title: Hepatitis C treatment access and uptake for people who inject drugs: a review mapping the role of social factors.
abstract: BACKGROUND
  Evidence documents successful hepatitis C virus (HCV) treatment outcomes for people who inject drugs (PWID) and interest in HCV treatment among this population. Maximising HCV treatment for PWID can be an effective HCV preventative measure. Yet HCV treatment among PWID remains suboptimal. This review seeks to map social factors mediating HCV treatment access.
  
  
  METHODS
  We undertook a review of the social science and public health literature pertaining to HCV treatment for PWID, with a focus on barriers to treatment access, uptake and completion. Medline and Scopus databases were searched, supplemented by manual and grey literature searches. A two step search was taken, with the first step pertaining to literature on HCV treatment for PWID and the second focusing on social structural factors. In total, 596 references were screened, with 165 articles and reports selected to inform the review.
  
  
  RESULTS
  Clinical and individual level barriers to HCV treatment among PWID are well evidenced. These include patient and provider concerns regarding co-morbidities, adherence, and side effect management. Social factors affecting treatment access are less well evidenced. In attempting to map these, key barriers fall into the following domains: social stigma, housing, criminalisation, health care systems, and gender. Key facilitating factors to treatment access include: combination intervention approaches encompassing social as well as biomedical interventions, low threshold access to opiate substitution therapy, and integrated delivery of multidisciplinary care.
  
  
  CONCLUSIONS
  Combination intervention approaches need to encompass social interventions in relation to housing, stigma reduction and systemic changes in policy and health care delivery. Future research needs to better delineate social factors affecting treatment access.
authors: Centre for Research on Drugs and Health Behaviour, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H9SH, UK. magdalena.harris@lshtm.ac.uk
authors: Magdalena
authors: M
authors: Harris
authors: Tim
authors: T
authors: Rhodes
mesh_terms: D003415:Crime / Q000523:psychology / Q000706:statistics & numerical data; D003469:Culture; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D019698:Hepatitis C, Chronic / Q000150:complications / Q000523:psychology / Q000628:therapy*; D006703:Ill-Housed Persons / Q000523:psychology / Q000706:statistics & numerical data; D006801:Humans; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data; D011287:Prejudice; D012111:Residence Characteristics; D012737:Sex Factors; D015819:Substance Abuse, Intravenous / Q000150:complications* / Q000523:psychology
references: Dig Liver Dis. 2011 Aug;43(8):589-95
references: 21256097
references: Drug Alcohol Depend. 2004 Jul 15;75(1):89-95
references: 15225892
references: Hum Organ. 2004 Sep;63(3):253-264
references: 16685288
references: N Engl J Med. 2011 Jun 9;364(23):2199-207
references: 21631316
references: Am J Gastroenterol. 2004 Sep;99(9):1720-5
references: 15330909
references: J Clin Gastroenterol. 2002 Apr;34(4):476-80
references: 11907367
references: Clin Infect Dis. 2005 Apr 15;40 Suppl 5:S304-12
references: 15768339
references: J Urban Health. 2004 Sep;81(3):428-47
references: 15273266
references: Aust N Z J Public Health. 2006 Oct;30(5):422-7
references: 17073222
references: Aust Health Rev. 2009 Feb;33(1):100-6
references: 19203339
references: Lancet. 2011 Aug 13;378(9791):571-83
references: 21802134
references: Int J Drug Policy. 2007 Oct;18(5):426-32
references: 17854732
references: Drug Alcohol Depend. 2002 Jul 1;67(2):117-23
references: 12095661
references: Aust Nurs J. 2004 Jul;12(1):23-5
references: 19149457
references: Antivir Ther. 2009;14(4):467-79
