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Abstract Details
Treatment for hepatitis C virus with direct acting antiviral agents: Perspectives and treatment experiences of people who inject drugs
1Department of Family and Social Medicine, Albert Einstein College of Medicine, 1300 Morris Park Blvd, Bronx, NY 10462, United States of America. Electronic address: alison.karasz@einsteinmed.org.
2Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY 10461, United States of America. Electronic address: reena.singh@nyu.edu.
3University of Massachusetts, School of Medicine and Albert Einstein, College of Medicine, 55 Lake Ave., North Worcester MA 01655/1300 Morris Park Ave, Bronx, NY 10461, United States of America. Electronic address: M.Diane.McKee@umassmed.edu.
4University of South Carolina, School of Medicine Greenville, 607 Grove Rd., Greenville, SC 29605, United States of America. Electronic address: krupam@email.sc.edu.
5Harvard Medical School and Massachusetts General Hospital, 55 Fruit Street Cox 5, Boston, MA 02130, United States of America. Electronic address: AKIM1@mgh.harvard.edu.
6University of New Mexico, Department of Internal Medicine, Division of Epidemiology, Biostatistics, and Preventive Medicine, MSC10 5550 1, University of New Mexico, Albuquerque, NM 87131. Electronic address: Pagek@salud.unm.edu.
7Clemson University, College of Behavioral, Social, and Health Sciences, 605 Grove Rd., Greenville, SC 29605, United States of America. Electronic address: iperico@clemson.edu.
8University of California, San Francisco, Mission Hall, 550-16th St., Suite 300, San Francisco, CA 94158. Electronic address: Ellen.Stein@ucsf.edu.
9University of Rhode Island, CODAC Behavioral Health, 80 Washington Street, Rm. 525, Providence, RI 02903, United States of America. Electronic address: letaylor@uri.edu.
10University of New Mexico, MSC10 5550 1, Albuquerque, NM 87131, United States of America. Electronic address: KWagner@salud.unm.edu.
11Prisma Health/Clemson University, Department of Medicine, Prisma Health Greenville Memorial Hospital, Medical Support Tower, 5th Floor, 701 Grove Rd., Greenville, SC 29695, United States of America. Electronic address: Alain.Litwin@prismahealth.org.
Abstract
Introduction: Increasingly, people who inject drugs (PWID) infected with hepatitis C virus (HCV) are gaining access to highly effective direct-acting antiviral agents (DAAs). Although past studies examined patient experiences with interferon-based treatments, few have explored patient experiences with these new generation therapeutics. Research and real world experience indicate that many PWID can be successfully treated with the new DAAs. Yet a substantial minority fail to complete treatment or achieve only suboptimal adherence. This qualitative study examines experiences with treatment among participants in Project HERO, a large multisite trial designed to compare treatment delivery methods for DAAs. We explored treatment experiences among HERO participants, with the goal of understanding potential barriers to treatment engagement and completion.
Methods: We conducted qualitative interviews with a sample of 21 participants, including 14 who completed HCV treatment and 7 participants who discontinued treatment before the end of the 12-week medication course. The first phase of the analysis was descriptive, examining participants' life experiences, histories of disease and treatment seeking, experiences with the program, and barriers to treatment completion. The second phase of the analysis examined differences between completers and noncompleters.
Results: Participants offered a variety of reasons for seeking treatment. Both groups of participants reported highly positive experiences of the HERO trial. Participants described research staff as caring, respectful, and nonjudgmental. Substance use was reported by both groups, yet completers described "manageable" substance use, while noncompleters described substance use that sapped their energy and motivation. Shame over drug use was a barrier to treatment completion. Homelessness and a reported lack of social support were much more common in the noncompleter group.
Conclusions: Reasons for noncompletion were not related to features of the clinical trial or treatment program. Our results indicate the importance of: 1) recognizing and addressing severe social and economic challenges such as homelessness; and 2) building a program culture of respect and compassion in treatment programs for PWID infected with HCV.