Research Spotlight: Stigma and HCV Cure Cascade Among Individuals Who Inject Drugs

Abigail Batchelder, PhD, MPH, an investigator in the Department of Psychiatry at Massachusetts General Hospital and an associate professor of Psychology at Harvard Medical School is the lead author of a recently published paper in Drug and Alcohol Dependence, Shame and Stigma in Association with the HCV Cascade to Cure Among People Who Inject Drugs

What Question Were You Investigating?

We studied whether there were changes in feelings of shame and experienced stigma linked to the initiation, adherence, completion, and sustained virologic response (SVR) of hepatitis C (HCV) treatment among individuals who inject drugs across a multi-site sample of people with HCV. 

What Methods Did You Use?

We examined baseline relationships with HCV-stigma and engagement across the HCV treatment cascade, as well as baseline and longitudinal relationships between shame and engagement across the HCV treatment journey.

We studied how feelings of shame affected different parts of the HCV treatment process, like starting treatment, sticking to it, finishing it, and reaching a sustained virologic response (SVR).

We did this with a group of individuals who inject drugs and have HCV—755 were randomized to the pragmatic trial comparing HCV treatment outcomes in modified directly observed treatment (mDOT) or patient navigation, and 623 of them began the treatment.

What Did You Find?

While cross-sectional assessments of shame and HCV-stigma were not associated with engagement across the HCV treatment cascade, those whose shame scores decreased compared to those who reported consistently high and increasing levels of shame were significantly more likely to complete HCV treatment.

What Are the Implications?

These results convey that persistently low or decreased shame was associated with completing HCV treatment and achieving SVR among people who inject drugs, a population facing a formidable stigma burden.

Although it is unclear whether lower levels of shame contributed to HCV treatment completion and SVR achievement or whether HCV treatment completion and SVR achievement contributed to reductions in shame, these results suggest the clinically meaningful association between shame and HCV treatment success.

These findings add to the growing literature calling for feasible, acceptable, and scalable evidence-based individual, provider, and systems-level interventions to reduce stigma and shame, as they are behaviorally influential psychological barriers to HCV treatment success among people who inject drugs.

Successful efforts to reduce shame among people who inject drugs living with HCV could not only increase HCV cure rates but also contribute to the eradication of HCV.

What Are The Next Steps?

My research team has an active grant to develop and pilot test an evidence-informed psycho-behavioral intervention to mitigate the negative consequences of shame. The intervention is paired with phone-delivered incentivized directly observed therapy for people who inject drugs living with HIV.

We would like to expand this work to include people who inject drugs living with HCV and other physical and mental health needs.

Paper Cited:

Batchelder, A. W., Heo, M., Foley, J. D., Sullivan, M. C., Lum, P., Pericot Valverde, I., Taylor, L. E., Mehta, S. H., Kim, A. Y., Norton, B., Tsui, J. I., Feinberg, J., Page, K., Litwin, A. H., & HERO Study Group (2023). Shame and stigma in association with the HCV cascade to cure among people who inject drugs. Drug and alcohol dependence, 253, 111013. https://doi.org/10.1016/j.drugalcdep.2023.111013

About Massachusetts General Hospital

Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The Mass General Research Institute conducts the largest hospital-based research program in the nation, with annual research operations of more than $1 billion and comprises more than 9,500 researchers working across more than 30 institutes, centers and departments. Massachusetts General Hospital is a founding member of the Mass General Brigham healthcare system.