Patients at a drug detoxification center share perspectives on how to increase hepatitis C treatment uptake: A qualitative study.
Access to care
Hepatitis C
Linkage to care
Medications for opioid use disorder
Persons who inject drugs
Journal
Drug and alcohol dependence
ISSN: 1879-0046
Titre abrégé: Drug Alcohol Depend
Pays: Ireland
ID NLM: 7513587
Informations de publication
Date de publication:
01 03 2021
01 03 2021
Historique:
received:
16
08
2020
revised:
16
12
2020
accepted:
19
12
2020
pubmed:
20
1
2021
medline:
9
6
2021
entrez:
19
1
2021
Statut:
ppublish
Résumé
The US opioid crisis is associated with a surge in hepatitis C virus (HCV) infections among persons who inject drugs (PWID), and yet the uptake of HCV curative therapy among PWID is low. To explore potential solutions to overcome barriers to HCV treatment uptake among individuals at a drug detoxification center. Qualitative study with in-depth interviews and thematic analysis of coded data. Patients (N = 24) had the following characteristics: mean age 37 years; 67 % White, 13 % Black, 8 % Latinx, 4 % Native Hawaiian/Pacific Islander, 8 % other; 71 % with a history of injecting drugs. Most patients with a positive HCV test had not pursued treatment due to few perceived immediate consequences from a positive test and possible complications arising in a distant poorly imagined future. Active substance use was a major barrier to HCV treatment uptake because of disruptions to routine activities. In addition, re-infection after treatment was perceived as inevitable. Patients had suggestions to improve HCV treatment uptake: high-intensity wraparound care characterized by frequent interactions with supportive services; same-day/walk-in options; low-barrier access to substance use treatment; assistance with navigating the health care system; attention to immediate needs, such as housing; and the opportunity to select an approach that best fits individual circumstances. Active substance use was a major barrier to treatment initiation. To improve uptake, affected individuals recommended that HCV treatment be integrated within substance use treatment programs. Such a model should incorporate patient education within low-barrier, high-intensity wraparound care, tailored to patients' needs and priorities.
Sections du résumé
BACKGROUND
The US opioid crisis is associated with a surge in hepatitis C virus (HCV) infections among persons who inject drugs (PWID), and yet the uptake of HCV curative therapy among PWID is low.
PURPOSE
To explore potential solutions to overcome barriers to HCV treatment uptake among individuals at a drug detoxification center.
METHODS
Qualitative study with in-depth interviews and thematic analysis of coded data.
RESULTS
Patients (N = 24) had the following characteristics: mean age 37 years; 67 % White, 13 % Black, 8 % Latinx, 4 % Native Hawaiian/Pacific Islander, 8 % other; 71 % with a history of injecting drugs. Most patients with a positive HCV test had not pursued treatment due to few perceived immediate consequences from a positive test and possible complications arising in a distant poorly imagined future. Active substance use was a major barrier to HCV treatment uptake because of disruptions to routine activities. In addition, re-infection after treatment was perceived as inevitable. Patients had suggestions to improve HCV treatment uptake: high-intensity wraparound care characterized by frequent interactions with supportive services; same-day/walk-in options; low-barrier access to substance use treatment; assistance with navigating the health care system; attention to immediate needs, such as housing; and the opportunity to select an approach that best fits individual circumstances.
CONCLUSIONS
Active substance use was a major barrier to treatment initiation. To improve uptake, affected individuals recommended that HCV treatment be integrated within substance use treatment programs. Such a model should incorporate patient education within low-barrier, high-intensity wraparound care, tailored to patients' needs and priorities.
Identifiants
pubmed: 33465604
pii: S0376-8716(21)00021-1
doi: 10.1016/j.drugalcdep.2021.108526
pmc: PMC8064807
mid: NIHMS1673330
pii:
doi:
Substances chimiques
Antiviral Agents
0
Pharmaceutical Preparations
0
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
108526Subventions
Organisme : NIDA NIH HHS
ID : K23 DA044085
Pays : United States
Organisme : NIDA NIH HHS
ID : P30 DA040500
Pays : United States
Organisme : NIDA NIH HHS
ID : R01 DA046527
Pays : United States
Informations de copyright
Copyright © 2021 Elsevier B.V. All rights reserved.
Références
Lancet Infect Dis. 2016 Dec;16(12):1409-1422
pubmed: 27615026
J Viral Hepat. 2013 Nov;20(11):745-60
pubmed: 24168254
Ann Intern Med. 2019 May 7;170(9):594-603
pubmed: 30959528
Eur J Gastroenterol Hepatol. 2010 Mar;22(3):270-7
pubmed: 20425880
JAMA. 2013 Sep 18;310(11):1156-67
pubmed: 24045740
Addiction. 2002 Oct;97(10):1289-94
pubmed: 12359033
MMWR Morb Mortal Wkly Rep. 2015 May 8;64(17):453-8
pubmed: 25950251
Clin Gastroenterol Hepatol. 2015 Nov;13(11):2005-14.e1-3
pubmed: 25724704
Addiction. 2014 Dec;109(12):2053-9
pubmed: 25041346
Harm Reduct J. 2019 Feb 11;16(1):14
pubmed: 30744628
Soc Sci Med. 2004 Nov;59(9):1807-18
pubmed: 15312916
Drug Alcohol Depend. 2018 Sep 1;190:246-254
pubmed: 30071457
Emerg Infect Dis. 2016 May;22(5):907-9
pubmed: 27089172
Psychol Bull. 1992 May;111(3):455-74
pubmed: 1594721
Drug Alcohol Depend. 2020 Jan 1;206:107705
pubmed: 31718924
Liver Int. 2020 Mar;40(3):522-529
pubmed: 31815353
Alcohol Clin Exp Res. 2006 Sep;30(9):1520-6
pubmed: 16930214
J Infect Dis. 2020 Sep 2;222(Suppl 5):S376-S383
pubmed: 32877557
Hepatology. 2007 Dec;46(6):1741-9
pubmed: 18046707
J Addict Med. 2020 Mar/Apr;14(2):95-98
pubmed: 31567596
AIDS Patient Care STDS. 2005 May;19(5):298-305
pubmed: 15916492
Clin Infect Dis. 2002 Oct 1;35(7):783-8
pubmed: 12228813
Drug Alcohol Depend. 2009 Nov 1;105(1-2):160-3
pubmed: 19647375
Int J Drug Policy. 2017 Sep;47:34-46
pubmed: 28797498
J Subst Abuse Treat. 2019 Dec;107:1-7
pubmed: 31757259
J Subst Abuse Treat. 2019 May;100:45-51
pubmed: 30898327
Nurs Health Sci. 2013 Sep;15(3):398-405
pubmed: 23480423
Am J Manag Care. 2018 Sep 1;24(9):e300-e304
pubmed: 30222926
JAMA Intern Med. 2014 Dec;174(12):1974-81
pubmed: 25347412
N Engl J Med. 2014 May 15;370(20):1889-98
pubmed: 24725239
Clin Infect Dis. 2014 Mar;58(6):755-61
pubmed: 24363333
Addiction. 2003 Apr;98(4):509-16
pubmed: 12653820