“Treated Like a Human Being”: Perspectives of People Who Inject Drugs Attending Low-Threshold HCV Treatment at a Syringe Service Program in New York City.

Author: Shashi Kapadia Yesenia Aponte-Melendez Alicia Rodriguez Benjamin Eckhardt Chunki Fong Melinda Pai Kristen Marks Pedro Mateu-Gelabert

Theme: Social Science & Policy Research Year: 2022

Low-threshold hepatitis C virus (HCV) treatment models can effectively provide access to people
who inject drugs (PWID). Perspectives of PWID treated in low-threshold models can reveal program
features that address barriers to treatment, and guide implementation of similar models.
We conducted qualitative interviews with 29 participants enrolled in the intervention arm of a
randomized trial. The trial enrolled HCV-infected PWID in New York City from 2017-2020 and tested
the effectiveness of low-threshold HCV treatment at a syringe services program compared with
referral to specialist providers. Participants were purposively sampled for interviews to achieve
diversity in age, gender, and ethnicity. Interviews were conducted in English or Spanish. The
interview guide focused on prior experiences with HCV testing and treatment, and experiences
during the trial. Interviews were inductively coded using thematic analysis. Codes were used to
generate themes via discussion and consensus.
Before enrollment, participants reported often being tested for HCV in transient settings, such as
prison, inpatient drug treatment, and emergency rooms. Treatment was often not offered or
delayed because it was considered non-urgent. Participants reported stigma by health care
providers and other barriers, such as insurance, waiting lists, and incarceration. Treatment during
the trial was facilitated through feeling respected by caring staff, which overcame prior stigma. The
flexible care model (allowing for walk-ins and missed appointments) helped mitigate logistical
barriers. Finally, participants valued the willingness of the care team to address social determinants
of health, such as linking patients to housing services.
Findings highlight the need for low-threshold programs to emphasize nonjudgmental, low-stigma
behavior from program staff, and to maintain flexible care models to adapt to participants’ needs
and lifestyle. Social determinants of health such as loss of housing remain a significant barrier, but
programs’ efforts to address these factors can engender trust and facilitate treatment.
Disclosure of Interest Statement:
This work was funded by the National Institute on Drug Abuse (R01 DA041298 and K01 DA048172).
Dr Kapadia, Dr Eckhardt, Ms Pai and Dr Marks report research grants paid to their institution from
Gilead Sciences Inc for the study of hepatitis C, that were not related to the current study. Dr
Aponte-Melendez reports research grants from Abbvie for the study of hepatitis C, not related to the
current study.

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