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Resources and support, fexible, low threshold approaches to assessment and a willingness to provide treatment to current IDUs, would promote equitable access to treatment among these groups.

Introduction and Aims Increasing treatment uptake among people who inject drugs (PWID) with chronic hepatitis C virus (HCV) infection is integral to eliminating viral hepatitis. This study explored the role of community‐based outreach in engaging and retaining Australian PWID in the testing component of the HCV care cascade. Design and Methods Semi‐structured interviews were conducted with 28 PWID, including new initiates to injecting and those from culturally and linguistically diverse (CALD) backgrounds, who acquired HCV infection while enrolled in a community‐based prospective observational study of hepatitis C vaccine preparedness in Sydney. Participants were interviewed at diagnosis and 12 months later. Transcripts were thematically analysed using constant comparative techniques. Results Community‐based outreach was effective in engaging newly infected participants in HCV monitoring and decision‐making about seeking interferon‐based treatment. Key factors in the acceptability of outreach were privacy and discretion, and opportunities to build trust with non‐judgmental staff. Retaining participants in the HCV cascade of care required more than a one‐off session of post‐test counselling. Ongoing discussions with staff enabled paced and tailored delivery of information about HCV prevention, testing and treatment. Increased understanding of the role of HCV ribonucleic acid viremia in determining the need for treatment, and access to this testing, was pivotal in making HCV monitoring salient for participants. Discussion and Conclusions Outreach is an effective strategy for engaging new initiates to injecting and CALD PWID in HCV testing and decision‐making about treatment. Findings highlight the need to increase availability and access to HCV ribonucleic acid testing for PWID.