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

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 (SSBBV) testing between 2005 and 2014, we investigate the continuum of care of those tested for HCV in England. Persons ≥1 year old with an anti-HCV test and subsequent RNA tests between 2005 and 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 and 2014, 2 390 507 samples were tested for anti-HCV, corresponding to 1 766 515 persons. A total of 53 038 persons (35 190 men and 17 165 women) with anti-HCV positive were newly reported to SSBBV. An RNA test was conducted on 77.0% persons who were 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.

French hepatitis C care cascade: substantial impact of direct-acting antivirals, but the road to elimination is still long

“…This work's has several strengths: rst, it focused on the French population at the national level (i.e., not local or speci c populations), enabling us to assess French progress toward the WHO's elimination objective [2]. Second, given the rapidly evolving situation in recent years, with the advent of DAAs in recent years, it provided estimates of the different stages of the CoC related to the same year (whether 2011 or 2016), not a larger period [8][9][10]. Third, almost all estimates of the numbers of people at the different stages were independently calculated.…”

Cost-Effectiveness of One-Time Birth Cohort Screening for Hepatitis C as Part of the National Health Service Health Check Program in England

“…The PHE sentinel surveillance of BBVs suggests reflex RNA tests (performed on the same antibody positive sample to avoid repeat attendance) were performed on 65% of HCV antibody positive tests. 23 The remainder were assumed to be RNA tested at a subsequent appointment. Based on PHE statistics, 67.7% of antibody positive tests would be RNA positive.…”

“…24,25 The uptake of DAA treatment for those attending their referral is unknown, but expected to be higher than published values for non-DAA treatments (21%). 23 We assumed 50% would receive treatment (35%-65% in sensitivity analyses).…”

“…Costs for RNA tests (£68.38) and subsequent appointments (£32, for those not receiving reflex testing) and outpatient visits prior to treatment were applied (Table 1). 23,38,39 The DAA acquisition costs for the NHS are confidential; however, an approximate £5000 price has been reported (reduced from list prices of .£30 000). 40 To remain conservative, we assumed DAA treatment costs of £10 000 for first treatment, and £15 000 for retreatment.…”

Defining a recovery-oriented cascade of care for opioid use disorder: A community-driven, statewide cross-sectional assessment

“…Applying a cascade of care framework offers a novel approach to curb this unrelenting crisis of drug-related harms by identifying novel points for intervention at the system level [2]. Cascades of care have been used to track and improve population health outcomes for multiple complex health conditions [3][4][5][6][7][8][9][10][11][12][13][14], with the most well-known and visible of such being the continuum of care for HIV infection [4,9,10,[12][13][14]. Applying this continuum of care framework has drastically improved health outcomes among people living with HIV infection, encouraged data-driven policy decisions, and brought about revolutionary systemlevel changes worldwide in how HIV infection is managed across the course of the disease [12][13][14].…”