Assessing the uptake of g phepatitis C testing and treatment in people whotreatment in people who inject drugs in Edinburgh

SFPH Conference

Backgroundac g ou d

• Novel Psychoactive Substances – large increase seen in 2015

• Hepatitis C prevalence – 7% increase to 48%

• Ongoing BBV outbreaks – HIV outbreak in GlGlasgow

Aims

1) What proportion of people who inject drugs ) p p p p j gwho register with specialist and primary care drug treatment services are tested fordrug treatment services are tested for hepatitis C annually?

2) How many people are successfully referred2) How many people are successfully referred and then treated for hepatitis C?

Rationale

1) What proportion of people who inject drugs h i t ith i li t d iwho register with specialist and primary care 

drug treatment services are tested for hepatitis C annually?

Current guidance recommends testing those h i k f bl d b iwho are at risk for blood‐borne viruses every 

year or more frequently. What proportion are meeting this target in primary care and drug treatment services?treatment services?

Rationale

2) How many people are successfully referred d th t t d f h titi C?and then treated for hepatitis C?

There are likely drop offs in those being referred attending clinics startingreferred, attending clinics, starting treatment, successfully completing treatment d l i HCV i f i Wh i hand clearing HCV infection. What is the 

proportion of those lost at each stage, where can we intervene and do drop offs vary between treatment site?between treatment site?

Methods• Data Linkage Methods‐ SMR25a registration for drug treatment servicesSMR25a registration for drug treatment services provided CHI numbers of those registering for 1 year periodyear period

‐ Primary care provided CHI numbers for those registering with National Enhanced Service for 1 year period

‐ CHI numbers separated into three groups 1)previously known positive HCV status1)previously known positive HCV status, 2)negative HCV status or 3)unknown

Methods• Data Linkage MethodsPreviously negative and unknown HCV status‐ Previously negative and unknown HCV status deemed as eligible for testing

Linked to laboratory records in Lothian which‐ Linked to laboratory records in Lothian which have data on whether they have been tested i hi h 1 i dwithin the 1 year period

Methods• Piot‐Fransen ModelTool used to assess drop offs from referral to‐ Tool used to assess drop offs from referral to treatment for HCV

Royal Infirmary of Edinburgh HCV database used‐ Royal Infirmary of Edinburgh HCV database used as has data for referrals to for treatment

‐ Data collected for RIE and Edinburgh AccessData collected for RIE and Edinburgh Access Practice (outreach clinic for homeless practice)

ResultsResults

HCV Testing for those registering with primary care NES

HCV Testing for those registering with drug treatment services

Piot‐Fransen Model of Attrition rates for HCV treatment

Piot‐Fransen Model of Attrition rates for HCV treatment

EAP RIE Total

Referred 80 Percentage Loss 128 Percentage Loss 208Percentage

Loss

Attended First Appointment 59 26% 43 66% 102 51%

Started Treatment 26* 56% 18** 58% 44 57%

*14 Sustained Virological Response, 2 relapsed, 1 incomplete treatment, 3 waiting on 3/12 post-treatment response, 6 currently on treatment

**6 Sustained Virological Response, 1 relapsed, 2 incomplete treatment, 5 waiting on 3/12 post treatment response, 1 currently on treatment, 3 outcome not recorded

Staff Views

Key FindingsBBV testing and treatment• HCV  antibody prevalence in people who inject drugs in y p p p j gLothian has increased in the past few years and is currently at 48% (NESI 2015‐16)

• Eighty nine people (55%) of 163 who registered for OST and were eligible for testing received BBV testing in the one year period (SMR25a/HCV database linkage)

• Seventy nine people (42%) of 186 who were newly i t d ith th i d i N ti lregistered with the primary care drug misuse National 

Enhanced Service and eligible received testing for HCV in the one year period(Drug Misuse National Enhancedthe one year period(Drug Misuse National Enhanced Service data/HCV database linkage)

Key FindingsAttrition rate of people who inject drugs from diagnosis to treatment of BBVs

• Of 208 people who inject drugs (current and ex‐injectors) referred for treatment at the Royal I fi f Edi b h 102 (49%) tt d d li iInfirmary of Edinburgh, 102 (49%) attended clinic and of those 44 (43%) started treatment (RIE Database)Database)

• Losses between referral and successful treatment• Losses between referral and successful treatment are less for patients at the Edinburgh Access Practice where patients may not have to travel for treatment p yand they are surrounded by both multi‐disciplinary generalist and specialist workers who can support h i h (RIE D b )their treatment pathway. (RIE Database)

Recommendations

Duncan.McCormick@nhslothian.scot.nhs.ukAmir.Kirolos@nhslothian.scot.nhs.uk

With thanks to:Gina McCallisterChristopher CooperChristopher CooperLee Barnsdale