Download Delivery Of Treatment In London Prisons – Janet Catt

HEPATITIS C
IN PEOPLE WHO USE DRUGS
Improving Care for Hepatitis C:
A Framework Approach
LONDON 2015
#LJWG2015
Delivery of treatment in
London prisons
Janet Catt
Lead Viral Hepatitis Nurse
Royal Free Hampstead NHS Trust
#LJWG2015
HCV transmission is most frequent via IVDU
Risk factor information in lab reports of Hepatitis C infection from England:
1996-2011
Hepatitis C in the UK: 2012 Report
(http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/Hepati
tisC/
Prevalence of HCV infection in the UK
250

215K
Patients in ,000s
200
150
100K

100

50
0
Prevalence
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
Diagnosed
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
Receptor binding
and endocytosis
Telaprevir
Boceprevir
Simeprevir
ABT 450/r
Asunaprevir
MK-5172
Transport
and release
Fusion
and
uncoating
Translation and
NS3/4 protease
polyprotein
inhibitors
processing
Daclatasvir
Ledipasvir
Ombitasvir
MK-8742
GS-5816
(+) RNA
ER lumen
LD
Membranous
web
ER lumen
LD
Virion
assembly
LD
NS5A* inhibitors
*Role in HCV life cycle not well defined
Adapted from Manns MP, et al. Nat Rev Drug Discov.
2007;6:991-1000.
NS5B
polymerase
inhibitors
RNA
replication
Nucleoside/nucleotide
Nonnucleoside
Sofosbuvir
Dasabuvir
BMS-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
Change is not
“quick and easy”
Lack of knowledge
(HCV not a priority)
Work together to
develop care
pathway
Shared
Decision
making
Achieve the best outcomes for
patients
Training - DBST
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