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Addiction. 2019 Jun;114(6):1113-1122. doi: 10.1111/add.14569. Epub 2019 Mar 12.

The Hepatitis C Awareness Through to Treatment (HepCATT) study: improving the cascade of care for hepatitis C virus-infected people who inject drugs in England.

Author information

1
NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK.
2
United Lincolnshire Hospitals Lincoln County Hospital, Lincoln, UK.
3
Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK.
4
Change Grow Live, Walsall, UK.
5
Walsall Healthcare NHS Trust, Walsall, UK.
6
University Hospitals of Leicester NHS Trust, Leicester, UK.
7
Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK.
8
University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.
9
Addaction, Clerkenwell, London, UK.
10
Nottingham University Hospitals NHS Trust, Nottingham, UK.
11
QueenMary University of London, London, UK.
12
The Hepatitis C Trust, London, UK.
13
Population Health Sciences, University of Bristol, Bristol, UK.
14
Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK.

Abstract

BACKGROUND AND AIMS:

Previous studies have shown low rates of diagnosis and treatment of hepatitis C virus (HCV) infection in people who inject drugs (PWID). Our aims were to test the effect of a complex intervention [Hepatitis C Awareness Through to Treatment (HepCATT)] in drug and alcohol clinics-primarily, on engagement of HCV-positive PWID with therapy and, secondarily, on testing for HCV, referral to hepatology services and start of HCV treatment.

DESIGN AND SETTING:

A non-randomized pilot study in three specialist addiction clinics in England comparing an intervention year (starting between September 2015 and February 2016) with a baseline year (2014), together with three control clinics.

PARTICIPANTS:

Analysis included all attendees at the intervention and control specialist addiction clinics identified as PWID.

INTERVENTION:

The intervention comprised the placement of a half-time facilitator in each clinic for 12 months with the brief to increase diagnosis of HCV infection within clients at those services and the engagement of diagnosed individuals with an appropriate care pathway. The facilitator undertook various activities, which could include training of key workers, direct interaction with clients, streamlining and support for hepatology appointments and introduction of dried blood-spot testing.

MEASUREMENTS:

For each clinic and period, we obtained the total number of clients and, as relevant, their status as PWID, tested for HCV, known HCV-positive, engaged with HCV therapy or treated.

FINDINGS:

Compared with baseline, there was strong evidence that engagement with HCV therapy in the intervention year increased (P < 0.001) more in the HepCATT centres than controls, up + 31 percentage points [95% confidence interval (CI) = 19-43] versus -12 (CI = -31 to + 6) and odds ratio (OR) = 9.99 (CI = 4.42-22.6) versus 0.35 (CI = 0.08-1.56). HepCATT centres also had greater increases in HCV testing (OR = 3.06 versus 0.78, P < 0.001), referral to hepatology (OR = 9.60 versus 0.56, P < 0.001) and treatment initiation (OR = 9.5 versus 0.74, P < 0.001).

CONCLUSIONS:

Introducing a half-time facilitator into drug and alcohol clinics in England increased engagement of HCV-positive people who inject drugs with hepatitis C virus care pathways, with increased uptake also of testing, referral to hepatology and initiation of treatment.

KEYWORDS:

Antiviral therapy; diagnosis; drug treatment services; engagement with therapy; hepatitis C; people who inject drugs

PMID:
30694582
DOI:
10.1111/add.14569

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