Summary of Expert Panel meeting discussions on interventions to increase linkage to care and adherence to treatment for hepatitis B and C, HIV and tuberculosis among people who inject drugs

In 2018, a stakeholders survey identified a need for an update to the joint European Centre for Disease Prevention and Control (ECDC) and European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) guidance, ‘Prevention and control of infectious diseases among people who inject drugs’ published in 2011 [1]. In 2019, several evidence reviews were commissioned by the two agencies. A systematic literature review of interventions to increase linkage to care and adherence to treatment for hepatitis B and C, human immunodeficiency virus (HIV) and tuberculosis (TB) among people who inject drugs was commissioned by ECDC to the Austrian National Public Health Institute (Gesundheit Österreich, GOEG). The objectives, methods and results of the systematic review are comprehensively presented in the ECDC technical report, ‘A systematic literature review of interventions to increase linkage to care and adherence to treatment for hepatitis B and C, HIV and tuberculosis among people who inject drugs’ [2]. Eight main categories of interventions were identified: directly observed therapy (hepatitis C virus (HCV), TB), contingency management (HCV), telemedicine (HCV), peers (HCV), treatment provided in primary care (HCV), opioid substitution treatment (HCV), multicomponent interventions (HCV, HIV) and cooperation between service providers (HCV, TB).

The evidence retrieved through the systematic review was transferred into evidence-to-decision tables, one table for each category of intervention, and critically reviewed by a multidisciplinary panel of experts appointed by ECDC and EMCDDA. The Expert Panel further supported the translation of research findings into recommendations for public health practice and practice considerations.

This report documents the process and outcome of the assessment and translation of the evidence into guidance recommendations on linkage to care and/or adherence to treatment for HCV, HIV and TB. For each intervention, the following is presented: the evidence as retrieved through systematic literature review, including the conclusion based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system; the summary of judgement tables; the Expert Panel's assessment on the benefits, acceptability and transferability of the intervention; the Expert Panel’s comments and considerations on specific barriers or obstacles for the implementation; and the Expert Panel’s suggestions for the recommendation, including their opinion on the strength (strong vs. conditional) of the recommendations and their suggestions for practice considerations.

The Expert Panel strongly recommended two interventions: peer mentors to increase adherence to HCV treatment and cooperation between service providers to increase linkage to HCV treatment. The following interventions were conditionally recommended:

• To increase linkage to HCV care and adherence to treatment: directly observed therapy, contingency management, multicomponent interventions, telemedicine, primary care-based treatment.
• To increase linkage to HCV care alone: peer mentors.
• To increase adherence to HCV treatment alone: integrated opioid substitution treatment and HCV treatment.
• To increase linkage to HIV care and adherence to treatment: multicomponent interventions.
• To increase adherence to TB treatment: cooperation between service providers.

Success factors for the implementation of the interventions on linkage to care and adherence to treatment indicated by the experts included: tailoring the interventions to national circumstances, integrating the interventions into existing services people who inject drugs that are close to their daily lives, ensuring adequate funding and coverage of interventions, and providing testing and treatment free of cost for people who inject drugs.