Theme: Models of Care Year: 2019
Background: In spite of directly-acting antiviral (DAA) access, hepatitis C (HCV) RNA+ patient
attendance at Barnsley Hospital HCV outpatient clinic was poor. From August 2016 to July 2017, of
194 new referrals, 111 (57.2%) did not attend their first appointment, 83 (42.7%) attended their first
appointment only and only 44 (22.7%) commenced HCV treatment. 80% of referrals originated from
drug services. We aimed to improve HCV clinic attendance and treatment uptake in HCV RNA+ drug
Description of model of care/intervention: A community drug service-based HCV clinic was
established. Initially, HCV clinic appointments were offered separate to Opiate Substitution
Treatment (OST) assessment and prescription appointments. After 6 weeks, HCV appointments were
combined with OST appointments, with the HCV specialist nurse and drug service nurse or doctor
providing a single extended appointment in one room for both HCV and OST assessment and
treatment. Following HCV treatment initiation, follow up appointments were offered 4-weekly, with
4 weeks of DAA treatment and a 4 week OST prescription issued simultaneously until the HCV
treatment course was completed.
Effectiveness: During the initial 6 weeks, when appointments were not linked to OST issue, HCV
clinic attendance only improved to 56%. Once linked with OST assessment and prescription issue,
attendance at first HCV appointment improved to 90%. Since combined clinic set-up, of 418 clients
screened, 145 (34.7%) were HCV RNA+, of whom 100 (68.9%) initiated HCV treatment. Of 64
reaching post-treatment week 12, SVR12 (excluding lost to follow-up) was 41 (80.3%).
Conclusion and next steps: Drug service-located combined HCV / OST appointments linked to OST
assessment and prescription issue significantly improved attendance, engagement and HCV
treatment uptake in HCV RNA+ drug service clients. Offering HCV assessment and treatment as part
of a “multi-service” improves HCV care engagement in people with a history of injecting drug use.
Disclosure of Interest Statement: MC: Gilead (Speaker). BS: Gilead, Abbvie and MSD (Speaker,
Conferences and Travel).