Facilitators and barriers for implementation of a decentralized hepatitis C care chain for people who use drugs in Dutch addiction care.

Abstract

People who use drugs (PWUD) are an important target population for HCV elimination goals of the World Health Organization (WHO). Case-finding and treatment of these patients is challenging due to population specific barriers like stigma and care avoidance. Low threshold HCV screening and treatment within addiction care may facilitate viral elimination. This study aims to identify facilitators and barriers to implement HCV care within addiction care. In this qualitative study we conducted semi-structured interviews with fifteen physicians, nurses and policy makers of addiction care centers with varying degrees of HCV care implementation as well as a gastroenterologist and an infectiologist. The barriers and facilitators resulting from the interviews were coded, themed, and categorized using thematic analyses. Major barriers to implementation of HCV care within addiction care included slow decision-making processes in large addiction centers, limited financial and personnel resources, comorbidity and missed appointments, and low HCV prevalence hindering expertise development. Crucial facilitators were the role of nurse specialists, patient familiarity and trust in addiction care staff, and increased treatment adherence. Despite low prevalence, managing uncomplicated HCV cases was deemed feasible with minimal expertise. Implementation of HCV care within addiction care was generally enthusiastically received by participants. Identified organizational, staff, patient, and HCV treatment-related barriers and facilitators can aid in the implementation of integrated HCV-addiction care, thus contributing to WHO HCV elimination goals.