#ljwg2015 hepatitis c in people who use drugs improving care for hepatitis c: a framework approach...
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#LJWG2015
HEPATITIS CIN PEOPLE WHO USE DRUGS
Improving Care for Hepatitis C:A Framework Approach
LONDON 2015
#LJWG2015
Delivery of treatment inLondon prisons
Janet CattLead Viral Hepatitis Nurse
Royal Free Hampstead NHS Trust
HCV transmission is most frequent via IVDU
Hepatitis C in the UK: 2012 Report (http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/Hepatitis
C/
Risk factor information in lab reports of Hepatitis C infection from England: 1996-2011
Prevalence of HCV infection in the UK
215K
100K
0
50
100
150
200
250P
ati
ents
in ,0
00s
Prevalence Diagnosed
· Prevalence is estimated at 215,0001 in the UK but other sources place the prevalence as high as 466,0002
· There is no formal monitoring system in the UK, except for acute infections3
· Only approximately 3% of those diagnosed receive NICE-approved therapies annually3
1. Health Protection Agency (HPA). Hepatitis C in the UK 2013 report. 2013.2. The Hep C Trust. The UK vs. Europe: Losing the Fight Against Hepatitis C. 2004.
3. Hepatitis Awareness Leading Outcomes (HALO). Confronting the silent epidemic: a critical review of hepatitis C management in the UK. 2013.
HCV Life Cycle and DAA Targets – drugs
Adapted from Manns MP, et al. Nat Rev Drug Discov. 2007;6:991-1000.
Receptor bindingand endocytosis
Fusion and
uncoating
Transportand release
(+) RNA
Translation and
polyprotein processing
RNA replication
Virionassembly
Membranousweb
ER lumen
LD
LDER lumen
LD
NS3/4 protease inhibitors NS5B polymerase inhibitors
Nucleoside/nucleotideNonnucleoside
*Role in HCV life cycle not well defined
NS5A* inhibitors
TelaprevirBoceprevirSimeprevirABT 450/rAsunaprevirMK-5172
DaclatasvirLedipasvirOmbitasvirMK-8742GS-5816
Sofosbuvir
DasabuvirBMS-791325
What do we want to achieve?
• Co-ordinating patient pathways in prison
• To improve access to testing and treatment
• To improve quality and equity of access to treatment.
• To improve outcomes
Work together to develop care
pathway
Achieve the best outcomes for patients
Change is not “quick and easy”
Lack of knowledge (HCV not a priority) Training - DBST
Shared Decisionmaking
Where are we now?
• DBST – 20 staff trained• Staff attending education days to improve
knowledge• Keen to drive OPT- OUT testing forward • Advertise on Prisoner televisions• Prisoner competition to design “liver clinic”
poster
Is Opt-out Achievable?
• YES........ But there are Hurdles• No clear directive – effectively being left for
Healthcare staff to organise (time consuming and frustrating)
• Healthcare staff very keen to engage and learn• They need support to drive this forward• ....... A “Lead” to Champion Opt-out testing.
Treatment with new regimens
• HMP Pentonville – one patient commenced: Sofosbuvir/PegIfn/Ribavirin (4 weeks)
• HMP Mount – one patient commenced: Sofosbuvir/Daclatasvir/Ribavirin (one week)
• HMP Brixton – one patient commenced: Harvoni / Ribavirin (2 weeks)
#LJWG2015
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