Evaluating The Population Impact of Hepatitis C Direct Acting Antiviral Treatment as Prevention For People Who Inject Drugs (Epitope) – A Natural Experiment

Author: Matt Hickman John Dillon Lawrie Elliott Daniela De Angelis Peter Vickerman Graham Foster Peter Donnan Ann Eriksen Paul Flowers David Goldberg William Hollingworth Samreen Ijaz Paul David Liddell Sema Mandal Natasha Martin Lewis Beer Kate Drysdale Hannah Fraser Rachel Glass Lesley Graham Rory Gunson Emma Hamilton Helen Harris Magdelena Harris Ross Harris Ellen Heinsbroek Vivian Hope Jeremy Horwood Sarah Inglis Hamish Innes Athene Lane Jade Meadows Beth Thorne Andrew McAuley Chris Stephanie Migchelsen Alex Murray Gareth Myring Norah Palmateer Anne Presanis Dr Andrew Radley Mary Ramsey Pantelis Samartsidis Ruth Simmons Katy Sinka Gabriele Vojt Zoe Ward David Whiteley Alan Sharon Hutchinson

Theme: Epidemiology & Public Health Research Year: 2022

We aim to generate empirical evidence on the effectiveness of HCV “Treatment as Prevention“
(TasP) in people who inject drugs (PWID) and give an overview of the EPIToPe programme.
Methods and Analysis
We have established a mixed method natural experiment with Tayside, Scotland, as a single
intervention site where HCV care pathways have been rapidly scaled-up (drug treatment clinics,
needle & syringe programmes, pharmacies, and prison). Since 2017, more than 570 PWID have been
treated in Tayside – which we hypothesised would reduce chronic HCV prevalence and transmission
by >60%.
A nested qualitative study with patients and service providers identified barriers and facilitators to
implementing TasP and generated a manual for delivering TasP. Peer and researcher-led interviews,
with 40 PWID assessed whether successful treatment alters perspectives on and engagement with
opioid drug treatment and recovery – and also raised questions over how to support peer-led
Chronic HCV prevalence in PWID measured using information from the Needle Exchange
Surveillance Initiative (NESI) survey in Tayside fell from ~30% to 10% – but also fell in other sites in
Scotland and in England. This meant we had to move away from adapting synthetic control methods
to other statistical methods to estimate the intervention effect – and test the probability that
intervention scale-up intensity is associated with reductions in chronic HCV and that WHO
elimination targets are met.
We are adapting a dynamic HCV transmission model to evaluate the cost-effectiveness of the HCV
TasP intervention and estimate contribution of HCV treatment and other interventions to reductions
in HCV transmission.
We are creating a “virtual cohort” of PWID in Scotland linking administrative databases on HCV
treatment, Opioid Drug Treatment, and Mortality that will test whether DAA treatment improves
drug treatment outcomes for comparison with qualitative accounts; and update estimates of the
size of the PWID population.
Disclosure of Interest Statement:
MH in the last five years has received unrestricted honoraria for presenting at meetings from
Abbvie, Gilead, MSD. SH has received honoraria from Gilead, unrelated to submitted work. NM has
received unrestricted research grants and honoraria from Gilead and Merck. PV has received
unrestricted honoraria for presenting at meetings from Abbvie and Gilead. PTD has received
unrestricted grants from Shire pharmaceuticals, Novo Nordisk and Gilead and is a member of the
Scottish Medicines Consortium. HF has received an honorarium from MSD. AR has
received unrestricted honoraria and grants from Gilead Inc, AbbVie, grants from Roche and grants
from Bristol Myers Squibb. KD has worked as a sub-investigator on clinical trials sponsored by Gilead
and AbbVie. JFD has received unrestricted honoraria and grants from Gilead, BMS, MSD and
Abbvie. GRF has received unrestricted honoraria from Abbvie, Gilead, MSD and GSK.
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 authors and not necessarily those of the NIHR or the Department of Health and
Social Care.

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