Taylor Vega, BA Ximena Levander, MD Andrew Seaman, MD P. Todd Korthuis, MD, MPH Honora Englander, MD
Persons who use drugs (PWUD) commonly experience complex illnesses, psychosocial stressors, housing insecurity, and stigma, which may play a key role in their struggles with addiction. In a study of hospitalized PWUD with hepatitis C virus infection (HCV), participants described treating HCV as “part of recovery”. These findings led us to explore patient perceptions of the relationship between substance use disorder (SUD) and readiness to engage with HCV curative treatment.
We audio recorded in-depth semi-structured individual interviews of 27 hospitalized adults with SUD and chronic HCV seen by an addiction consult service at an urban academic medical center between June and November 2019. We transcribed and dual coded interviews deductively and inductively at the semantic level then analyzed for themes using iterative categorization.
Many patients described feeling that they should get their SUD treatment prior to HCV treatment in order to avoid possible reinfection. Patients newly engaged in SUD treatment during hospitalization felt that starting HCV treatment would serve as a “step towards recovery”. They felt it would reinforce their motivation to continue SUD treatment. Among patients in recovery before hospitalization, many felt that HCV was a “symbol of using” in their “old life” and that HCV cure would allow them to “move forward.” For them, having HCV directly challenged their identity as someone in recovery. Among patients with limited motivation to stop using, most were not interested in discussing HCV treatment during hospitalization.
Counter to current national HCV eradication guideline recommendations, most hospitalized adults with SUD and HCV felt that addictions treatment and sobriety should precede HCV treatment. Patients believed HCV cure could facilitate sobriety by “mentally putting drugs in the past” and was a future oriented action towards “better health.” Discussing HCV treatment during hospitalization may be an opportunity to support people in their recovery journey.
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