Models of Care for the Management of Hepatitis C Virus Among People Who Inject Drugs: One Size Does Not Fit All

Abstract

One of the major obstacles to hepatitis C virus (HCV) care in people who inject drugs (PWID) is the lack of treatment settings that are suitably adapted for the needs of this vulnerable population. Nevertheless, HCV treatment has been delivered successfully to PWID through various multidisciplinary models such as community-based clinics, substance abuse treatment clinics, and specialized hospital-based clinics. Models may be integrated in primary care--all under one roof in either addiction care units or general practitioner-based models--or can occur in secondary or tertiary care settings. Additional innovative models include directly observed therapy and peer-based models. A high level of acceptance of the individual life circumstances of PWID rather than rigid exclusion criteria will determine the level of success of any model of HCV management. The impact of highly potent and well-tolerated interferon-free HCV treatment regimens will remain negligible as long as access to therapy cannot be expanded to the most affected risk groups.

Expanding access to prevention, care and treatment for hepatitis C virus infection among people who inject drugs

“…community health centres, OST clinics, primary care) (Bruggmann & Litwin, 2013). In Canada, several successful HCV care models have been developed in Victoria (Milne, this issue) and Toronto (Mason, this issue) within community health centres with extensive health care and other services targeted for PWID.…”

“…This study demonstrates that a multi-disciplinary, community-based model of HCV treatment can improve the lives of PWID in ways that extend beyond HCV. The common theme from this spectrum of HCV care models among PWID, is that ''one size does not fit all'' (Bruggmann & Litwin, 2013). When barriers are systematically addressed within a supportive environment, HCV assessment and treatment among PWID can be very successful.…”

Policy responses to viral hepatitis B and C among people who inject drugs in Member States of the WHO European region: a sub-analysis of the WHO 2013 global hepatitis policy survey

“…Coupling these with initiatives to enable access to affordable, quality screening and treatment is key to curtailing the epidemic among PWID. Prevention and access campaigns are increasingly important to control unsafe injection-associated infections, as the illicit nature and associated marginalisation of PWID populations make them hard to reach for conventional healthcare providers [14,34]. A recent review outlines the need for social interventions relating to housing, stigma reduction and systemic changes in policy and health care delivery in order to improve access and uptake of hepatitis C treatment among PWID [35].…”

Ten priorities for expanding access to HCV treatment for people who inject drugs in low- and middle-income countries

“…Successful models of integration of HCV care within different services have been documented, including opioid substitution clinics, general practitioner clinics, prisons, and secondary/tertiary care settings. (Bruggmann andLitwin, 2013, Lloyd et al, 2013) Service integration has been found to lead to improved patient outcomes in other areas, including HIV and TB, maternal, new-born, and child health services. (Suthar et al, 2014) Considering the high rates of HIV/HCV coinfection in some settings, integration of HCV-related services, as well as service for other common health concerns faced by people who inject drugs, into existing HIV programmes for people who inject drugs is a clear way to increase access to treatment, and this strategy is endorsed by WHO.…”