Progress towards hepatitis C elimination: the feasibility and success of a nurse and harm reduction practitioner led model of care utilising rapid point of care HCV RNA testing at a medically supervised injecting room in Melbourne, Australia

MacIsaac, Michael; Whitton, Bradley; Anderson, Jenine; Penn, Matthew; Weeks, Anthony M.; Cogger, Shelley; Elmore, Kasey; Pemberton, David; Papaluca, Timothy; Hellard, Margaret; Stoové, Mark; Wilson, David J.; Pedrana, Alisa; Doyle, Joseph; Clark, N.J.; Holmes, Jacinta A; Thompson, Alexander

doi:10.1016/s0168-8278(22)01422-2

Cited by 3 publications

(5 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

Section: Discussionsupporting

confidence: 87%

“…Our findings indicate that people who inject drugs perceive the traditional testing process as a significant barrier to HCV testing and treatment uptake due to the need for venipuncture and lengthy wait times, aligning with existing literature [ 19 , 60 – 63 ]. In contrast, the simplicity and rapid results of finger stick point-of-care antibody and RNA HCV tests are viewed as enablers [ 19 , 60 – 63 ]. Also aligning with previous research in Australia is the perception of the needle and syringe program as an ideal environment to access HCV testing, with most individuals feeling at home, trusting service providers, and highlighting that it would align with their activities of daily living [ 16 , 62 , 64 , 65 ].…”

Section: Discussionsupporting

confidence: 87%

See 1 more Smart Citation

Using an intersectionality lens to explore barriers and enablers to hepatitis C point-of-care testing: a qualitative study among people who inject drugs and service providers

Fontaine,

Presseau,

Bruneau

et al. 2024

Int J Equity Health

View full text Add to dashboard Cite

Background Hepatitis C virus (HCV) infection is a significant global health burden, particularly among people who inject drugs. Rapid point-of-care HCV testing has emerged as a promising approach to improve HCV detection and linkage to care in harm reduction organizations such as needle and syringe programs. The objective of this study was to use an intersectionality lens to explore the barriers and enablers to point-of-care HCV testing in a needle and syringe program. Methods A qualitative study was conducted using semi-structured interviews with clients (people who inject drugs) and service providers in a large community organization focused on the prevention of sexually transmitted and blood borne infections and harm reduction in Montreal, Canada. An intersectionality lens was used alongside the Theoretical Domains Framework to guide the formulation of research questions as well as data collection, analysis, and interpretation. Results We interviewed 27 participants (15 clients, 12 providers). For clients, four themes emerged: (1) understanding and perceptions of HCV testing, (2) the role of an accessible and inclusive environment, (3) the interplay of emotions and motivations in decision-making, and (4) the impact of intersectional stigma related to HCV, behaviors, and identities. For providers, five themes emerged: (1) knowledge, skills, and confidence for HCV testing, (2) professional roles and their intersection with identity and lived experience, (3) resources and integration of services, (4) social and emotional factors, and (5) behavioral regulation and incentives for HCV testing. Intersectional stigma amplified access, emotional and informational barriers to HCV care for clients. In contrast, identity and lived experience acted as powerful enablers for providers in the provision of HCV care. Conclusion The application of an intersectionality lens provides a nuanced understanding of multilevel barriers and enablers to point-of-care HCV testing. Findings underscore the need for tailored strategies that address stigma, improve provider roles and communication, and foster an inclusive environment for equitable HCV care. Using an intersectionality lens in implementation research can offer valuable insights, guiding the design of equity-focused implementation strategies.

show abstract

Section: Discussionsupporting

confidence: 87%

Section: Discussionsupporting

confidence: 87%

Using an intersectionality lens to explore barriers and enablers to hepatitis C point-of-care testing: a qualitative study among people who inject drugs and service providers

Fontaine,

Presseau,

Bruneau

et al. 2024

Int J Equity Health

View full text Add to dashboard Cite

show abstract

“…15,[55][56][57][58] In contrast, the simplicity and rapid results of nger stick point-ofcare antibody and RNA HCV tests are viewed as enablers. 15,[55][56][57][58] Also aligning with previous research in Australia is the perception of the needle and syringe program as an ideal environment to access HCV testing, with most individuals feeling at home, trusting service providers, and highlighting that it would align with their activities of daily living. 12,57,59,60 Our study expands current knowledge on the intersectional stigma faced by people who inject drugs in traditional healthcare settings and society, 54,[61][62][63][64][65][66] and how this stigma can compound key barriers related to accessing HCV care.…”

