Tackling Hepatitis C in Scotland. Dr Nicola Rowan NSS PHI (Health Protection Scotland)
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1 Tackling Hepatitis C in Scotland Dr Nicola Rowan NSS PHI (Health Protection Scotland) nicola.rowan@nhs.net
2 Context
3 Image: BBC News About Scotland
4 People who inject drugs (PWID): 50-80% Prevalence of Hepatitis C in different populations in Scotland GUM Clinic Attenders: <1% Pregnant women: <1% Surgeons/HCWs: <1% Hutchinson et al. SMJ 2006
5 Scotland s HCV Timeline: Key Milestones Drug Injecting Epidemic begins Acute Hep B and HIV among PWID Harm reduction developed Discovery of HCV INF therapy Epidemiological data - HCV Diagnosis Database - HCV Prevalence Surveys Patient Advocacy established Epidemiological/clinical data - HCV Clinical Database - Projections of HCV Disease 2004 HCV Consensus Conf Parliam/CMO Working Groups PEGINF + RBV therapy INF + RBV therapy Hepatitis C Action Plan (Phases I, II and III)
6 Advocacy Milestones 1999 National Needs Assessment 2003 UK Hepatitis C Resource Centre 2003 Scottish Hepatitis C Awareness & Parliamentary Event 2004 Consensus Conference (RCP, Edin) 2004 UK Awareness Day, Parliamentary Events, Parliamentary Questions 2004 Parliamentary Working Group on Hepatitis C 2004 Parliamentary Debate on Hepatitis C 2005 Action Plan Phase I (1 st draft, consultation and further advocacy)
7 What We Did: Phased Approach (Evidence first)
8 Phase I Evidence Gathering (Determined and costed future large scale action)
9 Scotland s Hepatitis C Action Plan Prevention Diagnosis High prevalence of HCV remained among young PWID in Glasgow Majority of HCV infected in Scotland remained undiagnosed Scotland, ,000 40,000 Chronic HCV 38,000 N Treatment Number treated/yr: 225 PWID 1,000 PWID 2,000 PWID Year Key Evidence in Phase I Modelling work demonstrated insufficient numbers on HCV treatment to curb rising trend in liver failure/deaths in Scotland Diagnosed (ever) N Disease 14,500 HCV related deaths AIDS related deaths Year
10 Phase II Service Improvement and Investment
11 Scotland s Hepatitis C Action Plan Aims To prevent the spread of Hepatitis C, particularly among people who inject drugs To diagnose Hepatitis C infected persons, particularly those who would most benefit from treatment To ensure that those infected receive optimal treatment, care and support
12 Phase II: Service Improvement Actions ( ) Prevention: Improvements in Injection Equipment provision National guidelines for injecting equipment provision Education (Peer to Peer, schools) Diagnosis: Awareness raising initiatives Finger prick sampling in non-clinical settings Treatment: Increase in clinical capacity Funding for treatment & national procurement of antivirals
13 Prevention What has been the impact? Evidence showing a reduction in new HCV infections in Scotland, in the context of a scale-up in interventions National Scale-Up 2008 to 2012) Injecting Equipment Provision (N/S coverage: 53% to 74%; Other Equipment: 5% to 40%) Methadone (50% to 64%) Estimated number of new HCV infections per year among PWID in Scotland 2,500 2,000 1,500 1, Palmateer N et al. Unpublished 2014.
14 Phase II: Outcome Number of people treated Number of people diagnosed Prevention activity Diagnoses Transmissions Incidence in people who inject drugs Chronic HCV infection
15 Lessons
16 Scotland s Hepatitis C Action Plan Driving Forces > Lessons Multidisciplinary Clinical & Public Health Leadership Good Communication High Profile Advocacy Strong Evidence Base Extensive Consultation Performance Managed Serious Investment Strong Governance
17 Hepatitis C Policy in Scotland Hepatitis C Action Plan, Phase I ( ) Gathering evidence to inform Phase II Actions Generating actions for Phase II Investment: 4 Million Hepatitis C Action Plan, Phase II ( ) Investment to improve services High level actions to improve prevention, diagnosis, treatment and care (& monitoring/evaluation) Investment: 43 Million Sexual Health and BBV Framework ( ) Continued focus on Hepatitis C Focus on improving joined-up working with SH & HIV/BBVs. Investment 116 Million across SH & BBV Refreshed Sexual Health & BBV Framework ( ?) Continued outcomes New treatments Investment???
18 Acknowledgements Health Protection Scotland David Goldberg Beth Cullen Allan McLeod Caroline Kelleher Norah Palmateer Nicola Rowan Lesley Wallace Sue McBride Kirsty Roy Miriam King Scottish Government Gareth Brown Glasgow Caledonian University Esther Aspinall Christian Schnier Ellen Carragher Heather Valerio Hamish Innes Amanda Weir Scott McDonald Sharon Hutchinson NHS Boards John Dillon Ray Fox Jim Shanley Third Sector Charles Gore Petra Wright Leon Wylie Supported through funding from Scottish Government
19 Thank-you Nicola Rowan
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