Theme: Epidemiology & Public Health Research Year: 2019
Background: Despite high coverage of harm reduction interventions, the prevalence of hepatitis C
virus (HCV) has remained relatively stable among people who inject drugs (PWID) in Scotland.
Modelling studies have suggested that treatment with new direct-acting antiviral (DAA) therapies
could achieve a reduction in the population prevalence of chronic HCV among PWID. A feasibility
study is underway in the Tayside region of Scotland to examine the impact of major rapid scale-up of
DAAs among PWID involving the provision of HCV testing and treatment in a range of community
drug services (including drug treatment, pharmacies, needle exchanges and prisons). Our aim was to
assess the early impact of that programme on chronic HCV prevalence among PWID in Tayside,
compared to the Rest of Scotland (RoS).
Methods: The Needle Exchange Surveillance Initiative is a national bio-behavioural survey of PWID
conducted biennially across mainland Scotland, involving a questionnaire and blood spot sample
(tested anonymously for HCV antibodies and RNA). Data from five surveys (involving more than
12,000 PWID) were used to examine the uptake of HCV therapy and chronic HCV prevalence
between 2010 and 2017-18.
Results: Uptake of HCV therapy (last year) among eligible PWID increased from 15% to 43% in
Tayside between 2013-14 and 2017-18, and from 8% to 19% in the RoS. Therapy was initiated in
community settings for 97% and 41% of treated PWID surveyed in Tayside and RoS during 2017-18,
respectively. Between 2010 and 2017-18, the prevalence of chronic HCV (among antibody-positives)
declined by 44% (95% CI: 26%-58%) in Tayside, and by 15% (95% CI: 9%-20%) in the RoS.
Conclusion: Major community-wide scale-up of DAA therapy among PWID can be achieved through
HCV testing and treatment in community drug services, and has yielded the greatest reduction in
chronic HCV prevalence at the population level.
Disclosure of Interest: this study is funded by the National Institute for Health Research (NIHR)
Programme Grants for Applied Research programme (Grant Reference Number RP-PG-0616-20008.
The views expressed are those of the author(s) and not necessarily those of the NIHR or the
Department of Health and Social Care. SJH received honoraria from Gilead, unrelated to the
submitted work.