"Stigma is where the harm comes from": Exploring expectations and lived experiences of hepatitis C virus post-treatment trajectories among people who inject drugs.
"Stigma is where the harm comes from": Exploring expectations and lived experiences of hepatitis C virus post-treatment trajectories among people who inject drugs.
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DOI：
10.1016/j.drugpo.2021.103238
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发表时间：
2021-10
期刊：
影响因子：
--
通讯作者：
Knight R
中科院分区：
文献类型：
--
作者：
Goodyear T;Brown H;Browne AJ;Hoong P;Ti L;Knight R
直接作用抗病毒(DAA)药物的出现为注射吸毒者(PWID)治疗丙型肝炎病毒(HCV)提供了机会。然而，仍然需要关于如何在DAA治疗后轨迹中以最佳方式支持PWID的数据，包括关于预防再感染的数据。因此，这项研究的目的是确定有丙型肝炎病毒生活经历的PWID如何描述他们在完成DAA治疗后对健康和社会结果、背景和物质使用实践的期望和经验。我们对2018年1月至6月在加拿大温哥华进行的深入、半结构化访谈的数据进行了主题分析，其中包括在DAA治疗的不同阶段(例如，前、周、后)的有目的的PWID样本(n = 50)。我们的分析产生了三个主题。首先，虽然参与者希望在丙型肝炎治愈后体验到幸福感的整体增强，但对实际治疗后体验的讨论往往集中在身体健康(例如，能量增加)。其次，与会者经常指出，丙型肝炎病毒相关的污名和其他污名限制了获得健康和医疗保健的机会。因此，与会者确定减少污名是治愈丙型肝炎病毒的一个关键动机，虽然有时减少了内在化的污名，但与会者强调，其他形式的成文污名(例如，与药物使用、艾滋病毒、贫困有关)仍然在他们的治疗后生活中占据突出地位。第三，与会者描述了在治愈后如何防止丙型肝炎病毒再次感染的大量知识，但他们也对社会结构性障碍，包括耻辱和定罪，可能如何干扰减少危害和预防再次感染的努力表示担忧。DaaS正在改变一些PWID的健康和福祉。然而，与丙型肝炎病毒相关的政策必须超越DAA的规模，包括协调一致的公共卫生投资，包括反耻辱努力和改善社会福利制度，以有意义地促进PWID治疗后轨迹和结果的公平性。
The advent of direct-acting antiviral (DAA) medications has facilitated opportunities to treat hepatitis C virus (HCV) among people who inject drugs (PWID). However, there remains a need for data about how to optimally support PWID throughout DAA post-treatment trajectories, including with regard to re-infection prevention. The objective of this study is therefore to identify how PWID with lived experience of HCV describe their expectations and experiences related to health and social outcomes, contexts, and substance use practices following completion of DAA treatment. We thematically analyzed data from in-depth, semi-structured interviews, conducted between January and June 2018, in Vancouver, Canada, with a purposive sample (n = 50) of PWID at various stages of DAA treatment (e.g., pre, peri, post). Our analysis yielded three themes. First, while participants had hoped to experience holistic enhancements in wellbeing following HCV cure, discussions of actual post-treatment experiences tended to be located in physical health (e.g., increased energy). Second, participants often pointed to the ways in which HCV-related and other stigmas had restricted opportunities for health and healthcare access. Participants therefore identified stigma-reduction as a key motivator of HCV cure, and while reductions in internalized stigma were sometimes achieved, participants underscored that other forms of enacted stigma (e.g., related to: substance use, HIV, poverty) had continued to feature prominently in their post-treatment lives. Third, participants described considerable knowledge about how to prevent HCV re-infection following cure, but they also expressed apprehensiveness about how socio-structural barriers, including stigma and criminalization, could interfere with harm reduction and re-infection prevention efforts. DAAs are transforming the health and wellbeing of some PWID. Yet, HCV-related policy must extend beyond the scale-up of DAAs to include concerted public health investments, including anti-stigma efforts and improvements to the social welfare system, to meaningfully advance equity in PWID’s post-treatment trajectories and outcomes.
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DOI：
10.1111/add.14393
发表时间：
2019-01
期刊：
Addiction (Abingdon, England)
影响因子：
--
作者：
Grebely J;Larney S;Peacock A;Colledge S;Leung J;Hickman M;Vickerman P;Blach S;Cunningham EB;Dumchev K;Lynskey M;Stone J;Trickey A;Razavi H;Mattick RP;Farrell M;Dore GJ;Degenhardt L
通讯作者：
Degenhardt L
影响因子：
4.4
作者：
Harris, Magdalena
通讯作者：
Harris, Magdalena
影响因子：
4.4
作者：
Goodyear, Trevor;Mniszak, Caroline;Knight, Rod
通讯作者：
Knight, Rod
DOI：
10.1111/1468-0009.12349
发表时间：
2018-12
期刊：
The Milbank quarterly
影响因子：
--
作者：
Ford-Gilboe M;Wathen CN;Varcoe C;Herbert C;Jackson BE;Lavoie JG;Pauly BB;Perrin NA;Smye V;Wallace B;Wong ST;Browne For The Equip Research Program AJ
通讯作者：
Browne For The Equip Research Program AJ
影响因子：
2
作者：
Asher AK;Portillo CJ;Cooper BA;Dawson-Rose C;Vlahov D;Page KA
通讯作者：
Page KA