Hepatitis C Diagnosis and Treatment, Impact on Engagement and Behaviour of People Who Inject Drugs, the Hooked C project

  • Madeleine Caven

Student thesis: Master's ThesisMaster of Science


Hepatitis C (HCV) virus affects around 71 million people globally, with people who inject drugs (PWID) the most at-risk population for acquisition of the virus. There is emerging evidence that HCV treatment engagement is associated with change in drug behaviours and reduced risk of mortality among PWID. A systematic review was conducted to determine the impact of HCV treatment on injecting risk behaviours in PWID. Following this, a series of retrospective case control studies investigated whether HCV diagnosis and treatment engagement reduces risk of all-cause mortality and drug related death among PWID, and whether any effect is dependent on treatment regimen and intensity of engagement with staff.

Comparison and synthesis of results of the systematic review was challenging due to heterogeneity between studies. However, results suggested that it is likely that engaging in HCV treatment has a positive impact upon patients’ injecting drug use and injection equipment sharing behaviour. Through the case control studies, it was found that HCV diagnosis does not impact upon mortality outcomes of PWID. However, HCV treatment engagement is significantly protective against all-cause mortality and drug related death, with this effect independent of treatment regimen and intensity of engagement with staff.

These findings provide strong evidence of the importance of universal HCV testing and treatment accessibility for PWID, reducing their risk of mortality beyond liver related outcomes. It is vital that efforts are made to actively minimise barriers and stigma relating to treatment access for PWID to facilitate HCV diagnosis and linkage to care. Future research should focus upon understanding the key barriers and facilitators to engagement to aid the development of interventions that increase the reach, accessibility and effectiveness of HCV care, improving treatment pathways in pursuit of the WHO goal of HCV elimination.
Date of Award2020
Original languageEnglish
SponsorsNHS Tayside
SupervisorJohn Dillon (Supervisor) & Emma Fletcher (Supervisor)

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