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      Evidence-based and guideline-concurrent responses to narratives deferring HCV treatment among people who inject drugs

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          Abstract

          Background

          Hepatitis C virus (HCV) infection is increasingly prevalent among people who inject drugs (PWID) in the context of the current US opioid crisis. Although curative therapy is available and recommended as a public health strategy, few PWID have been treated. We explore PWID narratives that explain why they have not sought HCV treatment or decided against starting it. We then compare these narratives to evidence-based and guideline-concordant information to better enable health, social service, harm reduction providers, PWID, and other stakeholders to dispel misconceptions and improve HCV treatment uptake in this vulnerable population.

          Methods

          We recruited HIV-uninfected PWID ( n = 33) through community-based organizations (CBOs) to participate in semi-structured, in-depth qualitative interviews on topics related to overall health, access to care, and knowledge and interest in specific HIV prevention methods.

          Results

          In interviews, HCV transmission and delaying or forgoing HCV treatment emerged as important themes. We identified three predominant narratives relating to delaying or deferring HCV treatment among PWID: (1) lacking concern about HCV being serious or urgent enough to require treatment, (2) recognizing the importance of treatment but nevertheless deciding to delay treatment, and (3) perceiving that clinicians and insurance companies recommend that patients who currently use or inject drugs should delay treatment.

          Conclusions

          Our findings highlight persistent beliefs among PWID that hinder HCV treatment utilization. Given the strong evidence that treatment improves individual health regardless of substance use status while also decreasing HCV transmission in the population, efforts are urgently needed to counter the predominant narratives identified in our study. We provide evidence-based, guideline-adherent information that counters the identified narratives in order to help individuals working with PWID to motivate and facilitate treatment access and uptake. An important strategy to improve HCV treatment initiation among PWID could involve disseminating guideline-concordant counternarratives to PWID and the providers who work with and are trusted by this population.

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          Most cited references37

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          Developing and Using a Codebook for the Analysis of Interview Data: An Example from a Professional Development Research Project

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            Increases in Acute Hepatitis C Virus Infection Related to a Growing Opioid Epidemic and Associated Injection Drug Use, United States, 2004 to 2014

            To compare US trends in rates of injection drug use (IDU), specifically opioid injection, with national trends in the incidence of acute HCV infection to assess whether these events correlated over time.
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              Treatment of hepatitis C: a systematic review.

              Hepatitis C virus (HCV) infects more than 185 million individuals worldwide. Twenty percent of patients chronically infected with HCV progress to cirrhosis. New, simpler therapeutics using direct-acting antivirals that target various stages of the HCV life cycle are in development to eradicate HCV without concomitant interferon.
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                Author and article information

                Contributors
                617-414-1355 , abazzi@bu.edu
                Journal
                Harm Reduct J
                Harm Reduct J
                Harm Reduction Journal
                BioMed Central (London )
                1477-7517
                11 February 2019
                11 February 2019
                2019
                : 16
                : 14
                Affiliations
                [1 ]ISNI 0000 0004 1936 7558, GRID grid.189504.1, Department of Health Law, Policy and Management, , Boston University School of Public Health, ; Boston, MA USA
                [2 ]ISNI 0000 0004 0367 5222, GRID grid.475010.7, Section of Infectious Diseases, Department of Medicine, , Boston University School of Medicine, ; Boston, MA USA
                [3 ]ISNI 0000 0004 1936 9094, GRID grid.40263.33, Center for Health Equity Research, , Brown University School of Public Health, ; Providence, RI USA
                [4 ]ISNI 0000 0004 1936 9094, GRID grid.40263.33, Departments of Behavioral and Social Health Sciences and Epidemiology, , Brown University School of Public Health, ; Providence, RI USA
                [5 ]ISNI 0000 0004 0457 1396, GRID grid.245849.6, The Fenway Institute, , Fenway Health, ; Boston, MA USA
                [6 ]ISNI 0000 0004 0367 5222, GRID grid.475010.7, Evans Center for Implementation and Improvement Sciences, , Boston University School of Medicine, ; Boston, MA USA
                [7 ]ISNI 0000 0001 0626 1381, GRID grid.414326.6, Center for Healthcare Organization and Implementation Research, , Edith Nourse Rogers Memorial Veterans Hospital, ; Bedford, MA USA
                [8 ]ISNI 0000 0004 1936 9094, GRID grid.40263.33, Department of Psychiatry and Human Behavior, , Brown University Alpert Medical School, ; Providence, RI USA
                [9 ]ISNI 0000 0004 1936 7558, GRID grid.189504.1, Department of Community Health Sciences, , Boston University School of Public Health, ; 801 Massachusetts Ave, 442e, Boston, MA 02118 USA
                Author information
                http://orcid.org/0000-0001-6828-1919
                Article
                286
                10.1186/s12954-019-0286-6
                6371610
                30744628
                67f6a539-4aaf-41fe-8755-1a48c8c96d31
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. 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.

                History
                : 8 January 2019
                : 30 January 2019
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100000026, National Institute on Drug Abuse;
                Award ID: K23DA044085
                Award ID: K01DA043412
                Award Recipient :
                Categories
                Research
                Custom metadata
                © The Author(s) 2019

                Health & Social care
                hcv infections,substance abuse,intravenous,risk factors
                Health & Social care
                hcv infections, substance abuse, intravenous, risk factors

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