Best practices to increase engagement and retention in hepatitis C care among people who use drugs


Key take-home messages
  • Chronic HCV infection can now be treated with direct-acting antivirals (DAAs), a drug regimen that can effectively cure HCV infection among all population groups, including people who use drugs.
  • While the uptake of HCV treatment is higher in the DAA era compared to the interferon era, it is still at suboptimal levels.
  • Overall, research suggests that integrating HCV care into other health care settings, as well as patient navigation or care coordination, can significantly improve linkage to HCV care and the uptake of DAA treatment.
  • Numerous interventions have been developed to improve engagement and retention in HCV care specifically among people who use drugs, and can be classified into four different categories: integrated services and case management, contingency management, telemedicine, and peer-involvement and support. In addition, there are certain approaches such as task-shifting (delivery of HCV care by non-specialist physicians or nurses or peers rather than specialists) or micro-elimination (incrementally achieving national elimination through initiatives that eliminate HCV for defined segments of the population) that can be utilized across these four broad categories of interventions.
  • Contingency management (i.e. cash incentives) may have a positive impact on engagement and retention in care among people who use drugs.
  • Telemedicine is one strategy used by integrated services that may facilitate engagement in the HCV care cascade among people who use drugs.
  • Peer involvement and support can be used to promote engagement in HCV care in various capacities: facilitating HCV testing, outreach and education, mentorship, and recruitment.
  • Several studies found that co-locating treatment for HCV with treatment for opioid use disorders can improve retention in the HCV care cascade.
  • For individuals co-infected with HIV/HCV, co-locating care had favourable outcomes for linkage to and engagement in the HCV care cascade.


The Ontario HIV Treatment Network: Rapid Response Service




  • Population(s)
    • People who use drugs
    • General HIV- population
  • Prevention, Engagement and Care Cascade
    • Engagement and Care Cascade
  • Engagement and Care Cascade
    • Linkage/engagement in care
    • Retention in care
  • Substance Use
    • Nonmedicinal drugs
  • Co-infections
    • Hepatitis B, C


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