Low threshold services play a crucial role in HIV/HCV testing and linkage to care.
Low threshold services play a crucial role in HIV/HCV testing and linkage to care. People who inject drugs (PWID) are a vulnerable group and they have reduced access to health care. HIV and HCV care typically involves repeated, regular contact with different services to which PWID may have more poor access and adherence to than the general population. For most chronic illnesses, successful engagement in the continuum of care begins with testing and diagnosis and linkage to care followed by retention in care over time. While initial linkage to care following testing is a crucial stage in the care continuum, many individuals are never successfully linked and thus may never receive the treatment, care and support they need. Ensuring that people who use drugs receive appropriate care is critical for preventing progression of various diseases and for preventing HIV/HCV transmission within the community.
Early knowledge of HIV/HCV infection is now recognized as a critical component in controlling the spread of these infections. Cohort studies have demonstrated that people living with HIV tend to reduce behaviours that might transmit the virus through sex or needle sharing once they know about their own positive status. Access to OST improves access to ART as well as adherence to it. Access to OST improves treatment outcomes among PWID who live with HIV and who are HIV-HCV co-infected. Needle and syringe exchange programs that are co-located with OST programs have achieved good uptake of HIV/HCV screening.
The linkage to care module is designed to help learn how to offer testing in low threshold settings and help people who use drugs overcome the many challenges they often face getting into care. It also addresses what practical steps can be implemented to improve the linkage and control HIV/HCV among vulnerable and hard-to-reach populations.
There is little guidance for threshold settings on how to plan and implement integrated HIV/HCV testing systems. Too often, providers focus only on a single service, rather than the patient’s overall well-being. By taking a more comprehensive approach, integrated care offers patients higher quality, more efficient care that better meets their needs.
We need a comprehensive, integrated approach to service delivery. We need to fight fragmentation. - WHO Director-General, 2007
