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Peers of drug users play key roles in hepatitis C treatment decision-making

Keith Alcorn
04 November 2020

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.


Goutzamanis S et al. Peer to peer communication about hepatitis C treatment amongst people who inject drugs: A longitudinal qualitative study. International Journal of Drug Policy, 87, 2021 (advance online publication).