Barriers to Hepatitis C Treatment among Women in Methadone Treatment: A Study from Iran, the Most Populous Persian Gulf Country

Omid Massah, Mohammad Effatpanah, Afsaneh Moradi, Mohammad Salehi, Ali Farhoudian, Zahra Karami

Abstract


Background: Untreated Hepatitis C Virus (HCV) has been reported among many Iranian female methadone patients. However, few of them report receiving HCV treatment. The present study is the first research from western Asia that explored the barriers to receiving HCV treatment among a group of Iranian female HCV-infected methadone patients.

Methods: This qualitative study was conducted in four main methadone treatment clinics in Tehran, Iran, in November 2016. Overall, fifty-six untreated HCV-infected women and eight clinicians from HCV and methadone treatment services were interviewed. Women either had not received HCV treatment or received HCV treatment but left it. Data were analyzed using NVivo software. This was based on the grounded theory of Strauss and Corbin.

Findings: Barriers to receiving HCV treatment included factors related to individuals and factors related to the system. Individual factors included the perception that untreated HCV infection was not a serious health concern, family responsibilities, and self-perceived discrimination against HCV-infected women. System-related factors included the lack of referral from methadone treatment staff, and a long distance between HCV treatment centers and methadone treatment centers. Interviews with the health professionals also confirmed the women’ self-reports.

Conclusion: The results of this research confirm the necessity of providing HCV education and the delivery of comprehensive care for this group in methadone treatment clinics. Other services such as staff education and HCV treatment services at methadone treatment centers are suggested.


Keywords


Drugs; Hepatitis C virus; Iran; Methadone; Treatment

Full Text:

PDF

References


Perz JF, Armstrong GL, Farrington LA, Hutin YJ, Bell BP. The contributions of hepatitis B virus and hepatitis C virus infections to cirrhosis and primary liver cancer worldwide. J Hepatol 2006; 45(4): 529-38.

Ly KN, Xing J, Klevens RM, Jiles RB, Ward JW, Holmberg SD. The increasing burden of mortality from viral hepatitis in the United States between 1999 and 2007. Ann Intern Med 2012; 156(4): 271-8.

Graham CS, Swan T. A path to eradication of hepatitis C in low- and middle-income countries. Antiviral Res 2015; 119: 89-96.

Schaefer M, Heinz A, Backmund M. Treatment of chronic hepatitis C in patients with drug dependence: Time to change the rules? Addiction 2004; 99(9): 1167-75.

Walley AY, White MC, Kushel MB, Song YS, Tulsky JP. Knowledge of and interest in hepatitis C treatment at a methadone clinic. J Subst Abuse Treat 2005; 28(2): 181-7.

Eskandarieh S, Nikfarjam A, Tarjoman T, Nasehi A, Jafari F, Saberi-Zafarghandi MB. Descriptive aspects of injection drug users in Iran’s national harm reduction program by methadone maintenance treatment. Iran J Public Health 2013; 42(6): 588-93.

Alam-Mehrjerdi Z, Abdollahi M, Higgs P, Dolan K. Drug use treatment and harm reduction programs in Iran: A unique model of health in the most populated Persian Gulf country. Asian J Psychiatr 2015; 16: 78-83.

Mehrjerdi ZA, Abarashi Z, Noroozi A, Arshad L, Zarghami M. Correlates of shared methamphetamine injection among methamphetamine-injecting treatment seekers: The first report from Iran. Int J STD AIDS 2014; 25(6): 420-7.

Alam-mehrjerdi Z, Noori R, Dolan K. Opioid use, treatment and harm reduction services: The first report from the Persian Gulf region. J Subst Use 2016; 21(2): 217-23.

Alam-Mehrjerdi Z, Moradi A, Xu F, Zarghami M, Salehi-Fadardi J, Dolan K. Willingness to receive treatment for hepatitis c among injecting drug users on methadone program: Implications for education and treatment. Addict Health 2016; 8(2): 90-7.

