Optimising Hepatitis C surveillance for women who inject drugs

Funding

NHS Bristol, North Somerset and South Gloucestershire ICB Research Capability Funding­­.

What is the problem?

Aligned with the ICB priorities of tackling inequalities, preventing illness and treating people earlier, this work focuses on hepatitis C follow-up testing for women who inject drugs who are at increased risk infection, and reinfection.

Hepatitis C can cause serious liver damage, cancer, and early death if untreated, but it is curable. Over the last decade, the UK has scaled up testing and treatment for people who inject drugs (the main group of people affected by the hepatitis C Virus). It is recommended that people who inject drugs and have been treated for hepatitis C receive annual testing to check for reinfection, with retreatment provided as needed. However, evidence suggests that this routine follow-up rarely happens beyond the first year (for either men or women). The aim of this ongoing work is to develop recommendations to optimise follow-up testing interventions. To date, our focus has been on people who inject drugs as a whole. However, evidence indicates that women face disproportionately higher risks of hepatitis C infection and encounter additional barriers to accessing community drug and alcohol services and harm reduction support compared with men.

What is the aim of the research?

The funding will support essential patient and public involvement (PPI) activities to ensure the intervention is tailored to women’s specific needs and experiences. This will be achieved through three key components:

  1. We will test the usability / acceptability / feasibility of the intervention using “think-aloud” interviews with women who inject drugs, to refine and optimise the follow-up testing approach. Up to ten interviews will be completed in iterative cycles, testing, revising the intervention plans, and re-testing to ensure that each round of feedback informs meaningful improvements.
  2. We will hold expert panels with service providers who support women who inject drugs and with women who have lived experience. These panels will review and refine the intervention to ensure it meets the needs of subgroups of women at highest risk of hepatitis C reinfection, including young women, women with a history of imprisonment, women who are pregnant or have infants, and women involved in the sex industry.
  3. The funding will provide dedicated time to develop a trial proposal and complete research methods training, focusing on recruitment for randomised controlled trials.

How will this be achieved?

With the help of the Bristol Trials Unit, and through collaborations with colleagues at the UK Health Security Agency, and Public Health Scotland (via our NIHR HPRU EBS team), we will design a study to test the effectiveness of the follow-up testing approach that we have optimised, to identify whether this approach has had the intended outcomes which would be:

  • Increasing annual follow-up test rates (and within this, the proportions of men/women followed up – and how this relates to the population of people who inject drugs).
  • Detection of reinfection through the annual follow-up tests and treatment uptake rates to understand whether this is a feasible and cost-effective approach to maintaining the micro-elimination levels that have been achieved in the UK.

We would collect qualitative data with services and people who inject drugs to understand how the intervention is implemented, and people’s experiences of follow-up (including experiences of reinfection, and re-treatment (if taken up). Within this proposal, we would also include a methodological sub-study to explore the impact that peer researchers (who facilitate or co-facilitate data collection) have on the data collected.

Who is leading the research?

This research is led by Dr Hannah Family, Research fellow at the University of Bristol.

Further information

For more information or to get involved with this project, please email bnssg.research@nhs.net.