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New approaches are needed for physicians to engage young people who inject drugs
Young hepatitis C virus (HCV)-infected people who inject drugs (PWID) face unique barriers to testing, counseling and treatment, according to a new study.
The study expands upon prior research with PWID done in the interferon treatment era. “This is important because in comparison the newer HCV treatment options have high success rates, are much shorter in duration, and have minimal side effects. It would be expected that given these improvements in the medication, uptake would be much higher, yet barriers still exist,” Margie Skeer, ScD, MPH, MSW, associate professor in the Department of Public Health and Community Medicine at Tufts University School of Medicine, told Medical Economics.
The researchers published their results on September 1, 2018, in Drug and Alcohol Dependence.
Skeer and colleagues conducted 24 in-depth interviews with active and recent drug users, aged 22 to 30 years, living with HCV in Boston from February to August 2016. At the time of the interviews, no participants had been prescribed or had taken the new direct-acting antivirals (DAAs).
“Our study sought to understand the barriers and facilitators to HCV treatment among this population, which are present even in Boston, an urban area with gold-standard healthcare, insurance coverage, and access to HCV treatment experts,” said Skeer.
The researchers found that major barriers to HCV treatment among young PWID include a feeling that they do not deserve treatment, feeling dissatisfied with provider interactions, perceived lack of referral to treatment and care continuity, stigma among healthcare providers, and policies that disincentivize HCV treatment.
“These persistently limit care, even when insurance and access to addiction medicine experts with training in HCV treatment are prevalent, as is the case in Boston,” Skeer said. “We found that negative interactions with healthcare providers during the HCV testing process and perceived inadequate access to HCV treatment reinforced the perception that young PWID are undeserving of treatment, resulting in a reduced willingness to ultimately pursue newly available treatment options.”
The researchers concluded: “Evidence suggests that PWID can successfully complete DAA treatment and can be cleared of HCV. Our study highlights that young PWID may have the determinants of believing that the new HCV medications are effective and also the desire to pursue treatment, but face many obstacles that hinder linkage to care.”
Skeer added: “As with prior research with this population, we found that participants in our study were treated poorly in clinical settings. This was true even in an area such as Boston with a strong infrastructure to support this population. Our results highlight the need for patient-oriented care in a safe setting where young PWID feel respected and destigmatized. Participants reflected that providers should become more educated about addiction and approach HCV treatment with this population in a manner that allows them to feel like people with a chronic condition, rather than merely being treated as ‘addicts’ or ‘junkies.’ Ultimately, positive clinical interactions may have a subsequent positive impact on their readiness and willingness to seek HCV treatment.”