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)

Characteristics of HCV diagnosed persons in Scotland ( , 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– – – –

1.How many people have been diagnosed with HCV in Scotland? 2.How many people have attended a clinic for HCV treatment/care?

0– – – – Locations of 16 HCV treatment/care centres Treatment centre N = 22,073 Number of diagnoses

Locations of HCV treatment/care centres 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 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 HCV treatment/care centres ( , 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 HCV treatment/care centres ( , 5 clinics, N = 1677) : 73% increase in new patients (range %, 5 clinics)

Follow-up of new patients attending HCV treatment/care centres ( , 5 clinics, N = 964) Assessed for Rx 57% (32-70%) New attendees N=964 Not assessed for Rx 43% Most common reason is failure to attend

Follow-up of new patients attending HCV treatment/care centres ( , 5 clinics, N = 964) Assessed for Rx 57% (32-70%) New attendees N=964 Not assessed for Rx 43% Not suitable for Rx 32% (17-76%) Most frequent: ongoing IDU chaotic lifestyle

Follow-up of new patients attending HCV treatment/care centres ( , 5 clinics, N = 964) Assessed for Rx 57% (32-70%) New attendees N=964 Not assessed for Rx 43% Suitable for Rx 68% (23-82%) Approximately 20% refused or deferred the offer

Follow-up of new patients attending HCV treatment/care centres ( , 5 clinics, N = 964) Assessed for Rx 57% (32-70%) New attendees N=964 Not assessed for Rx 43% Suitable for Rx 68% (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 ( , 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 ( , 5 clinics, N = 678) 2000/1 to 2004/5: 117% increase in number of patients initiating therapy (range %, 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 ( , 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%) is an impediment to treatment