWID). Project ITTREAT was established to mitigate barriers to HCV care by providing an integrated service within a local drug and alcohol treatment centre. This study aimed to explore the experiences of clients and staff involved in Project ITTREAT and assess the facilitators and barriers to a community-based HCV service. Between October 2014 and April 2016, drug and alcohol treatment attendees were interviewed using one-to-one semi-structured interviews.Drug and alcohol treatment staff took part in focus groups. All data were recorded, transcribed verbatim and analysed using thematic content analysis. Fifteen drug and alcohol treatment attendees with current/previous HCV infection were interviewed, and 15 staff members contributed across two focus groups. Drug and alcohol treatment staff and attendees reported that Project ITTREAT facilitated access to HCV care by mitigating previous negative hospital-based experiences. Other key facilitators were positive narratives around HCV care, and drug and alcohol treatment attendees being well engaged in their drug/alcohol recovery. Barriers included a lack of stability in drug and alcohol treatment attendees, negative discourse around testing/ treatment and stigma associated with attending the drug and alcohol treatment to access HCV treatment in some who had successfully achieved drug rehabilitation.Our findings indicate the positive impact of an integrated and personalized community-based service delivered by a dedicated hepatitis nurse. This played a crucial role in reducing barriers to HCV care for PWID. Our work also highlights areas for future investment including non-DAT-based community services and increasing awareness of new treatments amongst this cohort. K E Y W O R D S barriers, community HCV service, facilitators, hepatitis C virus, staff/client experience, substance misuse | 177 PHILLIPS et aL.

ITTREAT (Integrated Community Test ‐ Stage ‐ TREAT) Hepatitis C service for people who use drugs: Real‐world outcomes

“…We attribute the success of ITTREAT to it being a “one‐stop” integrated and non‐judgemental service, which helped mitigate against non‐engagement, corroborated by our qualitative data( 28 ) and a recent systematic review. ( 31 ) The Hepatitis nurse effectively linked all the different components of the service.…”

“…This community model of care was based at a single site in England, the trusting client provider relationship being the key to engagement. ( 28 ) Since this may not be applicable to other geographical sites our study lacks generalisability and external validity to support a national change in service delivery. However, a recent systematic review, involving studies from multiple countries reporting different models of care reported excellent community‐based SVR in PWUDs.…”

Engaging the Community in Designing a Hepatitis C Virus Treatment Program for Adults Experiencing Homelessness

“…The goal of this qualitative study was to assess the perceptions of PEH, who have been diagnosed with HCV, and treatment providers on the development of culturally sensitive designs to support HCV initiation and completion. Awareness of sociocultural differences is crucial in the design of any successful intervention to achieve HCVsustained virologic response (Phillips et al, 2020). We discovered three major themes which included: Our findings revealed that essentials of successful participant engagement and retention included an appreciation of the support role of the nurse-led CHW as well as the advocacy that they provided.…”

Therapy of chronic hepatitis C in people who inject drugs: focus on adherence

“…The aim of our study was to support the evidence that the efficacy of therapy in PWID is high and that the financial resources are invested effectively. Achieving cure of people in the epidemiologically high-risk group, we decrease the risk of disease transmission [ 4 , 20 , 21 ].…”