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Barriers and enablers to testing for hepatitis C virus infection in people who inject drugs
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The literature search resulted in 1554 citations and ultimately nine studies were included. Common barriers included
• self-perception of low risk for HCV,
• fear of diagnosis,
• stigma associated with IV drug use and HCV,
• antipathy in relation to mainstream health care services,
• limited knowledge about HCV,
• lack of rapport with provider,
• lack of motivation or competing priority of drug use,
• and limited awareness of new treatment options.
Common enablers to testing included increasing awareness of HCV testing and treatment and providing positive narratives around HCV care, positive rapport with provider, accessible testing options and individualized care.
Injection drug use is the primary mode of transmission of HCV infection in the developed world and guidelines recommend screening individuals with current or history of injection drug use for HCV [4]; however, the percentage of people who inject drugs (PWID) who are unaware of their HCV infection in Canada has been reported to be as high as 70% [5]. The low level of HCV status awareness suggests that screening in this population is not effective with current strategies.
There have been major advancements in the treatment of HCV in the past decade with the introduction of direct-acting antiviral (DAA) therapies [6] which are more effective, safe, and better tolerated, leading to increased cure rates of HCV infection [7]. If people are unaware of their HCV infection and thus not linked to care, they will not be able to realize the advantages of these agents. Treatment prevents disease progression, limits future morbidity and mortality and prevents cirrhosis, liver transplantations and liver cancer [8], but people would need to be aware of their infection to be linked to care. Understanding their barriers to testing is necessary to inform development of engaging testing options for PWID. This is the first step in improving health outcomes, as well as decreasing transmission and achieving viral eradication.
This qualitative scoping review aimed to determine the barriers and enablers and experiences of PWID with regards to HCV testing. This knowledge could help guide the design of an HCV testing strategy that would engage PWID and increase HCV awareness and linkage to care.
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