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Harm Reduct J. 2019 Feb 11;16(1):14. doi: 10.1186/s12954-019-0286-6.

Evidence-based and guideline-concurrent responses to narratives deferring HCV treatment among people who inject drugs.

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Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA.
Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.
Center for Health Equity Research, Brown University School of Public Health, Providence, RI, USA.
Departments of Behavioral and Social Health Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA.
The Fenway Institute, Fenway Health, Boston, MA, USA.
Evans Center for Implementation and Improvement Sciences, Boston University School of Medicine, Boston, MA, USA.
Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA.
Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI, USA.
Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Ave, 442e, Boston, MA, 02118, USA.



Hepatitis C virus (HCV) infection is increasingly prevalent among people who inject drugs (PWID) in the context of the current US opioid crisis. Although curative therapy is available and recommended as a public health strategy, few PWID have been treated. We explore PWID narratives that explain why they have not sought HCV treatment or decided against starting it. We then compare these narratives to evidence-based and guideline-concordant information to better enable health, social service, harm reduction providers, PWID, and other stakeholders to dispel misconceptions and improve HCV treatment uptake in this vulnerable population.


We recruited HIV-uninfected PWID (nā€‰=ā€‰33) through community-based organizations (CBOs) to participate in semi-structured, in-depth qualitative interviews on topics related to overall health, access to care, and knowledge and interest in specific HIV prevention methods.


In interviews, HCV transmission and delaying or forgoing HCV treatment emerged as important themes. We identified three predominant narratives relating to delaying or deferring HCV treatment among PWID: (1) lacking concern about HCV being serious or urgent enough to require treatment, (2) recognizing the importance of treatment but nevertheless deciding to delay treatment, and (3) perceiving that clinicians and insurance companies recommend that patients who currently use or inject drugs should delay treatment.


Our findings highlight persistent beliefs among PWID that hinder HCV treatment utilization. Given the strong evidence that treatment improves individual health regardless of substance use status while also decreasing HCV transmission in the population, efforts are urgently needed to counter the predominant narratives identified in our study. We provide evidence-based, guideline-adherent information that counters the identified narratives in order to help individuals working with PWID to motivate and facilitate treatment access and uptake. An important strategy to improve HCV treatment initiation among PWID could involve disseminating guideline-concordant counternarratives to PWID and the providers who work with and are trusted by this population.


HCV infections; Intravenous; Risk factors; Substance abuse

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