Increasing uptake of hepatitis C virus infection case-finding, testing, and treatment in primary care: evaluation of the HepCATT (Hepatitis C Assessment Through to Treatment) trial

Abstract

BackgroundHepatitis C virus (HCV) infection is a key cause of liver disease but can be cured in more than 95% of patients. Around 70 000 people in England may have undiagnosed HCV infection and many more will not have been treated. Interventions to increase case-finding in primary care are likely to be cost-effective; however, evidence of effective interventions is lacking. The Hepatitis C Assessment Through to Treatment (HepCATT) trial assessed whether a complex intervention in primary care could increase case-finding, testing, and treatment of HCV.AimTo investigate the feasibility and acceptability of the HepCATT intervention.Design and settingA qualitative study with primary care practice staff from practices in the south west of England taking part in the HepCATT trial.MethodSemi-structured interviews were carried out with GPs, nurses, and practice staff to ascertain their views of the HepCATT intervention at least 1 month after implementing the intervention in their practice. Normalisation process theory, which outlines the social processes involved in intervention implementation, informed thematic data analysis.ResultsParticipants appreciated the HepCATT intervention for increasing knowledge and awareness of HCV. Although some initial technical difficulties were reported, participants saw the benefits of using the audit tool to systematically identify patients with HCV infection risk factors and found it straightforward to use. Participants valued the opportunity to discuss HCV testing with patients, especially those who may not have been previously aware of HCV risk. Future implementation should consider fully integrating software systems and additional resources to screen patient lists and conduct tests.ConclusionWhen supported by a complex intervention, primary care can play a crucial role in identifying and caring for patients with HCV infection, to help stem the HCV epidemic, and prevent HCV-related illness.

Cost effectiveness of an intervention to increase uptake of hepatitis C virus testing and treatment (HepCATT): cluster randomised controlled trial in primary care

“…The nested qualitative study suggests that practices are willing to engage with our intervention 16. Our intervention was highly cost effective but increased HCV testing by only a modest amount—lower than expected from our original sample size calculation.…”

“…HepCATT (Hepatitis C Assessment Through to Treatment Trial) was a pragmatic, two armed, practice level, cluster randomised controlled trial carried out in general practices in the South West of England with both qualitative and economic evaluation components 15. The nested qualitative study is reported separately 16…”

Provider‐related barriers and enablers to the provision of hepatitis C treatment by general practitioners in Scotland: A behaviour change analysis

“…Expanding the role of GPs in relation to HCV treatment aims to capitalize on interventions designed to systematically identify and test individuals in primary care, closing gaps in the care cascade. For example, the HepCATT study in England demonstrated the effectiveness of a low‐cost intervention (which included key education/training elements) to increase HCV diagnoses in general practice 25,26 . However, the model relied on subsequent engagement with specialist services to translate this into improved treatment numbers.…”

Exploring the conduct and reporting of qualitative research in trials using mixed methods

“…These sites may have different settings, care pathways, processes, people who are involved or have more heterogeneous or different patient populations. These factors can influence how an intervention and the trial is perceived and implemented (99,110,192,193). Therefore, further qualitative research may be warranted to explore these factors.…”

“…The use of theoretical frameworks with QRT can be beneficial and used to help inform the design, conduct and interpretation of QRT (192,(233)(234)(235). Theories as defined by…”