Central City Concern, 232 NW 6th Ave., Portland, OR, 97209, United States.
Oregon State University, 2520 SW Campus Way, 118C Milam Hall, Corvallis, OR, 97331, United States.
Int J Drug Policy. 2019 Oct;72:138-145. doi: 10.1016/j.drugpo.2019.03.015. Epub 2019 Apr 15.
People who inject drugs (PWID) are disproportionately affected by chronic hepatitis C (HCV) in high-income countries. The advent of direct-acting antivirals (DAAs) makes treatment of this underserved population more possible than ever. The dearth of programs adapted to the needs of PWID and stigma associated with drug use and chronic HCV pose significant barriers to the effective uptake of treatment among this population. We employed "life projects" as a conceptual framework to examine the social incentives of PWID being treated for HCV. This study advances the existing literature on the transformative potential of HCV treatment among PWID, explores how these transformations may affect treatment success, and discusses implications for decisions around whether and when to treat PWID.
We conducted in-depth interviews with participants of a pilot clinical trial testing the effective delivery of DAA treatment to PWID within two healthcare for the homeless clinic settings - one group receiving opioid agonist therapy (OAT) and another group frequenting a needle and syringe exchange program (NSP). A purposive sample of 27 participants was selected based on place of care. Interviews were transcribed, coded, and analysed for patterns using a priori domains and emergent themes.
Participants in both treatment groups described significant life projects that motivated them to complete HCV treatment. These projects included social redemption, strengthening of relationships, pursuit of abstinence from substance use, and harm reduction. These themes were consistent between treatment groups, though more participants in the syringe exchange group relied on harm reduction than on pursuing abstinence to prevent reinfection after achieving virologic cure.
Understanding the incentives that propel PWID to complete HCV treatment could help to enhance treatment uptake and adherence through dedicated programs that address current barriers to care.
在高收入国家，注射吸毒者（PWID）受到慢性丙型肝炎（HCV）的影响不成比例。直接作用抗病毒药物（DAAs）的出现使得治疗这个服务不足的人群变得前所未有地可能。缺乏适应 PWID 需求的项目以及与吸毒和慢性 HCV 相关的污名化，对该人群有效接受治疗构成了重大障碍。我们采用“生活项目”作为概念框架，来研究针对 HCV 治疗的 PWID 的社会激励因素。本研究推进了关于 HCV 治疗对 PWID 的变革潜力的现有文献，探讨了这些转变如何影响治疗的成功，并讨论了围绕是否以及何时治疗 PWID 的决策的影响。
我们对一项试点临床试验的参与者进行了深入访谈，该试验旨在测试在两个无家可归者医疗保健诊所环境中向 PWID 有效提供 DAA 治疗的方法——一组接受阿片类激动剂治疗（OAT），另一组则经常光顾针具交换计划（NSP）。根据护理地点，选择了 27 名具有代表性的参与者进行访谈。使用先验的领域和新兴主题对访谈进行转录、编码和分析，以寻找模式。
两组治疗组的参与者都描述了激励他们完成 HCV 治疗的重要生活项目。这些项目包括社会救赎、加强人际关系、追求戒除物质使用和减少伤害。这些主题在治疗组之间是一致的，尽管 NSP 组更多的参与者依赖于减少伤害而不是追求戒除来防止在实现病毒学治愈后再次感染。
了解推动 PWID 完成 HCV 治疗的激励因素，可以通过专门的项目来提高治疗的接受度和依从性，这些项目可以解决当前护理障碍。
