Open Access Research

Perceptions of drug users regarding Hepatitis C screening and care: a qualitative study

Ashly E Jordan13*, Carmen L Masson2, Pedro Mateu-Gelabert34, Courtney McKnight13, Nicole Pepper2, Katie Bouche5, Laura Guzman6, Evan Kletter7, Randy M Seewald1, Don C Des-Jarlais13, James L Sorensen2 and David C Perlman13

Author Affiliations

1 Beth Israel Medical Center, 120 East 16th St, Floor 12, New York, NY, 10003, USA

2 Department of Psychiatry, San Francisco General Hospital, University of California, San Francisco, 1001 Potrero Avenue, Building 20, Suite 2100, San Francisco, CA, 94110, USA

3 Center for Drug Use and HIV Research, 120 East 16th St, Floor 12, New York, NY, 10003, USA

4 National Development and Research Institutes Inc, 71 West 23rd St. Floor 8, New York, NY, 10010, USA

5 Prevention Point, San Francisco AIDS Foundation, HIV Prevention Project, San Francisco AIDS Foundation, 1035 Market Street, Suite 400, San Francisco, CA, 94103, California

6 Mission Neighborhood Resource Center, 165 Capp Street, San Francisco, CA, 94110, California

7 BAART Programs, 433 Turk Street, San Francisco, CA, 94102, California

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Harm Reduction Journal 2013, 10:10  doi:10.1186/1477-7517-10-10

Published: 20 June 2013

Abstract

Background

Illicit drug users have a high prevalence of HCV and represent the majority of newly infected persons in the U.S. Despite the availability of effective HCV treatment, few drug users have been evaluated or treated for HCV. Racial and ethnic minorities have a higher incidence and prevalence of HCV and higher HCV-related mortality. Factors contributing to poor engagement in care are incompletely understood.

Methods

Fourteen mixed-gender focus groups of either African American or Latino/a drug users (N = 95) discussed barriers to HCV testing and treatment. Themes were identified through content analysis of focus group discussions.

Results

Many drug users were tested for HCV in settings where they were receiving care. Outside of these settings, most were unaware of voluntary test sites. After testing HCV positive, drug users reported not receiving clear messages regarding the meaning of a positive HCV test, the impact of HCV infection, or appropriate next steps including HCV clinical evaluations. Many drug users perceived treatment as unimportant because they lacked symptoms, healthcare providers minimized the severity of the diagnosis, or providers did not recommend treatment. Mistrust of the motivations of healthcare providers was cited as a barrier to pursuing treatment. Social networks or social interactions were a source of HCV-related information and were influential in shaping drug users perceptions of treatment and its utility.

Conclusion

Drug users perceived a paucity of settings for self-initiated HCV testing and poor provider-patient communication at test sites and during medical encounters. Notably, drug users reported having an unclear understanding about the meaning of a positive HCV test, the health implications of HCV infection, the importance of clinical evaluations and monitoring, and of treatment options for HCV. Efforts to improve the delivery of clinical messages about HCV infection for drug users at test settings and clinical encounters are needed.

Keywords:
Hepatitis C; Illicit drug use; Injection drug use; Health care access