Experiences of injecting drugs, alcohol use and hepatitis C in Merseyside: Barriers to hepatitis C support

Hepatitis C is a blood borne virus affecting the liver. In the UK, approximately 214,000 people are infected with the hepatitis C virus. Hepatitis C disproportionally affects marginalised populations and in the UK sharing equipment used to inject drugs is the main risk factor for hepatitis C infection. Despite there being treatments for hepatitis C, many do not access it or indeed get tested, leading to deaths from complications of hepatitis C such as end stage liver disease or hepatocarcinoma. The World Health Organization’s target to eliminate viral hepatitis as a major public health threat by 2030, has led to calls for action to increase access to hepatitis C testing and treatment. To increase uptake of testing and treatment, an understanding of the current barriers to access is required. Historically, alcohol and injecting drug use have been barriers to receiving treatment. Alcohol is also regarded as problematic as it expedites the progression of hepatitis C. There is however a paucity of research on experiences of alcohol use in People Who Inject Drugs (PWID) who have hepatitis C. The aim of this research was to gain an understanding of the experiences, practices and meanings of alcohol for people living with hepatitis C and to understand their needs and support requirements. Being qualitative in nature, this research took an explorative, inductive approach, allowing emerging themes to lead the direction of the research. The starting point was observation of hepatitis C support groups and interviews with people who have/had hepatitis C (services users, n=21), leading onto interviews with professionals (n=12) working in drug, alcohol and hepatitis C services. A multi-methods approach was used. Service user interviews were life history interviews, using a calendar method, and for the interviews with professionals, vignettes about hypothetical services users and semi structured interviews were used. Data were analysed using a combination of approaches. For the interviews using the calendar method, the individual calendars were studied to ascertain the sequence of events in a participant’s life. More generally, an ongoing constant comparative approach occurred throughout the various stages of the research and interview transcripts were analysed using thematic analysis. This research has explored alcohol use in PWID who have hepatitis C, however the methods employed have afforded wider findings, giving an insight into barriers and challenges to hepatitis C support. Barriers/challenges were found at service user, service and strategic levels. For service users, barriers were to accessing support (incorporating, testing, treatment, advice, information and peer support) and for service providers and commissioners, challenges were to providing support services for people with the hepatitis C virus. Alcohol fits in to this picture as a barrier to support from the PWID community, due to the stigma of becoming ‘a drinker’ and as an exclusion to receiving hepatitis C treatment. There is a paucity of qualitative research on alcohol use and hepatitis C in PWID. To our knowledge this research is the first study exploring the lived experience of alcohol use for PWID who have hepatitis C in England. The findings from this study therefore contribute to the current limited body of knowledge on this topic. Although on completing this thesis some of the findings are out dated as hepatitis C treatment is now being provided out of the hospital setting, other barriers to providing and accessing hepatitis C support are still relevant. These findings will be of interest to those working both in practice and public health policy who are working towards the elimination of hepatitis C by 2030.