Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK.
National Institute for Health and Care Research (NIHR) Health Protection Research Unit (HPRU) in Blood-borne and Sexually Transmitted Infections at UCL in partnership with the UK Health Security Agency (UKHSA), Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK.
BMC Public Health. 2024 Sep 6;24(1):2427. doi: 10.1186/s12889-024-19919-3.
Direct acting antivirals (DAAs) for the Hepatitis C virus (HCV) have shifted the World Health Organisation global strategic focus to the elimination of HCV by 2030. In England, the UK Health Security Agency (UKHSA) led a national 'patient re-engagement exercise', using routine surveillance data, which was delivered through the HCV Operational Delivery Networks (ODNs) with support from National Health Service England (NHSE), to help find and support people with a positive HCV PCR test result to access treatment. We report a quantitative evaluation of outcomes of this exercise.
Individuals with a recorded positive HCV antibody or PCR result between 1996 and 2017 were identified using UKHSA's records of HCV laboratory diagnosis. Linkage with established health-care datasets helped to enhance patient identification and minimise attempts to contact deceased or previously treated individuals. From September to November 2018 each ODN was provided with a local list of diagnosed individuals. ODNs were asked to perform further data quality checks through local systems and then write to each individual's GP to inform them that the individual would be contacted by the ODN to offer confirmatory HCV PCR testing, assessment and treatment unless the GP advised otherwise. Outcomes of interest were receipt of treatment, a negative PCR result, and death. Data were collected in 2022.
Of 176,555 individuals with a positive HCV laboratory report, 55,329 individuals were included in the exercise following linkage to healthcare datasets and data reconciliation. Participants in the study had a median age of 51 years (IQR: 43, 59), 36,779 (66.5%) were males, 47,668 (86.2%) were diagnosed before 2016 and 11,148 (20.2%) lived in London. Of the study population, 7,442 (13.4%) had evidence of treatment after the re-engagement exercise commenced, 6,435 (11.6%) were reported as PCR negative (96% had no previous treatment records), 4,195 (7.6%) had prescription data indicating treatment before the exercise commenced or were reported to have been treated previously by their ODN, and 2,990 (5.4%) had died. The status of 32,802 (59.3%) people remains unknown.
A substantial number of those included had treatment recorded after the exercise commenced, however, many more remain unengaged. Evaluation of the exercise highlighted areas that could be streamlined to improve future exercises.
直接作用抗病毒药物（DAAs）对丙型肝炎病毒（HCV）的治疗已经改变了世界卫生组织到 2030 年消除 HCV 的全球战略重点。在英格兰，英国卫生安全局（UKHSA）领导了一项全国性的“患者重新参与活动”，利用常规监测数据，并通过 HCV 运营交付网络（ODN）在英格兰国民保健服务（NHS）的支持下进行，以帮助发现并支持 HCV PCR 检测结果呈阳性的人获得治疗。我们报告了对该活动结果的定量评估。
使用 UKHSA 的 HCV 实验室诊断记录，确定了 1996 年至 2017 年间有记录的 HCV 抗体或 PCR 阳性的个体。与已建立的医疗保健数据集的链接有助于增强患者识别能力，并最大限度地减少联系死亡或已治疗个体的尝试。2018 年 9 月至 11 月，每个 ODN 都收到了一份诊断个体的当地名单。ODN 被要求通过本地系统进行进一步的数据质量检查，然后写信给每个个体的全科医生，告知他们将由 ODN 联系该个体，提供 HCV PCR 检测、评估和治疗，除非全科医生另有建议。感兴趣的结果是接受治疗、PCR 结果阴性和死亡。数据于 2022 年收集。
在与医疗保健数据集和数据协调后，有 176555 名 HCV 实验室报告阳性的个体被纳入研究，其中 55329 名个体参与了该研究。研究参与者的中位年龄为 51 岁（IQR：43，59），36779 名（66.5%）为男性，47668 名（86.2%）在 2016 年之前被诊断出患有 HCV，11148 名（20.2%）居住在伦敦。在研究人群中，7442 名（13.4%）在重新参与研究开始后有治疗证据，6435 名（11.6%）报告 PCR 阴性（96%无先前治疗记录），4195 名（7.6%）有处方数据表明在研究开始前进行了治疗，或被 ODN 报告为之前接受过治疗，2990 名（5.4%）死亡。32802 名（59.3%）人的状况仍不清楚。
在参与研究的人群中，有相当数量的人在研究开始后接受了治疗，但仍有更多的人没有参与。对该活动的评估突出了可以简化的领域，以改进未来的活动。
