Factors affecting hepatitis C treatment intentions among Aboriginal people in Western Australia: a mixed-methods study
Amineh Rashidi
A D , Peter Higgs B and Susan Carruthers C
A School of Nursing and Midwifery, Building 21, Room 409, Edith Cowan University, Joondalup Campus, WA 6207, Australia.
B Department of Public Health, La Trobe University, Plenty Road, Bundoora, Vic. 3083, Australia. Email: P.Higgs@latrobe.edu.au
C Peer Based Harm Reduction WA, Bunbury Site, Suite 21 & 22, 7 Aberdeen Street, Perth, WA 6230, Australia. Email: swcdw@harmreductionwa.org
D Corresponding author. Email: a.rashidi@ecu.edu.au
Australian Health Review 44(5) 755-762 https://doi.org/10.1071/AH19194
Submitted: 8 September 2019 Accepted: 20 March 2020 Published: 28 August 2020
Journal Compilation © AHHA 2020 Open Access CC BY-NC-ND
Abstract
Objective The aim of this study was to identify the hepatitis C treatment intentions of Aboriginal people living with hepatitis C virus (HCV) in Western Australia.
Methods This study used a mixed-methods design. In the cross-sectional survey, 123 Aboriginal people who inject drugs and self-report as living with hepatitis C completed a purpose-designed questionnaire. In the qualitative phase, 10 participants were interviewed about the factors influencing their future intentions to undertake hepatitis C treatment.
Results Analysis of the survey data revealed significant associations between an intention to undertake hepatitis C treatment and support, community attachment, stable housing and stigma. In addition, there was a high overall level of expressed intention to undertake HCV treatment, with 54% of participants responding positively. Analysis of the qualitative data supported quantitative findings, revealing concerns about stigma, lack of social support and unstable housing as factors affecting the intention to undertake hepatitis C treatment.
Conclusion This mixed methods study with Aboriginal people living with self-reported HCV indicates interventions focused on reducing stigma and unstable housing could positively affect hepatitis C treatment intentions. These findings have implications for developing holistic programs to promote and support people on hepatitis C treatment.
What is known about the topic? Substantial knowledge gaps need to be resolved if HCV elimination among Aboriginal Australians is to be achieved. Current research has prioritised non-Aboriginal communities.
What does this paper add? This study found that stigma and unstable housing require attention if Aboriginal Australians are to obtain the full benefits of direct acting antiviral (DAA) hepatitis C treatment.
What are the implications for practitioners? Reducing stigma (in the primary healthcare setting) and providing access to stable housing are vital components of supportive, non-judgemental and culturally appropriate care for Aboriginal people. This study highlights the importance of education for nurses and other primary care providers to increase engagement in the hepatitis cascade of care. To achieve this, scaling-up of HCV treatment engagement, trained Aboriginal community healthcare workers and HCV treatment advocates must mobilise and support Aboriginal people to avoid the negative effects of stigma, build positive and enabling relationships and reinforce positive attitudes towards DAA hepatitis C treatment.
Additional keywords: injecting drug use.
References
[1] Grebely J, Larney S, Peacock A, Colledge S, Leung J, Hickman M, Vickerman P, Blach S, Cunningham EB, Dumchev K, Lynskey M. Global, regional, and country-level estimates of hepatitis C infection among people who have recently injected drugs. Addiction 2019; 114 150–66.| 30035835PubMed |
[2] Kirby Institute. Bloodborne viral and sexually transmitted infections in Aboriginal and Torres Strait Islander people: annual surveillance report. Sydney: Kirby Institute; 2018.
