1. #LJWG2015 HEPATITIS C IN PEOPLE WHO USE DRUGS Improving Care for Hepatitis C: A Framework Approach LONDON 2015

2. #LJWG2015 Delivery of treatment in London prisons Janet Catt Lead Viral Hepatitis Nurse Royal Free Hampstead NHS Trust

3. HCV transmission is most frequent via IVDU Hepatitis C in the UK: 2012 Report (http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/Hepati tisC / Risk factor information in lab reports of Hepatitis C infection from England: 1996-2011

4. Prevalence of HCV infection in the UK Patients in,000s PrevalenceDiagnosed  Prevalence is estimated at 215,000 1 in the UK but other sources place the prevalence as high as 466,000 2  There is no formal monitoring system in the UK, except for acute infections 3  Only approximately 3% of those diagnosed receive NICE-approved therapies annually 3 1.Health Protection Agency (HPA). Hepatitis C in the UK 2013 report. 2013. 2.The Hep C Trust. The UK vs. Europe : Losing the Fight Against Hepatitis C. 2004. 3.Hepatitis Awareness Leading Outcomes (HALO). Confronting the silent epidemic: a critical review of hepatitis C management in the UK. 2013.

5. HCV Life Cycle and DAA Targets – drugs Adapted from Manns MP, et al. Nat Rev Drug Discov. 2007;6:991-1000. Receptor binding and endocytosis Fusion and uncoating Transport and release (+) RNA Translation and polyprotein processing RNA replication Virion assembly Membranous web ER lumen LD ER lumen LD NS3/4 protease inhibitors NS5B polymerase inhibitors Nucleoside/nucleotide Nonnucleoside *Role in HCV life cycle not well defined NS5A* inhibitors Telaprevir Boceprevir Simeprevi r ABT 450/r Asunaprevir MK-5172 Daclatasvir Ledipasvir Ombitasvir MK-8742 GS-5816 Sofosbuvir Dasabuvir BMS-791325

6. What do we want to achieve? Co-ordinating patient pathways in prison To improve access to testing and treatment To improve quality and equity of access to treatment. To improve outcomes

7. Work together to develop care pathway Achieve the best outcomes for patients Change is not “quick and easy” Lack of knowledge (HCV not a priority) Training - DBST Shared Decision making

8. Where are we now? DBST – 20 staff trained Staff attending education days to improve knowledge Keen to drive OPT- OUT testing forward Advertise on Prisoner televisions Prisoner competition to design “liver clinic” poster

9. Is Opt-out Achievable ? YES........ But there are Hurdles No clear directive – effectively being left for Healthcare staff to organise (time consuming and frustrating) Healthcare staff very keen to engage and learn They need support to drive this forward....... A “Lead” to Champion Opt-out testing.

10. Treatment with new regimens HMP Pentonville – one patient commenced: Sofosbuvir/PegIfn/Ribavirin (4 weeks) HMP Mount – one patient commenced: Sofosbuvir/Daclatasvir/Ribavirin (one week) HMP Brixton – one patient commenced: Harvoni / Ribavirin (2 weeks)

12. #LJWG2015