Download Sharon Hutchinson LJWG 2014

How aspirations can be built and levels of
performance can be assured:
Learning from the Scottish Action Plan
Professor Sharon Hutchinson
LJWG LDAPF Conference
Hepatitis C in London – practical steps to elimination
London, 17th November 2014
Scotland’s Hepatitis C Action Plan
Aims
 To prevent the spread of Hepatitis C, particularly
among people who inject drugs (PWID)
 To diagnose Hepatitis C infected persons,
particularly those who would most benefit from
treatment
 To ensure that those infected receive optimal
treatment, care and support
Scotland’s Hepatitis C Action Plan
Phase I
2006-08
The Business Case
Phase II
2008-11
Investment to improve
services
Phase III
2011-15
Continuing investment
Phase IV
2015-20
???
Phase I: Key evidence
Hepatitis C Landscape in Scotland, 2006
Estimates
0
20,000
40,000
38,000
Living with Chronic Infection
Ever injected drugs
Diagnosed (ever)
Attended clinic (in 2006)
34,000
14,500 (38% of chronics)
3,500 (9% of chronics)
Started Treatment (in 2006) 450 (1% of chronics)
Phase I: Key evidence
Projected number of PWID (ever injected)
in Scotland developing liver failure
each year with different Rx rates
Increasing uptake of
150
antiviral therapy to 2,000
per year could prevent in
N 100
excess of 5,000 cirrhosis
Uptake of HCV Rx:
225 PWID per year
50
1,000 PWID per year
2,000 PWID per year
0
2010
2020
2030
cases (incl. 2,700 liver
failures) during 2008-30
Scotland’s Hepatitis C Action Plan
Phase I
2006-08
The Business Case
Phase II
2008-11
Investment to improve
services
Phase III
2011-15
Continuing investment
Phase IV
2015-20
???
Phase II: Principles & Characteristics
 Based on extensive evidence base &
consultation process
 Involved high level actions
 Adopted multidisciplinary approach
 Strong governance / clear accountability
 Leadership (e.g. national coordination lead
by HPS)
 Agreed outcomes / performance monitored
(e.g. targets on treatment)
 Good coordination/communication (e.g.
national / local networks)
 Supported by serious investment
(£100million during 2008-15)
Phase II: Key Actions
Prevention
: Improvements in Injection
Equipment Provision
Diagnosis
: Awareness raising initiatives
: Finger prick sampling in non-clinical
settings
Treatment
: Increase in clinical capacity
: Funding for treatment and national
procurement of antiviral therapy
Prevention of Infection in Scotland: Progress
Provision of Key Interventions
to PWID
Year
2008/09 2011/12
Incidence of HCV infection
among PWID in Scotland
(derived from PCR data)
25%
20%
Needles/syringes
(N/S) distributed
4.4
million
4.7
million
Paraphernalia*
distributed
0.4
million
2.5
million
10%
On methadone
50%
64%
5%
Initiated on HCV
therapy among
PWID <30 yrs
~50
~100
0%
* Cookers/Filters
15%
2008/09
*
2010
2011/12
2013
Palmateer et al; PloS One, 2014
(plus updated data for 2013)
Progress In Drug Services
Number of new HCV diagnoses per year
in Scotland
Dried Blood Spot
Testing
2,000
(introduced into drug
services during 2009)
N 1,500
1,000
0
2004 2006 2008 2010 2012
Pre
Phase I Phase II onwards
% Infected Popln diagnosed
100
80
60
40
20
0
2000
1000
800
600
400
200
0
1500
1000
500
0
1999
2001
2003
2005
2007
2009
2011
500
%
(Scotland’s 4 largest NHS Boards)
Tested
2,500
Number of people tested for
HCV in drug services
Tested Positive
Diagnosis: Overall Progress
2005
Scotland:
Estimated: 2006-13
Projected: 2014-25
2010
2015
Year
2020
2025
Drug services referred 16% of new HCV diagnoses in
Scotland during 2009-13 (McLeod et al. JECH 2014)
International Context
Sweden
France
Denmark
Germany
Scotland
Belgium
Spain
Switzerland
Austria
England
Portugal
Czech Repub
0
10 20 30 40 50 60 70 80 90 100
Estimated % infected popln diagnosed
Razavi et al. J Viral Hepat. 2014
Scotland’s Hepatitis C Action Plan
Phase I
2006-08
The Business Case
Phase II
2008-11
Investment to improve
services
Phase III
2011-15
Continuing investment
Phase IV
2015-20
???
Phase IV
 Government is supportive
 Principles for HCV diagnosis and treatment
in Scotland, in the context of the new highly
effective therapies, to be published in 2015
Modelled incidence of HCV-related (i) Severe Liver Morbidity and (ii)
chronic infection in Scotland, according to different treatment
strategies and 2,000 treated per year (Innes et al. Gut 2014)
(i) Severe Liver Morbidity
(ii) New infection
600
Incident cases
Incident cases
200
160
120
80
500
400
300
200
100
40
2010
IFN-free therapy
2015 2020
2025
Status-Quo
0
2030
IFN-free therapy
2010 2015 2020
Target Advanced
Fibrosis (40%60%)
2025 2030
Target Active PWID
(13%  33%)
Aim going forward in Scotland
To rapidly control the number of people who
develop HCV related liver failure and/or
hepatocellular carcinoma and the number of people
who die from HCV related disease