Exploring how hospitalization can alter hepatitis c virus treatment prioritization and trajectories in people who use drugs: A qualitative analysis

Abstract

Background: People who use drugs (PWUD) have high rates of hepatitis C virus (HCV) infection. Hospitalization can be a time for PWUD to engage in addiction treatment, but little is known about how hospitalization shapes HCV treatment readiness. We aimed to describe how hospitalization and addiction medicine consult service (AMCS) can alter HCV prioritization of inpatient PWUD with HCV. Methods: We conducted a qualitative study consisting of semi-structured interviews (n = 27) of hospitalized adults with addiction and HCV infection seen by an AMCS at a single, urban, academic center. Interviews were audio-recorded, transcribed, and coded iteratively at the semantic level, and analyzed for themes. Results: Of the 27 participants, most identified as Caucasian (85%), male gender (67%), and they primarily used opioids (78%); approximately half (48%) reported HCV diagnosis over 5 years ago. We identified three main themes around hospitalization altering the prioritizations and HCV treatment preferences for PWUD: (1) HCV treatment non-engaged (2) HCV treatment urgency, and (3) HCV treatment in the future. Those wanting to treat HCV—whether urgently or in the future—shared the overlapping theme of hospitalization as a reachable moment for their addiction and HCV. These participants recognized the long-term benefits of addressing HCV and connected their hospitalization to substance use. Conclusion: In our study, PWUD with HCV expressed varying and competing priorities and life circumstances contributing to three main HCV treatment trajectories. Our results suggest ways hospitalization can serve as an HCV touchpoint for PWUD, especially in the context of addressing substance use, and could be used when designing and implementing targeted interventions to improve the HCV care continuum for PWUD.

Keywords:

• Substance-related disorders
• hepatitis C
• addiction medicine
• qualitative research
• hospitalization

Acknowledgments

We would like to thank Drs. Chinazo Cunningham, L. Kris Gowen, Elizabeth Haney, Lisa Marriott, Christina Nicolaidis, Anais Tuepker, and Adrienne Zell for their thoughtful feedback and guidance.

Disclosure statement

Dr. Andrew Seaman has received investigator-initiated research funding from Gilead and Merck pharmaceuticals not directly related to the conduct of this research. All other authors have no conflict of interests.

Additional information

Funding

The work was funded by the Research in Addiction Medicine Scholars Program [NIDA R25DA033211]. XAL completed this work as part of her Samuel H. Wise General Internal Medicine Fellowship. TAV was supported by the Oregon Clinical and Translational Research Institute (OCTRI) grant [TL1 TR002371] from the National Center for Advancing Translational Sciences. PTK and AS received support through NIH awards [UH3DA044831 and UG1DA015815]. Data management supported by OCTRI grant [UL1TR002369]. Funders had no role in study design, data collection, analysis, decision to publish, or preparation of manuscript.