3. Enhancing the HCV care cascade among people who inject drugs: a systematic review and considerations from an expert panel

Following advances in treatment for HCV, optimising 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 these two components of the cascade of care were priority areas for inclusion in the updated guidance. This systematic review aimed to evaluate the effectiveness of interventions on HCV linkage to care and adherence to treatment among people who inject drugs.

We searched five databases to identify studies published between 2011 and 2020. Studies were included if they had a comparative study design and reported on the primary outcomes for linkage to care (visits, treatment initiation) and/or adherence to treatment (treatment adherence, treatment completion, SVR12) among people who inject drugs/people receiving opioid substitution therapy. Following the risk of bias (EPHPP) and quality of evidence assessment (GRADE), evidence to decision tables were produced and shared for critical review with the expert panel. The panel also provided further considerations on the benefit, acceptability, and transferability of interventions.

Integrated care with case management, peer support, psychological interventions, contingency management, and cooperation between health care providers improved engagement in and adherence to HCV care in most studies. Available evidence suggests that integrated, people-centred 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.

The work of the Austrian National Public Health Institute was supported by the European Centre for Disease Prevention and Control (ECDC) through service contract No. ECD.10793/2020