Peer support improved hepatitis C treatment uptake and completion in England

30 Jun 2021 Keith Alcorn
Originally published on

Peer support increased hepatitis C treatment initiation and completion in England between 2017 and 2020, an evaluation of a national peer support scheme run by the Hepatitis C Trust has found. It also increased the likelihood that people who started treatment would do so in a drugs service, highlighting the value of providing hepatitis C treatment in non-clinical settings.

The evaluation findings were presented to the International Liver Congress last week by Davina Jugnarain of Barts Health Liver Centre, Queen Mary University of London.

The study evaluated the role of peer support in England’s national hepatitis C elimination campaign. Peer support with lived experience of hepatitis C treatment may encourage people to access treatment, especially those in marginalised groups such as people who inject drugs, prisoners and migrants.

Peer support has been shown to have a positive impact on the uptake of mental health, HIV and cancer services but previous studies of its impact in hepatitis C elimination have been inconclusive.

Hepatitis C elimination efforts in England have included a national peer support programme, partially funded by the pharmaceutical companies AbbVie, Gilead and Merck as part of the competitive procurement agreement between the National Health Service and manufacturers of direct-acting antivirals.

Hepatitis C care in England is organised through 22 Operational Delivery Networks (ODN). Seventeen ODNs began running a peer support scheme at a slightly different time while five did not have peer support schemes. The different start times for peer support offer the opportunity for researchers to analyse the impact of peer support on treatment initiation, completion and treatment failure rates in what amounted to a pseudo-randomised study.

Peer support co-ordinators were trained by the Hepatitis C Trust and co-ordinated volunteer peer support workers at ODN level. Peer support workers might discuss treatment informally with service users, deliver medication to people on treatment or deliver educational talks backed up by point-of-care antibody tests.

The analysis looked at 30,729 patients treated between January 2017 and the end of February 2020. The researchers looked at the effects of peer involvement in the management of hepatitis C patients immediately and after two months. The immediate analysis compared 6718 peer-supported patients with 24,011 non-peer-supported patients while the 2-month analysis compared outcomes in 6123 peer-supported patients and 24,606 non-peer supported patients.

Peer-supported and non-peer-supported patients were similar with respect to age, gender and ethnicity (46-49 years old, approximately 75% male and approximately 80% White). Peer-supported patients were somewhat more likely to have a history of drug use, so that 67% of peer-supported patients and 58% of non-peer-supported patients had probably acquired hepatitis C through injecting drug use. Forty-four per cent of peer-supported patients were current drug users compared to 23% of non-peer-supported patients.

In both the immediate and 2-month impact analyses, peer support increased the odds of starting treatment (rate ratio 1.12 and 1.15 respectively, p<0.01) and completing treatment (odds ratio 2.45 and 2.01 respectively, p<0.01). After two months of peer support activity, there was also a significant increase in referrals for treatment from drugs services (rate ratio 1.15, p=0.036) and in the likelihood that people who started treatment would do so in a drugs service (odds ratio 1.19, p=0.023).

The results of the immediate impact analysis suggest that the presence of peer support workers in a service may motivate staff and challenge unconscious bias regarding the suitability of people who inject drugs for treatment, said Davina Jugnarain. The two-month analysis suggests that the presence of peer support workers increases referrals and treatment initiation in drugs services.

“We believe that peers are effective in engaging at-risk groups and peers could accelerate attainment of elimination targets,” she concluded.