title: Impact of a positive hepatitis C diagnosis on homeless injecting drug users: a qualitative study.
abstract: BACKGROUND
  Increasing numbers of injecting drug users are presenting to primary care and a growing number of general practices are specifically providing care for homeless people. Injecting drug users are at the greatest risk of hepatitis C infection and homeless drug misusers, because of their drug-taking behaviour and patterns, have been identified as being at greater risk of harm of blood-borne diseases than the general population. However, little work has been conducted with injecting drug users or homeless people who have hepatitis C and little is known about how the virus may affect them.
  
  
  OBJECTIVE
  To explore the impact of a positive hepatitis C diagnosis on homeless injecting drug users.
  
  
  METHODS
  This study employed qualitative research. In-depth interviews allowed the exploration of the impact of a potentially life-threatening diagnosis within the context of a person's expressed hierarchy of needs.
  
  
  METHODS
  A primary care centre for homeless people in the north of England.
  
  
  METHODS
  In-depth interviews about the impact of a positive hepatitis C diagnosis on their lives were conducted with 17 homeless injecting drug users who had received a positive hepatitis C diagnosis. The interviews were audiotaped, transcribed, and analysed using the framework approach.
  
  
  RESULTS
  Receiving a positive diagnosis for hepatitis C resulted in feelings of shock, devastation, disbelief, anger, and questioning. A positive diagnosis had lasting social, emotional, psychological, behavioural, and physical effects on homeless injecting drug users, even years after the initial diagnosis. Most responders were diagnosed by a doctor in primary care or by hospital staff; however, not all had sought testing and a number were tested while inpatients and were unaware that blood had been taken for hepatitis C virus serology.
  
  
  CONCLUSIONS
  The implications for clinical policy and primary care practice are discussed, including the issues of patient choice, confidentiality, and pre- and post-test discussions. Posttest discussions should be followed up with additional social, psychological, and medical support and counselling.
authors.affiliation: Centre for Research in Primary Care, Leeds. c.tompkins@leeds.ac.uk
authors.forename: Charlotte Ne
authors.initials: CN
authors.lastname: Tompkins
authors.forename: Nat Mj
authors.initials: NM
authors.lastname: Wright
authors.forename: Lesley
authors.initials: L
authors.lastname: Jones
mesh_terms: D000328:Adult; D001294:Attitude to Health; D005260:Female; D006526:Hepatitis C / Q000175:diagnosis / Q000523:psychology*; D006703:Ill-Housed Persons / Q000523:psychology*; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D012650:Self Disclosure; D015819:Substance Abuse, Intravenous / Q000523:psychology*; D014504:Urban Health