Perceived barriers to access to hepatitis C for people who inject drugs in Morocco: A qualitative explorative study

Abstract

Worldwide, approximately there are 15.6 million people who inject drugs. Recently, a rising prevalence of hepatitis C virus among the people who inject drugs community (8.2 million, 40 to 80% of people who inject drugs) urged governments to implement targeted preventive and structural interventions. Yet, social stigma, poor interaction with health workers, and limited health literacy are critical challenges to equitable access to care. This study explores the perceived barriers and facilitators of people who inject drugs access to hepatitis C virus care in Morocco. We adopted an explorative qualitative single-embedded case study design. We conducted 19 semi-structured interviews and a focus group discussion with people who inject drugs, health workers, and social community health workers. We performed an inductive qualitative data analysis using thematic analysis. We coded data using NVivo software. We summarized our findings using a causal loop diagram of critical barriers and facilitators. Multi-layered and interdependent factors constrain access to care for people who inject drugs. People who inject drugs are considered a vulnerable population experiencing irregular housing, lack of family support, gender-based stigmatization, and incarcerations. Individual factors include limited hepatitis C virus health literacy, mistrust in health workers, and poor interaction with health workers within healthcare facilities. Both individual and structural elements decrease their perceived self-worth and self-esteem and reinforce their perceived social stigmatization. This leads to a lack of motivation to engage in hepatitis C virus care delivery. We found that peer educators are perceived as trustworthy and credible sources of hepatitis C virus health-related knowledge. Poor access to hepatitis C virus treatment for people who inject drugs involved an intertwined set of individual factors (level of knowledge, perceived social stigma, reduced self-esteem, and self-worth) and structural factors such as poor interaction with health workers and mistrust in healthcare institutions. More attention needs to be paid to alleviate structural barriers by integrating peer education, multiagency collaboration, community engagement, and capacity building of health workers for equitable access of people who inject drugs to hepatitis C virus care.