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HEPATITIS CIN PEOPLE WHO USE DRUGS

Improving Care for Hepatitis C:A Framework Approach

LONDON 2015

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Delivery of treatment inLondon prisons

Janet CattLead Viral Hepatitis Nurse

Royal Free Hampstead NHS Trust

HCV transmission is most frequent via IVDU

Hepatitis C in the UK: 2012 Report (http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/Hepatitis

C/

Risk factor information in lab reports of Hepatitis C infection from England: 1996-2011

Prevalence of HCV infection in the UK

215K

100K

0

50

100

150

200

250P

ati

ents

in ,0

00s

Prevalence Diagnosed

· Prevalence is estimated at 215,0001 in the UK but other sources place the prevalence as high as 466,0002

· There is no formal monitoring system in the UK, except for acute infections3

· Only approximately 3% of those diagnosed receive NICE-approved therapies annually3

1. Health Protection Agency (HPA). Hepatitis C in the UK 2013 report. 2013.2. The Hep C Trust. The UK vs. Europe: Losing the Fight Against Hepatitis C. 2004.

3. Hepatitis Awareness Leading Outcomes (HALO). Confronting the silent epidemic: a critical review of hepatitis C management in the UK. 2013.

HCV Life Cycle and DAA Targets – drugs

Adapted from Manns MP, et al. Nat Rev Drug Discov. 2007;6:991-1000.

Receptor bindingand endocytosis

Fusion and

uncoating

Transportand release

(+) RNA

Translation and

polyprotein processing

RNA replication

Virionassembly

Membranousweb

ER lumen

LD

LDER lumen

LD

NS3/4 protease inhibitors NS5B polymerase inhibitors

Nucleoside/nucleotideNonnucleoside

*Role in HCV life cycle not well defined

NS5A* inhibitors

TelaprevirBoceprevirSimeprevirABT 450/rAsunaprevirMK-5172

DaclatasvirLedipasvirOmbitasvirMK-8742GS-5816

Sofosbuvir

DasabuvirBMS-791325

What do we want to achieve?

• Co-ordinating patient pathways in prison

• To improve access to testing and treatment

• To improve quality and equity of access to treatment.

• To improve outcomes

Work together to develop care

pathway

Achieve the best outcomes for patients

Change is not “quick and easy”

Lack of knowledge (HCV not a priority) Training - DBST

Shared Decisionmaking

Where are we now?

• DBST – 20 staff trained• Staff attending education days to improve

knowledge• Keen to drive OPT- OUT testing forward • Advertise on Prisoner televisions• Prisoner competition to design “liver clinic”

poster

Is Opt-out Achievable?

• YES........ But there are Hurdles• No clear directive – effectively being left for

Healthcare staff to organise (time consuming and frustrating)

• Healthcare staff very keen to engage and learn• They need support to drive this forward• ....... A “Lead” to Champion Opt-out testing.

Treatment with new regimens

• HMP Pentonville – one patient commenced: Sofosbuvir/PegIfn/Ribavirin (4 weeks)

• HMP Mount – one patient commenced: Sofosbuvir/Daclatasvir/Ribavirin (one week)

• HMP Brixton – one patient commenced: Harvoni / Ribavirin (2 weeks)

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