Friday, May 25, 2018

UK - Increasing treatment uptake to eradicate hepatitis C infection

Nursing Times [online]; 114: 6, 38-42.
Increasing treatment uptake to eradicate hepatitis C infection
Gemma Botterill
25 May, 2018

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Viral hepatitis is a major cause of death across the world and hepatitis C virus infection represents a large share of the burden. Curing hepatitis C has become more feasible since the emergence of direct-acting antivirals, which have cure rates of >95%. NHS England has set up a national network of treatment services and, since February 2017, treatment has been available to all infected patients, regardless of genotype and liver fibrosis staging. Today the challenge is not so much how to treat patients, but how to identify them in the first place, as many are not known to health services. This is because they are unaware of their infection, they do not feel they need treatment, do not know about the new treatments available, or they belong to hard-to-reach groups such as homeless people, prisoners and injecting drug users. This article looks at the methods used at Queen Elizabeth Hospital Birmingham to re-engage with patients lost to follow-up and to engage with local drug users and prison inmates.

Extending DAA regimens
At the beginning of 2016, patients without cirrhosis became eligible for the new all-oral DAA regimens, except for genotype 3 patients, which led to many becoming disengaged from health services and lost to follow-up.

Finally, in February 2017, NHSE made DAA regimens available to all patients infected with HCV, regardless of genotype or liver fibrosis staging. The number of patients to treat in 2017/18 was increased by a quarter, with a corresponding increase in funding for the drugs, so 12,500 patients could be treated with an excellent chance of cure (Vine et al, 2015). The primary aim was to continue engaging with patients, particularly those without cirrhosis who could now be offered an all-oral treatment regimen (NHSE, 2016b).

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