Sylvestre DL. Treating hepatitis C in methadone maintenance patients: An interim analysis. Drug Alcohol Depend 2002; 67(2): 117-23.

Clark PJ, Muir AJ. Overcoming barriers to care for hepatitis C. N Engl J Med 2012; 366(26): 2436-8.

Strauss A, Corbin J. Basics of qualitative research: Grounded theory procedures and techniques. SAGE Publications: Thousand Oaks, CA; 1990.

Pope C, Mays N. Reaching the parts other methods cannot reach: An introduction to qualitative methods in health and health services research. BMJ 1995; 311(6996): 42-5.

Temple-Smith M, Stoové M, Smith A, O'Brien M, Mitchell D, Banwell C, et al. Gender differences in seeking care for hepatitis C in Australia. J Subst Use 2007; 12(1): 59-70.

Papatheodoridis GV, Tsochatzis E, Hardtke S, Wedemeyer H. Barriers to care and treatment for patients with chronic viral hepatitis in Europe: A systematic review. Liver Int 2014; 34(10): 1452-63.

Mendes-Correa MC, Martins LG, Ferreira PA, Tenore S, Leite OH, Leite AG, et al. Barriers to treatment of hepatitis C in HIV/HCV coinfected adults in Brazil. Braz J Infect Dis 2010; 14(3): 237-41.

Grebely J, Genoway KA, Raffa JD, Dhadwal G, Rajan T, Showler G, et al. Barriers associated with the treatment of hepatitis C virus infection among illicit drug users. Drug Alcohol Depend 2008; 93(1-2): 141-7.

Cooper CL, Giordano C, Mackie D, Mills EJ. Equitable access to HCV care in HIV-HCV co-infection can be achieved despite barriers to health care provision. Ther Clin Risk Manag 2010; 6: 207-12.

Barocas JA, Brennan MB, Hull SJ, Stokes S, Fangman JJ, Westergaard RP. Barriers and facilitators of hepatitis C screening among people who inject drugs: A multi-city, mixed-methods study. Harm Reduct J 2014; 11: 1.

Chan KY, Reidpath DD. Stigmatization of patients with AIDS: Understanding the interrelationships between Thai nurses' attitudes toward HIV/AIDS, drug use, and commercial sex. AIDS Patient Care STDS 2007; 21(10): 763-75.

Alammehrjerdi Z, Massah O, Farhoudian A, Shishehgar S, Moradi A, Dolan K. Opioid use among women on a stable methadone dose. Iran J Psychiatry Behav Sci 2017; 1(3): e9867.

Coupland H, Day C, Levy MT, Maher L. Promoting equitable access to hepatitis C treatment for Indo-Chinese injecting drug users. Health Promot J Austr 2009; 20(3): 234-40.

National AIDS Committee Secretariat, Ministry of Health and Medical Education. Islamic Republic of Iran: AIDS Progress Report: On Monitoring of the United Nations General Assembly Special Session on HIV and AIDS [Online]. [cited 2015]; Available from: URL: http://www.unaids.org/sites/default/files/country/documents/IRN_narrative_report_2015.pdf

Rezaei F, Noroozi A, Armoon B, Farhoudian A, Massah O, Sharifi H, et al. Social determinants and hepatitis C among people who inject drugs in Kermanshah, Iran: Socioeconomic status, homelessness, and sufficient syringe coverage. J Subst Use 2017; 22(5): 474-8.

Samiei M, Moradi A, Noori R, Aryanfard S, Rafiey H, Naranjiha H. Persian at-risk women and barriers to receiving HIV services in drug treatment: First report from Iran. Int J High Risk Behav Addict 2016; 5(2): e27488.




DOI: http://dx.doi.org/10.22122/ahj.v9i4.519

Refbacks

  • There are currently no refbacks.


Creative Commons Attribution-NonCommercial 4.0

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 Unported License which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.