Need For Decentralization and Task-Shifting of Hepatitis C (HCV) Services With a Non-Judgemental Approach for People who Inject Drugs: Results From a Global Values and Preferences Survey

Author: Marion Di Ciaccio Virginie Villes Cary James Daniela Rojas Castro Philippa Easterbrook Rosemary Delabre

Theme: Social Science & Policy Research Year: 2022

Background: The values and preferences of people who inject drugs are essential for developing
and/or adapting HCV service delivery to meet their specific needs. The objective of this analysis is to
identify specific needs and preferences among people who inject drugs.
Methods: A multi-country, anonymous, self-administered online survey was conducted in 2021. The
survey was developed by Coalition PLUS and the World Hepatitis Alliance in partnership with the WHO
and distributed via civil society email networks, social media, and mailing lists. Information concerning
preferences for simplifying HCV care, and test and treat locations, were collected among people living
with or affected by HCV. Chi-2 tests were used to compare respondents who had a history of injecting
drug use to other respondents.
Results: Among 202 respondents, 62 (30.7%) formerly or currently injected drugs. Compared to other
respondents, respondents who formerly or current injected drugs were older (median [IQR]: 48 [36-
57] vs. 39 [31-51] years, p=0.003), were more likely to have been tested for HCV (90.2% vs. 64.3%,
p=0.001) and were more likely to prefer testing in a community-based center (CBC) (55.4% vs. 33.3%,
p=0.005) or in a drug user support center (DUSC) (50.0 vs. 9.8%, p<0.001). Their most important
considerations regarding testing locations (see figure) were the non-judgemental atmosphere
(p<0.001), anonymity (p=0.018) and community worker (CW) presence (p<0.001). They would like to
receive HCV treatment in a CBC (63.0% vs. 44.8%, p=0.028) or in a DUSC (46.3 vs. 9.5%, p<0.001). and
their most considerations regarding treatment locations (see figure) were the non-stigmatizing/nonjudgemental approach (p<0.001) and the presence of community-friendly medical personnel or CW
(p=0.016 and p=0.002).
Conclusion: People who currently/formerly inject drugs showed specific needs concerning HCV
services. Decentralization, task-shifting, and a non-judgemental approach are important elements to
the development of adapted services to increase HCV care in this population.
Disclosure of Interest Statement:
All authors must declare any conflict of interest.

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