Phase I Update:

Prevention & Education

Community Outreach

Justin SchofieldHepatitis C MCN Manager

Phase I Action Plan

1. Co-ordination

2. Prevention

3. Testing

4. Treatment, Care & Support

5. Education, training & awareness raising

6. Surveillance and monitoring

• Sep 2006 – Aug 2008

• £4M new monies

• Initial local developments

• Period of national needs assessment to inform Phase II

HCV Prevention: NEX

• Access to needle exchange facilities (NEX)– Glasgow

• Highest number of syringes distributed by pharmacy services in Scotland.

• 213 syringes per injector per annum(above national average)

– Clyde• Lower numbers of syringes distributed• 57 syringes per injector per annum

(lowest in Scotland)

NEX Provision: Glasgow

Pharmacy provision:• 39 NEX pharmacy sites

• Average 6.2 per CH(C)P

• Funding– BBV Prevention monies

– Phase I HCV Action Plan funds enabled recruitment of additional 10 pharmacies

• Glasgow Addiction Services provide management

• NEX packs contain:– Needles, syringes, swabs,

citric acid, cin bin, health promotion info

Fixed Sites:

• Drug Crisis Centre:

– Almost 24-hr access

• Base 75:

– Health & Social work

– Women involved in prostitution

• Hunter St Health Service:

– Homeless health services

NEX Provision: Clyde

Pharmacy provision:• 10 NEX pharmacy sites

– 2 pre-existing

– 8 new funded by Phase I Action Plan monies

• Glasgow Addiction Services provide management

• Provision of NEX packs(same as Glasgow)

Fixed Sites• Part of wider harm reduction

model– Incl. wound management,

BBV / pregnancy testing,HAV & HBV vaccination

• Lennox, Inverclyde & Greenock drug services

• Pick & mix provision,incl. paraphernalia

NEX Activity & Returns 2006/07

Organisation n/s issued returned return rate

Glasgow Pharmacies 668,565 475,481 71%

Lennox Service 62,422 53,920 86%

Hunter Street 14,300 11,542 81%

Crisis Centre 153,895 77,180 50%

Inverclyde service 28,323 32,328 114%

Renfrew Service 24,905 21,350 86%

952,410 671,801 71%Total Total Average

* Return rate > 100% due to peoplereturning N/S collected elsewhere

*

HCV Prevention & Education

• C-Level– Voluntary sector provider, funded by Health Board

– Peer education to people at risk of HCV(Community Rehabs, Prisons, Drug Services)

– Training to a range of organisations

• Board HCV Training & Education group– NEX training

– HCV Awareness training for health & social care staff

– Peer-led safer injecting interventions

– NEX client survey re: paraphernalia

– Outreach / backpacking pilot

Phase I Update:

Community Outreach

Justin SchofieldHepatitis C MCN Manager

Community Outreach Project

Aims• Provide support, information &

advice to HCV infected individuals accessing addiction services.

• Improve the referral process.

• Increase access to treatment.

• Reduce the default rate amongst those referred for treatment (50%-70% DNA)

• Establish and maintain effective links between the CATs, tertiary treatment centres, voluntary sector, primary care and other addiction services.

• Pilot sites– 4 x CATs

• South (Gorbals)• South-East (Castlemilk)• North-East (Easterhouse)• West (Drumchapel)

– 3 x Community Rehabs• South-East Alternatives• New Horizon• Momentum

• Tertiary Care– 2.0 WTE Clinical Nurse

Specialists– 0.5 WTE clerical support

Community Outreach Project

• Activity: Testing & Info– 328 clients referred to

CNS at CAT– 218 attended

• DNA rate 33%– 122 HCV test

• 63 (52%) chronic infection

• Activity: Hospital Care– 50 referred to Hospital

• 20 appts in future• 30 had appts.

– 19 attended– DNA rate 37%

• Evaluation & Learning (Prof Avril Taylor)– Service attracted clients

– Retention rate at clinic higher than in tertiary sector

– Difficulties in setting up and implementing service but main problems dealt with and intra-team relationships improved

– Majority view that service should continue

– Overwhelming client support for service

Phase I Update:

Treatment, Care & Support

Dr Ray FoxConsultant in Infectious Diseases, Brownlee CentreLead Clinician, Hepatitis C Managed Care Network

National Action Plan: Phase I

• Action Plan:– NHS Boards will develop and improve local

community-based hepatitis C treatment, care & support services

• NHSGGC Managed Care Network– Mapping of current provision– Analysis of need– Determine local priorities– Inform initial investment plans

Phase I Developments

• Clinical Nurse Specialists– 3 new nurses working at Brownlee, Glasgow Royal,

Inverclyde Royal & Royal Alexandra hospitals• Supporting increase in clinical caseloads, including

assessment and treatment

• Dietetics– 1 new Dietician working across Glasgow city

hospitals• Providing dietetic input to patient care• Assessing dietetic needs of people accessing HCV care

services to inform future development

Phase I Developments cont.

• Outpatient Clinic provision– Refurbishment of Ward 7B at Gartnavel General

as dedicated hepatitis C outpatient clinic space– To be shared by Gartnavel Gastroenterology and

Brownlee Infectious Disease teams– Increase clinical capacity– Improve patient experience of care– Opens Autumn 2008

Clinical Audit

Introduction

• Aims1. Baseline data on current clinical activity2. Publish aggregate findings and provide hospital-

specific data to each treatment centre

• Outcome indicators:– Sustained Viral Response (SVR)

[undetectable viral RNA6 months after end of treatment]

– Number patients commencing treatment– Number who completed course of treatment– Response to treatment by viral genotype

Methodology

• Anonymised data from local copies of ‘National Hepatitis C Clinical Database’

• All patients who commenced treatment during 2006

Treatment

Dec 06

SVR?

Nov 07 May 08

48 weeks 26 weeks

Patient characteristics

• 125 patients commenced treatment

• Mean age = 39 years (range 20 to 69)

• Two thirds male

• 76% genotype 2 & 3, 24% genotype 1 & 4

• Three were co-infected with HIV

• 10% recorded diagnosis of cirrhosis

• 86% completed treatment

Outcomes of treatmentTreatment outcomes for all patients by genotype

10% 9% 10%

17%8% 10%

17%

3%6%

13%

7%

9%

43%

72%65%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

G1&4 G2&3 All patients

Sustained ViralResponse

Relapse

No response

Treatment Incomplete

Missing

(n=30) (n=95) (N=125)

Increasing number of patients starting treatment

Number of patients commencing treatment by treatment centre

21

39

46

49

18

30

36

41

0 10 20 30 40 50 60

Southern General& Victoria Infirmary

Gartnavel General

Glasgow Royal Infirmary

Brownlee Centre

2006

2007