PHE London / RCGP training online: New HCV Training in Small Bites

Emma Burke, PHE London Alcohol and Drug Programme Manager

The scale of the problem• Estimated 214,000 in the UK have Hepatitis C, 58,000 in London

• Injecting drug use continues to be the most important risk factor for infection

• 50% of people who have ever injected are expected to be infected

• Rates are on the increase in IPED injectors

• 40% of cases are estimated to be undiagnosed

• Left untackled HCV will lead to great health costs – both financial and to the individual

• There is no vaccine, but there is a cure

• Only 3% of those with the virus are estimated to be treated in any one year

• Treating people for HCV leads to a range of improved outcomes

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Estimated burden in London

3 Hepatitis C epidemiology in London

41,500 HCV RNA positive

40% previously used drugs (no longer

inject)

60,000 HCV antibody positive

20% never injected

drugs(half of whom are from South Asia)

40% current people

who inject drugs

Of which

Of whom 60%

estimated already

diagnosed

Public Health England. PHE Commissioning Template for Estimating HCV Prevalence by PCT and Numbers Eligible for Treatment. 2014.

Figure 1: Trend in anti-HCV prevalence* among people who inject drugs in England: 2003-2013

4 Hepatitis C in the UK 2014 report

*During 2009 to 2011 there was a phased change in the sample collected in the survey from an oral fluid to dried blood spot (DBS). The sensitivity of the anti-HCV tests on these two sample types is different. The sensitivity of the oral fluid test for anti-HCV is approximately 92%,(28) that on DBS samples is close to 100%. Data presented here have been adjusted for the sensitivity of the oral fluid test.

Harm reduction

5 Hepatitis C epidemiology in London

Level of direct and indirect sharing amongst PWID in London, 2004–2013 Source: Public Health England. Unlinked Anonymous Survey of People Who Inject Drugs.

London Hepatitis C Prevalence

London Boroughs

Total HCV estimates in all

populations London Boroughs

Total HCV estimates in all

populationsBarking & Dagenham DAAT 1221 Hounslow DAAT - FIO 1728Barnet DAAT 1686 Islington DAAT 2231Bexley DAAT 1178 Kensington & Chelsea DAAT 1137Brent DAAT 2089 Kingston upon Thames DAAT 865Bromley DAAT 1356 Lambeth DAAT 3605Camden DAAT 3002 Lewisham DAAT 2229City of London DAAT 69 Merton DAAT 1125Croydon DAAT 2049 Newham DAAT 2785Ealing DAAT 2183 Redbridge DAAT 1815Enfield DAAT

1620Richmond upon Thames DAAT 866

Greenwich DAAT 2111 Southwark DAAT 2921Hackney DAAT 2100 Sutton DAAT 1110Hammersmith & Fulham DAAT 1441 Tower Hamlets DAAT 2839Haringey DAAT 1729 Waltham Forest DAAT 1791Harrow DAAT 1260 Wandsworth DAAT 2179Havering DAAT 1133 Westminster DAAT 3100Hillingdon DAAT 1609    

London Hepatitis C estimates in current and former injectors

London BoroughsHCV estimates in current injectors

HCV estimates in previous injectors London Boroughs

HCV estimates in current injectors

HCV estimates in previous injectors

Barking & Dagenham 426 502 Hillingdon 397 760Barnet 250 976 Hounslow 459 739Bexley 340 603 Islington 1331 662Brent 568 913 Kensington & Chelsea 483 476Bromley 244 800 Kingston upon Thames 200 454Camden 2053 676 Lambeth 2272 972City of London 37 24 Lewisham 1113 821Croydon 503 1000 Merton 220 579Ealing 577 981 Newham 1006 943Enfield 413 853 Redbridge 250 768Greenwich 1090 731 Richmond upon Thames 150 513Hackney 1048 766 Southwark 1686 911Hammersmith & Fulham 645 579

Sutton366 515

Haringey 673 768 Tower Hamlets 1591 823Harrow 160 655 Waltham Forest 392 755Havering 273 609 Wandsworth 716 978      Westminster 2134 684

What needs to be done?• Continued and improved testing rates of drug users (18.9% of eligible

clients in the system have no record of a HCV test and 25.4% of those new to treatment)

• Retest those who have been in the system for some time who have continued risk factors

• Continued harm reduction advice

• Embedding testing in any new contracts which are under development

• Develop pathways from drug treatment into HCV treatment, if pathways are not already in place (good examples are already in place across a range of London boroughs)

• Decisions to be made about future access to new HCV drugs

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Why should we do it?• Increasing testing leads to greater awareness of the disease, enabling

people to make better decisions about their health – e.g. continued alcohol consumption

• Testing offers the opportunity to provide appropriate harm reduction advice to those who test positive which will reduce the further spread of infection

• Those who test positive have the opportunity to access treatment, potentially leading to a cure

• Curing those with HCV leads to reduced prevalence in the drug using population and reduces the further spread of infection

• Currently the prevalence of HCV is increasing

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RCGP training online: new training in short bites

Danny Morris, Expert Lead RCGP Hepatitis B and C Part 1

Developing competence through education

Certificate in Detection, Diagnosis and

Management of Hepatitis B and C in

Primary Care

(Part 1)

Online learning and f2f

NICE public health guidance

Identified a range of social and cultural barriers to hepatitis C

testing

Lack of awareness among health and social care professionals about the condition and of populations at increased risk and that and this may contribute to a low

uptake of testing

Repurposing e-learning • Commissioned by PHE and designed by the RCGP, the Course is designed to specifically meet learning needs of the range of non-clinical workers

• Hosted on the RCGP’sOnline Learning Environment (OLE)

• Free, Online, 2 hour CPD course, using a range of learning materials, opportunity to print a certificate

Development• Content is jointly badged with PHE and RCGP

• Content and structure scoped as part of the development process, around identified objectives

• Materials developed by educational and clinical professionals under the guidance of the RCGP e-learning team, including a range of substance misuse professionals and service users

• Available to anyone who would like to access the course

The audienceNon-clinical staff in primary and secondary

care including, health visitors, midwives, healthcare assistants and support workers as well as staff in sexual health, genitourinary medicine and HIV clinics

People working in drugs services including volunteers and service user advocates and peer educators

Staff in community-based criminal justice services

Prison and youth offender staff

Drug user peer, carer and recovery networks

Non- clinical or medical professionals providing health and social care services for people at increased risk of hepatitis C infection and also to people who currently or formerly inject drugs, their peers, including those in recovery

Session 2Session 2: Preventing Hepatitis C Transmission

This session will provide participants with core information on HCV transmission routes and risk prevention strategies

Session 3 Session 3: Testing and Diagnosis

This session will introduce participants to the main tests used to identify exposure to hepatitis C, whether a person is actively infected and to assess and monitor liver health

Session 4Session 4: Treatment and care

This session will summarise current hepatitis C (HCV) treatment options, factors that influence treatment effectiveness and potential future treatment opportunities

www.elearning.rcgp.org.uk/hepc

Hepatitis C: Enhancing Prevention, Testing and Care

FREE,AVAILABLE ONLINE NOW

RCGP’s Online Learning Environment

What can we do?• PHE can communicate the availability of the course to local staff / provide

you with quarterly data in numbers completing the course in your LA

Commissioners can:

• Encourage promotion of the course and ask local providers to commit to staff completing the course

Providers can:

• Include the course in the induction of new staff / appraisals of existing staff

• Ensure that all staff are aware of local testing opportunities and pathways to treatment