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Enumeration of disease is a key management tool. Setting of targets, like for hepatitis C elimination, have deep meaning and effect. We use the case of elimination in New South Wales (NSW), Australia to examine key informants' understandings of the use of targets, and the evidence that informs them, to drive action in elimination. Twenty‐eight key informants working in NSW, elsewhere in Australia and internationally in high‐income countries participated in a semi‐structured qualitative interview in 2022. Analysis was informed by scholarship calling for examination of the ways in which science constructs what is thought possible in action. Participants pointed to the power of quantified evidence and targets and their complex effects, and questioned the usefulness and certainty derived from these at the "pointy end" of elimination. Although a range of targets exist in global and local strategies, reaching testing targets was the assumed solution to achieving elimination. Achieving elimination was thought to require "off piste" and experimental approaches that went beyond available evidence. The different types of work that participants felt necessary for late‐stage elimination may require additional metrics to explain return on investment ratios. What threshold would be used to reduce efforts in elimination was a major concern. These data indicate that understandings of the evidence underpinning elimination targets and how to achieve them are far from settled. At this point, elimination efforts may need to rely on locally produced and community‐driven evidence and shift from evidence‐based to evidence‐making paradigm. [ABSTRACT FROM AUTHOR]

This article explores the differential coverage of drug overdose death in three major Australian newspapers between 2015 and 2020. It outlines the number of articles, the types of voices, and emotional collectives drawn on in three types of overdose death stories: those related to injecting drug use, pharmaceuticals (largely opioids), and those that occurred at music festivals. Our analysis finds that in each newspaper festival deaths are reported on more than other types of overdose stories, even though deaths in the other categories represent significantly larger loss of life. Beyond the number of articles written about each type of overdose, our analysis pays attention to emotional collectives, such as pity, surprise, and grief, and how these constitute the overdose victim. We argue that the differential media treatment of overdose deaths—depending on substance involved, social circumstance—is intimately (if implicitly) linked to a differential valuing of human life. We explore the way people who die of an overdose exist on a spectrum, from those who are visible and valued subjects in media coverage (the grievable), to those who are abject and already lost (the ungrievable). Finally, our analysis finds that proximity to White and middle-class culture structures the way the lives of overdose victims are (re)produced as lives worth grieving in media coverage. [ABSTRACT FROM AUTHOR]

Despite advances in understanding the structural contexts in which drug use occurs and shifts beyond the individual-level focus of adult education theory, peer education models remain wedded to questions of individual behaviour. Our analysis examines the structural context of peer education and its implications for peer training. People who inject drugs (PWID) were invited to participate in a series of three focus group discussions in order to develop peer education messages and strategies. These were then trialled by participants within their networks and their experiences discussed in subsequent focus groups. The influence of structural factors (such as the policing of public space) on participants' peer education attempts were identified and discussed. We propose that despite the damaging impact of structural factors on the lives of PWID, they can in turn be used by peer educators to develop innovative interventions designed to increase resilience and reduce internalized stigma. Peer education programmes need sufficient flexibility and resources to allow for the negotiation of participants' immediate needs and for collaborative learning between PWID and peer educators. This would require an informed and responsive funder--a challenge to the current orthodoxy wherein peer education is increasingly delivered in formats predetermined by the funder.

Until recently, the only medical treatment available for the hepatitis C virus (HCV) was interferon-based therapy, a notoriously long and arduous treatment with limited success. However, in December 2015, the Australian Government announced a scheme of 'universal access' to new, highly effective direct-acting antiviral therapies (DAAs). This article draws on in-depth interviews with community actors engaged in national and state-based drug user and viral hepatitis advocacy to trace how universal access to curative medicines affords revised notions of citizenship and social inclusion among people who inject drugs and others affected by HCV. To inform our analysis, we draw on and combine critical perspectives from the biological citizenship literature, particularly pharmaceutical citizenship, along with work on the concepts of 'publics and counterpublics'. We ask: what kinds of emergent HCV communities or publics are being enacted through our participant accounts in response to the new DAA-era of universal access, and what forms of citizenship and inclusion (or non-citizenship and exclusion) do they postulate? Some accounts indeed enacted treatment as an individual, sometimes collective, 'good': a citizenship potential. However, a number of accounts enacted situated limits to a straightforward actualisation of this potential, performing a model of public health governance that prioritised viral cure whilst rendering injecting drug use and its attendant social disadvantages an absent presence. Reconceptualising HCV treatment within a counterpublic health sensibility would, by engaging with the everyday health needs and aspirations of people living with HCV in conditions of social disadvantage, create space for new social inclusions and citizenships. [ABSTRACT FROM AUTHOR]

