1. Services and C Leon Wylie Lead Officer Hepatitis Scotland

4. People who inject drugs (PWID): 50-80% Prevalence of Hepatitis C in different populations in Scotland Pregnant women: <1% GUM Clinic Attenders: <1% Surgeons/HCWs: <1% Hutchinson et al. SMJ 2006

6. Slide adapted from S Hutchinson inaugural lecture, GCU

8. HCV infection and disease trends (2012) Outcome IndicatorOutcome 2007 2011/12 New Intervention Prevention Transmissions/yr *1500 500Injection paraphernalia provision (and methadone provision) Diagnosis % of Infected Population Diagnosed 39% 50%Dried Blood Spot Testing Treatment Initiations/yr400 1000Improved Access to Therapy

10. Access to treatment

13. 2013/14 57% of PWID surveyed in Scotland tested positive for antibodies, 88 % of PWID reported having been tested for hepatitis C in the past. In Scotland, of the estimated 20,300 diagnosed individuals living with chronic hepatitis C in 2013, an estimated 28% attended a specialist centre that year. January 2011 to June 2012, 67% were known to have achieved an SVR proportion of people attending a specialist centre within 12 months of a chronic HCV diagnosis in Scotland increased from 25% among those newly diagnosed in 1996-98 to 38% in 2005-07 and 45% in 2008-09

14. Barriers concurrent addiction, health and/or social care needs can limit ability to engage with specialist care. Often take priority over HCV for many clients, and act as barriers to attendance at clinical appointments, including those in addiction settings and at hospital. Negative Perception (staff)--lack of support, concerns about adherance including current drug use and reinfection risk, inadequate management of addiction and other drug-related problems and poor treatment/knowledge of side effects, perceptions of worthiness, stigma in hospital based settings, Lack of client knowledge e.g. Biopsy, SE, Tx success rate, fear of relapse Social support Mistrust Perception of unworthiness Zeremski et al, 2013, Harris and Rhodes, 2013, Mravcik et al, 2013, Alavi et al, 2013, Grebely et al, 2011, Treloar 2009

15. Enablers Improved awareness of HCV, risk factors, and treatment options and outcomes. Reduction in myths and outdated information Development of simplified care pathways, centred on the client, bridge the gap between systems (social) (integrated multidisciplinary model) Normalise HCV testing and care within Addiction settings Support clients to gain care, flexibility Geographic access (convenience) eg community based care OST currently has a critical role, takeaways? Is a one stop shop really best? (confidentiality, disclosure current drug use, staff attitudes) Community empowerment decreases stigma

16. Peer support groups Peer support workers

17. Many ongoing thanks to Health Protection Scotland Profs David Goldberg and Sharon Hutchinson, GCU and associated staff Magdelena Harris

18. Factors associated with uptake, adherence, and efficacy of hepatitis C treatment in people who inject drugs: a literature review, Mravcik et al, (2013), Patient Preference and Adherence Assessment and Treatment of hepatitis C Virus Infection among people who inject drugs in the opioid substitution setting: ETHOS Study, Alavi et al (2013), Clinical Infectious Diseases Uptake and delivery of hepatitis C treatment in opiate substitution settings: perceptions of clients and health professionals, Treloar et al, (2009), Journal of Viral Hepatitis Hepatitis C virus control among persons who inject drugs requires overcoming barriers to care, Zeremski et al, (2013), World Journal of Gastroenterology Hepatitis C in the UK, (2014), Public Health England Hepatitis C treatment access and uptake for people who inject drugs: a review mapping the role of social factors, Magdalena Harris and Tim Rhodes, (2013) Harm Reduction journal

19. Hepatitis Scotland 1 st Floor, 91 Mitchell Street, Glasgow, G1 3LN phone: 0300 343 0250 www.hepatitisscotland.org.uk email: info@hepatitisscotland.org.uk twitter: @hepscotland facebook: Hepatitis-Scotland