Integrating Hepatitis C Testing and Treatment Into Multiple Community Healthcare Settings for Those Who Inject Drugs: Facilitators and Barriers

Author: Gabriele Vojt Alex Murray Tammie Brown Sylvia Fox Paul Mudie Brian Stephens Jan Tait Sharon Hutchinson Matthew Hickman John Dillon Paul Flowers Lawrie Elliott Matthew

Theme: Epidemiology & Public Health Research Year: 2022

Background: Research to date focuses on the barriers and facilitators to optimal engagement in
treatment for those who are infected with HCV through injecting drug use. Studies typically focus on
single treatment pathways, e.g. primary care, community drug treatment or prison. This qualitative
study seeks to understand the facilitators and barriers when integrating Hepatitis C testing and
treatment into multiple community health care settings.
Methods: We interviewed 40 service providers and 31 service users across four HCV non-hospital
pathways: enhanced needle exchange, drug treatment services, community pharmacies and prison.
Using thematic analysis, we identified barriers and facilitators to the key steps in the HCV pathways,
i.e. Access, HCV testing, HCV treatment and Support.
Results: Key facilitators were in Access: a) co-locating services, b) drop-in service model, c) open and
non-judgemental service culture, d) deploying peer workers. Testing and Treatment: a) HCV Nurse to
provide enhanced testing and prescribe treatment, b) standard operating procedures, c) training of
all staff to conduct dry blood spot testing (DBST), d) HCV Oral swaps instead of DBST in prison only, e)
training of all staff to support treatment and testing, f) rapid point of care testing. Ongoing support:
a) repeat testing and regular follow-up including harm reduction, b) assertive outreach services to
peoples’ homes, c) digital or telephone consultations.
These facilitators worked best in pathways that were co-located with services that had close working
relationships to support wider harm reduction. The HCV nursing team was instrumental in facilitating
and co-ordinating testing and treatment across pathways.
Conclusion: Scaling up HCV treatment across community settings is highly complex. The barriers and
facilitators varied across the pathways. As viewed through the lens of socio-ecological theory, both
the facilitators and barriers necessitate change at the intrapersonal, interpersonal, organizational,
community and public policy levels.
Disclosure of Interest: None.

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