Understanding hepatitis C intervention success: qualitative findings from the HepCATT study

Harris, Magdalena; Bonnington, Oliver; Harrison, Graham; Hickman, Matthew; Irving, William L.

Abstract

The United Kingdom has committed to eliminating viral hepatitis as a public health threat. Innovative interventions for marginalized populations are required to realize this goal. In 2016, the HepCATT study team implemented a complex hepatitis C (HCV) intervention in three English drug treatment services, with five controls. We report qualitative study findings from two intervention sites to explore intervention success and transferability potential. The intervention comprised multiple components, including a nurse facilitator, peer support and education initiatives. Qualitative data were generated at baseline (2014) and post-intervention (2016) at two sites through in-depth interviews, focus groups and observations. The 96 participants comprised drug service and intervention providers and clients with an injecting history. Data were triangulated and thematically analysed. Client engagement with a HCV treatment service rose from 16 at baseline to 147 in 2016. There was no comparable increase at the five control sites. Baseline testing and treatment barriers included the following: limited HCV knowledge; fear of diagnosis and treatment; precarious living circumstances and service-specific obstacles. Treatment engagement was aided by intervention timeliness; improved communication structures; personalized care; streamlined testing and treatment pathways; peer support. Multiple interrelated components influenced the increased levels of treatment engagement documented in HepCATT. The nurse facilitator, involved in implementation and innovation, was key to intervention success. Baseline barriers correspond with international literature—indicating transferability potential. Control data indicate that biomedical innovation alone is not sufficient to increase engagement among the most marginalized. Sustainable resourcing of community services is crucial to effect change.

Citation

Harris, M., Bonnington, O., Harrison, G., Hickman, M., & Irving, W. L. (in press). Understanding hepatitis C intervention success: qualitative findings from the HepCATT study. Journal of Viral Hepatitis, https://doi.org/10.1111/jvh.12869

• Journal Article Type: Article
• Acceptance Date: Dec 14, 2017
• Online Publication Date: Feb 27, 2018
• Deposit Date: Mar 1, 2018
• Publicly Available Date: Feb 28, 2019
• Journal: Journal of Viral Hepatitis
• Print ISSN: 1352-0504
• Electronic ISSN: 1365-2893
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• DOI: https://doi.org/10.1111/jvh.12869
• Public URL: https://nottingham-repository.worktribe.com/output/917582
• Publisher URL: http://onlinelibrary.wiley.com/doi/10.1111/jvh.12869/full
• Additional Information: This is the peer reviewed version of the following article: Harris M, Bonnington O, Harrison G, Hickman M, Irving W; on behalf of the HepCATT team. Understanding hepatitis C intervention success—Qualitative findings from the HepCATT study. J Viral Hepat. 2018;00:1–9, which has been published in final form at http://onlinelibrary.wiley.com/doi/10.1111/jvh.12869/full. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.