Inequitable Access of People Who Injected Drugs to HCV Care in Tangier, Morocco: An Explorative Qualitative Study

Abstract BackgroundWorldwide, approximately 16 million people inject drugs, 5 to 6 million people are living with hepatitis C virus (HCV) infection. In Morocco, people who inject drugs (PWID) exceeds 1500 and the majority lives in the northern region of Morocco (Tangier-Tetouan-Al Hoceima). Evidence suggests that 75% of them are infected with HCV. However, PWID suffers from inequitable access to hepatitis C care. For instance, 75 % of PWID affiliated to Hassnouna Association for the Support of Drug Users (AHSUD) do not have access to HCV treatment in Tangier. In this study, we aimed at exploring the underlying mechanisms and contextual conditions that hinders PWID from accessing HCV treatment. MethodsWe adopted qualitative multiple embedded case study design. We conducted 19 semi-structured interviews and a focus group discussion with PWIDs, community stakeholders and caregivers. We also carried out document review. We performed qualitative data analysis using NVivo software using concept, hypothesis and nvivo coding. We summarised key findings in the forms of barriers and facilitators. Results Access to care for PWID is constrained by individual, group, healthcare and socio-institutional factors. Individual factors include poor compliance to treatment, non-integration of care in personal priorities, level of knowledge of the disease with mistrust in government owned health institutions. At healthcare level, access to HCV care is also constrained by lack of appropriate management of co-morbidities and adequate management of drug dependence. Social barriers include poor access to housing, lack of family support, social-institutional, gender-based stigmatisation and criminalisation of drug use. This is often responsible for negative experiences of care, feeling of discomfort and perceived mistrust in government owned healthcare services .Such contextual prevent them from an appropriate access to HCV. An emerging result is that PWID are sharing and learning health related knowledge from their peers. This reinforces their perceived self-efficacy and social support and enhance the likelihood of following HCV treatment. Discussion and conclusion Poor access to HCV treatment for PWID involved an intertwined set of individual (level of knowledge, healthcare poor management of comorbidities and drug dependency) and institutional factors (social stigma, gender based discrimination…. etc). To allow better access to HCV for PWID, more attention should be placed in peer education (the main channel of information for IDUs) and broader political and societal changes are needed to de-stigmatize the use of drugs in Morocco.