Understanding reinfection risk of Hepatitis C in people who inject drugs: A Qualitative Study

Abstract

Background: Given the ambition of the World Health Organisation (WHO) to eliminate Hepatitis C (HCV) as a public health concern by 2030, clarity on the factors contributing towards the reinfection of HCV in people who inject drugs (PWID) need better understood. In 2018, NHS Tayside implemented the ADVANCE trial which found no significant differences in the efficacy of Direct Acting Anti-Viral (DAA) treatment in curing HCV in PWID when different treatment regimens were compared: (1) directly observed therapy; (2) fortnightly dispensed and (3) fortnightly dispensed with a psychological intervention. Despite NHS Tayside diagnosing 90% of PWID with HCV and initiating treatment in 92% of these, there are still cases of reinfection following a successful cure. The objective of this study was to gain an improved understanding of the psycho-social factors associated with the reinfection of HCV in patients who participated in the ADVANCE trial.

Methods: Semi-structured interviews were conducted with 6 patients who had received HCV treatment via the ADVANCE trial. All patients self-reported as having no further HCV infections following their cure. To further develop the grounded theory and to obtain some comparative data between those who do and do not become reinfected, 6 healthcare staff were recruited to offer their experience in supporting those who do become reinfected. A constructivist grounded theory methodology was used to analyse the data.

Results: The core category of “Identity Shift” was developed. The identity shift which occurs can be explained through five theoretical categories: (1) Good Healthcare Relationships; (2) Re-establishing Place in Society; (3) Hierarchy of Substance Use; (4) Shifting Locus of Control and; (5) Socially Responsible Patient.

Conclusion: The positive identity shifts which occur in this study are thought to be protective of HCV reinfection. The findings of the study also provide evidence that DAA treatment can support patients to achieve non-clinical outcomes and Sustained Virologic Response (SVR), despite concerns around the impact that a less intensive treatment regimen would have. Providing longer-term clinical care to patients also appears to be important in maintaining HCV cure and a recovery orientated identity.