references: 19578232
references: J Addict Med. 2010 Mar;4(1):20-6
references: 20485532
references: Gastroenterol Clin Biol. 2004 Jun-Jul;28(6-7 Pt 1):533-9
references: 15243385
references: J Health Care Poor Underserved. 2005 May;16(2):345-61
references: 15937397
references: Gastroenterol Res Pract. 2010;2010:
references: 20811482
references: Qual Health Res. 2009 Sep;19(9):1321-34
references: 19690211
references: Clin Infect Dis. 2004 Nov 15;39(10):1540-3
references: 15546094
references: J Health Psychol. 2010 Sep;15(6):811-8
references: 20656767
references: AIDS Care. 2004 Jul;16(5):628-40
references: 15223532
references: Hepatology. 2007 Oct;46(4):991-8
references: 17668880
references: Clin Infect Dis. 2005 Apr 15;40 Suppl 5:S330-5
references: 15768343
references: Drug Alcohol Rev. 2003 Sep;22(3):317-21
references: 15385226
references: Gastroenterol Nurs. 2006 Jul-Aug;29(4):309-15
references: 16974168
references: J Viral Hepat. 2007 Sep;14(9):645-52
references: 17697017
references: Int J Drug Policy. 2007 Aug;18(4):313-8
references: 17689380
references: Eur J Gastroenterol Hepatol. 2006 Apr;18(4):381-8
references: 16538109
references: Int J Drug Policy. 2007 Oct;18(5):374-80
references: 17854725
references: Drug Alcohol Rev. 2007 Jul;26(4):437-43
references: 17564882
references: Am J Gastroenterol. 2003 Oct;98(10):2281-8
references: 14572580
references: Aliment Pharmacol Ther. 2009 Jan;29(1):38-45
references: 18945252
references: J Viral Hepat. 2009 Aug;16(8):557-67
references: 19243498
references: AIDS. 2007 Jan 30;21(3):271-81
references: 17255734
references: J Gastroenterol Hepatol. 2007 Sep;22(9):1519-25
references: 17645460
references: Addiction. 2008 Jun;103(6):905-18
references: 18422827
references: AIDS Patient Care STDS. 2010 Dec;24(12):753-62
references: 21138381
references: J Viral Hepat. 2011 Apr;18(4):e104-16
references: 20840350
references: J Subst Abuse Treat. 2009 Jul;37(1):32-40
references: 19038524
references: Ir Med J. 2005 Mar;98(3):73-4
references: 15869062
references: J Viral Hepat. 2010 Dec;17(12):839-44
references: 20070504
references: Gastroenterology. 2006 May;130(6):1607-16
references: 16697724
references: Int J Drug Policy. 2009 May;20(3):193-201
references: 19147339
references: Drug Alcohol Depend. 2008 Jan 11;93(1-2):141-7
references: 17997050
references: AIDS Patient Care STDS. 2008 Jan;22(1):53-64
references: 18095839
references: Subst Use Misuse. 2010 Mar;45(4):496-514
references: 20141461
references: Eur J Gastroenterol Hepatol. 2011 Jan;23(1):45-50
references: 21139470
references: Int J Drug Policy. 2007 Oct;18(5):437-43
references: 17854734
references: J Infect Dis. 2011 Jul 1;204(1):74-83
references: 21628661
references: Soc Sci Med. 2013 Apr;83:19-26
references: 23465200
references: Aust J Prim Health. 2010;16(2):119-25
references: 21128572
references: Lancet. 2010 Jul 31;376(9738):355-66
references: 20650513
references: Drug Alcohol Rev. 2009 Jul;28(4):436-40
references: 19594798
references: Am J Gastroenterol. 2009 Apr;104(4):1024-31
references: 19240708
references: Patient Educ Couns. 2006 Jul;62(1):148-55
references: 16098705
references: AIDS Patient Care STDS. 2009 Nov;23(11):925-9
references: 19827950
references: Clin Infect Dis. 2005 Apr 15;40 Suppl 5:S276-85
references: 15768335
references: Liver Int. 2009 Aug;29(7):1051-5
references: 19580634
references: J Assoc Nurses AIDS Care. 2010 Jan-Feb;21(1):63-74
references: 19853480
references: Harm Reduct J. 2008 Feb 25;5:8
references: 18298862
references: J Hepatol. 2011 Jun;54(6):1137-44
references: 21145810
references: Addiction. 2011 Nov;106(11):1978-88
references: 21615585
references: Psychol Health Med. 2008 May;13(3):360-6
references: 18569903
references: Eur Addict Res. 2007;13(4):216-21
references: 17851243
references: J Gen Intern Med. 2004 Apr;19(4):357-65
references: 15061745
references: Health Policy Plan. 2013 Oct;28(7):681-91
