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Symposium on Hepatitis Care in Substance Users

PHAST is presenting a poster on community models to tackle the problem of Hepatitis C Virus which is a silent disease that can lead to serious conditions such as liver cancer.

Background
In England about 160,000 people are living with HCV. Acquisition through injection drug use accounts for about 90%. There is evidence of barriers to PWID treatment access into traditional hospital based HCV treatment models. New direct acting antivirals treatments (DAAs) provide community delivery opportunities to overcome these barriers. This review summarises current evidence regarding: barriers to HCV care and community integrated HCV treatment models for PWID in England.

Aim 
To identify effective integrated HCV treatment models that successfully target at risk marginalised populations.
Key learning aims to stimulate discussion about how to optimise HCV care in marginalised populations and identify new research priorities.

Methods
This evidence synthesis included: a rapid literature review to identify studies relating to HCV care models including: the grey literature; a review of relevant case-studies of innovative ways to deliver HCV care and a series of semi-structured interviews with key stakeholders that included clinical, commissioning and academic experts. The findings were combined to determine the most effective treatment model strategies and intervention types. Key learning aims to stimulate discussion about how to optimise HCV care in marginalised populations.

Results
95 documents were selected for inclusion from over 1000 reviewed
There is good evidence regarding barriers to accessing HCV treatment, key themes include: Structural: physical service location, lack of appointment flexibility, lack of service evaluation; Social: PWID with mental health problems; Professional: poor staff HCV education and poor HCV care pathway communication.
Good practice interventions include: improved service design that specifically target PWID; HCV pathway integration; co-location within existing services; dually qualified staff; flexible appointments and practical support. 

Conclusions
This evidence synthesis identified that    HCV is a major health problem that primarily affects disadvantaged groups and that current HCV pathways in England are largely failing to meet the needs of PWID. While there is general agreement regarding how to improve access barriers and good practice elements, there are few well evaluated published interventions. Alongside the focus on therapeutic innovation, if we want to achieve elimination of HCV as public health problem better research evidence on the cost-effectiveness of integrated community-based HCV treatment models must be prioritised.  596

Learning audience 
This review found that

•  HCV is a major health problem that primarily affects disadvantaged groups.

•  Current HCV treatment pathways in the UK do not meet the needs of vulnerable populations

•  Better research must be prioritised on the cost-effectiveness of integrated community-based HCV treatment models. 

Authors
Dr Catherine Brogan1 MB BS FFPH
Tasmin Harrison1 MSc
Dr Murad Ruf2 MD MPH FFPH
Dr Cecilia Pyper1 MB BS MFPH 
Dr Torquil Pyper1 BSc PHD

1. Public Health Action Support Team (PHAST) CIC UK
2. Gilead Sciences Ltd. London UK

PHAST manage Health Knowledge, used by health professionals globally.

About PHAST

The Public Health Action Support Team (PHAST) is a Community Interest Company that can call on over 100 qualified, experienced public health professionals (Associates).

Our Associates provide high quality, innovative, rapid results in consultancy, training, interim staff, and deliver projects related to public health, commissioning, administration and delivery.

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