Introduction to Module 6

By the end of the module, you will understand:

• Integrated approaches in relation to substance use and HIV/HCV testing.
• The role of low threshold settings in improving linkage.
• Main barriers to service integration.
• What can be done to support linkage.

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 MAT 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.

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.