The Hepatitis C Awareness Through to Treatment (HepCATT) study: Improving the cascade of care for hepatitis C virus-infected people who inject drugs in England

Background and Aims Previous studies have shown low rates of diagnosis and treatment of hepatitis C virus (HCV) infection in people who inject drugs (PWID). Our aims were to test the effect of a complex intervention (“HepCATT”) in drug and alcohol clinics – primarily, on engagement of HCV‐positive PWID with therapy, and, secondarily, on testing for HCV, referral to hepatology services, and start of HCV treatment. Design and setting A non‐randomised pilot study in three specialist addiction clinics in England comparing an intervention year (starting between September 2015 and February 2016) with a baseline year (2014), together with three control clinics. Participants Analysis included a total of 5,225 PWID, of whom 1,055 were identified as HCV‐positive. Intervention The intervention comprised the placement of a half‐time facilitator in each clinic for 12 months with the brief to increase diagnosis of HCV infection within clients at those services and the engage diagnosed individuals with an appropriate care pathway. The facilitator undertook various activities, which could include training of key workers, direct interaction with clients, streamlining and support for hepatology appointments, and introduction of dried blood‐spot testing. Measurements For each clinic and period, we obtained the total number of clients and, as relevant, their status as PWID, tested for HCV, known HCV‐positive, engaged with HCV therapy, or treated. Findings Compared with baseline, there was strong evidence that engagement with HCV therapy in the intervention year increased (p<0.001) more in the HepCATT centres than controls, up +31 percentage points (95% CI 19 to 43) vs ‐12 (CI ‐31 to +6) and odds ratio 9.99 (CI 4.42–22.6) vs 0.35 (CI 0.08–1.56). HepCATT centres also had greater increases in HCV testing (OR 3.06 vs 0.78, p<0.001), referral to hepatology (OR 9.60 vs 0.56, p<0.001) and treatment initiation (OR 9.5 vs 0.74, p<0.001). Conclusions Introducing a half‐time facilitator into drug and alcohol clinics in England increased engagement of HCV‐positive people who inject drugs with hepatitis C virus care pathways, with increased uptake also of testing, referral to hepatology and initiation of treatment.