Comparing Outcomes of the Hepatitis C Virus Cascade of Care Between a Peer-Led Program and Drug Treatment Services in England, 2019-2023

Abstract

Objectives: The United Kingdom has committed to World Health Organization goals to eliminate hepatitis C virus (HCV) by 2030. Peer-led services (PLS) may enhance health care engagement and treatment outcomes. We compared progression through the HCV care cascade between those tested in a community using PLS (PLS group) with a population tested in drug services (non–PLS group) in England. Methods: We extracted data on individuals with HCV-RNA test results from a laboratory surveillance system (2019-2023) and linked them to a national HCV treatment database. We identified individuals tested by the Hepatitis C Trust as having received PLS. We compared differences along the care cascade using the Pearson χ2 test. Results: A total of 14 094 individuals in the PLS group (72.9% male; median age, 43 y) and 46 568 individuals in the non–PLS group (70.6% male; median age, 44 y) received a positive HCV-RNA test result. Significantly more individuals from the PLS group than the non–PLS group were linked to treatment (83% vs 51%) and initiated treatment (73% vs 33%; both P < .001). Among those with a treatment outcome, 75% in the PLS group versus 80% in the non–PLS group achieved a sustained virologic response (SVR) (P < .001). Significantly more individuals achieved SVR among those receiving a positive HCV-RNA test result in the PLS group than in the non–PLS group (36% vs 11%; P < .001). Conclusion: A key strength in peer-led models lies in linkage to treatment when compared with drug services alone. This finding highlights the importance of ongoing support for peer-led programs helping medically underserved populations living with HCV progress to treatment and achieve elimination.