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“Everybody living with a chronic disease is entitled to be cured” : Challenges and opportunities in scaling up access to direct-acting antiviral hepatitis C virus treatment among people who inject drugs Goodyear, Trevor; Ti, Lianping; Carrieri, Patrizia; Small, Will; Knight, Rod E.

Abstract

Background: Recent advances in the safety, tolerability, and efficacy of hepatitis C virus (HCV) treatments have led to the introduction of policy changes that include, in some settings, universal coverage of direct-acting antiviral (DAA) treatment for people living with HCV. However, people who inject drugs (PWID), a population with disproportionately high rates of HCV, often experience significant social and structural barriers to care, including when seeking treatment and care for blood-borne viruses. The objective of this study is to identify implementation challenges and opportunities for improving HCV-related care and scaling up DAA treatment for PWID living with HCV in a setting with universal DAA coverage since 2018. Methods: Informed by a critical interpretive framework, this study thematically analyzes data from in-depth, semi-structured interviews conducted between October 2018 and February 2019 with a purposive sample of 15 expert stakeholders (e.g., clinicians, community-based organization representatives, policy makers) related to HCV care provision, design, or research in British Columbia, Canada. Results: Our analysis revealed two key thematics: First, participants described existing challenges for scaling up DAA treatment, including how contextual factors (e.g., housing, stigma) restrict opportunities for PWID to engage in care. Participants also described how strained and compartmentalized health services are onerous to navigate for patients. Second, participants described opportunities for improving HCV-related care through various structural interventions (e.g., improved housing, decriminalization of substance use), and enhanced and more accessible models of care (e.g., decentralized, integrated, outreach-focused, and peer- and nurse-led services). Conclusions: These findings emphasize that several key service delivery and system-level adaptations are required in order to equitably scale up access of DAAs to PWID living with HCV, including policies and programs that are responsive to socio-structural determinants of health.

Item Metadata

Title
“Everybody living with a chronic disease is entitled to be cured” : Challenges and opportunities in scaling up access to direct-acting antiviral hepatitis C virus treatment among people who inject drugs
Creator
Goodyear, Trevor; Ti, Lianping; Carrieri, Patrizia; Small, Will; Knight, Rod E.
Contributor
British Columbia Centre on Substance Use
Publisher
Elsevier
Date Issued
2020-03-27
Description
Background: Recent advances in the safety, tolerability, and efficacy of hepatitis C virus (HCV) treatments have led to the introduction of policy changes that include, in some settings, universal coverage of direct-acting antiviral (DAA) treatment for people living with HCV. However, people who inject drugs (PWID), a population with disproportionately high rates of HCV, often experience significant social and structural barriers to care, including when seeking treatment and care for blood-borne viruses. The objective of this study is to identify implementation challenges and opportunities for improving HCV-related care and scaling up DAA treatment for PWID living with HCV in a setting with universal DAA coverage since 2018. Methods: Informed by a critical interpretive framework, this study thematically analyzes data from in-depth, semi-structured interviews conducted between October 2018 and February 2019 with a purposive sample of 15 expert stakeholders (e.g., clinicians, community-based organization representatives, policy makers) related to HCV care provision, design, or research in British Columbia, Canada. Results: Our analysis revealed two key thematics: First, participants described existing challenges for scaling up DAA treatment, including how contextual factors (e.g., housing, stigma) restrict opportunities for PWID to engage in care. Participants also described how strained and compartmentalized health services are onerous to navigate for patients. Second, participants described opportunities for improving HCV-related care through various structural interventions (e.g., improved housing, decriminalization of substance use), and enhanced and more accessible models of care (e.g., decentralized, integrated, outreach-focused, and peer- and nurse-led services). Conclusions: These findings emphasize that several key service delivery and system-level adaptations are required in order to equitably scale up access of DAAs to PWID living with HCV, including policies and programs that are responsive to socio-structural determinants of health.
Subject
Hepatitis C; direct-acting antivirals; people who inject drugs; substance use; qualitative research; treatment
Genre
Article; Postprint
Type
Text
Language
eng
Date Available
2022-02-23
Provider
Vancouver : University of British Columbia Library
Rights
Attribution-NonCommercial-NoDerivatives 4.0 International
DOI
10.14288/1.0406642
URI
http://hdl.handle.net/2429/80866
Affiliation
Applied Science, Faculty of; Medicine, Faculty of; Non UBC; Medicine, Department of; Nursing, School of; Population and Public Health (SPPH), School of
Citation
Goodyear T, Ti L, Carrieri P, Small W, & Knight R. (2020). “Everybody living with a chronic disease is entitled to be cured”: Challenges and opportunities in scaling up access to direct-acting antiviral hepatitis C virus treatment among people who inject drugs. International Journal of Drug Policy, 81, 102766, 1-8.
Publisher DOI
10.1016/j.drugpo.2020.102766
Peer Review Status
Reviewed
Scholarly Level
Faculty; Graduate
Rights URI
http://creativecommons.org/licenses/by-nc-nd/4.0/
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Attribution-NonCommercial-NoDerivatives 4.0 International