Theme: Models of Care Year: 2019
Background: Majority of HCV positive individuals in England are people who inject drugs
(PWID). HCV elimination will be impossible without engaging them. This mandates a
community based “find and treat” strategy.
Methods: Eight-year study (2013-2021) conducted at a substance misuse service in SE England.
Individuals offered dry blood spot testing (DBST), transient elastography (TE), HCV treatment
and assessment of patient reported (SF-12v2, SFLDQOL) and health economic (HE) (EQ-5D-5L)
outcomes.
Results: To date, 573 individuals recruited, 81% (n=462) males, mean age 40.5 + 10.0 yrs,
injecting drug use (IDU) [n=411 (72%)], alcohol use [n=505 (88%)] and psychiatric illness
[n=204(36%)]. Uptake of DBST was 97% (n=558). Prevalence of positive HCV Ab/PCR were 58%
(n=323) and 80% (259/323) respectively; genotypes (GT) 1 (49%) and GT 3 46%. Median LSM
was 6.8kPa (2.7-75.0) with 28% having cirrhosis. Eighty (31%) were too chaotic, 125/179(70%)
of those eligible commencing HCV treatment. Characteristics of treated cohort were: mean
age 45.1 + 9.1 yrs; n=41 (33%) and n=34 (27%) having on going alcohol and IDU respectively;
median LSM = 8.7kPa (2.7-75); 38% (n=47) having cirrhosis; treatment received: INF/RBV 12%,
INF+DAA 13% and DAA 75%. Treatment outcomes were: EOTR n=109 (96%), SVR12 n=91
(72%), awaiting results n=16 (13%), treatment on-going n=9 (7%) and no SVR12, n=10 (8%).
Treatment compliance was 96%. SFLDQOL analysis revealed significant (p<0.05) improvement
in QoL on seven domains post SVR12: symptoms (+15.6), memory (+21.4), distress (+41.3),
sleep (+13.2), loneliness (+7.2), hopelessness (+14.7) and stigma (+28.9); SF -12 v2 analysis:
improvement in physical (+7.2) and mental health (+6.4) domains (p<0.001). Reinfections
remained low (3.33/100 person yrs, 95% CI 1.29 - 7.95). A HE analysis is underway. Data has
been captured on all clinic contacts, diagnostic tests and treatment regimen. Analysis will
estimate cost per case screened, cost per case treated and cost per case cured using these
data
Conclusions: Despite the vulnerable nature of PWID, HCV treatment outcomes and compliance
are comparable to secondary care with low reinfection rates. Achievement of SVR is associated
with significant improvement in QOL. HE analysis awaited. Our data endorses the need for
community based integrated services to help pave the way for HCV elimination.
Conflict of interest: This project has been supported by an educational grant from the Brighton
and Hove Commissioners and the Gilead UK and Ireland Fellowship Programme/Gilead
Investigator Sponsored Research.