Re-Setting The Target For Hepatitis C Micro-Elimination In An Isolated Uk Population

Author: Buchanan R, Van der Heijden P, Grellier L, Parkes J, Khakoo S

Theme: Epidemiology & Public Health Research Year: 2018

Background: The World Health Organisation has set a target for the global elimination of HCV. A key part of the elimination strategy in the UK is the treatment of prevalent infection in people who inject drugs (PWID). On the Isle of Wight (IOW) (UK) historical estimates indicate that there may be 200 undiagnosed HCV infections but this figure is based on extrapolations from national data. This study describes a re-estimate of the prevalence of HCV in PWID and the PWID population size on the IOW in order to provide a revised target for HCV elimination. Methods: We recruited PWID to an HCV bio-behavioural survey via respondent driven sampling (RDS). Participants completed a questionnaire and gave an oral mouth swab for HCV antibody. An HCV prevalence estimate was calculated using RDSanalyst software. We made four population size estimates, these included a Handcock estimate from the pattern of recruitment in the RDS process and three data capture recapture estimates. Results: We recruited 69 participants using RDS. The majority were male (74%) and had been injecting drugs for many years (mean 17 years; SD 9.2). 27% were anti-HCV positive giving a population prevalence estimate of 29% (95% CI 13-44%). Anti-HCV in the survey was significantly associated with taking a risk with a needle or syringe during the last injection (p=0.03). The estimated PWID population size from the four estimates ranged from 184 (95%CI 69- 455) to 309 (95%CI 223-366) with a mean of 262. When considered alongside the revised HCV prevalence estimate the total number of expected cases on the IOW reduced from 323 to 218. Conclusion: This study indicates that the number of cases of HCV in PWID on the IOW may have been overestimated. This has positive implications for the feasibility of achieving the elimination in this population. Disclosure of Interest Statement: Ryan Buchanan was funded by a fellowship from the National institute of Health research (NIHR), he also received a fellowship from GILEAD LTD

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