Interventions to Improve HCV Care for People who Inject Drugs: A Systematic Review and Meta-Analysis

Author: Evan Cunningham Alice W Behzad Ha Clare French Rachel Roche Alison D Marshall Guillaume Fontaine Anna Conway Braulio M Valencia Sahar Bajis Justin Presseau John W Ward Braulio M Louisa Degenhardt Gregory J Dore Matthew Hickman Peter Vickerman Jason Grebely

Theme: Clinical Research Year: 2022


Most new and existing HCV cases are among people who inject drugs (PWID) in highincome countries; however, testing and treatment in this population remains suboptimal. We aimed
to assess the efficacy of interventions to improve HCV care among PWID.


We searched bibliographic databases and conference abstracts for studies assessing
interventions to improve the following study outcomes to July 21, 2020: HCV antibody testing, RNA
testing, linkage to care, and treatment initiation. We included randomised and non-randomised
studies (with comparator arm) assessing non-pharmaceutical interventions among a population of
PWID. Meta-analysis was used to pool the effect of interventions on study outcomes.


Of 15,342 unique records, 47 studies assessing an intervention to improve HCV care among
PWID were included – 28 randomised trials and 19 non-randomised studies. Four interventions
demonstrated an improvement on HCV antibody testing uptake: provider HCV care coordination
(two studies; OR 3.68, 95% CI 2.12-6.38), dried blood-spot testing (two studies; OR 3.11, 95% CI 2.70-
3.58), patient memory practice (a psychological intervention to improve client recall of recently
learned information; two studies; OR 2.45, 95% CI 1.50-4.01), and patient education (five studies; OR
1.63, 95% CI 1.12-2.36). Linkage to HCV care was improved by integration of HCV care into other
services (two studies; OR 8.11, 95% CI 3.69-17.31), patient navigation (three studies; OR 3.10, 95% CI
2.05-4.69), and point-of care antibody testing (three studies; OR 1.70, 95% CI 1.35-2.16). Integrated
care was also effective at improving the uptake of DAA treatment (two studies; OR 23.45, 95% CI


The identified interventions address key barriers to HCV care faced by PWID such as
those resulting from siloed care and stigma. Further research, including rigorously designed
randomised studies, are needed in key settings. Broad implementation of such interventions has the
potential to substantially improve progress towards HCV elimination.


No input into this work was provided by any of the below listed organisations or
institutions. AC, ADM, AW, BMV, BH, CEF, EBC, GF, JP, LD, RR, and SB had no conflict of interest to
declare. JG is a consultant/advisor and has received research grants from AbbVie, Camurus, Cepheid,
Gilead Sciences, Hologic, Indivor, and Merck/MSD and has received honoraria from AbbVie, Cepheid,
Gilead Sciences, and Merck. GJD is a consultant/advisor and has received research grants from
Abbvie, Abbot Diagnostics, Gilead Sciences, Bristol Myers Squibb, Cepheid, GlaxoSmithKline, Merck,
Janssen and Roche. JWW is supported by The Task Force for Global Health which receives funds for
the general support of the Coalition for Global Hepatitis Elimination from Abbott, Gilead, AbbVie,
Merck, Siemens, Cepheid, Roche, Pharco, Zydus-Cadila, governmental agencies and philanthropic
organizations. MH has received unrestricted honoraria and travel expenses from MSD and Gilead
unrelated to this project. PV has received research grants from Gilead Sciences and is in receipt of
grants from the UK National Institute of Health Research.

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