Hepatitis C Action Plan:

1
Hepatitis C Action Plan A Scottish Odyssey
The 11th International Hepatitis C Conference
Mainliners
Professor David Goldberg Health Protection
Scotland
2
Hepatitis C in Scotland Milestones

• 1989 Discovery of HCV
• 1991 Antibody Test
• 1992 Interferon Therapy
• 1996 HCV Diagnosis Database
• 1996-2002 Prevalence Surveys
• Interferon Ribavirin Therapy
• Needs Assessment
• Pegylated Interferon Ribavirin Therapy
• 2001 UK Hepatitis C Trust (NGO)
• 2003 UK Hepatitis C Resource Centre (NGO)
• 2003-2007 Clinical Database established
• 2004 Consensus Conference (RCP, Edin)
• 2004 Parliamentary (Scotland) Working Group on
  Hepatitis C
• 2006-2008 Action Plan Phase I
• Hepatitis C SIGN Clinical Guidelines
• Public Enquiry Hepatitis C infection
• through NHS
  Treatment
• 2008-2011 Action Plan Phase II

3
Hepatitis C Action Plan for Scotland

• Background Two Phased
• Aims Prevention, Diagnosis Care
• Phase I Sept 2006-March 2008 (41 Actions)
• Establishing a governance structure to oversee
  Phase 1 actions and the development of the Phase
  II Action Plan
• Producing educational materials for professionals
  and HCV infected persons
• Gathering evidence to inform Phase II Actions
• Generating Phase II Actions and the Phase II
  Action Plan

4
Hepatitis C epidemiological landscape
(estimates) Scotland 2006 People with chronic
infection
5
Annual and cumulative numbers of people diagnosed
with HCV in Scotland, 1991-2008.
2,000
25,000
20,000
1,500
Annual number (bars)
15,000
Cumulative number (red line)
1,000
10,000
500
5,000
0
0
1992
1994
1996
1998
2000
2002
2004
2006
2008
Year of first positive HCV diagnosis
Age at first positive HCV diagnosis (in years)
lt 20
20-29
30-39
40-49
50
Not known
6
HCV infection and disease trends
Number of hospital bed-days associated with
HCV-related liver failure in Scotland
New cases of HCV-related liver failure in
Scotland
HCV prevalence among IDUs lt25 years in Glasgow
Annual number of deaths related to HCV and
AIDS in Scotland
7
Hepatitis C Action Plan Phase II
2008-2011Principles and Characteristics

• The Plan
• is based on an extensive evidence base and
  consultation process
• is a high level one
• embraces all service needs
• adopts a multidisciplinary approach
• covers all geographical areas and settings
• is performance managed
• is supported by serious investment
• addresses inequalities

8
Scottish Hepatitis C Action Plan Phase II
2008-2011Government Investment (million)
9
Phase II Action Plan Prevention

• Issues
• Widespread variations in injection equipment
  provision
• Sharing of injection equipment and Hepatitis C
  transmission among IDUs very common
• Actions
• Prevention Networks for all NHS Boards
• Guidelines for injection equipment provision
• Injection equipment services improved in
  accordance with guidelines
• Education for vulnerable groups and
  schoolchildren
• National surveys of Hepatitis C and behaviours
  among IDUs
• Principal Outcome (2011)
• Incidence of infection less than 10 among IDUs
  throughout Scotland

10
Phase II Action Plan Diagnosis

• Issues
• Widespread variations in testing practice
• The majority of infected persons are undiagnosed
• Actions
• Awareness raising campaigns to promote testing
• Innovative approaches to improve testing and
  referral activities by GPs and other community
  setting practitioners
• Establishment of a national Hepatitis C test
  database
• Principal Outcome (2011)
• The great majority of infected people will have
  been diagnosed

11
Phase II Action Plan Treatment Care

• Issues
• Widespread variations in clinical management and
  social care practice
• Insufficient numbers of infected persons
  receiving therapy
• Actions
• MCNs for all NHS Boards
• Development of clinical standards training of
  workforce
• Services will be developed to increase numbers
  treated
• Development of national clinical database and
  patient management system
• Principal Outcome (2011)
• At least 1500 treated/yr

12
SVR rates among 1) Scottish patients initiated
Jan 06-July 07, 2) Trent database patients 3)
pooled RCT trial participants, by genotype group
13
Observed and future expansion of HCV antiviral
therapy across Scotland
14
Hep C Action Plan Phase II Governance
Action Plan Advisory Board
Scottish Government
Action Plan Governance Board
KEY ReportingAdvice, expertise, best
practiceAccountability
HPS Programme Team
Lead Organisations NHS Boards, SPS, NES..
National Networks MCN Leads, Prevention Leads