Promoting equitable access to hepatitis C treatment for Indo-Chinese injecting drug users

Issue addressed: Increasing the uptake of hepatitis C treatment by injecting drug users (IDUs) is a key strategy in addressing the escalating disease burden of chronic hepatitis C virus (HCV) infection in Australia. Little is known about barriers to treatment uptake among culturally diverse groups of IDUs. Indo-Chinese IDUs represent a marginalised group with high rates of incident and prevalent HCV infection. Methods: An ethnographic study was conducted to explore barriers to HCV treatment uptake experienced by Indo-Chinese IDUs and inform the development of policies and practices that promote access to treatment. Following a baseline interview, participants (n=23) received a brief intervention about HCV treatment and an offer of facilitated referral to a tertiary liver clinic. Follow-up interviews were conducted three and six months post intervention, to explore decision-making about treatment-seeking and experiences accessing the clinic. Results: While 'getting rid of' HCV was regarded as highly desirable, only three participants were assessed for treatment. For most participants, seeking treatment was not seen as feasible given social and structural barriers related to their drug use, lack of resources and support. Institutional barriers included the clinic's administrative procedures, limited flexibility and apparent reluctance to consider current IDUs suitable candidates for treatment. Conclusions: Resources and support, flexible, low threshold approaches to assessment and a willingness to provide treatment to current IDUs, would promote equitable access to treatment among these groups.