Access to HCV treatment for people who inject drugs
by NHS Tayside
Diagnosing and referring patients with hepatitis C is not routine practice within the majority of drug or prison services. In 2004 a Hepatitis C Managed Care Network was formed in Tayside with the aim to increase referrals and access to the specialist hepatology service. The study evaluated the long-term outcomes of people who inject drugs who had recently been tested and diagnosed with hepatitis C. This project demonstrated that people who inject drugs can have similar or even better treatment outcomes than non injectors. Many were younger, had low viral loads and less prevalence of fibrosis/cirrhosis, so while this group of patients may be difficult to reach they are easier to cure if there are effective pathways of care in place.
"The programme demonstrates longevity and sustainability having been running for over 10 years. It has a proven high referral rate and is embedded in the care network. It is a cost-effective initiative with a patient-centred approach providing persuasive evidence that people who inject drugs can have similar or better treatment outcomes than people who do not inject drugs - much needed in the face of widespread resistance to treating this group of patients. This is a really good example of how patient experience and outcomes can be improved when funding is available."
Community HCV Treatment in Cornwall
The Cornish hepatitis C management model is an integrated model of care, incorporating partnerships between hospital-based hepatology and drug and alcohol services. Blood-borne virus (BBV) screening is performed in the community by all Addaction staff with each result reviewed by the BBV lead nurse. The BBV lead nurse then discusses the positive results with the patients and when ready for treatment takes each case to the monthly hepatology multidisciplinary meetings. Addaction covers the whole of Cornwall with clinics in its own premises, GP surgeries, probation offices and pharmacies. The choice of treatment location is decided on where the patient lives and how accessible the service is to them.
"This is an example of excellent multi-agency working. A brilliant co-ordination between primary and secondary care services, designed for the rural community in Cornwall, delivering excellent outcomes for patients."
Leeds Community and Prison Hepatitis C Service
by Leeds Community Healthcare NHS Trust
Up to 83% of the expected number of patients with chronic hepatitis C have already been diagnosed by the proactive blood-borne virus testing carried out by community drug treatment services in Leeds. Once stabilised in drug treatment services, these patients are offered further investigations with a view to referral for antiviral therapy in the locally-commissioned Community Hepatitis C Service. This beacon service provides a diagnostic, investigation, referral and treatment service for people living with hepatitis C who have traditionally found it difficult to access treatment programmes in conventional hospital-based clinical settings. This allows for continuity of care between prisons, hospital and the community drug treatment service.
"This is a great example of sustainable, multi-agency collaboration among services working with some of the most at risk groups for hepatitis C. By providing a joined-up service linking prisons with community care they are producing very good results that have been clearly reported."
Mind the Gap – Increasing the referral rate of new hepatitis C patients
by NI Hepatitis B&C Managed Clinical Network
In 2009 an audit identified a sizeable gap between those diagnosed with hepatitis C and those seen at the specialist hepatitis C clinic. Subsequently it was decided that the Hepatitis B&C Managed Clinical Network Coordinator would follow up every confirmed hepatitis C polymerase chain reaction (PCR) positive case for which there was no referral received for specialist assessment. Now all new referrals to the liver unit at the Royal Victoria Hospital for assessment of hepatitis C are entered into a referral/treatment database. The positive test result list is cross-referenced with the referral database and the hospital patient administration system to identify patients not referred within 4-6 months of the test and measures are taken when patients have not been referred. The team can now account for 100% of PCR-positive cases and virtually every patient who should be referred is being referred to treatment services.
"The Mind the Gap programme should be highlighted as an example of good practice. In Belfast they’ve found an effective solution to address the gap between HCV PCR positive diagnosis and clinical referral. The programme demonstrates impressive results with 30 more patients per year access treatment services."