hepatitis c needs assessment:
DESCRIPTION
Hepatitis C Needs Assessment:. Contributions from the National HCV Diagnosis and Local Clinical Databases. Key questions. How many people have been diagnosed with HCV in Scotland? How many people have attended a clinic for HCV treatment/care? - PowerPoint PPT PresentationTRANSCRIPT
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
w H
CV
dia
gn
os
es
0
5000
10000
15000
20000
25000
Cu
mu
lati
ve
HC
V d
iag
no
se
s
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