Theme: Social Science & Policy Research Year: 2024
Background: Hepatitis C (HCV) disproportionately affects people who inject drugs (PWID). Despite availability of safe and effective treatment, HCV treatment access and uptake among PWID in low- and middle-income countries (LMICs) has been limited. Understanding the lived experiences of PWID who have undergone treatment in these settings offers insight into how to implement treatment programs that best meet the needs of this population.
Methods: We conducted in-depth semi-structured interviews from August to September 2019 with 35 PWID (Nairobi N=12 and Coast N=23) who received HCV treatment in Kenyan methadone clinics and drop-in centres (DICs). All the interviews were recorded and then transcribed in Swahili before being translated into English. Translated and transcribed interviews were coded for emerging themes by four coders.
Results: Three overarching themes emerged in our thematic analysis: 1) Financial constraints as a barrier to HCV treatment, “Sometimes I lacked the fare and sometimes I used to feel so hungry that I could not take the medication;” 2) HCV-related stigma, “Initially people used to say this disease is only prevalent among the drug users.. when we got the treatment slowly people started trusting us;” and 3) HCV treatment impacts on health and risk behaviours, “You know when I started treatment I stopped using drugs and I was told that sex is one mode of transmission and I started using condoms frequently not like before.” Despite these barriers, treatment provided at no cost through our study and peer support emerged as facilitators to treatment as evidenced by high uptake and adherence to treatment completion.
Conclusion: These data signal unique challenges faced by PWID seeking HCV treatment in LMIC setting and highlight the importance of interventions to reduce barriers to treatment. Sustainable and impactful HCV treatment programs must address the barriers patients face at multiple levels and implement system-level changes.