A newly published scoping review in Open Forum Infectious Diseases shows that integrating hepatitis C virus treatment into syringe services programs significantly improves treatment initiation and cure rates among people who inject drugs. This population has historically faced major barriers to accessing care.
The review analyzed 13 studies from across the United States. These included randomized controlled trials, cohort studies, and qualitative evaluations of treatment models located within syringe service programs. Compared to traditional referral-based models of care, the integrated approaches consistently showed better outcomes.
The programs used a variety of approaches. Some were based in mobile units, while others operated in fixed clinical settings. Providers delivered care in person or through telehealth. The programs also differed in how they handled pretreatment evaluations, pharmacy access, peer support, and funding.
Sarah Rowan, MD, infectious disease physician at Denver Health and a co-author of the study, explained that success often depended on tailoring the model to the needs of each program and community, “We did look at different models, and some of the models use on site providers at syringe access programs. Some of the syringe access programs are brick and mortar and others are mobile units,” Rowan said.
“And then there are different approaches to where the provider was. Sometimes a provider was on site, seeing patients, person to person, face to face. Other times, the provider was available via video visit so through like a telehealth model, and really both approaches, or sort of all the variety of approaches had their pros and cons, but in general, they really were tailored to fit the situation for the program and the clients and the providers and the state.”
Rowan gave her key takeaway, “I think the kind of take home message was that various approaches can all work very well as long as they’re kind of developed in concert with the folks at the syringe access center and the clients that you’ll be serving,” she said.
Rowan also pointed out ongoing barriers that limit access to Hepatitis C treatment for people who inject drugs, “I think the main barrier for people who inject drugs is access to providers. So right now, the current models generally request that people go to a clinic, and it’s often an infectious disease clinic or a gastroenterology clinic, and that has not worked very well for a lot of people who just don’t have the bandwidth in their lives,” she said. “The traditional model involves scheduled appointments, insurance, transportation needs. The barrier of the traditional system is what the problem is.”
She described how barriers show up at multiple stages of care.
“Sometimes the barrier is follow up labs, finding someone to share results, and then getting the medication to people, ensuring that they can get their full supply of medication. So sometimes people will get medication and then it’s stolen or lost. So having a safe place to store medication has been a big barrier, and then getting the follow up test of cure results that all of those have been really pretty big barriers in the traditional systems,” Rowan said.
The programs included in the review addressed these challenges using strategies such as on-site lab work, medication storage, and peer support. Stay tuned for the second part of our interview soon.
