Pragmatic barriers for delay in access to HCV testing services: Perspective of People With Injecting Drugs and living with HIV


  • Varada Jayant Madge MAMTA - Health Institute for Mother and Child
  • Ruchi Sogarwal Former Associate Director Non Communicable Diseases Department
  • Sunil Mehra MAMTA Health Institute for Mother and Child


social determinants of health


Abstract Background: Hepatitis C (HCV) is emerging as a major public health problem and its co-infection with HIV is on the rise especially in People With Injecting Drugs (PWID). Barriers for delay in accessing services for HCV care may lead to disease progression and impact the society in the form of loss of productive workforce. Aim: This qualitative research was undertaken to explore the barriers for delay in testing for HCV amongst PWIDs. Methods and Material: The study was conducted in two districts of India i.e. Imphal (Manipur state) and Amritsar (Punjab state). A total of 32 PWIDs participated through In-Depth Interviews (IDI) and Focus Group Discussions (FGD). Results: Mostly, the barriers reported for delay in HCV testing were related to socio economic context in which the PWIDs live; inhibitions to get tested due to fear of a positive result, unavailability of HCV services particularly in rural and remote areas, financial costs and long waiting period. Drug use amongst females influenced care seeking behavior. Conclusion: PWIDs face significant health risks of HCV. The socio economic and health systems related barriers create gap for continuum of care for PWIDs. Supportive role of the health care providers, awareness on viral hepatitis, care and support from family is thus fundamental to PWIDs living a healthy life. Key words: Barriers, Hepatitis C Virus, PWID, Health Systems and continuum of care.

Author Biographies

Varada Jayant Madge, MAMTA - Health Institute for Mother and Child

Regional Manager- Research and Evidence Building Non Communicable Diseases Department

Ruchi Sogarwal, Former Associate Director Non Communicable Diseases Department

Associate Director

Sunil Mehra, MAMTA Health Institute for Mother and Child

Executive Director



Burke Nancy and Galen Joseph (2009), “Theorizing Social Context: Rethinking Behavioral Theory”, Health Education Behaviour, vol 36, number 5, pp: 1-15.

Cullen W, Stanley J, Langton D, Kelly Y, Bury G (2007), “Management of hepatitis C among drug users attending general practice in Ireland: Baseline data from the Dublin Area Hepatitis C in General

Practice Initiative”, European Journal of General Practice 2007;13:5–12.

Ezzy D (2003), Qualitative Analysis: Practice and Innovation, Routledge publications, New York.

Grebely J, Genoway KA, Raffa JD, et al (2008), “Barriers associated with the treatment of hepatitis C virus infection among illicit drug users”, Drug Alcohol Depend vol 93, pp: 141–147.

Harris Magdalena and Rhodes Tim (2013), “Hepatitis C treatment access and uptake for people who inject drugs: a review mapping the role of social factors,” Harm Reduction Journal, vol 10, number 7, pp: 1-11.

Joshua A Barocas, Meghan B Brennan, Shawnika J Hull,Scott Stokes, John Fangman and Ryan Westergaard (2014), “Barriers and facilitators of hepatitis C screening among people who inject drugs: a multi-city, mixed-methods study, Harm Reduction Journal, vol 11, number 1, pp: 1-8.

Mennis Jeremy and Mason Michael (2010), “Social and geographic contexts of adolescent substance use: The moderating effects of age and gender”, Elsevier, vol 34, pp: 150-157.

Morse J (2002), Qualitative Health Research. Thousand Oaks,: Sage Publications, CA

Perz JF et al.(2006), “The contributions of hepatitis B virus and hepatitis C virus infections to cirrhosis and primary liver cancer worldwide”, Journal of Hepatology, vol 45, pp:529–538.

Shaodong Ye, Lin Pang, Xiaochun Wang, and Zhongfu Liu (2014), “Epidemiological Implications of HIV-Hepatitis C Co-Infection in South and Southeast Asia”, Curr HIV/AIDS Report, pp: 128-133.

Suthar Amitabh and Harries Anthony (2015), “A Public Health Approach to Hepatitis C Control in Low and Middle-Income Countries”, Plos Medicine ,pp: 1-12.

Swan D, Long J, Carr O, et al, (2010), “Barriers to and Facilitators of Hepatitis C Testing, Management, and Treatment among Current and Former Injecting Drug Users: A Qualitative Exploration”, AIDS Patient Care and STDs, vol. 24, number 12.

Web sites referred, accessed on January 2016., accessed online on January 2016, accessed online on October 2016

Jones Lisa, Atkinson Amanda, Lorna Porcellato, BatesGeoff, McCoy Ellie, Benon Caryl, McVeigh Jim and Bellis Mark (2008), A systematic review of qualitative research on the views perspectives and experiences of hepatitis B and C testing among practitioners and people at greatest risk of infection.pdf,

Available at, , accessed online on March 2016

HIV prevention among injecting drug users and their female sex partners: Implementation Gaps and Barriers, Available at,, accessed online on August 2016

More than 2 million people co-infected with HIV and hepatitis C, available at, , accessed online on March 2016






Original Research