Theme: Clinical Research Year: 2018
Background:
In England as in many countries there remains a substantial gap between number of people
with chronic HCV infection, diagnoses and HCV treatments. Models suggest interventions to
promote HCV case-finding in “higher risk” people in primary care (mainly people with an
injecting history or people who inject drugs) would be cost-effective. But is little robust RCT
evidence of specific interventions.
Approach:
Complex intervention in primary care:- offer of educational training on HCV for practice staff;
poster and leaflets displayed in the waiting room; HCV risk prediction algorithm using
information from electronic patient record (including drug use, drug treatment history, previous
HCV test, raised ALT, and other adverse exposures) run using Audit+ software to generate a
list of higher risk patients. Patients were invited for an HCV testing opportunistically through
computer pop-ups and by sending out screening invitation letters and follow-ups. Control
practices followed usual care.
Outcome:
Cluster RCT of 45 general practices with data successfully collected from 22 intervention
practices and 21 control practices. A total of 21,847 “high risk” patients were identified (11,407
in intervention and 10,440 in control practices). There was strong evidence that the
intervention increased HCV case-finding (13% vs 8.35%; Risk Ratio 1.59 95%CI 1.12-2.26
p=0.01); and increased referral and assessment for HCV treatment (32.6% vs 11%). A nested
qualitative study found that participating health care professionals increased knowledge and
awareness on HCV and valued the intervention.
Conclusion:
An economic evaluation is underway and will be presented and determine whether HepCATT
primary care intervention can be recommended for implementation.