[3] Mitrou F, Cooke M, Lawrence D, Povah D, Mobilia E, Guimond E, Zubrick S. Gaps in Indigenous disadvantage not closing: a census cohort study of social determinants of health in Australia, Canada, and New Zealand from 1981–2006. BMC Public Health 2014; 14 201
| Gaps in Indigenous disadvantage not closing: a census cohort study of social determinants of health in Australia, Canada, and New Zealand from 1981–2006.Crossref | GoogleScholarGoogle Scholar | 24568143PubMed |
[4] Gracey M, King M. Indigenous health part 1: determinants and disease patterns. Lancet 2009; 374 65–75.
| Indigenous health part 1: determinants and disease patterns.Crossref | GoogleScholarGoogle Scholar | 19577695PubMed |
[5] Brener L, Wilson H, Jackson LC, Johnson P, Saunders V, Treloar C. The role of Aboriginal community attachment in promoting lifestyle changes after hepatitis C diagnosis. Health Psychol Open 2015; 2 1–10.
| The role of Aboriginal community attachment in promoting lifestyle changes after hepatitis C diagnosis.Crossref | GoogleScholarGoogle Scholar |
[6] Freeman T, Edwards T, Baum F, Lawless A, Jolley G, Javanparast S, Francis T. Cultural respect strategies in Australian Aboriginal primary health care services: beyond education and training of practitioners. Aust N Z J Public Health 2014; 38 355–61.
| Cultural respect strategies in Australian Aboriginal primary health care services: beyond education and training of practitioners.Crossref | GoogleScholarGoogle Scholar | 25091076PubMed |
[7] Kirby Institute. Monitoring hepatitis C treatment uptake in Australia (Issue 9). Sydney: UNSW Sydney, Kirby Institute; 2018.
[8] Burnet Institute and Kirby Institute. Australia’s progress towards hepatitis C elimination: annual report 2019. Melbourne: Burnet Institute; 2019.
[9] Kirby Institute. Bloodborne viral and sexually transmitted infections in Aboriginal and Torres Strait Islander people: surveillance and evaluation report. Sydney: Kirby Institute; 2016.
[10] Doyle M, Maher L, Graham S, Wand H, Iversen J. Hepatitis C virus prevalence and associated risk factors among Indigenous Australians who inject drugs. Aust N Z J Public Health 2018; 42 52–6.
| Hepatitis C virus prevalence and associated risk factors among Indigenous Australians who inject drugs.Crossref | GoogleScholarGoogle Scholar | 29168317PubMed |
[11] Kirby Institute. Australian Needle and Syringe Program Survey national data report 2012–2016: prevalence of HIV, hepatitis C and injecting and sexual behaviour among NSP attendees. Sydney: UNSW Sydney, Kirby Institute; 2017.
[12] Alavi M, Law MG, Valerio H, Grebely J, Amin J, Hajarizadeh B, Selvey C, George J, Dore G. Declining hepatitis C virus-related liver disease burden in the direct-acting antiviral therapy era in New South Wales, Australia. J Hepatol 2019; 71 281–8.
| Declining hepatitis C virus-related liver disease burden in the direct-acting antiviral therapy era in New South Wales, Australia.Crossref | GoogleScholarGoogle Scholar | 31078544PubMed |
[13] Loxley W, Carruthers S, Bevan J. In the same vein: first report of the Australian study of HIV and injecting drug use. Perth: National Centre for Research into the Prevention of Drug Abuse, Curtin University of Technology; 1995.
[14] McNally S, Sievert W, Pitts MK. Now, later or never? Challenges associated with hepatitis C treatment. Aust N Z J Public Health 2006; 30 422–7.
| Now, later or never? Challenges associated with hepatitis C treatment.Crossref | GoogleScholarGoogle Scholar | 17073222PubMed |
[15] Rawstorne P, Prestage G, Grierson J, Song A, Grulich A, Kippax S. Trends and predictors of HIV-positive community attachment among PLWHA. AIDS Care 2005; 17 589–600.
| Trends and predictors of HIV-positive community attachment among PLWHA.Crossref | GoogleScholarGoogle Scholar | 16036245PubMed |
[16] Treloar C, Brener L, Wilson H, Jackson LC, Saunders V, Johnson P, Gray R, Newland J. Evaluation of NSW Health Aboriginal Hepatitis C Program. Sydney: Centre for Social Research in Health Arts and Social Sciences, UNSW Australia; 2014.
