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Table 6 Qualitative research reporting on patients’ and health providers’ experiences

From: Hepatitis C virus infection in Irish drug users and prisoners – a scoping review

  Date and author Setting Sample (n) Data collection Design Main results
[43] 2005 Cullen et al Dublin Single site General practice Heroin users - past history (25) 2002 (6 months) Mixed methods using interviewer-administered semi-structured questionnaire Anti-HCV =88%
• Follow up investigations for HCV =8
• Treatment = 1
• 100% aware of HCV
• 22/25 consulted healthcare professional about HCV
• 21/25 knew HCV infection was caused by injecting
• High awareness of harm reduction measures and health implications of HCV
• Negative experiences of diagnosis, assessment and treatment
[85] 2005 Dillon Dublin Multi-site 4 prisons Prison officers   Cross sectional survey • 87% reported not knowing enough about these diseases to enable them to take the necessary precautions at work
• Longer serving and senior officers were less fearful and less anxious about contracting the infections
• Officers who had received hepatitis B vaccination were no less worried about hepatitis B than unvaccinated colleagues
• Training on blood borne viruses had little effect on prison officers’ knowledge or perception of blood borne viral infections
[81] 2006 Golden Dublin Single-site Hospital HCV infected patients awaiting treatment (87; m = 64; PWID = 46%)   Prevalence of illness-related stigma and mood disorders using standardised instruments • Fear of disclosure combined with social isolation and social rejection
• Stigma was higher in those in manual occupations and the unemployed than in those in non-manual occupation
• High levels of disease-associated stigma in those with disease associated with IDU and iatrogenic disease caused by transfusion or anti-D blood products
• Stigma was associated with depression (OR = 1.4)
• Stigma was also associated with poorer work and social adjustment, lower acceptance of illness, higher subjective levels of symptoms and greater subjective impairment of memory and concentration. These associations were replicated in the non-depressed subsample.
• Strong link between stigma and well-being in hepatitis C
[83] 2010 Swan et al Dublin Multi-site (7) Drug treatment clinic (2) GP (1) Community drop in (1) Hepatology (2) ID clinic (1) PWID (36; m = 28) 2007–2008 In-depth one-to-one interviews using grounded theory methodology Anti-HCV = 91% HIV co-infected = 11% Barriers to HCV screening and treatment:
• Perceptions of HCV infection as relatively benign
• fear of investigations and treatment including liver biopsy and interferon
• feeling well
• limited knowledge of testing sites
• not being referred for specialist investigations
• ineligibility for treatment
• competing priorities (employment, education, and addiction).
Facilitators to HCV screening and treatment:
• relationships with health care providers
trust in providers
• concern for the service-user
• continuity of care
• education on HCV infection, investigations, and treatment
• becoming symptomatic
• responsibilities for children
• wanting to move on from drug use
[84] Whitaker et al. 2011 Dublin Drug using sex workers (35; m = 4)   One-to-one in-depth interviews Multiple layers of stigma were reported, linked to sex work, drug use (including IDU) and having contracted HIV or HCV
• Stigma was powerfully reinforced by the language routinely used by health professionals.
 • To improve the effectiveness of harm-reduction interventions, it is recommended that service providers change their language, in particular in recognition of the human dignity of these clients, but also to help attract and retain drug users in services, and to help reduce the unacceptable mortality levels among drug users.
[73] 2017Crowley et al Dublin Single site Community drug treatment centre PWID attending community fibroscan clinic (68) 2017 Mixed methods Researcher administered questionnaire Attendance = 90%
• high levels of unemployment (90%) and homelessness (40%)
 • higher fibroscan scores (> 8.5Kpa) were associated with longer time since diagnosis (p = 0.016).
Patient identified barriers to engagement:
 • alcohol and drug use
 • fear of HCV treatment and liver biopsy
 • imprisonment
 • distance to hospital
 • early morning appointments.
Patient identified enablers:
 • afternoon appointments
 • enhanced prison referral mechanisms into the community Fibroscan unit
 • location of services within the addiction treatment and detoxification services
[79] 2017 Ni Cheallaigh et al. National Multi-site Community drug treatment centres, homeless hostels, GPs Study sites: Pilot sites (4): 2 Dublin based community drug treatment centres, 1 Waterford based; 1 Dublin based homeless hostel 10 interviewees from 8 sites at baseline. 6 participants in pilot programme at study completion Mar-Oct 2015 Purposive sampling Estimated HCV prevalence in GP practices = 1–10%
Estimated chronic prevalence in pilot sites = 15–75%
 • PWID were identified as the main group facing barriers to accessing specialist HCV care.
 • State-employed doctors and nurses were successfully recruited to participate in the project.
 • GPs did not participate, due mainly to a lack of time and the absence of reimbursement for participation.
 • Benefits to practitioners and their patients were reported. Participants expressed interest in continued engagement with similar multidisciplinary, multisite educational interventions in the future.