Author: Hathorn E, Bufton S, Roberts M, Elsharkawy A, Mutimer D

Theme: Models of Care Year: 2019

Background: The West Midlands hepatitis Operational Delivery Network (ODN) is the largest in
England serving a population of just over 5,500,000 people. Overall hepatitis C prevalence is low
(0.2%) but is 29.2% in people who inject drugs (PWID) and 10.6% in people with a history of injecting
drug use. The ODN consists of a regional hub that oversees treatment across 13 spoke National
Health Service (NHS) Trusts. In 2017/18, the ODN treated 742 people with antivirals but treatment
rates will need to increase if the NHS is to realise its elimination target of 2025.
A situational analysis of the West Midlands ODN was initiated in 2017 to define the management
pathways of services providing hepatitis C care to PWIDs with the aim of addressing barriers to
Description of model of care/intervention: 13 NHS Trusts and 14 drug and alcohol services were
identified. Informal interviews were performed with staff from each service and a baseline map of
the service developed to visually represent the patient journey from testing to treatment. Each map
was then reviewed to identify barriers to treatment and recommendations made to redesign or
remove steps. Barriers included unnecessary clinic appointments, a requirement for hospital-based
consultant-delivered appointments, and the requirement for pre-treatment transient elastography.
Effectiveness: A ‘best practice’ map was developed against which services were compared. Best
practice required three patient visits (‘dried spot test offered’, ‘results, counsel and full bloods
taken’ and ‘treatment started’) within a 4-week period. A mapping tool was developed to enable
reporting of patient attrition at each visit and performed at baseline and following change.
Conclusion and next steps: Regional mapping of hepatitis C services has highlighted common
challenges and enabled simplification of care. Services across the ODN are working towards threevisit pathways. An equivalent mapping process is underway in the ODNs prisons.
Disclosure of Interest Statement: This work was completed by Faith Cullen, Specialised
Commissioning Manager, Market Access, AbbVie Ltd. The authors have no other relevant

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