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Evaluating the population impact of hepatitis C direct acting antiviral treatment as prevention for people who inject drugs - EPIToPe

Lead researchers

Dictionary definition of Hepatitis C with syringe


About the project

An estimated 200,000 people in the UK have been infected with the hepatitis C virus (HCV), which is an important cause of liver disease, cancer and death. Most HCV infections in the UK are in people who inject drugs. New HCV drugs cure over 90% of patients within 12 weeks with few side-effects, but are expensive (over £20,000) and currently restricted to people with moderate or severe liver disease. 

Mathematical models suggest that HCV 'treatment as prevention', that is, treating people who inject drugs and have mild liver disease, can reduce the overall number of new HCV infections in the population, even though some people who inject drugs may also become re-infected. 

Further, if HCV treatment is increased sufficiently, HCV will eventually be 'eliminated' from the UK population. However, the findings from these models need to be tested out in patients. 

Project aim

This study aims to test whether increasing HCV direct acting antiviral treatment among people who inject drugs can contribute to the elimination of HCV in the UK, as suggested by mathematical models.

Design

In the first study, our target is to treat at least 500 people who inject drugs in Dundee/NHS Tayside over two years. This large rapid increase in HCV treatment will be delivered across multiple sites in the community, including pharmacies, addiction services, and prisons.  
As the number of HCV treatments increase in England, we will co-design a second and larger evaluation of HCV 'treatment as prevention' with regional HCV clinical services. We will use evidence gathered from our first study to show how we can scale up HCV treatment in the community, and determine whether HCV infections reduce more in sites with greater scale-up than in sites with less intense scale-up of HCV treatment.

We estimate that this will reduce chronic HCV in people who inject drugs in Dundee by two thirds, from nearly 30% to less than 10%. To measure changes in HCV in the population, we need to increase the data available from surveys of people who inject drugs in Tayside and the rest of the UK, and develop novel statistical methods that can provide unbiased estimates of whether HCV has changed over time.

We will interview services providers in Dundee/NHS Tayside to identify key barriers and facilitators that can help other sites successfully scale-up HCV treatment. We will interview patients following treatment, and link to administrative databases to assess if being cured from HCV also helps people who inject drugs stay in specialist drug treatment and recover from addiction. We also will estimate whether the increase in HCV treatment to people who inject drugs is cost-effective to the NHS.

For more detailed information about the project and study design, see the University of Bristol website.

Partners

Glasgow Caledonian University, University of Dundee, MRC Biostatistics Unit University of Cambridge, Queen Mary University of London, Health Protection Scotland, University of California San Diego, NHS Tayside, Public Health England, Scottish Drugs Forum, London School of Hygiene and Tropical Medicine

Funder

National Institute for Health Research (NIHR) Programme Grant for Applied Research (PGfAR RP-PG-0616-20008)

Project dates

2018-2023

Research team

  • Matt Hickman, Professor (University of Bristol) 
  • Sharon Hutchinson, Professor (Glasgow Caledonian University)
  • John Dillon
  • Daniela De Angelis, Dr (MRC Biostatistics Unit, University of Cambridge)
  • Lawrie Elliott
  • Graham Foster
  • David Goldberg
  • Natasha Martin, Dr (University of Bristol)
  • Ann Eriksen
  • Peter Donnan
  • Sema Mandal, Dr (Public Health England)
  • Peter Vickerman (University of Bristol)
  • William Hollingworth (University of Bristol)
  • David Liddell
  • Paul Flowers
  • Samreen Ijaz
  • Magdalena Harris