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Hepatitis C Needs Assessment:. Contributions from the National HCV Diagnosis and Local Clinical Databases. Key questions. How many people have been diagnosed with HCV in Scotland? How many people have attended a clinic for HCV treatment/care?
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Hepatitis C Needs Assessment: Contributions from the National HCV Diagnosis and Local Clinical Databases
Key questions • How many people have been diagnosed with HCV in Scotland? • How many people have attended a clinic for HCV treatment/care? • How many people have been initiated on HCV antiviral therapy? • How many patients have cleared HCV from antiviral therapy?
Characteristics of HCV diagnosed persons in Scotland(2003-2006, N = 6442) • 66% male • 22% 40 years at diagnosis; mean age = 34 • 90% current/former injecting drug users • 55% genotype 2/3 • 50% of referrals were from hospitals,24% from GPs, 6% GUM, 3% prisons
Cumulative HCV diagnoses by NHS Board in Scotland(to 2006) 0–249 250–749 Grampian 12% 750–1499 1500–4999 5000+ Tayside 7% Lothian 14% Greater Glasgow & Clyde 41% N = 22,073
How many people have been diagnosed with HCV in Scotland? • How many people have attended a clinic for HCV treatment/care?
Locations of 16 HCV treatment/care centres Number of diagnoses 0–249 250–749 750–1499 1500–4999 5000+ Treatment centre N = 22,073
Locations of HCV treatment/carecentres in relation to the HCV diagnosed population • Mean drive-time of 20 min. from HCV diagnosed person’s place of residence (postcode district) to the nearest HCV treatment/care centre.(range 10-80 min. for NHS Boards in mainland Scotland)
Numbers of diagnosed HCV attending HCV treatment/care centres(to 2006) Living+ dead Diagnosed HCV antibody positive: 22,073 Diagnosed with chronic HCV (est.): 16,500 Attended specialist services for chronic HCV (est.): 9,000 Diagnosed with chronic HCV (est.): 14,500 Ever chronic HCV and ever attended specialist services (est.): 8,000 Living Approximately 55% of persons living with diagnosed chronic HCV have ever been in specialist care
New attendees at HCVtreatment/care centres(2003-2006, 5 clinics, N = 1202) • 70% male • 38% 40 years at first attendance; mean age = 38 • 78% current/former injecting drug users • 52% of referrals were from hospitals, 28% from GPs • 92% PCR positive
New attendees at HCVtreatment/care centres(2000-2005, 5 clinics, N = 1677) • 2000-2005: 73% increase in new patients (range 16-174%, 5 clinics)
Follow-up of new patients attending HCV treatment/care centres(2003-2005, 5 clinics, N = 964) Not assessed for Rx43% Most common reason is failure to attend New attendeesN=964 Assessed for Rx 57% (32-70%)
Follow-up of new patients attending HCV treatment/care centres(2003-2005, 5 clinics, N = 964) Not assessed for Rx43% New attendeesN=964 Not suitable for Rx32% (17-76%) Assessed for Rx 57% (32-70%) • Most frequent: • ongoing IDU • chaotic lifestyle
Follow-up of new patients attending HCV treatment/care centres(2003-2005, 5 clinics, N = 964) Not assessed for Rx43% New attendeesN=964 Approximately 20% refused or deferred the offer Assessed for Rx 57% (32-70%) Suitable for Rx 68% (23-82%)
Follow-up of new patients attending HCV treatment/care centres(2003-2005, 5 clinics, N = 964) Not assessed for Rx43% New attendeesN=964 Not suitable for Rx32% (17-76%) Assessed for Rx 57% (32-70%) Suitable for Rx 68% (23-82%) Approximately 30% of new attendees began therapy
How many people have been diagnosed with HCV in Scotland? • How many people have attended a clinic for HCV treatment/care? • How many people have been initiated on HCV antiviral therapy?
Numbers of HCV diagnosed persons initiated on antiviral therapy(to 2006) Diagnosed HCV antibody positive: 22,073 Diagnosed with chronic HCV (est.): 16,500 Attended specialist services for chronic HCV (est.): 9,000 Initiated on antiviral therapy (est.): 2,300 Living+ dead Approximately 14% of persons who have ever been diagnosed with chronic HCV have been initiated on antiviral therapy
Patients initiated on HCV antiviral therapy (2003-2006, 5 clinics, N = 353) • 71% male • 57% 40 years at initiation; mean age = 41 • 56% injecting drug users • 62% genotype 2/3 • 12% known to have cirrhosis • 92% pegylated interferon +/- ribavirin
Patients initiated on HCV antiviral therapy (2000-2005, 5 clinics, N = 678) • 2000/1 to 2004/5: 117% increase in number of patients initiating therapy (range 50-208%, 5 clinics)
Key questions • How many people have been diagnosed with HCV in Scotland? • How many people have attended a clinic for HCV treatment/care? • How many people have been initiated on HCV antiviral therapy? • How many patients have cleared HCV from antiviral therapy?
Response to antiviral therapy (2003-2006, 5 clinics, N = 286) • 46% sustained viral response • 43% no sustained viral response • 11% incomplete • major side effect: 52% • patient request: 30% • other: 18%
Current capacity of HCV treatment/care centres (2006) Number of patients attending HCV treatment/care centres in 2006: 4,000 Number of patients initiated on antiviral therapy in 2006 (est.): 450 Number of patients currently on waiting list for therapy (est.): 330
Summary • Estimated that 55% of people living with chronic HCV have ever attended specialist services • Estimated that 14% of those with diagnosed HCV have ever initiated therapy • Annual numbers of new attendances and therapy initiations are increasing • Low completion of assessment (57%) isan impediment to treatment