Theme: Epidemiology & Public Health Research Year: 2019
Background: In San Francisco (SF), an estimated 67.9% of the approximately 12,000 people with viremic
HCV are people who inject drugs (PWID); almost one of every two PWID in SF lives with HCV. Despite the
advent of direct acting antivirals (DAAs), PWID have low treatment uptake. In 2018 only 1/3 of SF-based
PWID with self-reported HCV reported accessing treatment. This qualitative study aims to identify
barriers and facilitators of two HCV treatment models.
Methods: We qualitatively interviewed 30 participants enrolled in a randomized-controlled trial to test
two medication delivery models (directly observed therapy (DOT) and unobserved dosing) in SF from
2015-2017. Interviews were audio-recorded and transcribed verbatim. Using thematic content analysis,
two analysts developed a codebook and subsequently coded the interviews using a priori and
inductively generated codes.
Results: Participants were largely male (81%), White (74%), with a mean age of 42. Nearly half the
participants reported daily injection drug use in the past 30 days (45%) and had a mean of 6 (SD 15)
injection partners. Nearly all study visits were attended (89.4% DOT and 96.4% unobserved) and HCV
was undetectable for 96.8% at end of treatment and 89.7% 12 weeks after treatment, with no
differences by arm. There were no differences in reported facilitators or barriers between to the
treatment arms. Two thematic categories emerged related to treatment facilitators: logistical support
(financial incentives, routines, and reminders) and emotional support (community support, staff
engagement and personal empowerment). Identifying barriers to treatment engagement was
challenging for participants; the primary two barriers were chaotic lifestyles and conflicting obligations.
Conclusions: There was a high rate of visit attendance in this study and participants identified a number
of facilitators to support their treatment engagement. Providers should consider these logistical and
emotional facilitators when integrating DAA HCV treatment into clinical practice.
Disclosure of Interest: none