The clinical effectiveness of nurse-led and peer partnership outreach models of hepatitis C care: a systematic review and meta-analysis

Outreach models of care aim to minimise the barriers to accessing hepatitis C care for people who inject drugs. Integrating nurses and/or peer-partnerships into hepatitis C models of care can increase accessibility, acceptability and cost-effectiveness of hepatitis C services. We aimed to assess the clinical effectiveness of nurse-led and peer-partnership outreach models of hepatitis C care. A systematic review and meta-analysis of research reporting on outcomes from outreach hepatitis C services in non-clinical settings that were nurse-led or peer-partnership models of care. We searched MEDLINE, EMBASE, CINAHL and EMCARE in July 2025 for studies reporting clinical effectiveness of hepatitis C services. Studies were included if they offered hepatitis C testing and treatment in an outreach setting and where a nurse and/or peer were substantially involved in service delivery. We describe the features of implementation models used to encourage retention in care and report rates of treatment initiation and sustained virological response, with pooled estimates calculated using random-effects meta-analysis. Of 1,836 studies identified, 12 studies were included. Five models of care were street-based, four at needle and syringe or supervised consumption services, and three at housing services. Five of the included studies reported findings from models that were nurse-led only, four were peer-partnership and three were nurse and peer partnership models of care. Most models included patient support to encourage retention in care, including appointment and transport assistance, financial reimbursements, and telephone support and reminders. Treatment initiation rates ranged from 50 to 97%, with a pooled estimate of 79% (95%CI 71–88%). Despite including only a small number of studies, our review indicates that nurse-led and peer-partnership outreach models of hepatitis C care are effective and can be supplemented with supportive strategies to maximise retention in care. This protocol was registered with PROSPERO (2025 CRD420251060650).