Shame and stigma in association with the HCV cascade to cure among people who inject drugs

Abigail W Batchelder; Moonseong Heo; Jacklyn D Foley; Matthew C Sullivan; Paula Lum; Irene Pericot Valverde; Lynn E Taylor; Shruti H Mehta; Arthur Y Kim; Brianna Norton; Judith I Tsui; Judith Feinberg; Kim Page; Alain H Litwin; HERO Study Group

doi:10.1016/j.drugalcdep.2023.111013

Shame and stigma in association with the HCV cascade to cure among people who inject drugs

Drug Alcohol Depend. 2023 Dec 1:253:111013. doi: 10.1016/j.drugalcdep.2023.111013. Epub 2023 Oct 31.

Authors

Affiliations

¹ Behavioral Medicine Program, Psychiatry Department, Massachusetts General Hospital, One Bowdoin Square, Suite 701, Boston, MA 02114, USA; Department of Psychiatry, Harvard Medical School, One Bowdoin Square, Suite 701, Boston, MA 02114, USA; The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215, USA. Electronic address: ABatchelder@mgh.harvard.edu.
² Department of Public Health, College of Behavioral, Social, and Health Sciences, Clemson University, 116 Edwards Hall, Clemson, SC 29634, USA.
³ Behavioral Medicine Program, Psychiatry Department, Massachusetts General Hospital, One Bowdoin Square, Suite 701, Boston, MA 02114, USA; Department of Psychiatry, Harvard Medical School, One Bowdoin Square, Suite 701, Boston, MA 02114, USA.
⁴ Department of Medicine, University of California, San Francisco, CA, USA.
⁵ Department of Psychology, Clemson University, 321 Calhoun Dr, Clemson, SC 29634, USA.
⁶ College of Pharmacy, University of Rhode Island, Providence, RI, USA.
⁷ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁸ Department of Infectious Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
⁹ Department of Medicine, Montefiore Medical Center, Bronx, NY, USA.
¹⁰ Department of Medicine, University of Washington, Seattle, WA, USA.
¹¹ Department of Behavioral Medicine & Psychiatry and Department of Medicine, West Virginia University School of Medicine, Morgantown, WV, USA.
¹² Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
¹³ Department of Medicine, Clemson University, Clemson, SC, 29634 USA; Department of Medicine, University of South Carolina School of Medicine, Greenville, SC, USA; Department of Medicine, Prisma Health, Greenville, SC, USA. Electronic address: alain.litwin@prismahealth.org.

PMID: 37951006
DOI: 10.1016/j.drugalcdep.2023.111013

Abstract

Background: Psycho-social experiences including shame and experienced and internalized stigma have been associated with substance use, HCV infection, and reluctance to disclose HCV status and pursue treatment. These psycho-social barriers have been examined independently for many chronic diseases, including HCV, but to our knowledge have not been quantitatively explored in a large multi-site US-based sample of people who inject drugs (PWID) in HCV treatment.

Methods: We examine baseline relationships with HCV-stigma and engagement across the HCV treatment cascade as well as baseline and longitudinal relationships between shame and engagement across the HCV treatment cascade including treatment initiation, adherence, completion, and sustained virologic response (SVR) among a multi-site sample of PWID with HCV, where N=755 were randomized to the pragmatic trial comparing HCV treatment outcomes in modified directly observed treatment (mDOT) or patient navigation, and N=623 initiated treatment.

Results: While cross-sectional assessments of shame and HCV-stigma were not associated with engagement across the HCV treatment cascade, those whose shame scores decreased compared to those who reported consistently high and increasing levels of shame were significantly more likely to complete HCV treatment (aOR=5.29; 95%CI: 1.56,18.00) and achieve SVR (aOR=6.32; 95%CI: 1.61, 24.87).

Conclusion: Results underscore the relationships between lower levels of shame and health-related behavior and treatment outcomes among PWID and suggest SVR achievement may contribute to reductions in shame or that reductions in shame may contribute to continued treatment and thus SVR.

Keywords: Hepatitis C; Injection drug use; Shame; Stigma; Substance use; Sustained virologic response (SVR).

Publication types

Randomized Controlled Trial

MeSH terms

Antiviral Agents / therapeutic use
Cross-Sectional Studies
Drug Users*
Hepacivirus
Hepatitis C* / complications
Humans
Shame
Substance Abuse, Intravenous* / drug therapy

Substances

Antiviral Agents