Improving ascertainment and treatment rates of chronic viral hepatitis

Abstract

Introduction and aims: In the United Kingdom hepatitis B virus (HBV) and hepatitis C virus (HCV) disproportionately affect migrants and people who inject drugs (PWID). Ascertainment rates of HBV and HCV are 10-40% and screening is recommended in at risk groups. Treatment uptake for HCV in PWID is low at 2-18%, and the most effective way to increase uptake is not known. This research aims to evaluate methods to address the low ascertainment and treatment rates of HBV and HCV in these populations. Methods: A pilot observational cohort study of screening for chronic viral hepatitis in primary care. A retrospective observational cohort study into outcomes of HCV treatment in PWID. A prospective cluster randomised trial of nurse versus doctor initiated treatment for HCV in PWID and a qualitative analysis exploring the engagement with treatment for HCV of PWID. Results: Direct testing results in a greater uptake of screening than opportunistic testing in migrants in primary care (21% versus 1.9%, p = <0.0001). PWID have SVR rates of 55%, re-infection rates of 2.4 per 100 person years, and crack cocaine use reduces over treatment (90% to 49%, p=<0.0001). Nurse initiation of treatment does not result in a higher uptake of therapy (9.6 % versus 7.8%, p=0.53). Treatment engagement themes included the normalisation and stigmatisation of HCV and the perception of HCV treatment as a transformative process. Discussion: Direct testing for HBV and HCV appears to result in a greater uptake of testing in migrants in primary care and should be investigated in a randomised controlled trial. HCV treatment in PWID is safe and effective, and illicit drug use may reduce over treatment. Further service development is unlikely to result in a greater uptake of antiviral therapy for HCV in PWID and other options should be explored to improve treatment uptake.