Abstract
Scotland has committed to eradicating Hepatitis C (HCV) by 2030. In order to achieve this goal, rates of HCV diagnosis, treatment and cure need to be escalated. Given that those most at risk of HCV infection e.g. people who inject drugs (PWID) often belong to a marginalised part of society and find it difficult to engage in conventional hospital based medical care, it is important that diagnosis and treatment initiatives are accessible for all.The aim of the thesis was to determine the efficacy and cost-effectiveness of HCV diagnosis and treatment pathways in Tayside. A scoping review (Chapter 2) assessed models of care (MoCs) utilising direct acting antivirals (DAAs) to identify the key concepts underpinning their success, especially in underserved populations. Findings from a systematic review and meta-analysis (Chapter 3) demonstrated the feasibility of decentralising care and providing local services with reach into communities of people infected with HCV.
The study presented in Chapter 4 analysed a number of specialised pathways for testing and treatment of HCV amongst the most at-risk populations. Diagnostic pathways targeting populations most at risk of HCV are more effective at yielding new HCV diagnoses than standard pathways. A subsequent cost-effectiveness evaluation of the pathways (Chapter 5) found that testing in injecting equipment provision (IEPS) and in primary care were most cost effective.
These tailored diagnostic pathways will also resolve some of the health inequalities around drug use and provide methods of ensuring entry to treatment. We believe using targeted testing will find the majority of our undiagnosed population. This will help us to direct resources and achieve our aim of elimination by 2030.
| Date of Award | 2023 |
|---|---|
| Original language | English |
| Awarding Institution |
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| Supervisor | John Dillon (Supervisor) & Michael Miller (Supervisor) |