Theme: Epidemiology & Public Health Research Year: 2019
Background: Hepatitis C (HCV)-related deaths and infections are increasing in the US, with more than
80% of acute HCV cases among people who inject drugs (PWID). It is critical to involve PWID in the
development of HCV programs.
Methods: As part of a larger project involving three harm reduction organizations across the US, the
North Carolina Urban Survivors Union (NC-USU) in Greensboro, NC and People’s Harm Reduction
Alliance (PHRA) in Seattle, WA conducted formative research with PWID to inform development of our
HCV programs. In 2017, NC-USU performed three focus groups with PWID, including women and
stimulant users, and PHRA conducted 20 in-depth interviews (11 HCV+, 9 HCV-). Focus group transcripts
and interview notes were reviewed for salient themes. Focus groups and surveys are ongoing for
program evaluation.
Results: We identified several provider and patient-level barriers for seeking HCV testing and treatment
among PWID. Across all NC-USU focus groups, there was confusion about HCV transmission and
treatment options. Participants reported barriers related to lack of insurance and employment. Female
participants with children feared problems with social services. Less than half of PHRA interviewees who
had HCV had asked their doctors about treatment. The main barrier was that doctors required sobriety
or housing prior to initiating treatment, which is inconsistent with WA treatment guidelines.
Conclusion: Several system and individual-level barriers for HCV treatment exist among PWID. Our
programs aim to support PWID in overcoming these barriers, including helping obtain insurance
coverage and case management. Although barriers were similar across participants, different state
policies require that approaches respond to local context. In WA we have identified providers who
follow guidelines to treat all PWID; sobriety restrictions should be lifted in NC. We perform ongoing
evaluations of our HCV programs to ensure they are responsive to the needs of PWID.
Disclosure of Interest: We received funding from Gilead Sciences for the work described in this abstract.