PROACTIVE: HePatitis C Reinfection: Optimising surveillAnCe for deTectIon and preVEntion

Background Optimising annual follow-up testing for Hepatitis C Virus (HCV) following treatment for people who inject drugs (PWID) is key to achieving, and measuring progress towards, the World Health Organization (WHO) 2030 HCV global elimination targets.

This proposal follows the EPIToPe study, which has generated empirical evidence on the effectiveness of rapid scale up of community based testing and treatment for HCV in reducing infections amongst PWID in Scotland and England.

To keep HCV infections supressed, current guidance recommends annual follow-up testing for PWID who have been treated for HCV. However, findings from EPIToPe indicate follow-up only happens for a minority of PWID.

This is important, not only because cases may be missed, but also because accurate data on re-infection rates are needed to demonstrate progress towards the WHO elimination targets.

Aim: To co-produce and optimise public health surveillance within harm reduction and other services for the detection and prevention of hepatitis C virus re-infection amongst PWID The objectives are to: Conduct a scoping review of published and grey literature on the barriers and facilitators to follow-up HCV testing Interview service providers and PWID to: describe how annual follow-up tests are provided in the context of the service and other harm reduction interventions) identify barriers and facilitators to provision and engagement in annual follow-up tests determine what data are collected in clinical history on harm reduction exposure and what gaps in the evidence need to be filled Use the Person-Based Approach, to map key behavioural issues, contextual needs, identified barriers and facilitators to behaviour change theory (COM-B and Theoretical Domains Framework) and construct a logic model Refine and prioritise the intervention elements to optimise HCV follow-up testing and co-produce recommendations for implementation and practice.

There will be 3 phases of work in this study. A scoping review of the evidence on the barriers and facilitators to annual follow-up test.

Barriers and facilitators will be summarised in an "intervention planning table" and mapped to the COM-B and Theoretical Domains Framework.

Qualitative interviews, co-facilitated with peer researchers, with staff and PWID at four purposively chosen services (two in England, and two in Scotland) that offer HCV follow-up tests.

The findings from the interviews will be analysed, and interpreted using behaviour change theory to identify areas for optimisation of follow-up testing.

Conduct focus groups (two with service providers, experts and policy makers and two with PWID) to refine and prioritise intervention elements for optimisation, co-produce intervention content and recommendations for implementation and practice.

Timelines: Scoping review (Phase 1): 3 months, Qualitative interviews and concurrent qualitative and behavioural analysis (Phase 2): 9 months. Co-production to optimise follow-up tests and recommendations for practice and policy (Phase 3): 3 months. Write-up and dissemination: 3 months. Total 16 months.

Impact and dissemination The evidence generated from the PDG will directly inform strategies to improve surveillance, diagnosis and treatment of HCV re-infection and research on the implementation of these strategies. Dissemination will be through policy and practice recommendations, academic papers and conferences.