Combined community drug recovery and hepatitis C treatment ......Cirrhosis •Different care pathway involving consultant review •24 patients found to have cirrhosis •12 allocated

Combined community drug recovery and hepatitis C treatment clinic

Dr Lee Middleton

Glasgow Alcohol and Drug Recovery Service

Background

• OST clinics in Govan

• Average caseload of 200

• Regular HCV testing (uptake >98%)

• Approx. 1/3 active HCV

Problem

• Poor engagement with available hospital based treatment service

• Chronic, untreated HCV

• How to increase engagement with assessment?

• How to increase treatment?

The plan

• Offer one-stop drug recovery service and HCV treatment clinic

• Work collaboratively with hospital services to ensure continuity of care

• Maintain engagement with a view to quick assessment/treatment

Staff

• Two addiction nurses

• Senior HCV addiction nurse

• Medical officer

• Hospital clinical nurse specialist

• Third sector HCV support service

Interventions

• Liver assessments

• Fibroscans

• Direct-acting antiviral (DAA) medication

• OST

• Harm reduction

• Befriending and HCV 1:1 support

Interventions

Results HCV Clinic (%) Hospital (%) Overall (%) p-value

Allocated 35 (47.3) 39 (52.7) 74 (100)

Gender M/F 29/6 (82.9M) 26/13 (66.7M) 55/19 (74.3M)

Treatment

completed

18 (51.4) 9 (23.1) 27 (36.5) 0.011

Continuing

engagement

16 (45.7) 8 (20.5) 24 (32.4) <0.001

Untreated/

disengaged

0 (0) 15 (38.7) 15 (20.3) <0.001

Deceased 1 (2.9) 7 (17.9) 8 (10.8) 0.036

Cirrhosis

• Different care pathway involving consultant review

• 24 patients found to have cirrhosis

• 12 allocated to each clinic

• Combined clinic – all treated or continued engagement

• Hospital services – 3 treated/engaged, 7 disengaged, 2 deceased

Drug use

HCV Clinic (%) Hospital (%) p-value

Treatment completed 18 9

Reported drug use pre-

treatment

14 (77.8) 5 (55.6) 0.234

Reported reduced/no drug

use during treatment

13/14 (92.8) 0/5 (0) <0.001

Maintained reduced/no

drug use 3 months post

treatment

6/13 (46.2) n/a

Conclusion

• Combined clinic more effective than traditional care model

• Reduction in all cause mortality

• Reduced drug use, sustained post-treatment

• Easily to replicate

Thank you

Questions?

[email protected]