Taming systems to create enabling environments for HCV treatment: Negotiating trust in the drug and alcohol setting.

Harris, M; Rhodes, T; Martin, A; (2013) Taming systems to create enabling environments for HCV treatment: Negotiating trust in the drug and alcohol setting. Social science & medicine (1982), 83. pp. 19-26. ISSN 0277-9536 DOI: https://doi.org/10.1016/j.socscimed.2013.01.031

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HCV (hepatitis C) treatment uptake among the population most affected - people who inject drugs - is suboptimal. Hospital based treatment provision is one evidenced barrier to HCV treatment uptake. In response, HCV treatment is increasingly located in treatment settings seen as more amenable to people who inject drugs, such as drug and alcohol services. We explored the accessibility of HCV treatment provision at two such partnerships. Data collection comprised qualitative interviews collected in 2011 and 2012 with 35 service users and 14 service providers of HCV treatment in London, United Kingdom. We draw here primarily on thematic analyses of service provider accounts, yet narratives relating to trust and environment emerged unsolicited in both user and provider accounts of negotiated HCV treatment access. A key theme in service provider accounts were strategies they deployed to 'tame' the treatment system so as to create an 'enabling environment' of care, in which trust was a critical feature. This 'taming' of the system was enacted through practices of 'negotiated flexibility', including in relation to appointments, eligibility, and phlebotomy. Service user accounts accentuated familiar environments and known health providers as those most trusted, and the potentially stigmatising effects of negotiating treatment in unfamiliar territory, especially hospital settings. Whilst noting the effects of provider strategies to negotiate flexibility on behalf of would-be patients seeking treatment, we conclude by noting the limits of trust relations in settings of constrained choice.

Item Type: Article
Faculty and Department: Faculty of Public Health and Policy > Dept of Social and Environmental Health Research
Research Centre: Centre for Maternal, Reproductive and Child Health (MARCH)
PubMed ID: 23465200
Web of Science ID: 317025600003
URI: http://researchonline.lshtm.ac.uk/id/eprint/639128


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