title: Views and experiences of hepatitis C testing and diagnosis among people who inject drugs: systematic review of qualitative research.
abstract: BACKGROUND
  Many developed countries are facing a major challenge to improve identification of individuals acutely and chronically infected with hepatitis C virus (HCV) infection. We explored the views and experiences of people who inject drugs (PWID) in relation to HCV testing, and diagnosis through a review and synthesis of qualitative research.
  
  
  METHODS
  Based on the thematic synthesis of qualitative research. Searches were conducted in 14 databases and supplemented by reference checking, hand searching of selected journals, and searches of relevant websites. Studies of any qualitative design that examined the views and experiences of, and attitudes towards, HCV testing and diagnosis among PWID or practitioners involved in their care were included. Key themes and sub-themes were systematically coded according to the meaning and content of the findings of each study which proceeded to the preparation of a narrative account of the synthesis.
  
  
  RESULTS
  28 qualitative studies were identified. We identified a number of overarching descriptive themes in the literature, finding overall that PWID hold complex and differing views and experiences of testing and diagnosis. Three major themes emerged: missed opportunities for the provision of information and knowledge; shifting priorities between HCV testing and other needs; and testing as unexpected and routine. Evidence of missed opportunities for the provision of knowledge and information about HCV were clear, contributing to delays in seeking testing and providing a context to poor experiences of diagnosis. Influenced by the nature of their personal circumstances, perceptions of the risk associated with HCV and the prioritisation of other needs acted both to encourage and discourage the uptake of HCV testing. Undergoing HCV testing as part of routine health assessment, and an unawareness of being testing was common. An unexpected positive diagnosis exacerbated anxiety and confusion.
  
  
  CONCLUSIONS
  This review has identified that there are modifiable factors that affect the uptake of HCV testing and experiences of HCV diagnosis among PWID. Intervention development should focus on addressing these factors. There is a need for further research that engages PWID from a diverse range of populations to identify interventions, strategies and approaches that they consider valuable.
authors: Centre for Public Health, Faculty of Education, Health and Community, Liverpool John Moores University, 15-21 Webster Street, Liverpool L3 2ET, UK. Electronic address: l.jones1@ljmu.ac.uk.
authors: L
authors: L
authors: Jones
authors: Centre for Public Health, Faculty of Education, Health and Community, Liverpool John Moores University, 15-21 Webster Street, Liverpool L3 2ET, UK.
authors: A
authors: A
authors: Atkinson
authors: Centre for Public Health, Faculty of Education, Health and Community, Liverpool John Moores University, 15-21 Webster Street, Liverpool L3 2ET, UK.
authors: G
authors: G
authors: Bates
authors: Centre for Public Health, Faculty of Education, Health and Community, Liverpool John Moores University, 15-21 Webster Street, Liverpool L3 2ET, UK.
authors: E
authors: E
authors: McCoy
authors: Centre for Public Health, Faculty of Education, Health and Community, Liverpool John Moores University, 15-21 Webster Street, Liverpool L3 2ET, UK.
authors: L
authors: L
authors: Porcellato
authors: Centre for Public Health, Faculty of Education, Health and Community, Liverpool John Moores University, 15-21 Webster Street, Liverpool L3 2ET, UK.
authors: C
authors: C
authors: Beynon
authors: Centre for Public Health, Faculty of Education, Health and Community, Liverpool John Moores University, 15-21 Webster Street, Liverpool L3 2ET, UK.
authors: J
authors: J
authors: McVeigh
authors: Public Health Wales, Haydn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK.
authors: M A
authors: MA
authors: Bellis
mesh_terms: D019937:Diagnostic Techniques and Procedures / Q000523:psychology; D007722:Health Knowledge, Attitudes, Practice; D006526:Hepatitis C / Q000150:complications* / Q000175:diagnosis* / Q000523:psychology; D006801:Humans; D036301:Qualitative Research; D015819:Substance Abuse, Intravenous / Q000150:complications* / Q000523:psychology*
keywords: Hepatitis C; Injecting drug use; Qualitative synthesis; Screening