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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