Peers are important sources of information about hepatitis C
treatment and may be the most persuasive advocates for engaging with treatment
and care among drug users, a study in Melbourne, Australia, shows.
People who inject drugs have a high prevalence of hepatitis
C but may be less engaged with specialist hepatitis C care. Improving
engagement with medical care is an important first step towards curing
hepatitis C in people who inject drugs and the Australian research suggests
that peer networks are highly influential for information gathering and
decision-making about treatment among drug users.
The findings come from an interview study that formed part
of the Treatment and Prevention study in Melbourne. The study investigated the
uptake and outcomes of a community-based nurse-led model of hepatitis C
treatment in people who inject drugs.
The Treatment and Prevention study recruited people who had
injected drugs within the previous six months and people who joined the study
were encouraged to recruit up to three other drug users to the study.
The qualitative study of peer networks embedded within the
larger study interviewed 20 Treatment and Prevention study participants during
and after direct-acting antiviral treatment between 2017 and 2019. Participants
were asked about motivations for treatment, perceptions of treatment, sources of
information about treatment and personal networks.
Participants were also
asked “What kinds of things have you told people
about starting/being on/finishing treatment?”.
Although interviewees received information about treatment
from healthcare providers, they agreed that peers were their most important source
of information. One participant said, prior to starting treatment:
“I reckon it's better to hear back from the
horse's mouth rather than someone who is just promoting it and they don't care
what they give you and they don't care how much they give you. So you're better
off hearing it from a person that's done it, because then they know exactly.”
Although
most respondents perceived doctors to be giving accurate information, there was
a need to fill in the gaps and compare notes with peers. Messages designed to
emphasise the tolerability and convenience of treatment were less persuasive
than accounts of the lived experience of taking medication and being cured that
came from trusted peers, the researchers found.
These
messages were especially important when they came from close peers. Observing
successful completion of treatment in people who were actively injecting was
also important. “If this bloke can do it, I'll be able to do it easy”, reasoned
one participant.
Peers were also judged as important as
treatment supporters. “For example, me and my brother do it together so if I
forget about it that day he'll remember and vice
versa and yeah it's good like that,” one man
said. Peers on treatment at the same time shared information about side effects,
offering reassurance and support.
Starting treatment together was judged
especially important in intimate relationships and the authors suggest that
physicians should ask about close peers who may be ready to start treatment too
when discussing treatment initiation with patients.
Interviewees also discussed their own experience
of treatment and how it led them to become advocates of treatment to their
peers. All became more enthusiastic about treatment after their own experience
and moved from cautious advocacy to stronger recommendation. Most participants
expressed a need to pass on information about how they had benefitted from
treatment.
Some participants
felt it was important to stress to peers that they needed to be ready to start
treatment – “give yourself the best chance at like
completing it”, as one participant put it. Readiness of peers to avoid
reinfection was viewed as an important marker of treatment preparedness.
“People who inject drugs are proactive
agents in supporting their peers and hepatitis C elimination efforts,” the authors
conclude. They say that more research is needed into the roles of people who
inject drugs as treatment advocates and the types of interventions that can promote
hepatitis C elimination by building on the supportive characteristics of drug
user networks.