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Hepatitis C Good Practice Roadshow

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Hepatitis C Good Practice Roadshow Hepatitis C Good Practice Roadshow Tuesday 24 November 2015 Brighton Welcome and introduction and setting the scene Charles Gore, Chief Executive, The Hepatitis C Trust Tuesday 24 November 2015 Brighton Local epidemiology Paul Crook, Consultant Epidemiologist, Public Health England Tuesday 24 November 2015 Brighton Hepatitis C epidemiology in the South East Dr Paul Crook Consultant Epidemiologist Field Epidemiology Services South East & London National Infection Service, Public Health England Rate of new hepatitis C reports Rate of laboratory confirmed diagnoses of hepatitis C per 100,000 residents, by Region, 2014 Source: Laboratory reports PHE 50.0 2014 rate 2014 number 4,500 45.0 4,000 40.0 3,500 35.0 3,000 30.0 2,500 25.0 2,000 Number Rate/100,000 20.0 1,500 15.0 10.0 1,000 5.0 500 45.2 28.4 20.9 17.7 15.3 13.3 12.0 11.6 11.4 0.0 0 London Yorkshire North West South West South East East East of North East West and Midlands England Midlands Humber PHE Centre 5 Hepatitis C epidemiology in the South East Risk factors for hepatitis C People who have ever injected drugs People who received a blood transfusion before 1991 or blood products before 1986 People born or brought up in a country with an intermediate or high prevalence (2% or greater) of chronic hepatitis C. Babies born to mothers infected with hepatitis C Prisoners, including young offenders Looked-after children and young people, including those living in care homes People living in hostels for the homeless or sleeping on the streets HIV-positive men who have sex with men Close contacts of someone known to be chronically infected with hepatitis C 6 Hepatitis C epidemiology in the South East Men who have sex with men (MSM) with hepatitis C 75% - history of non-injecting recreational drug use 33% - injecting drug use 86% - sex under influence of drugs High proportions – unprotected sex Source: Public Health England. The Enhanced Surveillance of Newly Acquired Hepatitis C infection in men who have sex with men (SNAHC). 7 Hepatitis C epidemiology in the South East Ethnicity Proportion testing positive for anti-HCV by ethnicity in sentinel laboratories in the South East, 2010–2014. Source: Public Health England. Sentinel Surveillance of Blood-borne Virus Testing 3.0% 2.5% 2.0% 1.5% % Positive % 1.0% 0.5% 1.9% 1.0% 2.5% 1.5% 2.5% 0.0% Asian Black White Other Unknown Ethnic group 8 Hepatitis C epidemiology in the South East Age and sex Age-group and gender of individuals testing positive for anti-HCV in sentinel laboratories in the South East, 2014 Source: Public Health England. Sentinel Surveillance of Blood-borne Virus Testing Male Female 65+ 55-64 ) 45-54 35-44 25-34 Age Group (years Group Age 15-24 1-14 500 400 300 200 100 0 100 200 Number 9 Hepatitis C epidemiology in the South East Estimated burden in the South East 41% current people Of whom who inject drugs 60% 17,500 HCV estimated antibody already positive diagnosed 29% previously used Of which drugs (no longer inject) 12,000 HCV RNA 30% positive never injected drugs (1/3 of whom are Public Health England. PHE Commissioning Template for Estimating HCV from South Asia) Prevalence by PCT and Numbers Eligible for Treatment. 2014. 10 Hepatitis C epidemiology in the South East Crude hospital admission rate for hepatitis C related end-stage liver disease and hepatocellular carcinoma, persons per 100,000 population by South East local authority, 2012/3 (Source PHE Liver Disease Profiles). 12.0 10.0 8.0 6.0 Admission rate / 100,000rate 4.0 1.4 2.0 6.2 4.5 4.4 3.8 3.5 3.3 2.8 2.4 2.2 2.2 .0 Local authority (Medway, Bracknell Forest, West Berkshire, Reading, Slough, Windsor & Maidenhead, Portsmouth and Isle of Wight values suppressed for disclosure control due to small count) 11 Hepatitis C epidemiology in the South East Hospital admissions in South East residents (note different scales) Diagnosis of hepatitis C Diagnosis of HCV related Diagnosis of HCV related (2008–2014) ESLD (end stage liver HCC (hepatocellular disease), 2008–2014 carcinoma), 2008–2014 250 1400 90 83 1152 80 1200 200 197 70 1000 60 150 800 869 50 51 128 40 Number 600 Number Number 100 30 400 50 20 200 10 0 0 0 2008 2009 2010 2011 2012 2013 2014 2008 2009 2010 2011 2012 2013 2014 2008 2009 2010 2011 2012 2013 2014 Year Year Year Source: Hospital Episode Statistics (HES), Health and Social Care Information Centre 12 Hepatitis C epidemiology in the South East Transplants 120 First registrations with post-hepatitis C 100 103 cirrhosis as primary, secondary or tertiary 80 indication for transplant, South East 60 residents, 1999–2014 Number 40 49 20 0 2000-2004 2005-2009 2010-2014 Year group Source: NHS Blood and Transplant. 