Developing a community HCV service: project ITTREAT (Integrated Community based Test - stage - TREAT) service for people who inject drugs

Liver disease is now the third most common cause of premature death in the UK, with chronic viral hepatitis being an important contributory factor. Often the diagnosis of chronic liver disease is only made when patients present late in the disease trajectory. This underscores the importance of near patient testing and linkage into care. The need for community based models for liver disease is in line with the recently commissioned National Liver report, which calls for assessment and treatment of high-risk individuals in the community. In this manuscript our objectives are to discuss the need for community services for individuals with hepatitis C virus (HCV) infection and give an overview of the different community models for HCV. Finally we describe our experiences in setting up a successful nurse led service for screening, stratification and treatment of HCV related liver disease at a substance misuse service. We highlight the important stages of this process including engaging with stakeholders, obtaining funding and service set up. We also explore the obstacles and challenges faced and summarise our key recommendations. A brief summary of interim clinical outcomes is also presented.