APPEAL: a toolkit for attracting people who inject drugs with hepatitis C to healthcare systems

Abstract

Aim: The “APPEAL” toolkit was developed to address the challenges in diagnosing people who inject drugs (PWID) with hepatitis C (HCV) and engaging them with healthcare systems. It introduces an ecosystemic approach based on health and well-being literacy across awareness, prevention and diagnosis dimensions of the hepatitis C’s care cascade (CC) for PWID. Subject and methods: The framework incorporated a scoping review and thematic analysis of 54 studies, alongside contributions from 57 hepatitis C key opinion leaders across seven countries. The toolkit is structured around five main axes: problems, solutions, outputs, outcomes and feedback process, employing a holistic perspective that considers economic, legal and social contexts. Eighteen policy prescriptions (PP) are proposed and supported by selective references to ensure relevance and applicability. Results: The APPEAL toolkit facilitates a strategic workflow for policymakers, health authorities and patient advocacy organizations, guiding them through action flowcharts to evaluate and enhance their interventions within the hepatitis C’s CC for PWID. Notably, its implementation demonstrated potential in identifying and attracting PWID to hepatitis C treatment pathways, contributing to increased diagnostics, education on risk behaviours and raising overall disease awareness. The toolkit’s intelligent cycle system supports accountability, enabling continuous data-driven improvement and innovation in addressing hepatitis C. Conclusion: The APPEAL toolkit was developed to attract PWID living with HCV to healthcare systems in a proactive manner. By managing information and fostering education on HCV, it aims to amplify awareness, prevention and diagnosis. The toolkit’s design and functionality underscore the importance of continuous quality improvement and the potential for its use in internal or external quality audits of healthcare services related to hepatitis C.