It is generally recognised that engaging consumers to participate in policy making, programming, and practice is fundamental to effective alcohol and other drug (AOD) treatment, however, literature continues to document challenges and barriers to its implementation in AOD settings. This study reports on an evaluation of the Consumer Participation Project implemented in key non‐government AOD services in Australia. Data collection consisted of an online survey of 86 staff members at the five participating AOD services and 27 consumer interviews. The survey examined staff attitudes towards and beliefs about consumer participation, perceived current levels of consumer participation and service changes as a result of the consumer participation project. The qualitative arm explored consumer's prior knowledge and current experiences of consumer participation. Staff who took part in the consumer participation training offered as part of the project were more likely to believe that service changes could encourage greater consumer participation rather than any barriers associated with consumer circumstances. Additionally, while services offered low‐level involvement consumer activities, there were fewer examples of mid‐ and high‐level activities being conducted at the different services. Consumers discussed the significance of being actively involved in their AOD treatment service while stressing the importance of proper training and support for those engaging in consumer participation. This research highlights the benefits of consumer participation in AOD treatment and suggests that most consumer participation activities undertaken at present are "low" level involvement concerned with providing and receiving information from consumers. Importantly, however, our study did demonstrate some support for "high" level involvement activities and service providers being open to doing more to encourage consumer participation. [ABSTRACT FROM AUTHOR]

Background and aims: Mathematical modelling has demonstrated the theoretical feasibility of HCV treatment‐as‐prevention strategies in custodial settings, yet limited empirical data exists. The Australian 'Surveillance and Treatment of Prisoners with Hepatitis C' study is the world's first trial of hepatitis C virus (HCV) treatment‐as‐prevention in prison. This study aimed to analyse how expert stakeholders involved in the Australian HCV response assessed the acceptability of HCV treatment‐as‐prevention in prison using interview data from the SToP‐C qualitative substudy. Design and setting: Qualitative analysis using semi‐structured interviews in Australia. Participants: Nineteen key HCV experts. Measurements Drawing upon Sekhon's theoretical framework of acceptability, data were organized thematically under four component constructs of acceptability: affective attitude; ethicality; opportunity costs; and perceived effectiveness. Findings Most differences in participant assessments of acceptability were a matter of relative emphasis and prioritization rather than absolute polarity. Nonetheless, a small minority of participants was overtly critical of the approach. Arguing against the focus on treatment, they instead advocated for prevention‐as‐prevention, including the improvement and expansion of existing harm reduction measures. Conclusions: Qualitative analysis of expert stakeholder assessments of the acceptability of hepatitis C virus treatment‐as‐prevention in Australian prisons found no opposition to the universal rollout of direct‐acting anti‐virals, but most voiced concern regarding the lack of effective primary prevention in Australian prisons. [ABSTRACT FROM AUTHOR]

Background and Aims: Hepatitis C (HCV) is a global public health concern, particularly in the prison setting where prevalence is substantially higher than in the general population. Direct‐acting antivirals have changed the treatment landscape, allowing for treatment scale‐up efforts potentially sufficient to achieve prevention of onward transmission (treatment‐as‐prevention). The Surveillance and Treatment of Prisoners with hepatitis C (SToP‐C) study was the first trial to examine the efficacy of HCV treatment‐as‐prevention in the prison setting. Social capital is a social resource which has been found to influence health outcomes. This qualitative study sought to understand the role of social capital within an HCV treatment‐as‐prevention trial in the prison setting. Design Semi‐structured in‐depth interviews were undertaken with participants recruited from the SToP‐C study following HCV treatment completion (with cure). Setting: Three male correctional centres in New South Wales, Australia (including two maximum‐security and one minimum‐security). Participants: Twenty‐three men in prison participated in semi‐structured interviews. Measurements Thematic analysis of transcripts was completed using a social capital framework, which enabled exploration of the ways in which bonding, bridging and linking social capital promoted or inhibited HCV treatment uptake within a treatment‐as‐prevention trial. Findings Social capital fostered HCV treatment uptake within an HCV treatment‐as‐prevention trial in the prison setting. Bonding social capital encouraged treatment uptake and alleviated concerns of side effects, bridging social capital supported prison‐wide treatment uptake, and linking social capital fostered trust in study personnel (including nurses and correctional officers), thereby enhancing treatment engagement. Conclusions: Social capital, including bonding, bridging and linking, can play an important role in hepatitis C treatment‐as‐prevention efforts within the male prison setting. [ABSTRACT FROM AUTHOR]

