Theme: Social Science & Policy Research Year: 2024
Background: Hepatitis C treatment uptake is lower among people who are homeless or unstably housed compared to those who are housed, including in Australia. Understanding and addressing this is essential to ensure no one is left behind in hepatitis C elimination efforts. Using a case study approach, we aimed to explore in detail peoples’ experiences of unstable housing and healthcare, and how these experiences influenced engagement in hepatitis C treatment.
Methods: Purposeful sampling was used to recruit people with lived experience of injection drug use, hepatitis C and unstable housing in Melbourne, Australia. In-depth semi-structured interviews were conducted, and a case-study approach with interpretative phenomenological analysis was used to identify personal experiential themes and group experiential themes.
Results: Four people were interviewed; all reported current injection drug use and self-identified as being ‘stably housed’ at the time of interview. Three had a recent history of rough sleeping and two were currently living with active HCV at the time of interview; one had been treated and reinfected twice while the other had not been able to engage in treatment because of other health issues. The precarious nature of housing for women who inject drugs was a group experiential theme. Other group experiential themes included ‘right place, right time, right people’ with these three elements required to facilitate hepatitis C treatment and ‘cycles of housing and harm reduction’ as all participants reported substantial challenges maintaining engagement in opioid agonist treatment while unstably housed.
Conclusion: To ensure people who are homeless and unstably housed are not left behind in hepatitis C elimination efforts, our research suggests a need to move beyond a ‘one size fits-all’ approach to hepatitis C care and an expansion of testing and treatment beyond harm reduction services. Instead, care should be tailored to the needs of individuals and their personal circumstances. This includes giving greater attention to gender in intervention design and evaluation.
Disclosure of Interest Statement
The cohort study from which these people were recruited is funded by the Australian National Health and Medical Research Council. There was no specific funding for this research project.