Post-treatment life-trajectories among people who inject drugs who completed hepatitis C treatment with direct acting antivirals: a thematic analysis

Background
Hepatitis C Virus is a global health burden, particularly affecting people who inject drugs. Direct-acting antiviral treatment can cure almost all people infected with hepatitis C. However, the longer-term impacts on within people's life trajectories are unknown, although some suggest it may lead to fundamental behavioural changes.

Design
A cross-sectional exploratory retrospective qualitative design.

Methods
We interviewed 30 people who inject(ed) drugs and who had previously been treated with direct-acting antivirals on average 18 months before the interview (range: 12–24 months). Most were male, aged 36–55 years, and had been treated in urban community-based needle and syringe programmes in Scotland. All interviews were semi-structured, conducted over the phone by either peer or academic researchers, and analysed thematically.

Results
We present three discernible post-treatment life-trajectories. Firstly, ‘A cure that was like totally new life’ involved identity transformation, often associated with controlled or zero drug use, and improved physical and mental health. Secondly, ‘There isn't much afterwards’ comprised poor quality of life and social isolation, often due to participants' disengagement from former drug use and support networks. Thirdly, ‘I'm getting tested every year now’ detailed a few life changes but normalized hepatitis C testing and treatment.

Conclusion
Our thematic analysis reinforces the positive impacts on mental well-being, physical health and self-transformation of direct-acting antiviral treatment in the short- and long-term. However, there is an urgent need for psychosocial interventions to maintain health behaviour changes and self-management, and social support for individuals post hepatitis C treatment.