2013. These figures are based on registry data as at 2nd July 2014. New national registration criteria for selecting adult patients for elective liver transplantation were introduced in September 2007 (http://odt.nhs.uk/pdf/liver_selection_policy.pdf) Data source: NHS Blood and Transplant UK Transplant Registry 13 Hepatitis C epidemiology in the South East Mortality Map showing the rate of deaths from ESLD or HCC in individuals with HCV mentioned on their death certificate by PHE Centre (2008– 14) Source: Office of National Statistics. Death certification 14 Hepatitis C epidemiology in the South East Mortality Crude mortality rate from hepatitis C related end-stage liver disease/hepatocellular carcinoma in persons less than 75 years per 100,000 population by South East local authority, 2011-13 (Source PHE Liver Disease Profiles). 3.50 3.00 2.50 2.00 1.50 1.00 .50 .00 Under 75mortality rate100,000 / Local authority 15 Hepatitis C epidemiology in the South East Trends in testing Number of individuals tested and the proportion testing positive for anti- HCV in sentinel laboratories in the South East, 2009 to 2014 Please note that the numbers relate to those tested in the sentinel laboratories, and do not represent all tests across the South East. Source: Public Health England. Sentinel Surveillance of Blood-borne Virus Testing 25,000 3.5 3.0 20,000 19,132 2.5 15,000 16,027 2.0 1.5 Number 10,000 % positive % 1.0 5,000 0.5 2.3 2.9 2.8 2.2 2.3 0 0.0 2010 2011 2012 2013 2014 Year 16 Hepatitis C epidemiology in the South East Service of testing Number of individuals tested for anti-HCV and the proportion testing positive by service type in sentinel laboratories in the South East, 2009 to 2014. Please note that the numbers relate to those tested in the sentinel laboratories and do not represent all tests across London. Source: Public Health England. Sentinel Surveillance of Blood-borne Virus Testing 25,000 30.0 25.5 Number tested % positive 25.0 20,000 20.0 15,000 16.0 15.0 10.1 10,000 9.0 10.0 Positive % Number tested(bars)Number 5,000 2.7 2.6 2.3 2.7 2.4 2.7 5.0 0.2 0.0 0.3 0.5 0.7 0.8 0.4 0 0.0 Renal Antenatal Pharmacy Paediatrics Unspecified GUM Clinics GUM Obs & GynaeObs Specialist Liver Specialist Prison ServicesPrison Other Ward Type WardOther IVF/fertility services IVF/fertility General Practitioner General Occupational Health Occupational HIV specialist services HIV specialist General Med/Surg Depts Med/Surg General Accident and Emergency Accident and Drug Dependency Services Dependency Drug Primary Services Secondary Services 17 Hepatitis C epidemiology in the South East Testing of people who inject drugs (PWID) Hepatitis C test uptake among PWID and their awareness of infection in the South East, 2004–2014 Source: Public Health England. Unlinked Anonymous Survey of People Who Inject Drugs. 100% 90% 90% 80% 66% 70% 60% 50% 56% 50% 40% Percentage HCV Voluntary Confidential Test 30% (VCT) Uptake 20% Proportion aware of HCV infection 10% 0% 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Year 18 Hepatitis C epidemiology in the South East Testing in drug treatment services Proportion of clients of drug treatment services eligible and received a hepatitis C test by local authority in the South East 2013/4 Source: National Drug Evidence Centre University of Manchester on behalf of Public Health England. National Drug Treatment Monitoring System. 100% Proportion of clients eligible and received a hepatits C test England (80%) 90% 80% 70% 60% 50% Percent 40% 30% 20% 10% 83% 95% 94% 93% 92% 92% 88% 88% 88% 87% 86% 86% 85% 85% 83% 80% 72% 67% 0% 19 Hepatitis C epidemiology in the South East % of receptions with a hepatitis C test Prison performed within 31 Testing in prisons days of reception Aylesbury (HM/YOI) 0% Hepatitis C testing in prisons in Blantyre House (HMP) 0% the South East, NHS Trust Bronzefield (HMP) 16% Development Authority, Prison Bullingdon (HMP) 5% Coldingley (HMP) 36% Health Reporting System, 2013 Cookham Wood (HMP) 0% Source: NHS Quality Observatory. Prison Health Downview (HMP) 35% Performance & Quality Indicators (PHPQIs). East Sutton Park (HMP/YOI) 66% Elmley (HMP/YOI) 5% Ford (HMP) 7% Grendon (HMP) 9% High Down (HMP) 2% Huntercombe (HMYOI) 9% Isle of Wight (HMP) 3% Lewes (HMP/YOI) 8% Maidstone (HMP) 18% Reading (HMP/YOI) 12% Rochester (HMP/YOI) 26% Send (HMP) 23% Spring Hill (HMP) 1% Standford Hill (HMP) 5% Swaleside (HMP) 11% Winchester (HMP) 2% South East 7.3% England 7.9% 20 Hepatitis C epidemiology in the South East Harm reduction Level of direct and indirect sharing amongst PWID in the South East, 2004–2014 Source: Public Health England.
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