Towards The Microelimination Of HCV In Tayside, Scotland

Author: Inglis SK, Cleary S, Eriksen A, Robinson E , Tait J , Thain D and Dillon JF

Theme: Models of Care Year: 2018

Background: EASL has suggested that hepatitis C (HCV) elimination may be achieved through microelimination in smaller target populations. Tayside comprises approximately 8% of the Scottish population (around 400,000), is relatively delineated geographically and comprises both urban and rural deprived areas. Estimated population of HCV active infection prevalence is 5.5-6%. Methods: Five diverse pathways of care have been established via a combination of NHS and clinical trialbased delivery: • Conventional hospital-based hepatitis treatment service • Dry blood spot (DBS) HCV testing offered to clients on opiate substitution therapy (OST) attending drug treatment services. HCV therapy delivered in addiction treatment centres/ community clinics • Pharmacist-led model of HCV testing, referral and treatment for OST clients in community pharmacies • DBS HCV testing offered to clients at fixed-site needle exchanges and treatment provided on-site by HCV specialist nurses • Opt-out HCV testing offered to all new prisoners at two prisons in Tayside. Prison nurses trained in HCV arrange for initiation of therapy, supported by HCV specialist nurses The pathways are not mutually exclusive and the aim is to reach individuals by more than one pathway to normalise the idea and reinforce the benefits of HCV testing and treatment. Results: At April 2018, the estimated prevalent chronic population was 2,183 people; 1,769 (81%) have been diagnosed. 1,329 (61% of prevalent, 75% of diagnosed) have been initiated on treatment or cured. Leaving 414 to diagnose and 854 to treat, but only 635 to treat to achieve WHO definition of elimination (>90% reduction in prevalence). Conclusion: Scaled-up treatment delivered in novel ways designed to target individuals who are largely disengaged from conventional treatment pathways can lead to micro-elimination of HCV in defined populations. We believe that we will have eliminated HCV in our population within two years. Lessons learned from this approach will be used to inform similar elimination plans. Disclosure of Interest Statement: Studies contributing to this work have been supported by the Scottish Government, Janssen, Roche, MSD, AbbVie, Bristol-Myers Squibb and Gilead. SI declares no conflict of interest. SC declares no conflict of interest AE declares no conflict of interest ER declares no conflict of interest JT declares no conflict of interest DT declares no conflict of interest JFD has received honoraria for lectures and research grants from Janssen, Roche, MSD, AbbVie, Bristol-Myers Squibb and Gilead.

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