Moving towards elimination: The use of novel surveillance systems to monitor coverage and outcomes of BBV testing in Substance Misuse Services across Wales.
PHE ePoster Library. Morgan G. Apr 10, 2019; 259607; 15575
Mr. Gareth Morgan
Mr. Gareth Morgan
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Abstract
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Abstract Background

: Routine opt-out blood borne virus testing within substance misuse services (SMS) was introduced in 2017, providing an essential framework for achieving the WHO elimination targets for hepatitis C (HCV) in Wales. There were 14,000 individuals in regular contact with Needle and Syringe Programmes in Wales and 6,500 individuals initiating treatment within SMS in 2017. However, the coverage and outcomes of blood borne virus (BBV) testing in such settings was unclear. Methodology: In 2017, the Harm Reduction Database (HRD) Wales BBV module was developed, to better monitor HCV screening, diagnosis and outcomes, and evidence trends and identify inefficiencies across Wales. The system enables real-time, on-site recording of demographic, risk factor, screening and outcome data in all substance misuse and community-based services providing BBV testing, over time. An extract of all testing data recorded in 2017-18 was analysed, representing the baseline year for data collection. Outcome: 1,606 individuals were tested for HCV (anti-HCV and/or RNA) across 44 sites in Wales in 2017-18 with results available for 1,424 (90.4%). Risk factors were reported for 1,190 (74.1%). Overall, 18.4% tested reactive for anti-HCV. Of the 53% reported having ever injected drugs, 31.3% were reactive. However, of those anti-HCV detected, only half had received a confirmatory test within period. A total of 111 individuals were confirmed HCV chronically infected, of which 99 individuals were referred into clinical treatment.

Conclusion:

To achieve the WHO HCV elimination targets, robust national surveillance systems are required. The HRD provides such a mechanism in which BBV testing of unique individuals can be monitored across all SMS and related settings over time. The baseline data indicates that considerable upscaling and targeting of HCV screening is required, as is streamlining confirmatory testing and referral to treatment. This data also pinpoints clinical system improvements and efficiencies required at a geographic level.
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