Authors
Taylor Vega, BA Ximena Levander, MD Andrew Seaman, MD P. Todd Korthuis, MD, MPH Honora Englander, MD
Introduction
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 鈥減art of recovery鈥. These findings led us to explore patient perceptions of the relationship between substance use disorder (SUD) and readiness to engage with HCV curative treatment.
Methods
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.
Results
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 鈥渟tep towards recovery鈥. They felt it would reinforce their motivation to continue SUD treatment. Among patients in recovery before hospitalization, many felt that HCV was a 鈥渟ymbol of using鈥 in their 鈥渙ld life鈥 and that HCV cure would allow them to 鈥渕ove forward.鈥 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.
Conclusion
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 鈥渕entally putting drugs in the past鈥 and was a future oriented action towards 鈥渂etter health.鈥 Discussing HCV treatment during hospitalization may be an opportunity to support people in their recovery journey.
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