references: 23197431
references: Hepatology. 2009 Apr;49(4):1335-74
references: 19330875
references: Eur J Gastroenterol Hepatol. 2011 Jan;23(1):23-31
references: 21042221
references: J Acquir Immune Defic Syndr. 2010 Dec;55 Suppl 1:S37-42
references: 21045598
references: Int J Prison Health. 2008;4(3):156-63
references: 18698530
references: Am J Public Health. 2005 Oct;95(10):1737-9
references: 16131642
references: Int J Drug Policy. 2007 Oct;18(5):364-73
references: 17854724
references: Int J Epidemiol. 2007 Apr;36(2):396-405
references: 17218325
references: J Hepatol. 2005 Mar;42(3):323-8
references: 15791696
references: Clin Infect Dis. 2005 Apr 15;40 Suppl 5:S321-4
references: 15768341
references: Soc Sci Med. 2012 Jan;74(2):245-53
references: 22133583
references: Int J Drug Policy. 2013 Nov;24(6):e43-50
references: 23199896
references: Soc Sci Med. 2011 May;72(9):1472-81
references: 21481509
references: Eur J Gastroenterol Hepatol. 2010 Mar;22(3):270-7
references: 20425880
references: Aliment Pharmacol Ther. 2009 Jan;29(1):29-37
references: 18752631
references: Eur J Gastroenterol Hepatol. 2011 Jan;23(1):32-40
references: 21048503
references: Addiction. 2008 Nov;103(11):1828-36
references: 18778390
references: BMC Public Health. 2009 Jul 29;9:270
references: 19640297
references: J Urban Health. 2007 May;84(3):455-8
references: 17394085
references: Drug Alcohol Depend. 2011 Jul 1;116(1-3):233-7
references: 21177046
references: J Addict Dis. 2008;27(2):1-10
references: 18681186
references: J Soc Work Pract Addict. 2011 Jan 1;11(3):254-269
references: 22102796
references: Am J Psychiatry. 2000 Jun;157(6):867-76
references: 10831463
references: Liver Int. 2012 Feb;32 Suppl 1:151-6
references: 22212587
references: BMC Public Health. 2007 Jun 07;7:98
references: 17555573
references: Int J Drug Policy. 2007 Oct;18(5):381-7
references: 17854726
references: Gastroenterol Nurs. 2011 Mar-Apr;34(2):102-6
references: 21455042
references: J Gastroenterol Hepatol. 2006 Apr;21(4):694-9
references: 16677155
references: J Hepatol. 2006 Mar;44(3):499-506
references: 16427717
references: Clin Infect Dis. 2005 Apr 15;40 Suppl 5:S313-20
references: 15768340
references: Curr Opin Psychiatry. 2005 Nov;18(6):678-83
references: 16639097
references: Eur J Gastroenterol Hepatol. 2009 Sep;21(9):963-8
references: 19318966
references: Int J Drug Policy. 2010 Jan;21(1):4-9
references: 19747811
references: Med J Aust. 2011 Apr 18;194(8):398-402
references: 21495939
references: J Gastroenterol Hepatol. 2010 Jul;25(7):1281-4
references: 20594256
references: Aust Fam Physician. 2010 Aug;39(8):589-92
references: 20877755
references: Int J Drug Policy. 2008 Dec;19(6):429-35
references: 17962008
references: J Community Health. 2008 Jun;33(3):126-33
references: 18165889
references: Lancet. 2010 Jul 24;376(9737):268-84
references: 20650523
references: J Addict Dis. 2008;27(2):61-8
references: 18681192
references: Int J Drug Policy. 2007 Oct;18(5):433-6
references: 17854733
references: J Viral Hepat. 2008 Oct;15(10):747-52
references: 18637072
references: Drug Alcohol Depend. 2011 Jul 1;116(1-3):52-6
references: 21194852
references: Dig Dis Sci. 2007 May;52(5):1168-76
references: 17357838
references: Eur J Gastroenterol Hepatol. 2010 Sep;22(9):1050-7
references: 20351554
references: Int J Drug Policy. 2007 Oct;18(5):406-10
references: 17854729
references: J Subst Abuse Treat. 2005 Mar;28(2):181-7
references: 15780548
references: Qual Health Res. 2005 May;15(5):635-46
references: 15802540
references: Clin Infect Dis. 2005 Apr 15;40 Suppl 5:S336-8
references: 15768344
references: Addiction. 2010 May;105(5):907-13
references: 20331553
references: J Gastroenterol Hepatol. 2003 Jul;18(7):841-50
references: 12795758
references: Aust Health Rev. 2008 Aug;32(3):570-6
references: 18666886
references: Soc Sci Med. 2008 Mar;66(5):1046-56
references: 18164525