Producing a Hepatitis C
Improvement Framework through
Partnership Working
Dr. Éamonn O’Moore, FFPH.
Director for Health & Justice, PHE.
November 17th, 2014.
LJWG Conference 2014 Livery Hall, Guildhall London.
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Hepatitis C Partnership Group
•
Multiagency group co-chaired by Prof. Paul Cosford, Director for Health
Protection, PHE and Kate Davies OBE, Head of Public Health, Armed
Forces, Health and Justice for NHS England;
• Membership includes representatives from DH, The Hepatitis C Trust,
NHS England Hepatobiliary and Pancreas CRG, The Hepatitis C
Coalition, senior clinicians and public health specialists from PHE.
• Aims of the Hepatitis C Partnership include joint actions across
partner organisations to identify and address key challenges to improve
diagnosis, treatment and care for people living with Hepatitis C virus
infection and to reduce the risk of transmission of infection.
• Agreed to develop a Five Year Hepatitis C Improvement Framework
which is now in final draft pending sign-off following recent meeting on
November 5.
• Planned publication date January 2015.
Presentation to Hepatitis C in London: Practical Steps to Elimination 17 Nov 2014
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Hep C Improvement Framework
•
Hepatitis C is a curable infection.
•
The overarching goal of this framework is to eliminate hepatitis C as a
significant public health concern in England through the collective
action of all partner organisations.
•
This 5 year improvement framework is intended to establish the
foundations of an active case-finding, prevention, diagnosis and
treatment programme for that long-term aim.
•
In order to keep the improvement framework (and the Partnership Board)
focussed on this, the following ‘vision and mission’ has been agreed.
Presentation to Hepatitis C in London: Practical Steps to Elimination 17 Nov 2014
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Draft Vision and Mission Statement
• All people at risk of hepatitis C virus to have access to
testing and if infected, access to appropriate
treatment and care, which in the majority of cases
will clear the virus.
• The long-term outcome aimed for is to reduce hepatitis
C transmission, hepatitis C-related serious liver disease,
liver cancer and the resulting premature mortality thus
laying the groundwork for eventual elimination of
hepatitis C as a serious public health concern in
England.
Presentation to Hepatitis C in London: Practical Steps to Elimination 17 Nov 2014
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Two draft ambitions for the Framework:
• The following was proposed at a meeting of the
Hepatitis C Partnership Group on November 5
following review of the latest draft:
• Hospital admissions for HCV-related ESLD to
remain stable over the next 10 years and to be
falling significantly by 2025;
• Prevalence of chronic infection in PWID reduced
by a quarter (from ~ 40% to 30%) over next 10
years.
Presentation to Hepatitis C in London: Practical Steps to Elimination 17 Nov 2014
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Framework topic: People who inject drugs
•
People who inject drugs (PWIDs) and
share needles are at a significantly
higher risk of acquiring HCV.
•
Drug treatment services are an
important location for offering tests
and providing health promotion
messages to prevent transmission
as well as being an entry point on
to a care pathway;
•
PWIDs seeking help for their drugrelated problems through drug
treatment services should also be
offered a hepatitis C test as part of
BBV testing with pre- and posttest counselling.
Presentation to Hepatitis C in London: Practical Steps to Elimination 17 Nov 2014
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PWID cont’d: Objectives & Measures
Objective
Measure
Hepatitis C & other BBV testing is
offered to all PWIDs attending drug
treatment services as part of an opt-out
system, and those testing negative
should be re-offered tests as
appropriate.
Proportion and number of people in
contact with drug treatment services
offered and accept hepatitis C (as part
of BBV) testing (through UAM and
NDTMS).
HCV treatment services to be
commissioned to deliver in non-hospitalbased settings such as substance use
services or other community settings.
Proportion of PWIDs offered hepatitis C
treatment who are seen in a non-acute
setting.
Improve the effectiveness of Hepatitis C
prevention messages to PWIDs
Attitudes and behaviour among PWID
through unlinked anonymous monitoring
(UAM) survey.
