research

Year:

2018

Citation:

Open Forum Infectious Disease 5(4) doi:�10.1093/ofid/ofy048

Study Methods:

SSP participants with confirmed HCV antibody positivity were eligible for enrollment. Recruitment was initially limited to those who had injected in the past 30 days, but starting in the spring of 2016, all interested WHCP participants were enrolled. Participants with clinical evidence of decompensated cirrhosis or deemed to have a life expectancy of less than 1 year were excluded from the co-located treatment program and referred to existing clinic-based services. Fifty-three participants started therapy, and 91% achieved sustained virologic response.

Gap in evidence addressed:

Hepatitis C virus (HCV) is a significant public health problem that disproportionately afflicts people who inject drugs. We describe outcomes of HCV treatment co-located within a syringe services program (SSP).�To our knowledge, this is the first study examining the effectiveness of a new model of care known as an Accessible Care Program, in which HCV treatment is co-located within an SSP and provides individualized education and support to meet participants� needs.

Key Findings:

SSPs provide an effective venue for HCV treatment. These data provide further evidence that PWID can achieve similar cure rates to those seen in clinical trials. Despite a limited sample size, high rates of SVR were seen across subgroups irrespective of sex, homelessness, active injection drug use, or the presence of advanced fibrosis.

Year:

2017

Citation:

Harm Reduction Journal 14:26 https://doi.org/10.1186/s12954-017-0151-4

Study Methods:

Between December 2014 and January 2015, we conducted in-depth interviews (n?=?14) with SEP staff, including both program managers and health navigators, to assess knowledge, attitudes, and beliefs related to health insurance enrollment and access to enhanced referrals among SEP clients. We developed a preliminary coding scheme from the interview guide and used a grounded theory approach to guide inclusion of subsequent thematic codes that emanated from the data. We analyzed the coded data thematically in an iterative fashion using a consensus-based approach.

Gap in evidence addressed:

Little is known about access to health insurance among people who inject drugs (PWID) who attend syringe exchange programs (SEPs). The goal of the current study was to assess perceptions of SEP staff, including health navigators and program managers, on access to health insurance and healthcare access among SEP clients following implementation of state and federal policies to enhance universal healthcare access in Massachusetts.

Key Findings:

We identified five primary themes that emerged from the qualitative interviews, including high levels of health insurance enrollment among SEP clients; barriers to enrolling in health insurance; highly needed referrals to services, including improved access to substance use disorder treatment and hepatitis C virus treatment; barriers to referring clients to these highly needed services; and recommendations for policy change. While barriers to enrollment and highly needed referrals remain, access to and enrollment in healthcare insurance plans among PWID at SEPs in Massachusetts are high. With the uncertain stability of the Affordable Care Act following the US presidential election of 2016, our findings summarize the opportunities and challenges that are connected to health insurance and healthcare access in Massachusetts. SEPs can play an important role in facilitating access to health insurance and enhancing access to preventive health and primary care.