Theme: Epidemiology & Public Health Research Year: 2024
Background: The World Health Organisation recommends peers (people with lived/living experience) are involved in the delivery of services to find and treat people with hepatitis C (HCV). Peer models are complex interventions: they include multiple components, involve a range of skills and expertise, require flexibility and are highly context dependent. The MRC complex intervention framework (CIF) advocates that intervention design, testing, content and evaluation are reported in detail to allow accurate evaluation to inform health decision-making. This review examined existing HCV peer intervention evaluation literature to determine how comprehensively they are described against the MRC CIF phases and specify essential components of successful ‘find-and-treat’ peer models.
Methods: Five databases were systematically searched for papers published between 2012 and 2022 which described or evaluated HCV peer interventions. Data were synthesised to assess the detail of CIF phases reported, followed by a narrative synthesis to allow for the heterogenous nature of included studies (qualitative, quantitative and theoretical).
Results: Twenty-nine studies met our inclusion criteria. The majority were conducted after 2018 (n=21), in the UK (n=7), in community settings (n=23) and with people who inject drugs (n=13). We found that peer interventions are rarely described in detail, the CIF is under-used and its recommended components and phases are not fully reported. Whilst most studies present clear evaluative data, key aspects such as the training and recruitment of peers, their expertise, and intervention delivery context were rarely detailed. No papers described an underlying logic model or programme theory; these themselves help with intervention planning, implementation, management and evaluation.
Conclusion: Current reporting of HCV ‘find-and-treat’ peer interventions limits scope for scaling, replication, and establishing a strong evidence base on effectiveness and cost-effectiveness. Evaluations are needed that detail intervention content (e.g. logic models) alongside implementation science theory.
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