Presentation to Hepatitis C in London: Practical Steps to Elimination 17 Nov 2014
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Framework Topic: Testing & diagnosis
•
The offer and uptake of testing and
use of appropriate tests for
diagnosis of the infection is the
cornerstone of improving services for
people with HCV
•
Improved access to targeted testing
as recommended by NICE, in several
settings, including primary care, GUM,
drug and needle exchange services
and prisons and other PPDs is
needed along with greater
consistency in reporting
confirmatory diagnostic results.
•
Dried Blood Spot Testing is good
vehicle to improve uptake.
Presentation to Hepatitis C in London: Practical Steps to Elimination 17 Nov 2014
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Testing & Dx: Objectives & Measures
Objectives
Increase the offer and uptake of
testing and diagnosis among
population groups at risk of infection,
in line with current evidence and
national guidelines.
Measures
Numbers of tests offered and
proportion positive by setting;
Key actions include ensuring HCV antibody test is always confirmed with
PCR test; people diagnosed with hepatitis C are assessed for specialist
care according to guidelines; commissioners of primary care, sexual health,
drug treatment and prison health services ensure HCV/BBV testing and
referral in service specifications.
Presentation to Hepatitis C in London: Practical Steps to Elimination 17 Nov 2014
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Framework Topic: Needle & syringe programmes (NSPs)
•
NSPs central to public health
programmes to reduce transmission of
BBVs since HIV epidemic.
•
Critical point of contact with those at
risk of infection, known to be infected
and those not yet ready for treatment .
•
Investment needs to be maintained to
stop BBV prevalence rising and to
prevent infection outbreaks.
•
Commissioners and service providers
should assess and respond to the
needs of all people who do not
perceive themselves to be PWIDs –
such as people who use image and
performance enhancing drugs (IPEDs).
Presentation to Hepatitis C in London: Practical Steps to Elimination 17 Nov 2014
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NSPs: Objectives & Measures
Objectives
Ensure that needle and syringe
programmes provide an appropriate
range of services with sufficient
coverage to meet local need and
informed by current evidence and
national guidelines;
Measures
Monitor a basket of measures from
existing needle exchange collections
Make better use of needle exchanges Numbers of tests offered and
to increase engagement and testing; proportion positive by setting.
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Framework Topic: Prisons & Secure Settings
•
Significant overlap of risk of
incarceration with risk of HCV
infection due to IDU;
•
Testing & treatment here improves
health not only of prisoners but those
in ‘at or near prison social networks’ in
wider community- community
dividend.
•
Evidence of the effectiveness of
treating hepatitis C in a prison
setting including in-reach and outreach models; introduction of opt-out
testing policy via Pathfinder
Prisons is already leading to
increased coverage of testing even
beyond those prisons.
Presentation to Hepatitis C in London: Practical Steps to Elimination 17 Nov 2014
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Prisons & Secure Settings: Objectives & Measures
Objectives
Measures
The offer of blood-borne virus (BBV) optout testing to be the norm at the point of
the healthcare/screening assessment in
secure & detained settings;
Number and proportion of people offered
BBV in secure & detained settings (H-JIPs)
Opt-out testing process to be completed
within 2 weeks of arrival, including pre and
post-test counselling.
Health & Justice Indicators of Performance
(H-JIPs)
Increase the proportion of people with
HCV in secure & detained settings to be
on a treatment care pathway.
Proportion of people diagnosed with HCV
infection in a secure or detained setting on
a care pathway
Presentation to Hepatitis C in London: Practical Steps to Elimination 17 Nov 2014
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Framework Topic: Treatment
•
Treating hepatitis C infection has
clear benefits for the person
including avoidance of severe illness
and early mortality;
•
Treatment also avoids associated
healthcare costs of treating ESLD.
•
Treatment and cure also protects
the community against further
transmission by reducing the pool
of infection : ‘treatment as
prevention’;
•
However, currently only 3% of
people living with HCV are treated.
