Dr Ryan Buchanan

Better care for Hepatitis C patients – but are we still missing 200 people?

I’m Ryan Buchanan, a specialist registrar doctor in liver disease and a PhD student. My research is paid for by something called the National Institute for Health Research (it’s the research arm of the NHS and here in our region I work for the bit of it called CLAHRC Wessex).

Just over a year ago I wrote an article describing how I was part of a project to improve the care for patients living with Hepatitis C on the Isle of Wight.

Hepatitis C is a pretty devastating virus that lives in the liver, and if untreated it can sometimes cause serious and potentially life-threatening damage over many years. It’s normally spread by blood to blood contact, so sharing needles or in some cases blood transfusions abroad.

My mission here on the island has two main goals; firstly to find people living in the community who don’t know they have Hepatitis C (we estimated there may be up to 200 such cases), and  secondly to make sure those people get fast and efficient care in their local community to hopefully eradicate the virus.

The project has now been running for 18 months, we have won two national awards. Most recently our work was was recognised at the Isle of Wight NHS awards where we picked up the prize for excellence in research.

Pharmacy training HEP c IOW
Pharmacists training to provide testing for Hepatitis C
IOW research award
The Hepatitis C care team picking up an award for excellence in research from the IOW NHS trust

Our Hepatitis C awareness campaign has increased testing across the Island and a we have carried out more than 150 tests in local pharmacies. Through that along we have found 10 previously undiagnosed cases of Hepatitis C.

Thirteen of our patients with Hepatitis C related liver scarring (also known as cirrhosis) have begun treatment and last week the first patient to complete treatment was declared cured of the virus.

So progress is being made and in many respects the project has been a success, however, when asking ‘how good is it?’ the project needs to be considered within the context of the disease and the Island community.  Most importantly we need a better idea of the true number of missing cases of Hepatitis C because if there are truly 200 missing cases then, even with the success of the pharmacy scheme, we have a long way to go.

We estimated the number of missing cases on the Island by doing some simple arithmetic. We identified all the known cases of Hepatitis C who had been diagnosed over the last 13 years and took that way from the Health Protection Agency (HPA) estimate for the number of cases thought to be on the Island. Even assuming we missed a few ‘known cases’ the answer left 200 unaccounted for, which, assuming the HPA estimate is accurate, are hidden within the Island community.

The next part of our project aims to gain a better understanding of how many cases of Hepatitis C are truly missing on the Isle of Wight and establish how best to reach them with testing and treatment services.

Across the UK 90% of new diagnoses of Hepatitis C are in people who currently or have previously injected drugs – So for us the challenge is to make sure we reach enough people this community on the Island.

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