Being asymptomatic led people to ignore their diagnosis and
not to engage with medical care for hepatitis C, and interviewees said that
they received little information about the impact of hepatitis C on their
health or the likely progression of liver disease.
People deferred treatment for a long time due to lack of
symptoms, but other commitments also kept people from engaging with the idea of
treatment. Work, pregnancy and childrearing claimed the attention of interviewees,
as did less specific anxieties about the time not being right to undertake a
course of treatment.
Interviewees were also put off seeking treatment by advice
from healthcare providers to wait for new drugs or confused about whether they
were eligible for treatment if they continued injecting drugs.
Long-term injectors with many damaged veins saw difficulties
in undergoing a course of treatment that might entail numerous blood samples.
“The big barrier for me is that no one can get blood out of
me, I’ve just got no veins and I mean this has been problem for the last 10 or
so years,” said a 64-year-old woman. “
Several interviewees commented unfavourably on the
competence of healthcare workers who drew blood. “It’s just quicker too and
less painful if I can do it,” said another woman, aged 42 years. Self-sampling
and the use of dried blood spots to collect samples were seen by some interviewees
as important tools for achieving higher rates of diagnosis and treatment uptake
among long-term injectors. (Taking blood for diagnosis and HCV viral load
testing at the same visit needs more attention, say the study investigators.)
Despite a push for treatment of hepatitis C through primary
care in Australia, some primary care physicians caring for people who use drugs
had told interviewees to seek specialist hepatitis care if they wanted DAA
treatment. Primary care physicians had shown little inclination to carry out
regular monitoring in their patients with hepatitis C and interviewees reported
that few primary care physicians were taking the opportunity to prescribe DAAs.
For some, the numerous competing demands of managing opioid
substitution therapy, co-morbid conditions, childcare and mental health
conditions made it difficult to access DAA treatment or to travel to healthcare
facilities where it was available. Intermediary services that can help to
connect people to treatment – for example, by providing transport – are needed,
the study investigators recommend.
Finding non-stigmatising and accepting healthcare workers
also represented a barrier to care. Many interviewees had internalised
stigmatising messages from healthcare workers and others. They felt that
physicians considered treating people who inject drugs “a waste of time” and
that they would be denied re-treatment if they became reinfected.
Interviewees agreed that information on where to access
non-stigmatising services that provide DAA treatment would encourage people to
The researchers say that to increase treatment uptake,
countries like Australia need to look simultaneously at patient and provider
barriers to treatment, as well as systemic obstacles, and need to acknowledge
past deficits in care to address distrust of the health system and healthcare
providers. Community and primary care barriers need attention alongside
barriers in specialist liver care.
“Efforts to increase DAA treatment uptake must reduce stigma
and discrimination as a central precept to any effective response,” they