title: Barriers and facilitators of hepatitis C screening among people who inject drugs: a multi-city, mixed-methods study.
abstract: BACKGROUND
  People who inject drugs (PWID) are at high risk of contracting and transmitting and hepatitis C virus (HCV). While accurate screening tests and effective treatment are increasingly available, prior research indicates that many PWID are unaware of their HCV status.
  
  
  METHODS
  We examined characteristics associated with HCV screening among 553 PWID utilizing a free, multi-site syringe exchange program (SEP) in 7 cities throughout Wisconsin. All participants completed an 88-item, computerized survey assessing past experiences with HCV testing, HCV transmission risk behaviors, and drug use patterns. A subset of 362 clients responded to a series of open-ended questions eliciting their perceptions of barriers and facilitators to screening for HCV. Transcripts of these responses were analyzed qualitatively using thematic analysis.
  
  
  RESULTS
  Most respondents (88%) reported receiving a HCV test in the past, and most of these (74%) were tested during the preceding 12 months. Despite the availability of free HCV screening at the SEP, fewer than 20% of respondents had ever received a test at a syringe exchange site. Clients were more likely to receive HCV screening in the past year if they had a primary care provider, higher educational attainment, lived in a large metropolitan area, and a prior history of opioid overdose. Themes identified through qualitative analysis suggested important roles of access to medical care and prevention services, and nonjudgmental providers.
  
  
  CONCLUSIONS
  Our results suggest that drug-injecting individuals who reside in non-urban settings, who have poor access to primary care, or who have less education may encounter significant barriers to routine HCV screening. Expanded access to primary health care and prevention services, especially in non-urban areas, could address an unmet need for individuals at high risk for HCV.
authors.affiliation: Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Ave, UWMFCB 5th floor, Madison, WI 53705, USA. jbarocas@medicine.wisc.edu.
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Barocas
authors.forename: Meghan B
authors.initials: MB
authors.lastname: Brennan
authors.forename: Shawnika J
authors.initials: SJ
authors.lastname: Hull
authors.forename: Scott
authors.initials: S
authors.lastname: Stokes
authors.forename: John J
authors.initials: JJ
authors.lastname: Fangman
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Westergaard
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D042241:Early Diagnosis; D004812:Epidemiologic Methods; D005239:Fear; D005260:Female; D006297:Health Services Accessibility; D019698:Hepatitis C, Chronic / Q000517:prevention & control* / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D018671:Needle-Exchange Programs; D010342:Patient Acceptance of Health Care / Q000523:psychology; D011369:Professional-Patient Relations; D057545:Social Stigma; D015819:Substance Abuse, Intravenous / Q000150:complications* / Q000523:psychology; D014922:Wisconsin; D055815:Young Adult