Hepatitis C virus treatment, people who inject drugs, and treatment barriers in the age of direct-acting antivirals

Hepatitis C virus (HCV) infection affects millions of Americans at a high public health cost. Despite the availability of a curative treatment, a significant proportion of people living with HCV are not treated. People who inject drugs (PWID), are one of the groups at highest risk of HCV transmission, and are among the least likely to get treatment. Using literature reviews to explore the evidence and a cross-sectional survey to assess what barriers providers see to treatment for PWID, this dissertation explores outcomes when PWID do receive treatment, facilitators to successful treatment outcomes, how current treatment guidelines address substance use, and how providers assess treatment candidacy in PWID. Barriers to treatment include patient-related factors such lack of engagement in healthcare and contradictions to treatment. Other barriers are provider-related, such assumptions about the ability of PWID to complete treatment, and concerns about ongoing drug use and reinfection risk. Although eradication of HCV infection through provision of this curative treatment is theoretically possible, this cannot happen until PWID are treated in large numbers. Currently, PWID face substantial barriers to treatment despite the existence of a cure. Improved provider willingness and knowledge, decreased medication costs, and interventions to address adherence and reinfection are all needed in order to facilitate increased treatment provision for PWID, and move toward eradication of HCV in the United States