Client and staff experiences of a co-located service for hepatitis C care in opioid substitution treatment settings in New South Wales, Australia.
BACKGROUND
Internationally, there are ongoing efforts to increase access to hepatitis C (HCV) assessment and treatment to counter a generally low uptake of treatment among people with a history of injecting drug use. The aim of this qualitative study was to examine client and staff attitudes towards and experience of co-location of HCV and opioid substitution treatment (OST) services.


METHODS
In-depth interviews were conducted with 57 clients and 19 staff from four NSW clinics participating in the Australian ETHOS study.


RESULTS
Client and staff participants typically welcomed integrated treatment, citing issues of convenience, reduced travel time and costs, persistent cues to engagement and immediacy of access to care. Positive attitudes towards the initiative were expressed even by clients who had not engaged with HCV care. Providing co-located care largely avoided the negative, stigmatising or discriminatory experiences that participants reported encountering in settings less familiar with people who use drugs. A minority of client participants expressed concerns about the lack of privacy and/or confidentiality available in the co-located model, preferring to seek HCV care elsewhere.


CONCLUSIONS
The co-location of HCV care in OST clinics was welcomed by the large majority of participants in this study. Besides issues of convenience, the appeal of the co-located service centred on the familiarity of existing relationships between clients and staff in the OST setting. While some clients remained distrustful of OST and chose not to take up HCV care in this setting, the co-located treatment model was overwhelmingly successful amongst both client and staff participants.
National Centre in HIV Social Research, The University of New South Wales, Australia. Electronic address: c.treloar@unsw.edu.au.
Carla
C
Treloar
Jake
J
Rance
Jason
J
Grebely
Gregory J
GJ
Dore
D000328:Adult; D001291:Attitude of Health Personnel; D003219:Confidentiality; D005260:Female; D006268:Health Facilities; D006282:Health Personnel; D006526:Hepatitis C / Q000150:complications / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D058850:Opiate Substitution Treatment / Q000191:economics / Q000379:methods*; D017060:Patient Satisfaction; D018907:Privacy; D011369:Professional-Patient Relations; D057545:Social Stigma; D016320:Substance Abuse Treatment Centers; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000628:therapy; D014187:Transportation of Patients
HCV; Integrated care; Opioid substitution treatment; People who use drugs; Qualitative research