Barriers and facilitators along the Hepatitis C reinfection journey: Qualitative interview study

Abstract Among people who have experienced hepatitis C virus (HCV) reinfection, we examined the barriers and facilitators to preventing (re)infection with HCV, to seeking testing and treatment, and for prospective prevention of further reinfection. Remote semi-structured interviews (January-August 2024) were conducted with participants recruited via the Hepatitis C Trust and the National Health Service in England. The data were thematically analysed using the COM-B model, exploring how capability, opportunity, and motivation affect behaviour during participants’ journeys with (re)infection-testing-treatment. Six participants were interviewed including 1 female, 1 person who acquired HCV via sex, 1 person who received care in prison, and 5 people who injected drugs. Some people who inject drugs reported not feeling capable of preventing reinfections whilst injecting drugs. Additional capability barriers were lack of knowledge of transmission risks beyond needles/syringes, and knowledge of treatment. During subsequent treatment, participants reported better knowledge of transmission risks and treatment, and that peer support helped motivate them to complete treatment. Participants also reported less stigma from healthcare professionals since their initial infection or treatment. Their future reinfection prevention strategies included opportunity and motivational changes including changing their social circles and environment, prioritising their health, and engaging in volunteering. Therefore, health services are an opportunity for education and behaviour change interventions, including peer support programmes, to support prevention of reinfection. However gaps remain in continuity of care and harm reduction access, which are also needed to enable opportunities to prevent first time infections.