Improving access to care for people who inject drugs: qualitative evaluation of Project ITTREAT - an integrated community hepatitis C service

Achieving hepatitis C virus (HCV) elimination by 2030 requires an increased linkage to care for people who inject drugs (PWID). Project ITTREAT was established to mitigate barriers to HCV care by providing an integrated service within a local drug and alcohol treatment centre. This study aimed to explore the experiences of clients and staff involved in Project ITTREAT and assess the facilitators and barriers to a community‐based HCV service. Between October 2014 and April 2016, drug and alcohol treatment attendees were interviewed using one‐to‐one semi‐structured interviews. Drug and alcohol treatment staff took part in focus groups. All data were recorded, transcribed verbatim and analysed using thematic content analysis. Fifteen drug and alcohol treatment attendees with current/previous HCV infection were interviewed, and 15 staff members contributed across two focus groups. Drug and alcohol treatment staff and attendees reported that Project ITTREAT facilitated access to HCV care by mitigating previous negative hospital‐based experiences. Other key facilitators were positive narratives around HCV care, and drug and alcohol treatment attendees being well engaged in their drug/alcohol recovery. Barriers included a lack of stability in drug and alcohol treatment attendees, negative discourse around testing/treatment and stigma associated with attending the drug and alcohol treatment to access HCV treatment in some who had successfully achieved drug rehabilitation. Our findings indicate the positive impact of an integrated and personalized community‐based service delivered by a dedicated hepatitis nurse. This played a crucial role in reducing barriers to HCV care for PWID. Our work also highlights areas for future investment including non–DAT‐based community services and increasing awareness of new treatments amongst this cohort

The cognitive organization of music knowledge: a clinical analysis

Despite much recent interest in the clinical neuroscience of music processing, the cognitive organization of music as a domain of non-verbal knowledge has been little studied. Here we addressed this issue systematically in two expert musicians with clinical diagnoses of semantic dementia and Alzheimer’s disease, in comparison with a control group of healthy expert musicians. In a series of neuropsychological experiments, we investigated associative knowledge of musical compositions (musical objects), musical emotions, musical instruments (musical sources) and music notation (musical symbols). These aspects of music knowledge were assessed in relation to musical perceptual abilities and extra-musical neuropsychological functions. The patient with semantic dementia showed relatively preserved recognition of musical compositions and musical symbols despite severely impaired recognition of musical emotions and musical instruments from sound. In contrast, the patient with Alzheimer’s disease showed impaired recognition of compositions, with somewhat better recognition of composer and musical era, and impaired comprehension of musical symbols, but normal recognition of musical emotions and musical instruments from sound. The findings suggest that music knowledge is fractionated, and superordinate musical knowledge is relatively more robust than knowledge of particular music. We propose that music constitutes a distinct domain of non-verbal knowledge but shares certain cognitive organizational features with other brain knowledge systems. Within the domain of music knowledge, dissociable cognitive mechanisms process knowledge derived from physical sources and the knowledge of abstract musical entities

A community based model for non-invasive detection, stratification and treatment of hepatitis C-related chronic liver disease in substance misusers: exploring barriers to and attitudes towards testing and treatment

Background: Despite discovery of direct acting antiviral agents (DAA), a two–three fold increase in hepatitis C virus (HCV) detection and treatment is necessary to reduce the national HCV burden. Ninety percent of HCV positive individuals in England are people who inject drugs (PWID), a population with a history of poor engagement with health services. This study forms part of a wider evaluation of an integrated ‘one stop’ community-based hepatitis and addiction service in Brighton. Our primary aim was to assess feasibility of non-invasive detection, stratification and treatment of HCV-related chronic liver disease (CLD) in the community. Our secondary aim was to evaluate the service via qualitative interviews with patients and clinical staff, with a particular focus on exploring barriers and motivators to hepatitis C testing and treatment. Methods: A total of nine participants were recruited for the qualitative sub-study. Participants were either currently receiving, waiting to start or had completed HCV treatment. Semi-structured interviews were conducted, covering topics such as history of injecting drug use, motivations for starting treatment and perceptions of the community-based service. Interviews were audio-taped, transcribed verbatim and analysed using thematic content analysis. Results: This is a vulnerable group of patients with complex health, emotional and social needs. The interviews identified multiple interrelated barriers to HCV care at the individual-, provider and system-level. At the individual-level fear of treatment side effects, reluctance to confront the diagnosis and competing health and social issues emerged as key barriers. Overall, hospital services appeared ill-adapted to meet the needs of this vulnerable population; the bureaucratic, inflexible and impersonal hospital environment coalesced to create a mistrust of secondary care. Many of these constraints were minimised in the community-based setting. However, the interviews revealed distinct and contrasting attitudes among participants towards the community-based treatment service: although a number of participants preferred an integrated ‘one stop’ service, for some the stigma attached to the SMS acted as an important system-level barrier. Despite multiple barriers a number of facilitators to engaging in HCV care emerged from the interviews. Most notably, an awareness of the impact of untreated HCV on the liver, a trusting client-provider relationship and the desire to regain one’s health following addiction recovery. Conclusion: Preliminary findings from this qualitative study have important implications for interventions aimed at engaging this complex population in hepatitisCtesting and treatment. Future research should explore the impact of newer treatments on existing barriers to treatment uptake