Sabrina A Assoumou1, Carlos R Sian2, Christina M Gebel3, Benjamin P Linas4, Jeffrey H Samet5, Judith A Bernstein6. 1. Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston Medical Center, 801 Massachusetts Ave., Crosstown Center, 2(nd) Floor, Boston, MA, USA; Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, 801 Massachusetts Ave., Crosstown Center, 2nd Floor, Boston, MA, USA. Electronic address: sabrina.assoumou@bmc.org. 2. Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, 801 Massachusetts Ave., Crosstown Center, 2nd Floor, Boston, MA, USA. Electronic address: csian@bu.edu. 3. Boston University School of Public Health, Boston, MA, USA. Electronic address: cgebel@bu.edu. 4. Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston Medical Center, 801 Massachusetts Ave., Crosstown Center, 2(nd) Floor, Boston, MA, USA; Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, 801 Massachusetts Ave., Crosstown Center, 2nd Floor, Boston, MA, USA; Boston University School of Public Health, Boston, MA, USA. Electronic address: Benjamin.Linas@bmc.org. 5. Boston University School of Public Health, Boston, MA, USA; Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA, 02118, USA. Electronic address: jsamet@bu.edu. 6. Boston University School of Public Health, Boston, MA, USA; Boston University School of Public Health, Dept of Community Health Sciences, 801 Massachusetts Ave., Crosstown Center, Boston, MA, 02118, USA. Electronic address: jbernste@bu.edu.
Abstract
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.
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.
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