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Table 2 Lessons learned during implementation of efforts focusing on testing and treatment of hepatitis C virus (HCV)

From: Peer involvement and cross-sector efforts in establishing integrated treatment of hepatitis C virus infection for people with substance use disorders: experiences from Norway

 Periods with difficulties in accessing HCV treatmentInitial difficulties in reaching people who inject drugsRotation in clinical staff
Description of situationUntil February 2018, Norwegian guidelines for HCV made treatment available for only approximately half of the people with chronic HCV. The other half were required to wait during monitoring until liver fibrosis had developed. Both user groups, clinicians and researchers working with HCV worked hard to change this policyInitially, several patients were less open for testing of HCV. This might partly have been related to some initial tension in the patient-clinician relationship, as many patients were not satisfied with the choice of opioid agonist therapy they received and the follow-up requirements for the opioidSome of the clinical staff groups such as physicians rotated frequently between different clinical sections. This made it more difficult to plan clinical patient contact and meetings with these groups
Impact of challengesThe guidelines caused substantial frustration for people living with HCV as they were impatient to initiate treatment. It threatened a good patient-clinician relationship as clinicians were not able to provide HCV treatment to people who wanted thisThe situation contributed to an initial slower start in testing of HCV, particularly during the first few monthsThis situation also made implementation of new routines more challenging as there was often a need for frequent training and provision of information
Efforts to overcome the challengesThe user group involvement helped patients living with HCV understand that the delay in making treatment available was due to policy that the clinicians were required to adhere to. This reduced tensionEfforts from highly motivated and patient-centred nurses together with user group involvement contributed to an improved patient-clinician relationship making testing and treatment of HCV more feasible and efficientThrough a combination of shifting of some tasks from clinicians with frequent rotation to clinicians with higher degree of stability in addition to frequent provision of information and training, we managed to achieve good continuity and quality of care