title: Perceptions of drug users regarding hepatitis C screening and care: a qualitative study.
abstract: BACKGROUND
  Illicit drug users have a high prevalence of HCV and represent the majority of newly infected persons in the U.S. Despite the availability of effective HCV treatment, few drug users have been evaluated or treated for HCV. Racial and ethnic minorities have a higher incidence and prevalence of HCV and higher HCV-related mortality. Factors contributing to poor engagement in care are incompletely understood.
  
  
  METHODS
  Fourteen mixed-gender focus groups of either African American or Latino/a drug users (N = 95) discussed barriers to HCV testing and treatment. Themes were identified through content analysis of focus group discussions.
  
  
  RESULTS
  Many drug users were tested for HCV in settings where they were receiving care. Outside of these settings, most were unaware of voluntary test sites. After testing HCV positive, drug users reported not receiving clear messages regarding the meaning of a positive HCV test, the impact of HCV infection, or appropriate next steps including HCV clinical evaluations. Many drug users perceived treatment as unimportant because they lacked symptoms, healthcare providers minimized the severity of the diagnosis, or providers did not recommend treatment. Mistrust of the motivations of healthcare providers was cited as a barrier to pursuing treatment. Social networks or social interactions were a source of HCV-related information and were influential in shaping drug users perceptions of treatment and its utility.
  
  
  CONCLUSIONS
  Drug users perceived a paucity of settings for self-initiated HCV testing and poor provider-patient communication at test sites and during medical encounters. Notably, drug users reported having an unclear understanding about the meaning of a positive HCV test, the health implications of HCV infection, the importance of clinical evaluations and monitoring, and of treatment options for HCV. Efforts to improve the delivery of clinical messages about HCV infection for drug users at test settings and clinical encounters are needed.
authors.affiliation: Beth Israel Medical Center, 120 East 16th St, New York, NY 10003, USA. Ashly.elizabeth.jordan@gmail.com
authors.forename: Ashly E
authors.initials: AE
authors.lastname: Jordan
authors.forename: Carmen L
authors.initials: CL
authors.lastname: Masson
authors.forename: Pedro
authors.initials: P
authors.lastname: Mateu-Gelabert
authors.forename: Courtney
authors.initials: C
authors.lastname: McKnight
authors.forename: Nicole
authors.initials: N
authors.lastname: Pepper
authors.forename: Katie
authors.initials: K
authors.lastname: Bouche
authors.forename: Laura
authors.initials: L
authors.lastname: Guzman
authors.forename: Evan
authors.initials: E
authors.lastname: Kletter
authors.forename: Randy M
authors.initials: RM
authors.lastname: Seewald
authors.forename: Don C
authors.initials: DC
authors.lastname: Des-Jarlais
authors.forename: James L
authors.initials: JL
authors.lastname: Sorensen
authors.forename: David C
authors.initials: DC
authors.lastname: Perlman
mesh_terms: D000328:Adult; D001741:Black or African American / Q000523:psychology; D001294:Attitude to Health; D003376:Counseling; D042241:Early Diagnosis; D005260:Female; D017144:Focus Groups; D006297:Health Services Accessibility; D019698:Hepatitis C, Chronic / Q000150:complications / Q000175:diagnosis* / Q000523:psychology; D006630:Hispanic or Latino / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009519:New York City; D010465:Perception; D036301:Qualitative Research; D012017:Referral and Consultation; D012495:San Francisco; D015819:Substance Abuse, Intravenous / Q000150:complications