What have we achieved so far? 

  • In WS1 we have treated over 600 PWID in NHS Tayside within drug treatment services, pharmacy, needle exchange and prison. This rapid scale-up of HCV treatment among PWID has advanced overall progress on HCV elimination. By the end of 2019, NHS Tayside had diagnosed an estimated 90% of all those HCV infected and treated 90% of those diagnosed, potentially meeting the World Health Organization’s 2030 HCV elimination target 11 years early.  

  • We hypothesised that scale-up of HCV treatment in Tayside would reduce chronic HCV in PWID to ~10%; this is an approximate 2/3 reduction in chronic HCV and provisional estimates show this has been achieved. 

  • Retrospective and prospective testing of samples from the Needle Exchange Surveillance Initiative (NESI) sweeps in Scotland show that scale-up of DAA treatment among PWID can be achieved through HCV testing and treatment in community drug services whilst maintaining high sustained virologic responses (SVR) and is associated with reduction in chronic HCV in the population https://doi.org/10.1111/add.15459. 

  • In WS3 whave interviewed service users and providers in NHS Tayside to identify key barriers and facilitators that can help other sites successfully scale-up HCV treatment.  We have also conducted stakeholder events with Scottish health boards, third sector organisations and Operational Delivery Networks within NHS England to gain their insights. The final recommendations for scaling up HCV testing and treatment for People Who Inject Drugs can be found here. 

  • In England, HCV testing has been completed on stored samples from 2011-2018. Evidence suggests there has been a small reduction in HCV viraemia among antibody-positive PWID in England since 2016, concomitant with DAA scale-up, and some indication that treatment access has improved in the same period https://onlinelibrary.wiley.com/doi/pdf/10.1111/jvh.13575. 


What’s next? 

  • Modelling work will be completed on the impact and cost effectiveness of the programme in Tayside. 

  • WS3 plan to analyse post treatment interviews and link to administrative databases to assess treatment impacts on service users’ general health and wellbeing, drug behaviours, and their relationships to others, including family, friends and staff. 

  • The main work of WS5 is to conduct an evaluation of HCV TasP in PWID in England to provide essential evidence for patients, clinicians and policy-makersThis will require evidence on chronic HCV infection in PWID and intensity of HCV treatment across sites in England to determine whether HCV infections reduce more in sites with greater scale-up than in sites with less intense scale-up of HCV treatment. We will develop an appropriate design with novel statistical methods to provide unbiased estimates of whether HCV has changed over time. 

  • WS5 will also include a qualitative aspect to follow up on the implementation and impact of the recommendations for scaling up HCV testing and treatment produced in WS3. 

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