Establishing the cascade of care for hepatitis C in England-benchmarking to monitor impact of direct acting antivirals

Simmons, Ruth; Ireland, Georgina; Irving, Will; Hickman, Matthew; Sabin, Caroline; Ijaz, Samreen; Ramsay, Mary; Lattimore, Sam; Mandal, Sema

Abstract

Little is known about engagement and retention in care of people diagnosed with chronic hepatitis C (HCV) in England. Establishing a cascade of care informs targeted interventions for improving case-finding, referral, treatment uptake and retention in care. Using data from the Sentinel Surveillance of Blood Borne Virus testing (SSBBV) between 2005-2014 we investigate the continuum of care of those tested for HCV in England.
Persons ?1 years old, with an anti-HCV test and subsequent RNA tests between 2005-2014 reported to SSBBV were collated. We describe the cascade of care, as the patient pathway from a diagnostic test, referral into care, treatment, and patient outcomes.
Between 2005-2014, 2,390,507 samples were tested for anti-HCV, corresponding to 1,766,515 persons. 53,038 persons (35,190 men and 17,165 women) anti-HCV positive were newly reported to SSBBV. An RNA test, was conducted on 77.0% persons anti-HCV positive, 72.3% of whom were viraemic (RNA positive) during this time period, 21.4% had evidence of treatment, and 3130 49.5% had evidence of a sustained virological response (SVR). In multivariable models confirmation of viraemia by RNA test varied by age and region/test setting; evidence of treatment varied by age, year of test and region/test setting; and SVR varied by age, year of test and region/setting of test. In conclusion,
Our findings provide HCV cascade of care estimates prior to the introduction of direct acting antivirals. These findings provide important baseline cascade estimates to benchmark progress towards elimination of HCV as a major public health threat.

Citation

Simmons, R., Ireland, G., Irving, W., Hickman, M., Sabin, C., Ijaz, S., …Mandal, S. (in press). Establishing the cascade of care for hepatitis C in England-benchmarking to monitor impact of direct acting antivirals. Journal of Viral Hepatitis, https://doi.org/10.1111/jvh.12844

• Journal Article Type: Article
• Acceptance Date: Dec 7, 2017
• Online Publication Date: Dec 14, 2017
• Deposit Date: Jan 15, 2018
• Publicly Available Date: Dec 15, 2018
• Journal: Journal of Viral Hepatitis
• Print ISSN: 1352-0504
• Electronic ISSN: 1365-2893
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• DOI: https://doi.org/10.1111/jvh.12844
• Public URL: https://nottingham-repository.worktribe.com/output/899775
• Publisher URL: http://onlinelibrary.wiley.com/doi/10.1111/jvh.12844/abstract
• Additional Information: This is the peer reviewed version of the following article: Simmons, R., Ireland, G., Irving, W., Hickman, M., Sabin, C., Ijaz, S., Ramsay, M., Lattimore, S. and Mandal, S. (), Establishing the cascade of care for hepatitis C in England–benchmarking to monitor impact of direct acting antivirals. J Viral Hepat. Accepted Author Manuscript. doi:10.1111/jvh.12844, which has been published in final form at http://onlinelibrary.wiley.com/doi/10.1111/jvh.12844/abstract. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving