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Hepatitis C Needs Assessment:

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?

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Hepatitis C Needs Assessment:

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  1. Hepatitis C Needs Assessment: Contributions from the National HCV Diagnosis and Local Clinical Databases

  2. Key questions • How many people have been diagnosed with HCV in Scotland? • How many people have attended a clinic for HCV treatment/care? • How many people have been initiated on HCV antiviral therapy? • How many patients have cleared HCV from antiviral therapy?

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

  4. Annual and cumulative HCV diagnoses in Scotland (to 2006)

  5. 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

  6. Cumulative HCV diagnoses by NHS Board in Scotland(to 2006) 0–249 250–749 Grampian 12% 750–1499 1500–4999 5000+ Tayside 7% Lothian 14% Greater Glasgow & Clyde 41% N = 22,073

  7. How many people have been diagnosed with HCV in Scotland? • How many people have attended a clinic for HCV treatment/care?

  8. Locations of 16 HCV treatment/care centres Number of diagnoses 0–249 250–749 750–1499 1500–4999 5000+ Treatment centre N = 22,073

  9. 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)

  10. Numbers of diagnosed HCV attending HCV treatment/care centres(to 2006) Living+ dead 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 Living Approximately 55% of persons living with diagnosed chronic HCV have ever been in specialist care

  11. 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

  12. New attendees at HCVtreatment/care centres(2000-2005, 5 clinics, N = 1677) • 2000-2005: 73% increase in new patients (range 16-174%, 5 clinics)

  13. Follow-up of new patients attending HCV treatment/care centres(2003-2005, 5 clinics, N = 964) Not assessed for Rx43% Most common reason is failure to attend New attendeesN=964 Assessed for Rx 57% (32-70%)

  14. Follow-up of new patients attending HCV treatment/care centres(2003-2005, 5 clinics, N = 964) Not assessed for Rx43% New attendeesN=964 Not suitable for Rx32% (17-76%) Assessed for Rx 57% (32-70%) • Most frequent: • ongoing IDU • chaotic lifestyle

  15. Follow-up of new patients attending HCV treatment/care centres(2003-2005, 5 clinics, N = 964) Not assessed for Rx43% New attendeesN=964 Approximately 20% refused or deferred the offer Assessed for Rx 57% (32-70%) Suitable for Rx 68% (23-82%)

  16. Follow-up of new patients attending HCV treatment/care centres(2003-2005, 5 clinics, N = 964) Not assessed for Rx43% New attendeesN=964 Not suitable for Rx32% (17-76%) Assessed for Rx 57% (32-70%) Suitable for Rx 68% (23-82%) Approximately 30% of new attendees began therapy

  17. How many people have been diagnosed with HCV in Scotland? • How many people have attended a clinic for HCV treatment/care? • How many people have been initiated on HCV antiviral therapy?

  18. 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

  19. 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

  20. 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)

  21. Key questions • How many people have been diagnosed with HCV in Scotland? • How many people have attended a clinic for HCV treatment/care? • How many people have been initiated on HCV antiviral therapy? • How many patients have cleared HCV from antiviral therapy?

  22. 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%

  23. 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

  24. 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

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