Assessing the uptake of hepatitis C testing and. inject drugs in Edinburgh. SFPH Conference

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1 Assessing the uptake of hepatitis C testing and treatmentin people who inject drugs in Edinburgh SFPH Conference

2 Background Novel Psychoactive Substances large increase seen in 2015 Hepatitis C prevalence 7% increase to 48% Ongoing BBV outbreaks HIV outbreak in Glasgow

3 Aims 1) What proportion p of people p who inject drugs who register with specialist and primary care drug treatment services are tested for hepatitis C annually? 2) How many people are successfully referred 2) How many people are successfully referred and then treated for hepatitis C?

4 Rationale 1) What proportion of people who inject drugs who register it with specialist ilitand primary care drug treatment services are tested for hepatitis C annually? Current guidance recommends testing those who are at risk ikfor blood borne b viruses every year or more frequently. What proportion are meeting this target in primary care and drug treatment services?

5 Rationale 2) How many people are successfully referred and then treated t dfor hepatitis C? There are likely drop offs in those being referred, attending clinics, starting treatment, successfully completing treatment and clearing HCV infection. i What is the proportion of those lost at each stage, where can we intervene and do drop offs vary between treatment site?

6 Methods Data Linkage Methods SMR25a registration for drug treatment services provided CHI numbers of those registering for 1 year 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 status, 2)negative HCV status or 3)unknown

7 Data Linkage Methods Methods Previously negative and unknown HCV status deemed as eligible for testing Linked to laboratory records in Lothian which have data on whether they have been tested within ihi the 1 year period

8 Piot Fransen Model Methods Tool used to assess drop offs from referral to treatment for HCV Royal Infirmary of Edinburgh HCV database used as has data for referrals to for treatment Data collected for RIE and Edinburgh Access Data collected for RIE and Edinburgh Access Practice (outreach clinic for homeless practice)

9 Results

10 HCV Testing for those registering with primary care NES

11 HCV Testing for those registering with drug treatment services

12 Piot Fransen Model of Attrition rates for HCV treatment

13 Piot Fransen Model of Attrition rates for HCV treatment EAP RIE Total Referred 80 Percentage Loss 128 Percentage Loss 208 Percentage Loss Attended First Appointment 59 26% 43 66% % 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

14 Staff Views

15 Key Findings BBV testing and treatment HCV antibody prevalence in people p who inject drugs in Lothian has increased in the past few years and is currently at 48% (NESI ) 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 registered with the primary care drug misuse National Enhanced Service and eligible received testing for HCV in the one year period(drug Misuse National Enhanced Service data/hcv database linkage)

16 Key Findings Attrition rate of people who inject drugs from diagnosis to treatment of BBVs Of 208 people who inject drugs (current and exinjectors) referred for treatment at the Royal Infirmary of Edinburgh, 102 (49%) attended d clinic i and of those 44 (43%) started treatment (RIE Database) Losses betweenreferral and successfultreatment are less for patients at the Edinburgh Access Practice where patients may not have to travel for treatment and they are surrounded by both multi disciplinary generalist and specialist workers who can support their hitreatment pathway. (RIE Database)

17 Recommendations

18 With thanks to: Gina McCallister Christopher Cooper Lee Barnsdale