Making Hep C treatment more accessible for addictions patients in Belfast

Background
Hepatitis C is a serious health condition that can lead to liver failure, cancer and death. It is also highly prevalent in people who use drugs. Recent clinical developments mean that it is now easily identified and treated. Traditionally, within Northern Ireland treatment for hep C required patients to attend the regional liver unit, located just over 1 mile from the Belfast Addictions Service. Unfortunately, patients open to the addictions service struggled to attend the liver unit for assessment and treatment. An udit conducted in 2019-20 highlhgted that 68% of those patients did not attend the regional liver unit for assessment and treatment. 
A joint project between the Belfast Addictions Service and Regional Liver Unit has been ongoing since March 2021. The aim of this project was to improve access to treatment for those patients presenting with HCV who were reluctant to attend a hosptial clinic with hepatology.  
Methods
Patients who attend the addictions service, and who test positive for hep C, have their assessment completed by an addictions advanced nurse practitioner. Until september 2023, only patients who had chronic hep C (infection present >3 months) were offered treatment. The assessment includes blood tests, blood borne virus screening and a fibroscan to assess liver fibrosis. Patients are suported regarding their diagnosis, with an emphasis on minimising the risk of further viral transmission and contact tracing of those potentially at risk of having contracted the virus. The addictions service also offer assessment and treatment to partners/significant others if they also test positive for hep C. The completed is sent to the regional liver unit and, if deemed suitable, their treatment is sent to the addictions service to be supplied to the patient. Patients are monitored throughout and have bloods undertaken at end of treatment and at 12 weeks post treatment to determine if they have had a sustained virologic response. From october 2023 we are now able to treat those with acute hep C (infection present <3months). 
Results 
Between March 2021 and December 2023 68 patients have been treated.
58 achieved SVR and were discharged from the regional liver unity. 10 did not achieve SVR. 7 out of these 10 completed a full course of treatment., however, 3 were lost to follow-up but were negative at end of treatment. 5 were reinfected by week 12. 1 died before completing treatment and 2 did not completed a full course of treatment (statistics to be updated at time of conference).
Conclusion
By providing assessments and treatment within the addictions service, with no requirement to attend the regional liver unit, we have been able to improve the assessment and treatment pathway for this group of patients.