Healthcare Access

This study builds upon an ongoing NIH-funded randomized controlled trial (R01DA053325) evaluating a Partner Navigation Intervention to increase hepatitis C virus (HCV) treatment initiation among young adult people who inject drugs (PWID) and their injecting partners in San Francisco. The proposed research includes secondary analyses of existing trial data, additional survey measures, qualitative interviews, and a pilot intervention adaptation. The study has two primary objectives. First, it examines how racialized discrimination (structural, interpersonal, and internalized) affects HCV treatment initiation and dyadic partner support processes within injecting partnerships. Second, it evaluates whether a brief, adapted "booster" partner navigation session delivered at HCV treatment completion can improve engagement in ongoing healthcare. Participants include adults (≥18 years) who inject drugs and have been diagnosed with HCV, along with their primary injecting partners. Study activities include longitudinal surveys, qualitative interviews with a subset of participants, and a pilot intervention session with follow-up evaluation. This research addresses critical gaps in understanding how social relationships and structural inequities influence healthcare engagement among PWID. Findings will inform culturally responsive adaptations to dyadic interventions and improve continuity of care in a population disproportionately affected by HCV and systemic barriers to healthcare.

A learning difference or disability is a reduction in intellectual ability (GMC, 2024). It causes lifelong difficulty with everyday activities. Different individuals require different levels of support. Individuals with learning disability may also have learning difficulties and mental health problems, but these conditions do not always co-exist. Learning difficulties affect the way someone processes information. They are not related to intelligence but can affect learning and education. People with learning differences can experience higher rates of mental and physical ill-health. The individual's life expectancy is shorter than the average for the population. This is related to access and experience of health care. These patients may experience discrimination affecting their healthcare. Discrimination arises from staff and organisational attitudes towards patients and judgements about their quality of life. These individuals' care is also at risk of diagnostic overshadowing where a patient's symptoms are attributed to their disability rather than a disease. Many people with learning disabilities may find it harder to use healthcare services, and the investigators want to find out what challenges these individuals face. For example, do these patient have trouble understanding what is being said to them? Are there issues with getting an appointment or understanding the information about their health? This project focuses on understanding the experiences of people with learning disabilities when they use health services. How easily do can these individuals communicate with their clinician? Are there barriers in accessing care? Do these individuals feel respected and listened to during their appointments? How should healthcare staff be trained to provide better care to these patients? The investigators will be speaking directly to patients with learning disabilities living in Derbyshire. This will be by interviews encouraging the patients to share their thoughts and experiences. The information the investigators gather will help understand these people's experiences of healthcare and how this could be improved. The investigators will also undertake an anonymised survey of medical students on their perceived learning needs regarding individuals with learning differences. This information will be used to develop educational resources for clinical teachers. medical students and staff. Working with the volunteers will better prepare future doctors to provide holistic care for patients with learning differences.