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      Using an intersectionality lens to explore barriers and enablers to hepatitis C point-of-care testing: a qualitative study among people who inject drugs and service providers


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          Hepatitis C virus (HCV) infection is a significant global health burden, particularly among people who inject drugs. Rapid point-of-care HCV testing has emerged as a promising approach to improve HCV detection and linkage to care in harm reduction organizations such as needle and syringe programs. The objective of this study was to use an intersectionality lens to explore the barriers and enablers to point-of-care HCV testing in a needle and syringe program.


          A qualitative study was conducted using semi-structured interviews with clients (people who inject drugs) and service providers in a large community organization focused on the prevention of sexually transmitted and blood borne infections and harm reduction in Montreal, Canada. An intersectionality lens was used alongside the Theoretical Domains Framework to guide the formulation of research questions as well as data collection, analysis, and interpretation.


          We interviewed 27 participants (15 clients, 12 providers). For clients, four themes emerged: (1) understanding and perceptions of HCV testing, (2) the role of an accessible and inclusive environment, (3) the interplay of emotions and motivations in decision-making, and (4) the impact of intersectional stigma related to HCV, behaviors, and identities. For providers, five themes emerged: (1) knowledge, skills, and confidence for HCV testing, (2) professional roles and their intersection with identity and lived experience, (3) resources and integration of services, (4) social and emotional factors, and (5) behavioral regulation and incentives for HCV testing. Intersectional stigma amplified access, emotional and informational barriers to HCV care for clients. In contrast, identity and lived experience acted as powerful enablers for providers in the provision of HCV care.


          The application of an intersectionality lens provides a nuanced understanding of multilevel barriers and enablers to point-of-care HCV testing. Findings underscore the need for tailored strategies that address stigma, improve provider roles and communication, and foster an inclusive environment for equitable HCV care. Using an intersectionality lens in implementation research can offer valuable insights, guiding the design of equity-focused implementation strategies.

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          Most cited references52

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          Mapping the Margins: Intersectionality, Identity Politics, and Violence against Women of Color

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            The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions.

            CONSORT guidelines call for precise reporting of behavior change interventions: we need rigorous methods of characterizing active content of interventions with precision and specificity. The objective of this study is to develop an extensive, consensually agreed hierarchically structured taxonomy of techniques [behavior change techniques (BCTs)] used in behavior change interventions. In a Delphi-type exercise, 14 experts rated labels and definitions of 124 BCTs from six published classification systems. Another 18 experts grouped BCTs according to similarity of active ingredients in an open-sort task. Inter-rater agreement amongst six researchers coding 85 intervention descriptions by BCTs was assessed. This resulted in 93 BCTs clustered into 16 groups. Of the 26 BCTs occurring at least five times, 23 had adjusted kappas of 0.60 or above. "BCT taxonomy v1," an extensive taxonomy of 93 consensually agreed, distinct BCTs, offers a step change as a method for specifying interventions, but we anticipate further development and evaluation based on international, interdisciplinary consensus.
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              A refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project

              Background Identifying, developing, and testing implementation strategies are important goals of implementation science. However, these efforts have been complicated by the use of inconsistent language and inadequate descriptions of implementation strategies in the literature. The Expert Recommendations for Implementing Change (ERIC) study aimed to refine a published compilation of implementation strategy terms and definitions by systematically gathering input from a wide range of stakeholders with expertise in implementation science and clinical practice. Methods Purposive sampling was used to recruit a panel of experts in implementation and clinical practice who engaged in three rounds of a modified Delphi process to generate consensus on implementation strategies and definitions. The first and second rounds involved Web-based surveys soliciting comments on implementation strategy terms and definitions. After each round, iterative refinements were made based upon participant feedback. The third round involved a live polling and consensus process via a Web-based platform and conference call. Results Participants identified substantial concerns with 31% of the terms and/or definitions and suggested five additional strategies. Seventy-five percent of definitions from the originally published compilation of strategies were retained after voting. Ultimately, the expert panel reached consensus on a final compilation of 73 implementation strategies. Conclusions This research advances the field by improving the conceptual clarity, relevance, and comprehensiveness of implementation strategies that can be used in isolation or combination in implementation research and practice. Future phases of ERIC will focus on developing conceptually distinct categories of strategies as well as ratings for each strategy’s importance and feasibility. Next, the expert panel will recommend multifaceted strategies for hypothetical yet real-world scenarios that vary by sites’ endorsement of evidence-based programs and practices and the strength of contextual supports that surround the effort. Electronic supplementary material The online version of this article (doi:10.1186/s13012-015-0209-1) contains supplementary material, which is available to authorized users.

                Author and article information

                Int J Equity Health
                Int J Equity Health
                International Journal for Equity in Health
                BioMed Central (London )
                17 June 2024
                17 June 2024
                : 23
                : 124
                [1 ]Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, ( https://ror.org/05jtef216) 501 Smyth Road, Ottawa, ON K1H 8L6 Canada
                [2 ]Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, ( https://ror.org/01pxwe438) 680 Rue Sherbrooke O #1800, Montréal, QC H3A 2M7 Canada
                [3 ]Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Sir Mortimer B. Davis Jewish General Hospital, CIUSSS West-Central Montreal, 3755 Chem. de La Côte-Sainte-Catherine, ( https://ror.org/056jjra10) Montréal, QC H3T 1E2 Canada
                [4 ]Viral Hepatitis Clinical Research Program, Kirby Institute, UNSW Sydney, UNSW, ( https://ror.org/03r8z3t63) Wallace Wurth Building (C27), Cnr High St & Botany St, Kensington, NSW 2052 Australia
                [5 ]School of Epidemiology and Public Health, University of Ottawa, ( https://ror.org/03c4mmv16) 600 Peter Morand Crescent, Ottawa, ON K1G 5Z3 Canada
                [6 ]School of Psychology, University of Ottawa, ( https://ror.org/03c4mmv16) 136 Jean-Jacques Lussier, Vanier Hall, Ottawa, ON K1N 6N5 Canada
                [7 ]Research Centre, Université de Montréal Hospital Centre, ( https://ror.org/0410a8y51) 900 Saint Denis St, Montreal, QC H2X 0A9 Canada
                [8 ]Department of Family and Emergency Medicine, Université de Montréal, ( https://ror.org/0161xgx34) 2900, Boulevard Édouard-Montpetit, Montréal, QC H3T 1J4 Canada
                [9 ]School of Rehabilitation Therapy, Queen’s University, ( https://ror.org/02y72wh86) Louise D Acton Building, 31 George St, Kingston, ON K7L 3N6 Canada
                [10 ]Direction of Community Services, CACTUS Montréal, 1300 Rue Sanguinet, Montréal, QC H2X 3E7 Canada
                [11 ]Department of Medicine, University of Ottawa, ( https://ror.org/03c4mmv16) 45 Smyth Road, Ottawa, ON K1H8M5 Canada
                © The Author(s) 2024

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                : 23 April 2024
                : 31 May 2024
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                © BioMed Central Ltd., part of Springer Nature 2024

                Health & Social care
                people who inject drugs,intersectionality,harm reduction,needle and syringe program,hepatitis c,implementation science,point-of-care testing,qualitative research


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