Investigating the health-related experiences and trajectories of direct-acting antiviral hepatitis C virus treatment among people who inject drugs

Background: The advent of highly tolerable and effective direct-acting antiviral (DAA) medications has auspiciously transformed the hepatitis C virus (HCV) treatment landscape. Yet, people who inject drugs (PWID) – a population with inequitably high rates of HCV and who face significant socio-structural barriers to healthcare access – continue to have low rates of DAA uptake. Given health and healthcare access inequities faced, there is a critical need for knowledge about how to optimize HCV care, experiences, and outcomes for this priority population. The objectives of this thesis are therefore to: (1) explore how PWID living with HCV perceive and experience DAA treatment; and (2) identify how PWID perceive and describe their health and social experiences, contexts, and practices (e.g., substance use, harm reduction) following DAA treatment. Methods: Drawing on a critical theoretical framework informed by principles of equity and dialectical social justice, I thematically analyze data from in-depth, semi-structured interviews conducted between January and June 2018 in Vancouver, Canada, with a stratified purposive sample (n=56) of PWID at various stages (e.g., pre, peri, post) of DAA treatment. Findings: The findings drawn from this research highlight how motivations for undergoing DAA treatment (e.g., burden of HCV symptoms, previous experiences with HCV treatments, desire for a “better” life following HCV cure), as well as features of healthcare delivery (e.g., provider-patient power dynamics, clinician “gatekeeping” of DAAs, approaches to care) influenced PWID’s experiences and trajectories of HCV treatment. At the same time, study findings surfaced the ways in which broader socio-contextual factors (e.g., peer and community supports, housing, stigma, drug criminalization) either facilitate or restrict opportunities for HCV treatment, re-infection prevention, and health and wellbeing more generally. Conclusions: These findings underscore several key programming and policy adaptations that are required to improve PWID’s HCV treatment experiences. Specifically, these findings highlight the demand for clinician approaches to HCV care that are equity-oriented, trauma- and violence-informed, and attentive to power differentials. These findings also indicate that, to further advance equity in HCV care for PWID, there is a need for harm reduction-oriented services, anti-stigma and -violence efforts, and improvements to housing and the social welfare system.Applied Science, Faculty ofMedicine, Faculty ofNursing, School ofPopulation and Public Health (SPPH), School ofGraduat