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: A half-time facilitator placed in each clinic 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 to baseline, there is 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 PWID with HCV care pathways, with increased uptake also of testing, referral to hepatology and initiation of treatment