Abstract:
BACKGROUND : Treatment of hepatitis C (HCV) among people who inject drugs (PWID) is a critical component of
efforts to eliminate viral hepatitis. A recent study found high HCV prevalence among PWID in two cities, Pretoria
(84%) and Cape Town (44%). Very few (< 5%) HCV-infected individuals attended follow-up appointments. This substudy
explores differences between stated desire for cure and appointment attendance in light of perceived
facilitators and barriers to HCV treatment and care access among PWID.
METHOD : Two sets of semi-structured interviews were implemented in a group of HCV-infected participants
opportunistically sampled and recruited at harm reduction service sites. Initial interviews, conducted before the
planned hospital appointment date, asked participants (N = 17, 9 in Pretoria and 8 in Cape Town) about past
experiences of healthcare provision, plans to attend their referral appointment and perceived barriers and
facilitators to seeking hepatitis treatment. Second interviews (n = 9, 4 in Pretoria, 5 in Cape Town), conducted after
the planned referral appointment date, asked about appointment attendance and treatment experience. Trained
social scientists with experience with PWID conducted the interviews which were recorded in detailed written
notes. Data was thematically analysed in NVivo 11.
RESULTS : Despite routine experiences of being stigmatised by the healthcare system in the past, most participants
(n = 16, 94%) indicated a desire to attend their appointments. Attendance motivators included the desire to be
cured, fear of dying and the wish to assist the research project. Perceived barriers to appointment attendance
included fear of again experiencing stigmatisation and concerns about waiting periods and drug withdrawal.
Perceived facilitators included the knowledge they would be treated quickly, and with respect and access to opioid
substitution therapy. In the end, very few participants (n = 5) went to their appointment. Actual barriers to
attendance included lack of finances, lack of urgency and forgetting and fatalism about dying.
CONCLUSIONS : South Africa can learn from other countries implementing HCV treatment for PWID. Successful linkage
to care will require accessible, sensitive services where waiting time is limited. Psychosocial support prior to
initiating referrals that focuses on building and maintaining a sense of self-worth and emphasising that delayed
treatment hampers health outcomes is needed.
