Motivations, facilitators and barriers to accessing hepatitis C treatment among people who inject drugs in two South African cities

Abstract

Background: Treatment of hepatitis C (HCV) among people who inject drugs (PWID) is a critical component of efforts to eliminate viral hepatitis. A recent study found high HCV prevalence among PWID in two cities, Pretoria (84%) and Cape Town (44%). Very few (< 5%) HCV-infected individuals attended follow-up appointments. This substudy explores differences between stated desire for cure and appointment attendance in light of perceived facilitators and barriers to HCV treatment and care access among PWID. Method: Two sets of semi-structured interviews were implemented in a group of HCV-infected participants opportunistically sampled and recruited at harm reduction service sites. Initial interviews, conducted before the planned hospital appointment date, asked participants (N = 17, 9 in Pretoria and 8 in Cape Town) about past experiences of healthcare provision, plans to attend their referral appointment and perceived barriers and facilitators to seeking hepatitis treatment. Second interviews (n = 9, 4 in Pretoria, 5 in Cape Town), conducted after the planned referral appointment date, asked about appointment attendance and treatment experience. Trained social scientists with experience with PWID conducted the interviews which were recorded in detailed written notes. Data was thematically analysed in NVivo 11. Results: Despite routine experiences of being stigmatised by the healthcare system in the past, most participants (n = 16, 94%) indicated a desire to attend their appointments. Attendance motivators included the desire to be cured, fear of dying and the wish to assist the research project. Perceived barriers to appointment attendance included fear of again experiencing stigmatisation and concerns about waiting periods and drug withdrawal. Perceived facilitators included the knowledge they would be treated quickly, and with respect and access to opioid substitution therapy. In the end, very few participants (n = 5) went to their appointment. Actual barriers to attendance included lack of finances, lack of urgency and forgetting and fatalism about dying.

A Lay-User Assessment of Hepatitis C Virus Self-Testing Device Usability and Interpretation in Johannesburg, South Africa

“…This HCVST study has shown that evaluated prototype blood-based HCVST kits exhibit high usability in the hands of untrained lay-users, with respect to their usability index, contrived results interpretation, and direct user feedback. Although there are no other published usability assessments of blood-based HCVST to give context to these results, our findings are in agreement with high usability scores for HIVSTs in similar settings [ 35 , 38 , 39 , 40 ]. Given the high usability of these prototype HCVSTs, and their potential to remove barriers to traditional HCV testing, these findings are useful in informing the improved development of blood based HCVST kits towards SRA approval.…”

“…For HCV, barriers to testing include stigma and discrimination, which suggests that the privacy offered by HCVSTs may facilitate testing [ 9 ]. In South Africa specifically, a recent study among PWID identified barriers to accessing HCV treatment as fear of stigma, and long waiting periods [ 40 ], both barriers that can be facilitated by the speed, privacy and convenience offered by HCVST. HCVSTs have the potential to remove barriers linked with traditional HCV testing, so obtaining SRA approval for HCVSTs will help reach the 2030 targets [ 1 , 9 , 40 ], especially in key populations, like PWID.…”

The Impact of Stigma on Treatment Services for People With Substance Use Disorders During the COVID-19 Pandemic—Perspectives of NECPAM Members

“…The stigma toward people who use opioids and how this serves as a barrier to effective treatment for opioid use disorders is well-described in the literature prior to the COVID-19 pandemic ( 13 ). Regarding these specific countries, there is evidence from the literature prior to the COVID-19 pandemic that stigma toward opioid users is a barrier to access to treatment ( 14 – 16 ). However, establishing a Healthline helpline to facilitate testing and treatment seems to have reduced the stigma around access for service users in New Zealand ( 17 ).…”

Drug Policies and Development

“…Consequently, stigma and discrimination towards people who use drugs is widely accepted in healthcare facilities. This includes denial of care, conditional access to care, shaming, lack of confidentiality and privacy and being made to wait disproportionately long periods for services (Shelly et al, 2017, Versfeld et al, 2020. Moreover, there are currently no effective accountability mechanisms within healthcare facilities to manage these rights abuses, nor is there easy access to legal recourse for people who use drugs whose rights have been violated (tb hiv Care and StopTB Partnership, 2018).…”