Theme: Clinical Research Year: 2018
In England as in many countries there remains a substantial gap between number of people
with chronic HCV infection, diagnoses and HCV treatments. Models suggest interventions to
promote HCV case-finding in “higher risk” people in primary care (mainly people with an
injecting history or people who inject drugs) would be cost-effective. But is little robust RCT
evidence of specific interventions.
Complex intervention in primary care:- offer of educational training on HCV for practice staff;
poster and leaflets displayed in the waiting room; HCV risk prediction algorithm using
information from electronic patient record (including drug use, drug treatment history, previous
HCV test, raised ALT, and other adverse exposures) run using Audit+ software to generate a
list of higher risk patients. Patients were invited for an HCV testing opportunistically through
computer pop-ups and by sending out screening invitation letters and follow-ups. Control
practices followed usual care.
Cluster RCT of 45 general practices with data successfully collected from 22 intervention
practices and 21 control practices. A total of 21,847 “high risk” patients were identified (11,407
in intervention and 10,440 in control practices). There was strong evidence that the
intervention increased HCV case-finding (13% vs 8.35%; Risk Ratio 1.59 95%CI 1.12-2.26
p=0.01); and increased referral and assessment for HCV treatment (32.6% vs 11%). A nested
qualitative study found that participating health care professionals increased knowledge and
awareness on HCV and valued the intervention.
An economic evaluation is underway and will be presented and determine whether HepCATT
primary care intervention can be recommended for implementation.