Hepatitis C-related knowledge, attitudes and perceived risk behaviours among people who inject drugs in Kenya: A qualitative study

ABSTRACT

Despite disproportionately high rates of Hepatitis C (HCV) among people who inject drugs (PWID) in low- and middle-income countries (LMICs), understanding of HCV-related knowledge, attitudes and perceived risk behaviours among this population remains limited. We aimed to elucidate knowledge, attitudes and experiences that could minimise transmission risk and maximise HCV treatment engagement among PWID in Kenya following the integration of HCV screening and education with needle and syringe programmes in drop-in-centres (DICs). We recruited 40 PWID with chronic HCV attending DICs in Nairobi and Coastal Kenya. Semi-structured interviews revealed a general understanding of HCV and awareness of HCV risk behaviours among participants; however, many felt limited control over their transmission risk due to factors such as ‘local doctors’, or individuals who perform a high volume of high-risk injections. Financial barriers, distance to clinic, poor health status and HCV-related stigma were all noted as barriers to HCV treatment. In conclusion, basic knowledge of and motivation for HCV treatment among PWID accessing DICs in Kenya was high; however, structural barriers and stigma complicate access to care. Local education programmes can address knowledge gaps, and behavioural and structural interventions can maximise the impact of HCV care in LMICs.

KEYWORDS:

• Hepatitis C virus (HCV)
• people who inject drugs (PWID)
• injection drug use (IDU)
• low- and middle-income country (LMIC)
• needle syringe programmes (NSP)

Acknowledgments

The authors would like to acknowledge several DICs and collaborating partners for their assistance in conducting this research: Teens Watch Centre, Reach Out Centre Trust, Muslim Education and Welfare Association (MEWA), Omari Project, Nairobi Outreach Service Trust (NOSET), Support for Addiction Prevention and Treatment in Africa (SAPTA) and Medecins du Monde (MDM). The authors thank the following deeply for their contributions and support: Peer Case Managers and study participants. The authors are grateful to the NIH/NIDA for study funding (R01DA032080 and R01DA032080-05S1, Kurth and Cherutich, principal investigators; K99DA043011, Akiyama, principal investigator) and NIDA Project Officers Dionne Jones and Raul Mandler for their continuing support.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data that support the findings of this study are available on request from the corresponding author, M. J. A. The data are not publicly available due to the fact that the data contain information that could compromise the privacy of research participants.

Additional information

Funding

This work was supported by the National Institutes of Health/National Institute on Drug Abuse [grant number R01DA032080, R01DA032080-05S1, K99DA043011, R00DA043011], and a pilot grant from the Albert Einstein College of Medicine Global Health Center.