Implementation considerations Implementation of the recommendations should be informed by local context, including HCV epidemiology and the prevalence of other comorbidities, the availability of resources, the organization and capacity of the health system and anticipated cost–effectiveness.

• Decentralization and/or integration of HCV testing and treatment services will require additional training and supervision for health care workers (see Task-sharing implementation considerations, section 6.6), access to quality-assured RDTs or collection and analysis of blood specimens, good specimen referral networks and documentation of results, including other features such as enhanced connectivity for return of results and an electronic results system. Planning and coordination are also important for delivery of integrated care, including establishment of integrated data systems and consistent cross-training of health care providers.
• Implementation alongside other existing good practice principles of simplified service delivery (see Box 5.1). These include comprehensive national planning, simple and standardized algorithms, differentiated care strategy, community engagement and peer support, strategies for more efficient procurement and supply management, and data systems to monitor the quality of individual care and coverage.
• Adaptation of service delivery recommendations for different contexts and high-income countries: Decentralization and integration require understanding of context, needs, service gaps and overall costs and benefits and the programmatic data to inform decision-making.
• Decentralization of HCV testing and treatment services and/or integration into existing health services may not be appropriate for all settings or acceptable to all clients, and the relative benefits should be assessed according to the context. For example, decentralization of services may be inefficient and costly in high-income countries with a low burden of HCV infection, and a centralized service delivery model with community linkage may be more appropriate.
• The selection of facilities for decentralization should take into consideration geographic distribution of the most affected populations, and will not be applicable to all primary health care facilities.
• Where care is partially decentralized, ie. testing at a community site and treatment at a different hospital site, it should be accompanied by efforts to strengthen linkage and referral systems. Community-based treatment programmes should be linked with care at health facilities and with adequate laboratory, diagnostics, monitoring and evaluation and drug and supply management systems. Mobile outreach services may also be utilized to address hot spots, which can be identified via routine HCV testing. Adaptations may be needed for specific populations. Although hepatitis care and treatment services for key populations can be provided in decentralized settings, it should be recognized that not all health care centres are equipped equally to deal with the specialized needs of people who use drugs. The experience of stigma and discrimination is one of the major problems in accessing services for people who inject drugs, and this problem may be greater at some facilities than others. Some may choose to receive their hepatitis care in a facility that is not close to their homes because of concerns about stigma and disclosure.