OTU-25 Treating in chaos: outcomes of hepatitis c treatment in newcastle's homeless drug users. (June 2019)

• Record Type: Journal Article
• Authors: Buchanan, Emma; Ord, Heather
• Is Part Of: Gut. Volume 68(2019)Supplement 2
• Page Start: A108
• Page End: A108
• Publication Date: 2019-06
• Subjects: Gastroenterology -- Periodicals; 616.33
• DOI: 10.1136/gutjnl-2019-BSGAbstracts.206
• Languages: English
• ISSNs: 0017-5749

Abstract

Abstract : Introduction: There is a high prevalence of Hepatitis C (HCV) among patients leading chaotic lives; this includes patients who are homeless, currently injecting drugs and dependently drinking alcohol. A HCV outreach treatment clinic was set up in the needle exchange in central Newcastle to bring treatment to those who have many barriers to attending treatment service in secondary care. This clinic was offered in conjunction with harm minimisation services. Methods: We retrospectively looked back at the referrals to the clinic and HCV treatment cure rates from September 2017 to November 2018. Data from the needle exchange's harm minimisation team was also collected to look at the number of HCV tests carried out during the first 3 months of the service running and the last 3 months of the study period to assess the impact treating chaotic patients is having on the prevalence of HCV in this community. Results: Between September 2017 and November 2018 54 patients were referred to the HCV outreach clinic following a HCV test. Of these patient 48 attended for treatment. 31 (65%) of the attenders were of no fixed abode (NFA). All the patients who attended for treatment stated intravenous drug use (IVDU) as their main risk factor for HCV and 73% of patients were still using IVDs at assessment for HCV treatment. A further 12 patients were also dependently drinking. 37 of the 48 patients assessed for treatment had commenced HCV treatment at the point of publication. 11 patients did not commence treatment due to 2 dying (both drug related deaths), 3 spontaneous clearance of HCV, 2 moved out of area, 2 being in custody and 2 did not reattend. Of the patients who commenced treatment 18 (49%) have achieved a sustained virological response (cure) 12 weeks post treatment. 2 patients failed to achieve a cure. 17 patients are still on treatment or have not yet reached 12 weeks post treatment to assess for cure. From July to September 2017 49 patients were tested for blood borne viruses in the needle exchange. 21 were HCV antibody negative and 28 antibody positive. Of the 28 HCV antibody positive patients 15 were HCV antigen positive thus having active HCV infection and were referred for treatment. For the 3 month period at the end of the retrospective look back exercise 33 patients were tested; 25 were negative and 8HCV antibody positive but no patients had HCV antigen positivity. 5 patients were referred to the clinic following disclosure to needle exchange staff that they had previously tested HCV positive in another service or area. Conclusions: Chaotic HCV patients can be successfully treated in the community where outreach services can be offered alongside harm minimisation services. Treating active IVDUs is achievable and can have an impact on the local prevalence of HCV amongst small chaotic communities.