Increasing linkage to care and adherence to treatment for hepatitis C among people who inject drugs

Hepatitis C virus (HCV) infection is a major public health threat due to disease burden and risk of complications and death. Injecting drug use is the most likely mode of HCV transmission reported in the EU/EEA and accounted for 49% of acute and 61% of chronic infections in 2018. Compared to other drug-associated blood-borne viral infections, HCV is the most prevalent one among people who inject drugs (PWID) across Europe. Prevalence of HCV antibody among PWID estimated from nationally representative samples ranged between 15% and 86% during 2018–2019. The prevalence of current infections measured by HCV-RNA (or antigen) tests ranged from 15% to 64% between 2013 and 2019 in six countries with available data. PWID are therefore considered as a priority population in prevention, testing, linkage to care and treatment, and prevention of re-infections to achieve HCV elimination.

Following advances in treatment for hepatitis C (HCV), optimizing linkage to care and adherence to treatment of people who inject drugs became of pivotal importance. An ECDC/EMCDDA stakeholders survey in 2018 indicated that two components of the cascade of care, linkage to care and adherence to treatment, were priority areas for inclusion in the updated guidance, planned for publication in 2022. The systematic review Interventions to increase linkage to care and adherence to treatment for hepatitis C among people who inject drugs: A systematic review and practical considerations from an expert panel consultation was commissioned with the aim to evaluate the effectiveness of interventions on HCV linkage to care and adherence to treatment among people who inject drugs.

Available evidence suggests that integrated, people-centered approaches may improve engagement throughout the continuum of HCV care among people who inject drugs. For progressing HCV elimination efforts, interventions should be implemented in colocation with harm reduction and counselling activities and in combination with additional services, including opioid substitution treatment, directly observed therapy, peer support and/or contingency management.

Highlights of the review include:

  • Integrated care and cooperation between service providers optimize the HCV care continuum among people who inject drugs.
  • Results suggest that people who inject drugs with HCV infection can be effectively linked and treated with direct-acting antivirals regimens in settings outside of hospital.
  • Interventions that facilitate HCV care must be implemented at settings where people who inject drugs are already accessing services.
  • The experts’ reflections complement the findings of the literature review and inform public health practice by considering the heterogeneity of health systems and national regulatory frameworks.
  • Higher quality studies investigating interventions addressing the entire care cascade from testing to cure and prevention of reinfections among highly vulnerable populations are urgently needed.

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