Knowledge, attitudes, and acceptability of direct-acting antiviral hepatitis C treatment among people incarcerated in jail: A qualitative study

• Published in: PloS one 2020-12, Vol.15 (12), p.e0242623
• Main Authors: Akiyama, Matthew J, Ross, Jonathan, Rimawi, Fatimah, Fox, Aaron, Jordan, Alison O, Wiersema, Janet, Litwin, Alain H, Kaba, Fatos, MacDonald, Ross
• Format: Article
• Language: English
• Subjects: Acceptability; Adult; Age; Antibodies; Antiretroviral drugs; Antiviral agents; Antiviral Agents - therapeutic use; Antiviral drugs; Attitudes; Beliefs, opinions and attitudes; Biology and life sciences; Codes; Communication; Dosage and administration; Drug abuse; Drug therapy; Drug use; Female; Health Knowledge, Attitudes, Practice; Health risks; Health services; Hepatitis; Hepatitis C; Hepatitis C - drug therapy; Hospitals; Housing; Humans; Imprisonment; Informed consent; Interviews; Jails; Male; Medical schools; Medicine; Medicine and health sciences; Patient Acceptance of Health Care; People and Places; Priorities; Prisoners; Prisons; Public opinion; Qualitative Research; Recurrence; Self Report; Social interactions; Social Sciences; Social Support; Substance use; Withholding Treatment
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0242623

While U.S. jails are critical sites for engagement in HCV care, short lengths-of-stay often do not permit treatment in jail. Therefore, linkage to HCV care after incarceration is crucial. However, little is known about HCV treatment acceptability among justice-involved individuals in U.S. jails. The goal of this study was to understand knowledge, attitudes, and acceptability of HCV treatment among people living with HCV in the New York City (NYC) jail system. We recruited 36 HCV-antibody-positive individuals in the NYC jails using clinical data reports and performed semi-structured interviews to explore participants' attitudes toward HCV treatment in jail and following return to the community. We continued interviews until reaching thematic saturation and analyzed interviews using an inductive, thematic approach. Participants were mostly male, Latina/o, with a mean age of 40 years. Nearly all were aware they were HCV antibody-positive. Two thirds of participants had some awareness of the availability of new HCV therapies. Key themes included: 1) variable knowledge of new HCV therapies affecting attitudes toward HCV treatment, 2) the importance of other incarcerated individuals in communicating HCV-related knowledge, 3) vulnerability during incarceration and fear of treatment interruption, 4) concern for relapse to active drug use and HCV reinfection, 5) competing priorities (such as other medical comorbidities, ongoing substance use, and housing), 6) social support and the importance of family. Patient-centered approaches to increase treatment uptake in jail settings should focus on promoting HCV-related knowledge including leveraging peers for knowledge dissemination. In addition, transitional care programs should ensure people living with HCV in jail have tailored discharge plans focused on competing priorities such as housing instability, social support, and treatment of substance use disorders.