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cialist tests, requested following referral to secondary care services for investigation and management. METHODS: All HCV testing undertaken between 2002 and 2011 were extracted from laboratory information systems of 23 participating centres in England, capturing an estimated 2/3 of all HCV testing. Duplicate records, infants under 1 year, and people tested through renal units were excluded. An algorithm based on frequency of HCV RNA testing within a defined time period was designed to identify treated patients. Findings for one centre were validated by comparison with treatment data recorded in a local clinical database managed by the Trent HCV study group. RESULTS: Between January 2002 and December 2011 267,887 PCR test results from 100,640 individuals were extracted. Of these, 78.9% (79,360) tested positive for viral RNA, indicating an active infection, 20.8% (16,538) of whom had a repeat pattern of HCV-RNA testing suggestive of treatment-monitoring. The number of individuals estimated to have started treatment annually increased significantly (p < 0.001) from 468 in 2002 to 3295 in 2009, decreasing to 3110 by 2010. An estimated 16% of HCV infected individuals with an active infection were treated within 2 years of their diagnosis, and 20% were ever treated. Approximately two-thirds (63.3; 10,468) of those treated had results consistent with a sustained virological response, including 55.3% and 67.1% of those with a genotype-one and non-one virus, respectively. Being younger, of Asian/Asian British ethnicity and infected with a non-genotype 1 virus, were independent predictors of being treated and achieving a sustained virological response. On validation, the algorithm was 95% sensitive and 93% specific in detecting treatment, and 100% sensitive and 93% specific for detecting treatment outcome. CONCLUSIONS: For the majority of individuals HCV can be cured, but it is essential that opportunities for treatment exits, and can be monitored. Laboratory testing activity, collected through a sentinel surveillance programme has enabled the first country-wide analysis of treatment and response among HCV-infected individuals. Our approach provides a sensitive, robust, and sustainable method by which service provision across England can be monitored. |
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