Stigma, Barriers to Care, and Other Factors Associated with Hepatitis C Viral Infection in Black Residents of Washington, DC

Abstract

Hepatitis C Virus (HCV) is a virus impacting the liver that is spread through blood contact and most transmitted through injection drug use (IDU) and sexual contact. HCV incidence in the US is 1.3 per 100,000, with highest incidence reported in male injection drug users. Black non-Hispanics have the third highest incidence among races in the US as well. While HCV is very treatable, the WHO reports that access to diagnosis and treatment is low globally. The aim of this study is to assess barriers associated with both diagnosis and treatment of HCV to comprehend reasons for low diagnosis and treatment rates in the Washington, DC metropolitan area.Building upon the ongoing study “Molecular and Genetic Signatures of Perturbed Diabetic Pathways with Hepatitis C Virus Infection and Co-Morbidity Risks in African American Population”, 116 of these participants were eligible for participation. There were 89 controls and 27 HCV participants. Sociodemographic data was collected prior to this study for all participants, and then qualitative interviews were performed with 4 HCV participants, 1 control, and 1 key information. Significant differences between cases and controls were found in gender (p=0.153), education (p=0.111), hypertension status (p=0.158), and Hba1c levels (p=0.057) where significance was calculated at the 80% confidence level. Further, significant odds ratios (OR) were calculated, with increased odds in those with education below high school, males, and smokers (smoke >3 months). Significant reduced odds were found in non-smoker, females, and those who drink 1-2 times per month. Perceived barriers determined in the interviews were found to be stigma, lack of education, mistrust in healthcare system, incarceration, homelessness, and injection drug use. Through this study I was able to close many gaps in the existing literature, particularly when looking at perceived barriers in the black community that stops them from seeking a diagnosis or treatment for HCV. Further, this paper was able to look specifically at vulnerable participants in the Washington, DC metropolitan area and gather their opinions on not only their perceptions of HCV and barriers, but also how our community could best aid those at risk who are IDU, homeless, and incarcerated.