JMIR Publications

ABSTRACT

People who inject drugs (PWID) are experiencing syndemic conditions, increasing risk of infection with hepatitis C (HCV) and human immunodeficiency virus (HIV). However, rates of accessing HCV and HIV testing and treatment among PWID are low for various reasons, including the criminalization of drug use, which leads to a focus on treating drug use rather than caring for drug-users. For many PWID healthcare becomes a form of structural violence, resulting in traumatic experiences, fear of police violence, unmet needs, and avoidance of medical care. There is a clear need for novel approaches to healthcare delivery for PWID. This brief report analyzes the process of a multidisciplinary team of healthcare professionals, community representatives, researchers, and people with lived experience using drugs co-creating low-barrier, innovative HCV/HIV care in a rural community. This project resulted in the creation of a mobile point of care testing program, embedded within a local syringe services program, that provided low-barrier linkages to treatment and healthcare. Analysis was based on an in-depth review of meeting notes from the project year, followed by member-checking with the project team to revise and expand upon the challenges encountered and strategies identified to navigate these challenges. Challenges and tensions included: scoping the project, setting the pace and urgency of the work, adapting to virtual work, navigating ethics and practice of payment, defining success, and situating the project for sustainability. Strategies to navigate these challenges included: dedicated effort to building personal and meaningful connections, fostering mutual respect, identifying common ground to make shared decisions, and redefining successes. While co-created care presents challenges, the resulting program is strengthened by challenging assumptions and carefully considering various perspectives to think creatively and productively about solutions.