title: Hepatitis C virus control among persons who inject drugs requires overcoming barriers to care.
abstract: Despite a high prevalence of hepatitis C virus (HCV) infection, the vast majority of persons who inject drugs (PWID) have not engaged in HCV care due to a large number of obstacles. Education about the infection among both PWID and providers remains an important challenge as does discrimination faced by PWID in conventional health care settings. Many providers also remain hesitant to prescribe antiviral therapy due to concerns about adherence and relapse to drug use resulting in reinfection. Presently, however, as a result of improvements in treatment efficacy combined with professional society and government endorsement of HCV treatment for PWID, a pressing need exists to develop strategies to engage these individuals into HCV care. In this article, we propose several strategies that can be pursued in an attempt to engage PWID into HCV management. We advocate that multidisciplinary approaches that utilize health care practitioners from a wide range of specialties, as well as co-localization of medical services, are strategies likely to result in increased numbers of PWID entering into HCV management. Pursuit of HCV therapy after stabilization through drug treatment is an additional strategy likely to increase PWID engagement into HCV care. The full impact of direct acting antivirals for HCV will only be realized if innovative approaches are pursued to engage all HCV infected individuals into treatment.
authors.affiliation: Marija Zeremski, Andrew H Talal, Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY 10065, United States.
authors.forename: Marija
authors.initials: M
authors.lastname: Zeremski
authors.forename: Jon E
authors.initials: JE
authors.lastname: Zibbell
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Martinez
authors.forename: Steven
authors.initials: S
authors.lastname: Kritz
authors.forename: Bryce D
authors.initials: BD
authors.lastname: Smith
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Talal
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D019033:Delivery of Health Care, Integrated; D055030:Drug Users / Q000523:psychology; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006526:Hepatitis C / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology / Q000635:transmission; D006801:Humans; D033183:Interdisciplinary Communication; D010342:Patient Acceptance of Health Care; D010348:Patient Care Team; D010353:Patient Education as Topic; D011287:Prejudice; D015819:Substance Abuse, Intravenous / Q000453:epidemiology / Q000523:psychology / Q000534:rehabilitation*; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents
keywords: Hepatitis C virus coinfection; Human immunodeficiency virus; Obstacles to treatment; Persons who inject drugs; Treatment of hepatitis C; Viral infection