The Hepatitis C Pre-DAA Cascade Of Care For Persons Using Drug Services In England.

Author: Ireland G, Mandal S, Eastwood B, Hickman M & Simmons R

Theme: Epidemiology & Public Health Research Year: 2018

The majority of hepatitis C (HCV) infections in England are found in people who inject drugs
(PWID) either currently or in the past. We aim to establish the cascade of care (CoC) for
people engaging with drug services.
The Sentinel Surveillance of Blood Borne Testing (SSBBV) was linked with the National
Drug and Treatment Monitoring System (NDTMS). For persons linked and HCV tested in
drug services between 2008 and 2016, we describe their characteristics, quantify repeat
anti-HCV testing, establish the CoC for people first diagnosed with HCV in drug services,
and estimate incidence of HCV in PWID.
Provisional results show that between 2008 and 2016, 29,773 persons were tested for HCV
within specialist drug services in SSBBV, and linked to an NDTMS record. Of these, 9091
(30.5%) tested HCV positive by the end of 2016. Most persons HCV positive were male
(71.6%), of white ethnicity (94.3%) and PWID (94.7%). Overall, 23.8% of persons tested for
HCV had more than one anti-HCV test (mean:1.4) and among persons ever anti-HCV
positive, half (50.8%, n=4625) had more than one positive HCV test reported to SSBBV from
any setting over this time (mean:2.0). For persons first diagnosed with HCV between 2008
and 2013 (n=3123), 77.2% were HCV RNA tested, 71.3% of whom were HCV RNA positive.
Of persons HCV RNA positive, 17.0% were treated with ribavirin and pegylated interferon,
and 8.0% achieved sustained virological response. For PWID (n=5,176) the estimated
incidence was 8.3 per 100 person years (95% CI:7.8-8.8).
The data highlights how HCV positive persons who have injected drugs are repeatedly
tested in drug services; however, few are successfully engaged in treatment. Record linkage
provides a baseline CoC in the PWID population which should be monitored to assess the
impact of strategies to increase treatment and cure in PWID.
Disclosure of Interest Statement: See example below:
This report is independent research by the National Institute for Health Research. The
research was funded by the National Institute for Health Research Health Protection
Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in
partnership with Public Health England (PHE) and in collaboration with the London School of
Hygiene and Tropical Medicine. The views expressed in this publication are those of the
author(s) and not necessarily those of the NHS, the National Institute for Health Research,
the Department of Health or Public Health England.

Download abstract Download Poster