Background

Direct acting antivirals (DAAs) for the Hepatitis C virus (HCV) have shifted the global strategic focus to the elimination of viral hepatitis by 2030. In England there have been significant efforts to (re)test, (re)diagnose, and (re)treat those living with chronic HCV infection. Many people diagnosed with HCV before widespread use of DAAs might not be aware of their infection or remain untreated. NHS England invited the UK Health Security Agency (UKHSA) to support a national ‘patient re-engagement exercise,’ delivered through the HCV Operational Delivery Networks (ODNs), to help find and support people previously diagnosed to access treatment. We report an evaluation of the effectiveness of this strategy.

Methods

Individuals infected with HCV between 1996 and 2017 were identified using UKHSA’s HCV diagnostic records. Linkage with established health-care datasets helped enhance patient identification and minimise attempts to contact deceased or cured individuals. In September 2018 each ODN was provided with a list of local cases and asked to perform local data quality checks and then write to each individual’s GP to inform them that they would be contacted by the ODN for confirmatory HCV RNA testing, assessment and treatment unless the GP declined. ODN data were collected in 2022.

Results

Of 176,555 individuals with an HCV laboratory report, 55,329 individuals were included in the exercise. Of those included 36,779 (65.5%) were males, 17,861 (32.3%) were aged 45–54 years; 20,981 (37.9%) were diagnosed between 2011–2015, and 11,148 (20.2%) were based in London. Of the study population, 6,435 (11.6%) were reported as RNA negative (96% of whom had no previous treatment records); 4,195 (7.6%) were reported to have been treated previously by their ODN or had prescription data indicating treatment before the exercise commenced, and 2,990 (5.4%) had died; leaving 41,709 of whom 7,442 (13.4%) were treated after the re-engagement exercise commenced. The status of 32,802 (59.3%) people remains unknown.

Conclusions

While the re-engagement exercise led to the treatment of 7,442 people, many more remain un-engaged and untreated. Evaluation of the exercise highlighted a number of interventions that may help to achieve elimination of HCV. Based on similar studies re-engagement could have been enhanced though awareness campaigns highlighting the effectiveness of DAAs, better contact information for cases and reporting of outcomes by ODNs, more operational support for ODNs and better engagement of GPs.