[17] Zimet GD, Dahlem NW, Zimet SG, Farley GK. The multidimensional scale of perceived social support. J Pers Assess 1988; 52 30–41.
| The multidimensional scale of perceived social support.Crossref | GoogleScholarGoogle Scholar |
[18] Horwitz R, Brener L, Treloar C. Evaluation of an integrated care service facility for people living with hepatitis C in New Zealand. Int J Integr Care 2012; 12 e229
| 23593067PubMed |
[19] Treloar C, Hull P, Dore G, Grebely J. Knowledge and barriers associated with assessment and treatment for hepatitis C virus infection among people who inject drugs. Drug Alcohol Rev 2012; 31 918–24.
| Knowledge and barriers associated with assessment and treatment for hepatitis C virus infection among people who inject drugs.Crossref | GoogleScholarGoogle Scholar | 22612899PubMed |
[20] Alavi M, Krahe M, Fortier E, Dunlop AJ, Balcomb AC, Day CA, Treloar C, Bath N, Haber PS, Dore GJ, Grebely J, ETHOS Study Group Effect of treatment willingness on specialist assessment and treatment uptake for hepatitis C virus infection among people who use drugs: the ETHOS study. J Viral Hepat 2015; 22 914–25.
| Effect of treatment willingness on specialist assessment and treatment uptake for hepatitis C virus infection among people who use drugs: the ETHOS study.Crossref | GoogleScholarGoogle Scholar | 25996567PubMed |
[21] Treloar C, Hull P, Dore G, Grebely J. Knowledge and barriers associated with assessment and treatment for hepatitis C virus infection among people who inject drugs. Drug Alcohol Rev 2012; 31 918–24.
| Knowledge and barriers associated with assessment and treatment for hepatitis C virus infection among people who inject drugs.Crossref | GoogleScholarGoogle Scholar | 22612899PubMed |
[22] Tolmie A, Muijs D, McAteer E. Quantitative methods in educational and social research using SPSS. Milton Keynes: McGraw-Hill Education; 2011.
[23] Cooper CL, Bailey RJ, Bain VG, Anderson F, Yoshida EM, Krajden M, Marotta P, Canadian Pegasys Study Group Outcomes of peginterferon alpha-2a and ribavirin hepatitis C therapy in Aboriginal Canadians. Can J Gastroenterol 2008; 22 677–80.
| Outcomes of peginterferon alpha-2a and ribavirin hepatitis C therapy in Aboriginal Canadians.Crossref | GoogleScholarGoogle Scholar | 18701944PubMed |
[24] Brener L, Wilson H, Jackson LC, Johnson P, Saunders V, Treloar C. Experiences of diagnosis, care and treatment among Aboriginal people living with hepatitis C. Aust N Z J Public Health 2016; 40 S59–64.
| Experiences of diagnosis, care and treatment among Aboriginal people living with hepatitis C.Crossref | GoogleScholarGoogle Scholar | 26123616PubMed |
[25] Madden A, Hopwood M, Neale J, Treloar C. Beyond interferon side effects: what residual barriers exist to DAA hepatitis C treatment for people who inject drugs? PloS One 2018; 13 e0207226
| 30500863PubMed |
[26] Treloar C, Jackson C, Gray R, Newland J, Wilson H, Saunders V, Johnson P, Brener L. Care and treatment of hepatitis C among Aboriginal people in New South Wales, Australia: implications for the implementation of new treatments. Ethn Health 2016; 21 39–57.
| Care and treatment of hepatitis C among Aboriginal people in New South Wales, Australia: implications for the implementation of new treatments.Crossref | GoogleScholarGoogle Scholar | 25665723PubMed |
[27] von Hippel C, Brener L, Horwitz R. Implicit and explicit internalized stigma: relationship with risky behaviors, psychosocial functioning and healthcare access among people who inject drugs. Addict Behav 2018; 76 305–11.
| Implicit and explicit internalized stigma: relationship with risky behaviors, psychosocial functioning and healthcare access among people who inject drugs.Crossref | GoogleScholarGoogle Scholar | 28889059PubMed |
[28] Hatzenbuehler ML. Structural stigma and health inequalities: research evidence and implications for psychological science. Am Psychol 2016; 71 742–51.
