The United Kingdom has committed to eliminating viral hepatitis as a public health threat. Innovative interventions for marginalized populations are required to realize this goal. In 2016, the HepCATT study team implemented a complex hepatitis C (HCV) intervention in three English drug treatment services, with five controls. We report qualitative study findings from two intervention sites to explore intervention success and transferability potential. The intervention comprised multiple components, including a nurse facilitator, peer support and education initiatives. Qualitative data were generated at baseline (2014) and post-intervention (2016) at two sites through in-depth interviews, focus groups and observations. The 96 participants comprised drug service and intervention providers and clients with an injecting history. Data were triangulated and thematically analysed. Client engagement with a HCV treatment service rose from 16 at baseline to 147 in 2016. There was no comparable increase at the five control sites. Baseline testing and treatment barriers included the following: limited HCV knowledge; fear of diagnosis and treatment; precarious living circumstances and service-specific obstacles. Treatment engagement was aided by intervention timeliness; improved communication structures; personalized care; streamlined testing and treatment pathways; peer support. Multiple interrelated components influenced the increased levels of treatment engagement documented in HepCATT. The nurse facilitator, involved in implementation and innovation, was key to intervention success. Baseline barriers correspond with international literature—indicating transferability potential. Control data indicate that biomedical innovation alone is not sufficient to increase engagement among the most marginalized. Sustainable resourcing of community services is crucial to effect change.
Bibliographical noteFunding Information:
We thank the Specialist Community Drug Treatment Centre service providers Addaction who supported the study. We would like to thank their service managers and clinical leads, along with all the other supporting staff, particularly the HepCATT coordinators, for their efforts, continued enthusiasm and willingness to accommodate the project. We also thank the NHS clinical teams, in particular the nurse facilitators, at each of the intervention sites for all their hard work and improvements to service provision, and we would like to express our gratitude to all the service users who kindly gave their time to take part in interviews and focus groups. This report presents independent research funded by the National Institute for Health Research (NIHR) under the Department of Health Policy Research Programme (PRP Reference 015/0309). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the UK Department of Health. The HepCATT Research team acknowledges the support of the National Institute of Health Research Clinical Research Network (NIHR CRN). MH has served as a speaker for AbbVie and a consultant for Gilead Sciences; WI has received speaker and consultancy fees from Roche, Janssen Cilag, Gilead Sciences and Novartis, educational grants from Boehringer Ingelheim, MSD and Gilead Sciences, and research grant support from GlaxoSmithKline, Pfizer, Gilead Sciences, Janssen Cilag, AbbVie and Bristol-Myers Squibb.
© 2018 John Wiley & Sons Ltd
- hepatitis C
- people who inject drugs