“Sobriety equals getting rid of hepatitis C”: A qualitative study exploring the interplay of substance use disorder and hepatitis C among hospitalized adults

Background: People who use drugs (PWUD) commonly experience complex illness, psychosocial stressors, housing insecurity, and stigma, which may play key roles in their struggles with addiction. In a study of hospitalized PWUD with hepatitis C virus infection (HCV), participants described treating HCV as “part of recovery.” These findings led us to explore how hospitalization and acute illness altered patients' perceptions of substance use disorder (SUD) and HCV. Methods: Researchers audio recorded in-depth semi-structured individual interviews of 27 hospitalized adults with SUD and HCV seen by an addiction consult service (ACS) at an urban academic medical center between June and November 2019. Research staff transcribed interviews and dual coded them deductively and inductively at the semantic level. Researchers used a matrix visualization to discern relationships among codes and conducted a thematic analysis. Results: Many participants believed addictions treatment should precede an HCV cure for varying reasons. Some wanted to avoid reinfection; others believed “getting clean” afforded the mental clarity to address health issues, including HCV. Patients newly engaged in SUD treatment described HCV treatment as a “step towards recovery” and could serve as motivation to continue SUD treatment. Participants believed HCV cure could facilitate sobriety by “mentally putting drugs in the past” and was a future-oriented action toward “better health.” Many participants described the compounded stigma of having HCV infection and SUD by multiple groups, including friends/family who do not use drugs, other drug users, and health care workers. Conclusion: Hospitalized adults with SUD and HCV believed addictions engagement should precede HCV treatment and HCV cure could play an important role in their “recovery” journey. Discussing HCV treatment during hospitalization may be an opportunity to support engagement in SUD treatment and targets an untreated patient population critical for achieving HCV elimination.