Expansion of HCV Treatment Access to People Who Have Injected Drugs Through Effective Translation of Research into Public Health Policy: Scotland's Experience

Seven years have elapsed since the Scottish Government launched its Hepatitis C Action Plan - a Plan to improve services to prevent transmission of infection, particularly among people who inject drugs (PWID), identify those infected and ensure those infected receive optimal treatment. The Plan was underpinned by industrial scale funding (around £100 million, in addition to the general NHS funding, will have been invested by 2015), and a web of accountable national and local multi-disciplinary multi-agency networks responsible for the planning, development and delivery of services. Initiatives ranged from the introduction of testing in specialist drug services through finger-prick blood sampling by non-clinical staff, to the setting of government targets to ensure rapid scale-up of antiviral therapy. 

The Plan was informed by comprehensive national monitoring systems, indicating the extent of the problem not just in terms of numbers infected, diagnosed and treated but also the more penetrative data on the number advancing to end-stage liver disease and death, and also through compelling modelling work demonstrating the potential beneficial impact of scaling-up therapy and the mounting cost of not acting. 

Achievements include around 50% increase in the proportion of the infected population diagnosed (38% to 55%); a sustained near two-and-a-half fold increase in the annual number of people initiated onto therapy (470 to 1050) with more pronounced increases among PWID (300 to 840) and prisoners (20 to 140); and reversing of an upward trend in the overall number of people living with chronic infection. 

The Action Plan has demonstrated that a Government-backed, coordinated and invested approach can transform services and rapidly improve the lives of thousands. Cited as "an impressive example of a national strategy" by the Global Commission on Drug Policy, the Scottish Plan has also provided fundamental insights of international relevance into the management of HCV among PWID.

Below:  Estimates of the number of people living with chronic HCV infection (i.e. HCV RNA positive) in Scotland during 2006, at the start of Scotland's Hepatitis C Action Plan

Below:  Modelled incident number of chronic HCV infected people, who had ever injected drugs, in Scotland developing decompensated cirrhosis (liver failure) each year according to different uptake rates of HCV antiviral therapy during 2008–2030.

Below:  Modelled prevalent number of chronic HCV infected people, who had ever injected drugs, with cirrhosis in Scotland according to different uptake rates of HCV antiviral therapy during 2008–2030.

Below:  Annual number of people in Scotland who were (a) newly diagnosed with HCV antibodies, and (b) initiated on HCV antiviral therapy, during 2003–2013

Below: Estimated number of people living with chronic HCV infection each year in Scotland during 2006–2013: (a) taking account of the impact of the national scale-up in interventions (solid line), and (b) not taking account of the impact of the national scale-up in interventions (dashed line).

Below:  Annual number of people in Scotland diagnosed HCV antibody positive and who had been hospitalised for the first time with either decompensated cirrhosis or hepatocellular carcinoma.

Full article at: http://goo.gl/UC2BNr

By: Hutchinson SJ1, Dillon JF2, Fox R3, McDonald SA4, Innes HA4, Weir A4, McLeod A5, Aspinall EJ4, Palmateer NE5, Taylor A6, Munro A6, Valerio H4, Brown G7,Goldberg DJ4.

• 1School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, Glasgow, UK. Electronic address: sharon.hutchinson2@nhs.net.
• 2Ninewells Hospital and Medical School, Dundee, UK.
• 3Gartnavel General Hospital, Glasgow, UK.
• 4School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, Glasgow, UK.
• 5Health Protection Scotland, Glasgow, UK.
• 6Institute for Applied Social and Health Research, University of the West of Scotland, Paisley, UK.
• 7Scottish Government, Edinburgh, UK.  

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