With the advent of highly efficacious Direct Acting Antiviral (DAA) Hepatitis C (HCV) therapy, the World Health Organisation project global HCV eradication by 2030 and NHS-England is targeting HCV eradication nationally by 2025. Despite a nationwide HCV operational delivery network it is estimated that ~90% of those infected in England are not actively engaged with secondary/tertiary HCV services providing therapy and many, often asymptomatic, remain untested and undiagnosed. These patients do engage with primary care; but with increasing pressures on these services and absence of national screening, detection and onward referral to treatment centres are poor. This is a barrier to achieving this target, and the new frontier for HCV services is improved detection and engagement in the community. People with a history of intravenous drug and alcohol misuse have a high prevalence of HCV, are often sexually active with higher rates of transmission, have limited access to and/or engagement with HCV services, but often do attend community drug and alcohol services (CDAS). Our aims were to increase identification and treatment of patients with HCV by engaging these individuals within a community-based setting.Methods
Over one year (August 2015–2016), in partnership with five local CDAS we provided onsite nurse-led consultation, counselling, screening and risk stratification through non-invasive measurement of liver stiffness (fibroscan), dried blood spot screening (HBV/HCV/HIV serology, HCV RNA, T-spot), and referral to secondary care for initiation of approved DAA therapy and ongoing management of any concomitant chronic liver disease.Results
174 CDAS service-users were screened and 123 (70%) were diagnosed as HCV RNA positive; 54% Genotype 3% and 46% Genotype 1. Median fibroscan score 7.1 Kpa, with 21 (12%) had a fibroscan Result suggestive of cirrhosis and were prioritised to treatment according to National guidance via our NHS-England HCV ODN.Results
To-date 86 (70%) pf the HCV positive patients have attended our clinic for consideration of access to DAA therapy.Conclusions
This community-based pilot had a significant rate of detection (70%), and excellent conversion to secondary care clinic review (70%). However, the majority of our patients had low levels of fibrosis and as NHS England policy over that period prioritised for patients with advanced disease, this cohort did not receive immediate access to treatment from the ODN over the time of the project, with Resultant disengagement by many from secondary care. Given recent changes in treatment access prioritisation we are now actively reengaging this group which represents an ongoing challenge.