Author: Coupland H, Pritchard-Jones J, Haber P, George J McCaughan G

Theme: Social Science & Policy Research Year: 2019

Background: Increasing uptake of direct-acting antiviral (DAA) treatment by people who inject drugs
(PWID) with chronic hepatitis C virus (HCV) infection is crucial for reaching global elimination targets
by 2030. Integration of hepatitis C and opioid agonist treatment (OAT) services has the potential to
facilitate linkage of PWID to HCV treatment and care. This presentation explores institutional factors
impacting on treatment uptake in hospital-based OAT settings and highlights effective strategies for
facilitating access to treatment for clients. In 2016-7 the clinics had rolled out DAA and 83 clients
were treated.
Methods: Thirty in-depth interview were conducted with clients (n=13) and staff (n=17) from two
hospital-based OAT clinics in Sydney, Australia. Interview data were thematically analysed using
constant comparative methods.
Results: Factors influencing HCV treatment initiation for clients included a focus on other priorities,
other health problems requiring investigation, concerns about side effects, and the inconvenience of
additional appointments to access testing and treatment, and with filling scripts. OAT clinic staff
reported that lack of resources and limitations in staff capacity to perform venepuncture and
prescribe HCV treatment resulted in referrals to other staff and services. Prescribing-related policies,
dispensing fees, and the need to order in medications at some community pharmacies raised the
number of client visits required to initiate treatment. A range of approaches were adopted to
address barriers including training clinic staff in venepuncture, escorting clients to services for
testing, involvement of a peer worker, changing prescribing practices, covering the cost of
dispensing fees for clients, shared care arrangements, and providing additional follow-up and
monitoring of clients seeking treatment.
Conclusion: Challenges exist in integrating HCV treatment into hospital-based OAT where resources
are often limited. Models of care need to include a range of intervention options to accommodate
the diverse support needs of clients with complex health and social problems.
Disclosure of Interest Statement
Professor McCaughan has received funding from a Medical Research Future Fund grant related to
this project. No pharmaceutical grants were received in the development of this study.
Professor Haber has received funding from Gilead, Abbvie and Indivior for consultation fees on
advisory boards and from Camurus for research involving opioid agonist treatment. No
pharmaceutical grants were received in the development of this study.
Nil disclosures for Professor Jacob George, Janice-Pritchard-Jones or Dr Heidi Coupland.

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