Theme: Epidemiology and Public Health Research Year: 2021
A stakeholders survey in 2018 identified linkage to care (LtC) and adherence to treatment (AtT) as
priority area for inclusion in the updated ECDC/EMCDDA guidance on prevention of infection among
people who inject drugs(PWID) (publication planned for end-of-2021). This systematic review aimed
to support guidance update process by identifying interventions that can improve LtC and AtT for
infections among PWID.
The protocol, including PICO questions and search strategy, is available at PROSPERO (2020
CRD42020191116). Searches were conducted in PubMed, EMBASE, PsycINFO, Clinical Trials Registry,
CDSR to identify studies published during 2011-2020 in EU/EEA/EFTA countries, EU candidate
countries, the UK, US, Canada, Australia and New Zeeland. Studies were included if had a
comparative study design (e.g. RCT, pre-post intervention comparison) and reported on LtC and or
AtT among PWID/people in 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 an expert panel convened by ECDC and EMCDDA. The expert panel provided
further considerations on benefit, acceptability and transferability of interventions.
Of 7318 unique records, 251 were reviewed in fulltext and 20 studies were included in evidence
synthesis. Eleven of 20 studies evaluated interventions based on direct-acting antiviral (DAA) therapy
and three on both interferon-based and DAA. Evidence indicates that integrated HCV care with case
management, peer support, psychological interventions, contingency management, and cooperation
between health care providers improves the primary outcomes (LtC: visits, treatment initiation,
treatment completion; AtT: treatment adherence, SVR12) in most studies.
Linkage to care of people diagnosed with HCV is pivotal for progressing the elimination efforts. To
improve the HCV cascade of care among PWID, interventions should be implemented in
combination with harm reduction services, drug treatment and considering the healthcare system
characteristics and legal framework.
Disclosure of Interest Statement: The authors have no conflicts of interest to declare.