Decentralization of services refers to delivery at peripheral health facilities, community-based venues and locations beyond hospital service sites, bringing care nearer to patients’ homes.

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

• Decentralization and/or integration. These approaches to simplifying HCV testing and treatment services will require additional training and supervision for health care workers (see Tasksharing Implementation considerations, page 19), access to quality-assured RDTs or collection and analysis of dried blood spot (DBS) specimens, good specimen referral networks and documentation of results, including other features such as enhanced connectivity for return of results and an electronic results reporting system. Planning and coordination are also important for delivery of integrated care, including establishment of integrated data systems and consistent crosstraining of health care providers.
• Implementation alongside other existing good practice principles of simplified service delivery (see Box 1). These include comprehensive national planning, simple and standardized algorithms, differentiated care strategy, community engagement and peer support, more efficient procurement and supply management and data systems to monitor coverage and the quality of individual care.
• Adaptation of service delivery recommendations for different contexts, including high-income countries.
• Decentralization of HCV testing and treatment services may not be appropriate for all settings or acceptable to all clients. The relative benefits and costs 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, where a centralized service delivery model with community linkage may be more appropriate.
• 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 equally able 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.