Phase I Update: Prevention & Education Community Outreach

1. Phase I Update:Prevention & EducationCommunity Outreach Justin Schofield Hepatitis C MCN Manager

2. Co-ordination Prevention Testing Treatment, Care & Support Education, training & awareness raising Surveillance and monitoring Sep 2006 – Aug 2008 £4M new monies Initial local developments Period of national needs assessment to inform Phase II Phase I Action Plan

3. 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)

4. 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: Glasgow

5. 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 Provision: Clyde

6. NEX Activity & Returns 2006/07 * * Return rate > 100% due to peoplereturning N/S collected elsewhere

7. 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

8. Phase I Update:Community Outreach Justin Schofield Hepatitis C MCN Manager

9. 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

10. 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 Community Outreach Project

12. Phase I Update:Treatment, Care & Support Dr Ray Fox Consultant in Infectious Diseases, Brownlee Centre Lead Clinician, Hepatitis C Managed Care Network

13. 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

14. 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

15. 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

16. Clinical Audit

17. Introduction • Aims • Baseline data on current clinical activity • 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

18. Dec 06 Nov 07 May 08 Treatment SVR? 48 weeks 26 weeks Methodology • Anonymised data from local copies of ‘National Hepatitis C Clinical Database’ • All patients who commenced treatment during 2006

19. 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

20. Outcomes of treatment

21. Increasing number of patients starting treatment