Institute for Global Health


The HALT Hepatitis Study

Effectiveness of Testing for, and Treatment of, Hard-to-Reach Groups for Hepatitis B Virus and Hepatitis C Virus in England

Project Summary 

Hard-to-reach individuals can be defined by numerous lifestyle factors which create problems for engagement with healthcare services. These are factors such as homelessness, injecting drugs use, and ex-prisoners.

These individuals are at an increased risk for a range of infectious diseases, often due to living conditions, exposure to injecting drug use, alcoholism, chaotic lifestyle factors, and generally poor physical and psychiatric health.

Exposure to, and prevalence of, tuberculosis, Hepatitis B virus (HBV) and Hepatitis C virus (HCV) amongst the hard-to-reach is known to be high. Additionally, the same factors that increase the risk of infection can also create barriers to passive presentation for diagnosis, and adherence to treatment, both from the individuals themselves, and within the healthcare system.

Support mechanisms are often needed to assist these people through the clinical process after they test positive for an infection.

Peer support and accompanied referrals can be effective measures to improve engagement with clinical services among difficult populations, although there is very little published literature surrounding this approach (particularly in developed countries), within hard-to-reach populations and in the field of hepatitis.

The primary objective of the study is to determine if peer intervention improves successful engagement with clinical services for Hepatitis C (attending three appointments at the Hepatitis Clinic).  In addition, the other study objectives are to; 

  • determine if a peer intervention improves a patient’s likelihood of successfully reaching a sustained virological response (SVR; an undetectable viral load for 6 months after the end of treatment) against HCV.
  • determine if a peer intervention improves a patient’s likelihood of successfully engaging, reaching a full clinical diagnosis, or commencing treatment for HBV.
  • determine the proportion of the hard-to-reach with adequate immune response to HBV vaccine and examine the factors influencing lack of vaccine uptake