Theme: Epidemiology & Public Health Research Year: 2024
Background: Awareness of hepatitis C (HCV) infection is an important indicator to understand unmet needs. Estimates of awareness from serosurveys can underestimate the proportion aware as diagnostic testing is frequently offered alongside, so respondents will receive results shortly after. In 2022, a new question was added to the Unlinked Anonymous Monitoring (UAM) Survey to investigate this. We used these data to better understand characteristics of people unaware of their infection.
Methods: Data were extracted from the 2022 UAM Survey in England, Wales, and Northern Ireland. Participants provided a blood sample and self-completed a questionnaire. Participants were included if they had chronic (Ab+ RNA+) HCV and either: provided the result of their last HCV test, had an HCV test on the day, or were awaiting their result (N=293). χ² tests were conducted to compare characteristics between those aware vs unaware.
Results: 48% (142/293) had an HCV test on the day or were awaiting their result. After accounting for this, 31% remained unaware (92/293). Of these, 55% (43/78) injected in the last month and 31% (20/64) were in prison within the last year. On the day of the survey, 34% (28/83) used a needle exchange and 52% (43/83) accessed drug treatment. In the last year, 78% (69/89) visited a GP and 73% (65/89) used a pharmacy.
A greater proportion of those unaware were recruited in the north of England (46% vs 24%) (p<0.001), were recent initiates (initiated injecting within the last 3 years) (23% vs 9%) (p=0.019) and had their last HCV test 2+ years ago (67% vs 36%) (p<0.001).
Conclusion: These data highlight risks for delayed diagnosis, despite people accessing services where testing is available. A large proportion of those unaware reported accessing healthcare or harm-reduction, suggesting there may be missed testing opportunities. Work is needed to understand potential barriers and inform person-centred testing initiatives.