Presentation to Hepatitis C in London: Practical Steps to Elimination 17 Nov 2014
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Treatment: Objectives & Measures.
Objectives
Measures
Ensure everyone diagnosed with HCV Proportion of people diagnosed with
is on a care pathway with access to
HCV infection on a structured care
appropriate treatment;
pathway
New hepatitis C treatments are emerging onto the market which are simpler to take,
have less side effects and require less monitoring (and so can facilitate a shift to
treatment in community settings), but are very expensive.
NHS England is committed to assessing which and how these new drugs could be
introduced in a managed way and reduce financial risk to the health & social care
system as a whole. NHS England has set up a task & finish group to assess the costs
and benefits in the short, medium and long-term and will complete its work in early
2015.
Presentation to Hepatitis C in London: Practical Steps to Elimination 17 Nov 2014
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Framework Topic: Workforce
•
Creation of a learning and
development framework to
provide an hepatitis C competent
and able workforce, with specific
sections relevant to different
healthcare professionals (i.e. drug
service professionals, GPs, and
pharmacy staff and so on)
•
Create an inventory of training
and educational resources
available for different
professionals e.g. RCGP emodule for GPs.
Presentation to Hepatitis C in London: Practical Steps to Elimination 17 Nov 2014
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Workforce: Objectives & Measures
Objectives
A learning and development framework to
provide an hepatitis C competent and able
workforce, with specific sections relevant
to different healthcare professionals (i.e.
drug service professionals, GPs, and
pharmacy staff etc.)
Measures
Publication of the learning & development
framework
Presentation to Hepatitis C in London: Practical Steps to Elimination 17 Nov 2014
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Framework Topic: Data & intelligence
•
Inclusion of hepatitis C indicators on national
policy documents such as the Public Health
Outcomes Framework prioritises the condition,
draws resources and galvanises action towards
achieving the targets.
•
Evidence of impact and cost-effectiveness of
prevention, diagnosis and treatment strategies,
are critical in advocating for new interventions or
approaches.
•
Monitoring of hepatitis C strategies should occur
at all levels, national and local, and by all
commissioners, including local authority (Health
and Wellbeing Boards),
•
PHE’s annual report on Hepatitis C in the UK will
track progress against the objectives and
actions in the framework by reporting on
included indicators.
Presentation to Hepatitis C in London: Practical Steps to Elimination 17 Nov 2014
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Intelligence & Data: Objectives & Measures
Objectives
Improve the quality of data and
intelligence on the outcomes and
impact of improved hepatitis C
prevention and treatment services;
Measures
HCV-related data sources increase
and improve in terms of coverage,
validity, reliability and timeliness.
Presentation to Hepatitis C in London: Practical Steps to Elimination 17 Nov 2014
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Improvement Framework – Next steps
• Tackling BBVs is a shared partnership public health priority;
• Framework will be published in January 2015;
• Implementation expected to commence from April 2015 onwards;
• HCV Partnership Board will monitor progress and provide update
reports to the PH tripartite governance system.
• It is intended that the Framework will be reviewed annually
enabling the re-prioritisation and the setting of new time-frames for
the delivery of actions.
Presentation to Hepatitis C in London: Practical Steps to Elimination 17 Nov 2014
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Engagement Events: HCV Action & PHE
• Awareness raising and engagement events are being planned
for delivery during 2015 to raise awareness of hepatitis C across
England, particularly where prioritisation is poor and prevalence is
high, and encouraging health professionals to work together
towards eliminating hepatitis C in their area;
• Attendees at the events would include local health professionals
(working in drug services, primary care, secondary care and prison
healthcare); commissioning representatives from local CCGs and
Local Authorities; and laboratory, NHS England specialised
commissioning, prison healthcare and PHE centre staff and patient
voice representatives.
Presentation to Hepatitis C in London: Practical Steps to Elimination 17 Nov 2014