Home > Barriers to and facilitators of hepatitis C care.

Long, Jean (2011) Barriers to and facilitators of hepatitis C care. Drugnet Ireland , Issue 37, Spring 2011 , p. 22.

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Hepatitis C infection is common among injecting drug users (IDUs), yet access to hepatitis C care, particularly treatment, is suboptimal. There has been little in-depth study of IDUs’ experiences of what enables or prevents them engaging at every level of hepatitis C care, including testing, follow-up, management and treatment processes. 

A qualitative study aimed to explore these issues with current and former IDUs in the greater Dublin area.1 Between September 2007 and September 2008 in-depth interviews were conducted with 36 service users across a range of primary and secondary care services, including two addiction clinics, a general practice, a community drop-in centre, two hepatology clinics, and an infectious diseases clinic. Interviews were analysed using a grounded theory approach.
 
Of the 36 participants interviewed, 28 were men and eight were women. They ranged in age from 24 to 54 years, with a median age of 32 years. The median reported age at first injecting drugs was 18.5 years (range 14–29 years). Of the 28 who reported their main problem drug, 79% reported heroin and 21% cocaine. Thirty-three (91%) participants reported testing positive for hepatitis C, of whom four (11%) reported HIV/HCV co-infection.
 
Among the factors influencing access to and uptake of HCV care were:
·         perceptions that every injector had this invisible infection (hepatitis C) and that its effects were not as serious as those of HIV;
·         perceptions that the investigations and treatments for hepatitis C were more severe than the infection itself;
·         use of coping strategies, such as blocking awareness, escape, support and positive thinking, to deal with fears about the future effects of hepatitis C, or anxieties about investigations or treatment;
·         the quality of relationships with health care providers;
·         contact with services, encouraging and caring doctors and nurses, family ties, recovery from addiction, and convenient access to testing and treatment; and
·         continued substance use, employment (lack of free time), contraindications to treatment, lack of reminders and lack of opportunity.
 
In conclusion, IDUs face multiple barriers to HCV care but a range of facilitators were identified that could increase access to and uptake of treatment.
 
1. Swan D, Long J, Carr O, Flanagan J, Irish H, Keating S et al. (2010) Barriers to and facilitators of hepatitis C testing, management, and treatment among current and former injecting drug users: a qualitative exploration. AIDS Patient Care and STDS, 24(12): 753–762.  www.drugsandalcohol.ie/14416
Item Type:Article
Issue Title:Issue 37, Spring 2011
Date:2011
Page Range:p. 22
Publisher:Health Research Board
Volume:Issue 37, Spring 2011
EndNote:View
Accession Number:HRB (Available)
Subjects:G Health and disease > Disorder by cause > Communicable disease > Hepatitis C
VA Geographic area > Europe > Ireland
J Health care, prevention and rehabilitation > Health related prevention > Health information and education > Communicable disease control

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