Taming systems to create enabling environments for HCV treatment: negotiating trust in the drug and alcohol setting.

摘要: HCV (hepatitis C) treatment uptake among the population most affected - people who inject drugs is suboptimal. Hospital based provision one evidenced barrier to uptake. In response, increasingly located in settings seen as more amenable drugs, such drug and alcohol services. We explored accessibility of at two partnerships. Data collection comprised qualitative interviews collected 2011 2012 with 35 service users 14 providers London, United Kingdom. draw here primarily on thematic analyses provider accounts, yet narratives relating trust environment emerged unsolicited both user accounts negotiated access. A key theme were strategies they deployed 'tame' system so create an 'enabling environment' care, which was a critical feature. This 'taming' enacted through practices 'negotiated flexibility', including relation appointments, eligibility, phlebotomy. Service accentuated familiar environments known health those trusted, potentially stigmatising effects negotiating unfamiliar territory, especially hospital settings. Whilst noting negotiate flexibility behalf would-be patients seeking treatment, we conclude by limits relations constrained choice.