ADHERE: a toolkit for retaining PWID living with hepatitis C in healthcare systems

Abstract Aim Despite advancements in hepatitis C care, significant gaps remain, particularly in retaining people who inject drugs (PWID) in treatment, which hinders progress toward achieving the World Health Organization’s (WHO) hepatitis C elimination goals. The ADHERE (Attract pwiD Hepatitis hEalthcaRE) toolkit was developed to address these challenges by optimizing linkage-to-care services for PWID, focusing on the critical steps within the care cascade (CC) where losses are most likely to occur. Subject and methods Retaining PWID through the entire treatment process until the achievement of sustained virologic response (SVR) remains a formidable challenge. The ADHERE toolkit interconnects micro-ecosystemic conditions with public health policy implementation, offering a structured approach to enhancing PWID retention in healthcare systems. This toolkit was developed through an extensive literature review and consultations with key opinion leaders (KOL) from seven countries, ensuring its relevance and applicability across diverse settings. Results The ADHERE toolkit provides a comprehensive framework and strategy for public health interventions, focusing on the later stages of the CC for hepatitis C. By facilitating continuous quality improvement and enabling the integration of various public health policies, the toolkit aims to minimize treatment dropouts and maximize the chances of achieving a cure among PWID. Conclusion The ADHERE toolkit aims to aid in advancing the management of hepatitis C among PWID, offering a feasible and auditable approach to improving patient retention and treatment outcomes. By establishing a robust network of health policy management processes, the toolkit is expected to contribute to the global effort to eliminate hepatitis C.