Background: With direct-acting antivirals dramatically reshaping the public health response to the hepatitis C virus (HCV), prisons are set to play a critical role in elimination efforts. Despite the theoretical demonstration of HCV treatment-as-prevention in prison in mathematical modeling, limited empirical data exist. The Australian 'Surveillance and Treatment of Prisoners with Hepatitis C' project (SToP-C) is the world's first trial of HCV treatment-as-prevention in prison. Drawing on interviews with HCV expert stakeholders, this paper explores the factors respondents identified as crucial to the success of future scale-up. Accounting for such perspectives matters because of the influence expert discourse has in shaping implementation. Methods: Semi-structured interviews were conducted with nineteen HCV experts working across key policy, advocacy, research and clinical dimensions of the Australian HCV response. Data were coded using qualitative data management software (NVivo 11). Analysis proceeded via a hybrid deductive and inductive approach. Results: Notwithstanding concerns regarding the lack of primary prevention in Australian prisons, stakeholders reported broad levels of support for the intervention and for the future scale-up of HCV treatment. A number of considerations, both external and internal to the prison system, were identified as key. The principal external factor was an enabling political-cum-policy environment; internal factors included: obtaining support from prisons' executive and custodial staff; promoting health within a security-first institutional culture; allocating time for treatment within prisoners' tightly regulated schedules; ensuring institutional stability during treatment given the routine movement of prisoners between prisons; prioritizing the availability of retreatment given the paucity of primary prevention; and securing sufficient clinical space for treatment. Conclusion: The challenges to implementation are considerable, ranging from macrolevel concerns to in-prison logistical matters. Nonetheless, we argue that prisons remain an obvious setting for treatment scale-up, not only for prevention and potential elimination benefit, but for the treatment opportunities they afford a socially disadvantaged and underserved population. While noting widespread concerns among respondents regarding the paucity of primary prevention in Australian prisons, results indicate broad levels of support among expert stakeholders for HCV treatment scale-up in prison. [ABSTRACT FROM AUTHOR]

The recent advent of new, highly effective, direct-acting antivirals (DAAs) is dramatically reshaping the hepatitis C virus (HCV) treatment landscape and prisons are set to play an important role. While there is a substantial literature addressing the centrality of stigma to experiences of living with HCV in the community, including as a barrier to treatment, scant attention has been paid to documenting how HCV-stigma figures within the distinct sociality of prison life. This article focuses on initial, pretreatment interviews with prisoner participants (n = 32) from the first, real-world trial of HCV 'treatment-as-prevention' in prison: Australia's Surveillance and Treatment of Prisoners with Hepatitis C (SToP-C) study. Drawing on recent developments in stigma theory alongside Goffman's original insights, we posit HCV-stigma as a relational, contingent and political process, materialised across the network of power relations in prison. Participant accounts describe a complex picture, with reports ranging from those suggesting the 'normalisation' of HCV to those detailing the potential effects of HCV-stigma, including additional disciplinary attention from officers and/or the rejection from peer networks by fellow prisoners. While acknowledging the limiting effects HCV-stigma may yet have on treatment-as-prevention efforts, we speculate that with committed political leadership, operational investment, sufficient prisoner engagement, interventions such as SToP-C may also afford opportunities for such effects to be challenged, disrupted, and even left behind. [ABSTRACT FROM AUTHOR]