Managed Care Networks Increase HCV Testing and Referral within Community Drug Services

Author: Tait JM, Stephens BP, Cleary S, McIntyre P, Dillon JF

Theme: Clinical Research Year: 2015

With the advent of oral therapies it will be possible in the future to cure virtually all hepatitis c virus (HCV) individuals however this will only occur if they are tested and offered treatment. Within the UK the main source of HCV infection is injecting drug use.
In 2004 only 1243 (31%) of our estimated 4000 cases had been diagnosed, 430 referred, 101 started treatment and 52 had achieved a sustained viral response (SVR). Our centre introduced a Managed Care Network (MCN) involving staff within drug and prison services. We implemented new strategies to improve HCV testing, care and treatment.

To evaluate the effectiveness of this network we carried out a retrospective cohort study on all HCV positive individuals tested in our region between 1994 and 2014.

3122 were included in the study. Before the MCN, 34.7% (432) of tests and 66% (284) of first referrals were carried out by a General Practitioner. Only 4.8% (60) of tests and 7.9% (34) of referrals came from drug services. After the introduction of the MCN 34.2% (644) of all new tests and 31.5% (429) of first referrals were from drug services.

651 were PCR negative, 285 had died, 334 had moved from area and 24 were not traced. Of the 1830 remaining, 97.5% (1789) were referred and 89% (1629) accessed care. A total of 872 started treatment(s) and 67.8% (592) have had an SVR. After accessing care 177 died and 181 moved from our area.

At the end of the study 78% had been diagnosed and 40.2% of our total caseload had an SVR. Our data shows that involving staff from drug services within a network can significantly increase HCV testing, diagnosis and treatment and can bring individuals who are perceived as difficult to reach into care.

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