Life projects: the transformative potential of direct-acting antiviral treatment for hepatitis C among people who inject drugs

Beth E. Williams, Devynne Nelons, Andrew Seaman, Martyna Witkowska, Wren Ronan, Haven Wheelock, Atif Zaman, Jonathan Garcia

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background and objectives: 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. Methods: 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. Results: 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. Conclusion: 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.

Original languageEnglish (US)
JournalInternational Journal of Drug Policy
DOIs
StatePublished - Jan 1 2019

Fingerprint

Hepatitis C
Antiviral Agents
Pharmaceutical Preparations
Needle-Exchange Programs
Harm Reduction
Therapeutics
Motivation
Interviews
Syringes
Vulnerable Populations
Chronic Hepatitis C
Group Psychotherapy
Opioid Analgesics
Clinical Trials
Delivery of Health Care
Population

Keywords

  • Harm reduction
  • HCV
  • Hepatitis C treatment
  • Life projects
  • People who inject drugs
  • Qualitative research

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Health Policy

Cite this

Life projects : the transformative potential of direct-acting antiviral treatment for hepatitis C among people who inject drugs. / E. Williams, Beth; Nelons, Devynne; Seaman, Andrew; Witkowska, Martyna; Ronan, Wren; Wheelock, Haven; Zaman, Atif; Garcia, Jonathan.

In: International Journal of Drug Policy, 01.01.2019.

Research output: Contribution to journalArticle

E. Williams, Beth ; Nelons, Devynne ; Seaman, Andrew ; Witkowska, Martyna ; Ronan, Wren ; Wheelock, Haven ; Zaman, Atif ; Garcia, Jonathan. / Life projects : the transformative potential of direct-acting antiviral treatment for hepatitis C among people who inject drugs. In: International Journal of Drug Policy. 2019.
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abstract = "Background and objectives: 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. Methods: 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. Results: 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. Conclusion: 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.",
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