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Graham Harrison, William Irving, Matt Hickman, HepCATT Team

Hep atitis C : A wareness T hrough to T reatment (HepCATT): Pilot of an intervention designed to increase diagnosis and treatment of patients with hepatitis C virus infection in drug treatment settings. Graham Harrison, William Irving, Matt Hickman, HepCATT Team. Acknowledgements.

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Graham Harrison, William Irving, Matt Hickman, HepCATT Team

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  1. Hepatitis C: Awareness Through to Treatment (HepCATT): Pilot of an intervention designed to increase diagnosis and treatment of patients with hepatitis C virus infection in drug treatment settings Graham Harrison, William Irving, Matt Hickman, HepCATT Team

  2. Acknowledgements • Work was funded by Department of Health (HepCATT), NIHR HPRU for Evaluation of Interventions. HepCATT Team:- • University of Nottingham: Will Irving, Graham Harrison, Brian Thomson • University of Bristol: Matt Hickman, Kirsty Roberts, Cherry Ann Waldron, Peter Vickerman, Zoe Ward, Rosy Reynolds, John Macleod, Natasha Martin (UCSD) • Hepatitis C Trust: Archie Christian, Stuart Smith, Emma Ward, Charles Gore • LSHTM: Magdalena Harris, Oliver Bonnington, Tim Rhodes • Nottingham University Hospital Trust: Stephen Ryder • Queen Mary University of London: Graham Foster • PHE: Sema Mandal, Ruth Simmons, Mary Ramsay • United Lincolnshire Hospital Trust: Aravamuthan Sreedharan, Karen Murray • Walsall Healthcare Trust: Amanda Hughes • Royal Liverpool and Broadgreen University Hospitals: Paul Richardson, Helen Caldwell, Roxanne Gore • CGL: Claire Walters, Annette Orton, Penelope Lee • Addaction Lincolnshire: Karen Ratcliff, Paul Newton • Addaction Liverpool: Stephen Jennings, Sandra Oelbaum, Stephen Purcell, Jo Whitfield, • Robbie Dreha, Tara Byrne, Debbie Thomas, Elisabeth Fraser • Addaction Central Office: Charlotte Simpson, Jo Bevan, Coleen Homan, Dave Reeve, Clare Hathaway • University Hospitals of Leicester: Martin Wiselka • Cambridge University Hospitals Trust: William Gelson, Darren Day • University Hospitals Coventry and Warwickshire: Esther Unit

  3. HCV Lead/facilitator in drug services • Drugs services should designate a hepatitis lead for the service. The lead should have the knowledge and skills to promote hepatitis B and C testing and treatment and hepatitis B vaccination. • Lack of robust trials on promotion of HCV treatment in community drug clinics… Hepatitis B and C: ways to promote and offer testing to people at increased risk of infection NICE public health guidance 43 2012 guidance.nice.org.uk/ph43

  4. Background - HepCATT • 3 UK cities for 1 year: Liverpool, Lincoln, Walsall • Complex Intervention • HCV Nurse facilitator (0.5) working with main drug treatment centre & linking to HCV specialist care • Increase uptake of HCV testing, referral & engagement • Staff training, staff and client education initiatives • HCV assessment a routine part of client management • Dried Blood Spot Testing • Quicker referrals with flexible appointment times • Improved communication between 2ry care and patient • Enhancing peer support and buddy systems

  5. Intervention ingredients & main drivers in bold

  6. Pilot Design • Non-randomised trial • 3 intervention & 3 control sites • Main Outcome/Ho: • Does HepCATT increase engagement with HCV treatment services/ HCV treatment readiness? • Secondary Outcomes/Ho: • Does HepCATT increase • uptake of HCV testing • referral to HCV specialist services • HCV treatment

  7. Engagement increases in all 3 intervention sites

  8. Increased Engagement – ~10-fold in HepCATT sites & 26-fold vs control Modest I2 heterogeneity: 51% (control); 44% (intervention). Strong evidence for an intervention effect - interaction Odds Ratio - 26 (95% CI 7 – 100)

  9. Uptake of HCV testing increases in all 3 intervention sites

  10. Increase in HCV testing – more heterogeneity Strong evidence for increase in HCV testing in intervention sites - interaction odds ratio of 3.7 (95%CI 1.7 – 8.1) High I2 heterogeneity: 50% (control); 96% intervention).

  11. Uptake of HCV testing increases in all 3 intervention sites

  12. Increase in referral from community drug agencies Strong evidence for increase in referral in intervention sites - interaction odds ratio of 10.3 (95% CI 3.13–34.0) High I2 heterogeneity: 81% (control); 94% intervention).

  13. Uptake of HCV treatment increases in all 3 intervention sites

  14. Increase in HCV treatment of PWID supported by community drug agencies Strong evidence for increase in referral in intervention sites - interaction odds ratio of 28.3 (95% CI 9.9-80.8) No I2 heterogeneity: 0%. No clients started treatment in site 3 so one added to fit intervention effect.

  15. Summary and Implications • Strong evidence that HCV Nurse Facilitators can improve HCV Care pathway in community drug agencies • Increased HCV treatment readiness/engagement; uptake of HCV testing; referral; HCV treatment • Complex intervention – multiple ingredients – locally defined/situation specific • Intervention development/ pilot non-randomised study • Manualise intervention • Replicate/ extend in larger trials (e.g. step wedge) • Determine cost-effectiveness

  16. Is HepCatt Cost-effective • Yes highly…! • The cost-effectiveness of interventions to improve case finding and engagement with HCV treatment for people who inject drugs in the UK. • Zoe Ward, Poster number 666, Wednesday 12:45-2:15. • Ask: Zoe.ward@bristol.ac.uk; matthew.hickman@bristol.ac.uk; peter.Vickerman@bristol.ac.uk

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