| Structural stigma and health inequalities: research evidence and implications for psychological science.Crossref | GoogleScholarGoogle Scholar | 27977256PubMed |
[29] Sellers RM, Shelton JN. The role of racial identity in perceived racial discrimination. J Pers Soc Psychol 2003; 84 1079–92.
| The role of racial identity in perceived racial discrimination.Crossref | GoogleScholarGoogle Scholar | 12757150PubMed |
[30] Pearce ME, Jongbloed K, Demerais L, MacDonald H, Christian WM, Sharma R, Pick N, Yoshida EM, Spittal PM, Klein MB. ‘Another thing to live for’: supporting HCV treatment and cure among Indigenous people impacted by substance use in Canadian cities. Int J Drug Policy 2019; 74 52–61.
| ‘Another thing to live for’: supporting HCV treatment and cure among Indigenous people impacted by substance use in Canadian cities.Crossref | GoogleScholarGoogle Scholar | 31525640PubMed |
[31] Swan D, Long J, Carr O, Flanagan J, Irish H, Keating S, Keaveney M, Lambert J, McCormick PA, McKiernan S, Moloney J. Barriers to and facilitators of hepatitis C testing, management, and treatment among current and former injecting drug users: a qualitative exploration. AIDS Patient Care STDS 2010; 24 753–62.
| Barriers to and facilitators of hepatitis C testing, management, and treatment among current and former injecting drug users: a qualitative exploration.Crossref | GoogleScholarGoogle Scholar | 21138381PubMed |
[32] Grebely J, Knightb E, Genoway K, Viljoen M, Khara M, Elliottc D, Gallagher L, Storms M, Raffa JD, DeVlaming S, Duncan F. Optimizing assessment and treatment for hepatitis C virus infection in illicit drug users: a novel model incorporating multidisciplinary care and peer support. Eur J Gastroenterol Hepatol 2010; 22 270–7.
| Optimizing assessment and treatment for hepatitis C virus infection in illicit drug users: a novel model incorporating multidisciplinary care and peer support.Crossref | GoogleScholarGoogle Scholar | 20425880PubMed |
[33] Grebely J, Tyndall MW. Management of HCV and HIV infections among people who inject drugs. Curr Opin HIV AIDS 2011; 6 501–7.
| Management of HCV and HIV infections among people who inject drugs.Crossref | GoogleScholarGoogle Scholar | 22001894PubMed |
[34] Harris M, Rhodes T. Hepatitis C treatment access and uptake for people who inject drugs: a review mapping the role of social factors. Harm Reduct J 2013; 10 7
| 23651646PubMed |
[35] Read P, Gilliver R, Kearley J, Lothian R, Cunningham EB, Chronister KJ, Dore GJ. Treatment adherence and support for people who inject drugs taking direct-acting antiviral therapy for hepatitis C infection. J Viral Hepat 2019; 26 1301–10.
| Treatment adherence and support for people who inject drugs taking direct-acting antiviral therapy for hepatitis C infection.Crossref | GoogleScholarGoogle Scholar | 31299127PubMed |
[36] Cunningham EB, Hajarizadeh B, Amin J, Litwin AH, Gane E, Cooper C, Lacombe K, Hellard M, Read P, Powis J, Dalgard O. Adherence to once-daily and twice-daily direct-acting antiviral therapy for hepatitis C infection among people with recent injection drug use or current opioid agonist therapy. Clin Infect Dis 2019; ciz1089
| 31677262PubMed |
[37] Beiser ME, Smith K, Ingemi M, Mulligan E, Baggett TP. Hepatitis C treatment outcomes among homeless-experienced individuals at a community health centre in Boston. Int J Drug Policy 2019; 72 129–37.
| Hepatitis C treatment outcomes among homeless-experienced individuals at a community health centre in Boston.Crossref | GoogleScholarGoogle Scholar | 30962036PubMed |
[38] Nielsen S, Gassowski M, Wenz B, Bannert N, Bock C-T, Kücherer C, Ross RS, Bremer V, Marcus U, Zimmermann R, DRUCK Study Group Concordance between self-reported and measured HIV and hepatitis C virus infection status among people who inject drugs in Germany. Hepatol Med Policy 2016; 1 8
| 30288312PubMed |
