Transcript Hepatitis C Community Outreach Evaluation Event

Phase I Update:
Prevention & Education
Community Outreach
Justin Schofield
Hepatitis C MCN Manager
Phase I Action Plan
1. Co-ordination
• Sep 2006 – Aug 2008
2. Prevention
• £4M new monies
3. Testing
• Initial local
developments
4. Treatment, Care &
Support
5. Education, training
& awareness raising
6. Surveillance and
monitoring
• Period of national
needs assessment to
inform Phase II
HCV Prevention: NEX
• Access to needle exchange facilities (NEX)
– Glasgow
• Highest number of syringes distributed by pharmacy
services in Scotland.
• 213 syringes per injector per annum
(above national average)
– Clyde
• Lower numbers of syringes distributed
• 57 syringes per injector per annum
(lowest in Scotland)
NEX Provision: Glasgow
Pharmacy provision:
Fixed Sites:
• 39 NEX pharmacy sites
• Average 6.2 per CH(C)P
• Funding
• Drug Crisis Centre:
– BBV Prevention monies
– Phase I HCV Action Plan
funds enabled recruitment
of additional 10 pharmacies
• Glasgow Addiction Services
provide management
• NEX packs contain:
– Needles, syringes, swabs,
citric acid, cin bin, health
promotion info
– Almost 24-hr access
• Base 75:
– Health & Social work
– Women involved in
prostitution
• Hunter St Health Service:
– Homeless health services
NEX Provision: Clyde
Pharmacy provision:
Fixed Sites
• 10 NEX pharmacy sites
• Part of wider harm reduction
model
– 2 pre-existing
– 8 new funded by Phase I
Action Plan monies
• Glasgow Addiction Services
provide management
• Provision of NEX packs
(same as Glasgow)
– Incl. wound management,
BBV / pregnancy testing,
HAV & HBV vaccination
• Lennox, Inverclyde &
Greenock drug services
• Pick & mix provision,
incl. paraphernalia
NEX Activity & Returns
2006/07
Organisation
n/s issued
returned
668,565
475,481
71%
Lennox Service
62,422
53,920
86%
Hunter Street
14,300
11,542
81%
Crisis Centre
153,895
77,180
50%
Inverclyde service
28,323
32,328
114%*
Renfrew Service
24,905
21,350
86%
952,410
671,801
71%
Total
Total
Average
Glasgow Pharmacies
return rate
* Return rate > 100% due to people
returning N/S collected elsewhere
HCV Prevention & Education
• C-Level
– Voluntary sector provider, funded by Health Board
– Peer education to people at risk of HCV
(Community Rehabs, Prisons, Drug Services)
– Training to a range of organisations
• Board HCV Training & Education group
– NEX training
– HCV Awareness training for health & social care staff
– Peer-led safer injecting interventions
– NEX client survey re: paraphernalia
– Outreach / backpacking pilot
Phase I Update:
Community Outreach
Justin Schofield
Hepatitis C MCN Manager
Community Outreach Project
Aims
• Provide support, information &
advice to HCV infected
individuals accessing addiction
services.
•
Improve the referral process.
•
Increase access to treatment.
•
Reduce the default rate
amongst those referred for
treatment (50%-70% DNA)
•
Establish and maintain effective
links between the CATs, tertiary
treatment centres, voluntary
sector, primary care and other
addiction services.
•
Pilot sites
– 4 x CATs
•
•
•
•
South (Gorbals)
South-East (Castlemilk)
North-East (Easterhouse)
West (Drumchapel)
– 3 x Community Rehabs
• South-East Alternatives
• New Horizon
• Momentum
•
Tertiary Care
– 2.0 WTE Clinical Nurse
Specialists
– 0.5 WTE clerical support
Community Outreach Project
• Activity: Testing & Info
– 328 clients referred to
CNS at CAT
– 218 attended
• DNA rate 33%
– 122 HCV test
• 63 (52%) chronic
infection
• Activity: Hospital Care
– 50 referred to Hospital
• 20 appts in future
• 30 had appts.
– 19 attended
– DNA rate 37%
• Evaluation & Learning
(Prof Avril Taylor)
– Service attracted clients
– Retention rate at clinic
higher than in tertiary sector
– Difficulties in setting up and
implementing service but
main problems dealt with
and intra-team relationships
improved
– Majority view that service
should continue
– Overwhelming client support
for service
Phase I Update:
Treatment, Care & Support
Dr Ray Fox
Consultant in Infectious Diseases, Brownlee Centre
Lead Clinician, Hepatitis C Managed Care Network
National Action Plan: Phase I
• Action Plan:
– NHS Boards will develop and improve local
community-based hepatitis C treatment, care &
support services
• NHSGGC Managed Care Network
–
–
–
–
Mapping of current provision
Analysis of need
Determine local priorities
Inform initial investment plans
Phase I Developments
• Clinical Nurse Specialists
– 3 new nurses working at Brownlee, Glasgow Royal,
Inverclyde Royal & Royal Alexandra hospitals
• Supporting increase in clinical caseloads, including
assessment and treatment
• Dietetics
– 1 new Dietician working across Glasgow city
hospitals
• Providing dietetic input to patient care
• Assessing dietetic needs of people accessing HCV care
services to inform future development
Phase I Developments cont.
• Outpatient Clinic provision
– Refurbishment of Ward 7B at Gartnavel General
as dedicated hepatitis C outpatient clinic space
– To be shared by Gartnavel Gastroenterology and
Brownlee Infectious Disease teams
– Increase clinical capacity
– Improve patient experience of care
– Opens Autumn 2008
Clinical Audit
Introduction
•
Aims
1. Baseline data on current clinical activity
2. Publish aggregate findings and provide hospitalspecific data to each treatment centre
•
Outcome indicators:
– Sustained Viral Response (SVR)
[undetectable viral RNA
6 months after end of treatment]
– Number patients commencing treatment
– Number who completed course of treatment
– Response to treatment by viral genotype
Methodology
• Anonymised data from local copies of ‘National
Hepatitis C Clinical Database’
• All patients who commenced treatment during
2006
Dec 06
Nov 07
May 08
Treatment
48 weeks
SVR?
26 weeks
Patient characteristics
• 125 patients commenced treatment
• Mean age = 39 years (range 20 to 69)
• Two thirds male
• 76% genotype 2 & 3, 24% genotype 1 & 4
• Three were co-infected with HIV
• 10% recorded diagnosis of cirrhosis
• 86% completed treatment
Outcomes of treatment
Treatment outcomes for all patients by genotype
100%
90%
80%
43%
70%
65%
72%
60%
50%
Sustained Viral
Response
Relapse
13%
No response
40%
Treatment Incomplete
17%
9%
30%
7%
20%
17%
6%
3%
8%
10%
10%
9%
10%
G1&4
G2&3
All patients
(n=30)
(n=95)
(N=125)
10%
0%
Missing
Increasing number of patients
starting treatment
Number of patients commencing treatment by treatment centre
41
Brownlee Centre
49
36
Glasgow Royal Infirmary
46
2006
2007
30
Gartnavel General
39
18
Southern General
& Victoria Infirmary
21
0
10
20
30
40
50
60