Project INTACCT (Integrated Community Hepatitis C Treatment)

Author: Sander-Hess C, Parker M, Maggs J, Hansford L

Theme: Models of Care Year: 2018

Background: Inclusion (part of South Staffordshire and Shropshire Healthcare NHS Foundation Trust) identified the care pathway for Hepatitis C (HCV) in Buckinghamshire was dysfunctional. Our team operated a proactive testing/referral system yet treatment was limited due to the amount of preparatory GP surgery appointments required (minimum 3) before obtaining a Hepatology outpatient referral. Additionally the cost of travel to Oxford in a semirural community presented a major barrier for this already marginalised group of patients. Description of model of care/intervention: In 2015 we developed a new service model in consultation with service users, commissioner and hepatologist. After initial dry blood spot test (DBS) including PCR, treatment assessment/decision is now made in 2 appointments with a Hepatology outreach clinic offered in-house, removing the need for patients to travel and therefore improving access.. The consultant appointment is linked to the opiate substitute prescription which increases engagement Effectiveness: Buckinghamshire data 1/4/16-1/4/18: • HCV antibody (Ab) test uptake:302/395 (75%) • HCV Ab positive: 63/302 (21%) • Of which received PCR-DBS test:63/63 (100%) • Of which 31/63 (49% ) with active HCV, • 31/31 (100%) accessed the pathway and commenced DAA treatment. Outcomes (snapshot date: April 2018) • 4 discontinued (2 non adherent, 1 subsequently HIV diagnosed,1 false positive • Sustained virological response (SVR): 15 • Negative at EOT: 5 (awaiting SVR 3/12) • Currently in the middle of treatment, early results show all are responding well: 7 Conclusion and next steps: Our integrated community-based HCV treatment model demonstrated high HCV test uptake, excellent linkage to care and treatment outcomes comparable to secondary care. Currently 31 patients have completed or are in the process of completing their DAA. Inclusion is now implementing this pilot model across all community drug services increasing access for approximately 8500 patients. Moving forward we are additionally aiming to engage more patients with lived experience in our services to increase testing, linkage and treatment adherence.

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