Section: Discussionmentioning

confidence: 99%

“…Our ndings indicate that people who inject drugs perceive the traditional testing process as a signi cant barrier to HCV testing and treatment uptake due to the need for venipuncture and lengthy wait times, aligning with existing literature. 15,[55][56][57][58] In contrast, the simplicity and rapid results of nger stick point-ofcare antibody and RNA HCV tests are viewed as enablers. 15,[55][56][57][58] Also aligning with previous research in Australia is the perception of the needle and syringe program as an ideal environment to access HCV testing, with most individuals feeling at home, trusting service providers, and highlighting that it would align with their activities of daily living.…”

Section: Discussionmentioning

confidence: 99%

Promoting Equity in Hepatitis C Care: A Qualitative Study Using an Intersectionality Lens to Explore Barriers and Facilitators to Point-of-Care Testing Among People Who Inject Drugs and Service Providers

Fontaine,

Presseau,

Bruneau

et al. 2024

Preprint

View full text Add to dashboard Cite

Background: Hepatitis C virus (HCV) infection is a significant global health burden, particularly among people who inject drugs. Rapid point-of-care HCV testing has emerged as a promising approach to improve HCV detection and linkage to care in harm reduction organizations such as needle and syringe programs. The objective of this study was to use an intersectionality lens to explore the barriers and enablers to point-of-care HCV testing in a needle and syringe program. Methods: A qualitative study was conducted using semi-structured interviews with clients (people who inject drugs) and service providers in a large community organization focused on the prevention of sexually transmitted and blood borne infections in Montreal, Canada. An intersectionality lens was used alongside the Theoretical Domains Framework to guide the formulation of research questions as well as data collection, analysis, and interpretation. Results: We interviewed 27 participants (15 clients, 12 providers). The intersectional analysis revealed that intersectional stigma amplifies access, emotional and informational barriers to HCV care for people who inject drugs, while identity and lived experience of HCV and drug use represent powerful tools leveraged by providers. There were four themes for clients: (1) understanding and perceptions of HCV testing, (2) an accessible and inclusive environment for HCV testing, (3) the interplay of emotions and motivations in HCV testing decision-making, and (4) the impact of intersectional stigma related to HCV, behaviors (e.g., drug use), and identities (e.g., gender identity). For providers, five themes emerged: (1) knowledge, skills, and confidence for HCV testing, (2) professional roles and their intersection with identity and lived experience, (3) resources and integration of services, (4) social and emotional factors, and (5) behavioral regulation and incentives for HCV testing. Conclusion: The application of an intersectionality lens provides a nuanced understanding of the impact of intersectional stigma in the lives of people who inject drugs, which amplifies barriers to point-of-care HCV testing. Findings underscore the need for tailored strategies that address stigma, improve provider roles and communication, and foster an inclusive environment for equitable HCV care. Integrating an intersectionality lens into implementation research offers valuable insights for more equitable and effective interventions.

show abstract

“…The GenXpert has been evaluated as a single-test approach to HCV diagnosis. In studies in supervised injection sites (SIS), first in Canada [ 9 ] and subsequently in Australia [ 10 ], the tests were offered to clients of the SIS. In Toronto, the prevalence of HCV viremia was 42% and in Melbourne, it was 28%.…”

Section: Options For One-step Diagnosis Of Hcv Infectionmentioning

confidence: 99%

What Is Needed to Move Toward Single-Step Diagnosis of Current HCV Infection?

Feld

2023

The Journal of Infectious Diseases

View full text Add to dashboard Cite

Despite remarkable therapeutic advanced, hepatitis C virus (HCV) infection continues to be a major global problem. While the development of highly effective direct-acting antivirals (DAAs) has ensured that almost all those who are treated achieve viral cure, progress toward HCV elimination globally has stalled due to challenges upstream of treatment in the cascade of care, namely diagnosis and linkage to care. The major challenge continues to be the relative complexity of HCV diagnosis with the current requirement for a confirmatory HCV RNA test after an initial antibody-positive result. in this review, challenges with the current paradigm are highlighted with a focus on new technologies, as well as simple strategies using existing tools, that may simplify diagnosis and improve linkage to care and treatment. To achieve HCV elimination, improvements in the HCV diagnostics field to allow for a simple single-step diagnosis are required.

show abstract

Progress towards hepatitis C elimination: the feasibility and success of a nurse and harm reduction practitioner led model of care utilising rapid point of care HCV RNA testing at a medically supervised injecting room in Melbourne, Australia

Cited by 3 publications

References 0 publications

Using an intersectionality lens to explore barriers and enablers to hepatitis C point-of-care testing: a qualitative study among people who inject drugs and service providers

Using an intersectionality lens to explore barriers and enablers to hepatitis C point-of-care testing: a qualitative study among people who inject drugs and service providers

Promoting Equity in Hepatitis C Care: A Qualitative Study Using an Intersectionality Lens to Explore Barriers and Facilitators to Point-of-Care Testing Among People Who Inject Drugs and Service Providers

What Is Needed to Move Toward Single-Step Diagnosis of Current HCV Infection?

Contact Info

Product

Resources

About