An evidence review – Integrated community based HCV treatment models, enabling people who inject drugs to access HCV treatment

Author: Dr Cecilia Pyper, Tasmin Harrison, Dr Murad Ruf MPH FFPH, Dr Torquil Pyper1 BSc PHD

Theme: Epidemiology & Public Health Research Year: 2017

Background: In England ~160,000 people are living with HCV. Acquisition through injection drug use accounts for about 90%. There is evidence of barriers to PWID treatment access into traditional hospital based HCV treatment models. New direct acting antivirals treatments (DAAs) provide community delivery opportunities to overcome these barriers. This review summarises current evidence regarding: barriers to HCV care and community integrated HCV treatment models for optimising care for PWID in England.

Methods: Rapid evidence review including grey literature; case studies; and semi-structured interviews with national clinical, commissioning and academic experts.

Results: Over 1000 documents were reviewed, 95 were selected for inclusion. There is good evidence regarding barriers to accessing HCV treatment, key themes include: Structural: physical service location, lack of appointment flexibility, lack of service evaluation and quality improvement; Social: PWID with additional problems (e.g. mental health, poverty, homelessness); Professional: poor staff HCV education and poor communication between providers along the HCV care pathway.

Good practice service model interventions identified included: improved service design that specifically target PWID; HCV pathway integration; co-location within existing community services; dually qualified key staff in HCV care and substance misuse; flexible appointment scheduling and practical support for patients.

Conclusion: This evidence synthesis identified that current HCV pathways in England are largely failing to meet the needs of PWID. While there is general agreement regarding how to improve access barriers and good practice elements, there are few well evaluated published interventions. Alongside the focus on therapeutic innovation, if we want to achieve elimination of HCV as public health problem better research evidence on the effectiveness and cost-effectiveness of integrated community-based HCV treatment models must be prioritised.

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