Table 2 Epidemiology post 2008

[13]

2014 Drummond et al

National Multi-site Prisons (15)

Prisoners (817; m = 772; Hx IDU = 26%)

2011

Observational Cross-sectional prevalence study including self- administered drug and risk questionnaire

Anti-HCV prevalence = 13%

Significant risk factors (p < 0.05):

• Hx of IDU and sharing drug taking equipment

• Older age

• female gender

• prison tattoo

[57]

2014 Galander

Dublin Single site Prison

Male prisoners on MMT (119)

October 2011

Patient Survey

Retrospective chart review

Anti-HCV = 38%

• Anti-HCV negative = 33%

• Unknown HCV status = 29%

• Number anti-HCV on treatment = 0

[62]

2014 McCormick et al.

Dublin Single site Drug treatment clinic

Drug Users fibroscaned attending MMT (84; m = 66)

Letter – reporting on five year follow up study

Anti-HCV = 74.4%

HCV-RNA = 58.3%,

Heavy alcohol use = 37%

Five-year mortality = 15% (Liver related deaths = 6; probable liver related = 1; drug overdose = 5; laryngeal carcinoma = 1)

• 5/6 patients who died of liver disease, were HCV RNA-positive with heavy alcohol use

• Mean liver stiffness values were higher in patients who died compared with survivors (28.5 kPa ±7.9 vs. 9.0 ± 1.5, P = 0.0045)

• Mean liver stiffness values were higher in patients with liver-related death compared with survivors (50.6 ± 11.2, P < 0.0002).

• 12 patients with fibroscan score > 14 kPa, (7 died; 4 developed liver failure)

• Fibroscan scores were higher in patients with a history of heavy alcohol use (23 ± 4.5 vs. 5.6 ± 0.3, P < 0.0001).

• A single liver stiffness measurement was highly predictive of liver-related mortality

[58]

Ryan and Ryan 2014

Limerick Single site Community drug treatment centre

Drug users on MMT(174)

2010–2012

Retrospective prevalence study (log review)

Anti-HCV 2010 = 6%

Anti-HCV 2011 = 13%

Anti-HCV 2012 = 24%

On average 58 HCV tests ordered annually

2014 Horan

Cork Single site Community drug treatment Centre

Drug users on MMT (30)

2-week periods ×2 separated by a few months in 2014

Chart audit of HCV screening measuring the effect of chart labelling (star)

• No evidence of HCV screen = 50%

• Follow up audit = 72.7% had evidence of documentation of an HCV screen

Burke M. Audit of HCV screening using retrospective patient records [Unpublished audit]

Dublin Multi-site Community drug treatment centres (23)

PWUD - Opioid users on MMT (358; 40% of eligible population; PWID = 79%)

2015

Audit of HCV screening using retrospective patient records

Anti-HCV = 66%

HCV RNA = 65%

• Screening uptake = 95%

• RNA tested = 208

[63]

2016 McCombe et al.

Dublin Multi-site GP (16)

PWUD attending primary care for MMT (106)

2015

Commentary (letter) Secondary analysis of data collected during a feasibility study of an alcohol brief intervention for patients attending primary care for MMT

Anti-HCV = 51%

• HCV tested = 99%

• Self-reported HCV treatment = 19%

Problem alcohol use = 45%

• 37% were anti-HCV and had problem alcohol use

Patients’ knowledge of HCV care can best be optimised through community-based approaches to HCV treatment

[59]

Keegan et al. 2017

Dublin Single site Community drug treatment centre

PWUD attending for MMT (228; m = 168)

January 2015

Cross sectional prevalence study (retrospective chart review) with associated risk factors

Anti-HCV = 63.6% with no significant

gender difference (p = 0.717)

Significant risk factors for HCV infection (p < 0.05):

• age

• age of first drug use

• age of first injection

• type of first drug used

• early age of MMT entry

Those with no IDU had decreased odds of being HCV positive by 91.1%.

(Burke M: Audit of HCV screening using retrospective patient records, unpublished)

Dublin Multi-site Community drug treatment centre (23)

PWUD on MMT (282; PWID = 79%)

2016

Audit; Retrospective chart review

Anti-HCV = 79%

HCV RNA = 65%

[60]

2017 Murtagh et al.

Dublin GPs Multi-site (n = 14)

Drug users on OST (133; m = 81)

2017

Cross-sectional Prevalence

Anti-HCV = 77.2%

• 92.5% had been screened for HCV

• 14 (14.7%) patients previously diagnosed with HCV had ever initiated HCV treatment

[9]

2017 Garvey et al

National

General population > 18 years (3795; m = 1860)

2014–2016

Anonymised and randomised laboratory analysis of residual serum samples at the NVRL

Anti-HCV = 1.4%

HCV RNA = 0.57% (95% CI: 0.40–0.81%)

• higher in men (0.91%; 95% CI: 0.61–1.4%)

• east of the country (1.4%; 95%CI: 0.99–2.0%)

• 0–39 years (1.1% (95% CI: 0.59–2.0%)

• 40–49 years (1.1% (95% CI: 0.64–1.9%)

• Men born between 1965 and 1984 from the east of the country have the highest rate of chronic HCV infection.

[61]

2014 O’Connor et al

Dublin Single site Hospital ED

PWID (146; m = 101)

January – March 2010

Prospective observational study

Anti-HCV = 74%

• High levels of comorbid illness

[19]

2016 Carew et al.

National

PWID registered on NDTRS (14,320; m = 10,597)

1991–2014

Mathematical modelling

Number of PWID with HCV infection = 12,423 (95% CI 10,799-13,161)

Number of PWID with chronic HCV infection = 9317 (95% CI 8022-9996)

• Estimated number of new infections peaked in 1997.

• By 2014, more than one quarter (27.0%) of PWIDs with chronic HCV infection were estimated to have been infected for 0–10 years, 43.4% for 11–20 years, 22.8% for 21–30 years and 6.7% for over 30 years.