hepatitis c needs assessment:

Hepatitis C Needs Assessment:

Contributions from the National HCV Diagnosis and

Local Clinical Databases

Key questions

1. How many people have been diagnosed with HCV in Scotland?

2. How many people have attended a clinic for HCV treatment/care?

3. How many people have been initiated on HCV antiviral therapy?

4. How many patients have cleared HCV from antiviral therapy?

1. How many people have been diagnosed with HCV in Scotland?

Annual and cumulative HCV diagnoses in Scotland (to 2006)

0

500

1000

1500

2000

2500

3000

3500

4000

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Year of HCV diagnosis

Ne

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CV

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0

5000

10000

15000

20000

25000

Cu

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Characteristics of HCV diagnosed persons in Scotland(2003-2006, N = 6442)

• 66% male

• 22% 40 years at diagnosis; mean age = 34

• 90% current/former injecting drug users

• 55% genotype 2/3

• 50% of referrals were from hospitals,24% from GPs, 6% GUM, 3% prisons

Cumulative HCV diagnoses by NHS Board in Scotland(to 2006)

Lothian 14%

Tayside 7%

Grampian 12%

Greater Glasgow & Clyde 41%

N = 22,073

0–249

250–749

750–1499

1500–4999

5000+

1. How many people have been diagnosed with HCV in Scotland?

2. How many people have attended a clinic for HCV treatment/care?

0–249

250–749

750–1499

1500–4999

5000+

Locations of 16 HCV treatment/care centres

Treatment centre

N = 22,073

Number of diagnoses

Locations of HCV treatment/carecentres in relation to the HCV diagnosed population

• Mean drive-time of 20 min. from HCV diagnosed person’s place of residence (postcode district) to the nearest HCV treatment/care centre.(range 10-80 min. for NHS Boards in mainland Scotland)

Numbers of diagnosed HCV attending HCV treatment/care centres(to 2006)

Diagnosed HCV antibody positive: 22,073

Diagnosed with chronic HCV (est.): 16,500

Attended specialist services for chronic HCV (est.): 9,000

Diagnosed with chronic HCV (est.): 14,500

Ever chronic HCV and ever attended specialist services (est.): 8,000

Approximately 55% of persons living with diagnosed chronic HCV have ever been in

specialist care

Living+

dead

Living

New attendees at HCVtreatment/care centres(2003-2006, 5 clinics, N = 1202)

• 70% male

• 38% 40 years at first attendance; mean age = 38

• 78% current/former injecting drug users

• 52% of referrals were from hospitals, 28% from GPs

• 92% PCR positive

New attendees at HCVtreatment/care centres(2000-2005, 5 clinics, N = 1677)

• 2000-2005: 73% increase in new patients (range 16-174%, 5 clinics)

Follow-up of new patients attending HCV treatment/care centres(2003-2005, 5 clinics, N = 964)

Assessed for Rx57% (32-70%)

New attendeesN=964

Not assessed for Rx43%

Most common reason is failure to attend

Follow-up of new patients attending HCV treatment/care centres(2003-2005, 5 clinics, N = 964)

Assessed for Rx57% (32-70%)

New attendeesN=964

Not assessed for Rx43%

Not suitable for Rx

32% (17-76%)

Most frequent:• ongoing IDU• chaotic lifestyle

Follow-up of new patients attending HCV treatment/care centres(2003-2005, 5 clinics, N = 964)

Assessed for Rx57% (32-70%)

New attendeesN=964

Not assessed for Rx43%

Suitable for Rx68% (23-82%)

Approximately 20% refused or deferred the offer

Follow-up of new patients attending HCV treatment/care centres(2003-2005, 5 clinics, N = 964)

Assessed for Rx57% (32-70%)

New attendeesN=964

Not assessed for Rx43%

Suitable for Rx68% (23-82%)

Approximately 30% of new attendees began therapy

Not suitable for Rx

32% (17-76%)

1. How many people have been diagnosed with HCV in Scotland?

2. How many people have attended a clinic for HCV treatment/care?

3. How many people have been initiated on HCV antiviral therapy?

Numbers of HCV diagnosed persons initiated on antiviral therapy(to 2006)

Diagnosed HCV antibody positive: 22,073

Diagnosed with chronic HCV (est.): 16,500

Attended specialist services for chronic HCV (est.): 9,000

Initiated on antiviral therapy (est.): 2,300

Living+

dead

Approximately 14% of persons who have ever been diagnosed with chronic HCV have been

initiated on antiviral therapy

Patients initiated on HCV antiviral therapy (2003-2006, 5 clinics, N = 353)

• 71% male

• 57% 40 years at initiation; mean age = 41

• 56% injecting drug users

• 62% genotype 2/3

• 12% known to have cirrhosis

• 92% pegylated interferon +/- ribavirin

Patients initiated on HCV antiviral therapy (2000-2005, 5 clinics, N = 678)

• 2000/1 to 2004/5: 117% increase in number of patients initiating therapy (range 50-208%, 5 clinics)

Key questions

1. How many people have been diagnosed with HCV in Scotland?

2. How many people have attended a clinic for HCV treatment/care?

3. How many people have been initiated on HCV antiviral therapy?

4. How many patients have cleared HCV from antiviral therapy?

Response to antiviral therapy (2003-2006, 5 clinics, N = 286)

• 46% sustained viral response

• 43% no sustained viral response

• 11% incomplete

– major side effect: 52%– patient request: 30%– other: 18%

Current capacity of HCV treatment/care centres (2006)

Number of patients attending HCV treatment/care centres in 2006: 4,000

Number of patients initiated on antiviral therapy in 2006 (est.): 450

Number of patients currently on waiting list for therapy (est.): 330

Summary

• Estimated that 55% of people living with chronic HCV have ever attended specialist services

• Estimated that 14% of those with diagnosed HCV have ever initiated therapy

• Annual numbers of new attendances and therapy initiations are increasing

• Low completion of assessment (57%) isan impediment to treatment