title: Expansion of HCV treatment access to people who have injected drugs through effective translation of research into public health policy: Scotland's experience.
abstract: Seven years have elapsed since the Scottish Government launched its Hepatitis C Action Plan - a Plan to improve services to prevent transmission of infection, particularly among people who inject drugs (PWID), identify those infected and ensure those infected receive optimal treatment. The Plan was underpinned by industrial scale funding (around £100 million, in addition to the general NHS funding, will have been invested by 2015), and a web of accountable national and local multi-disciplinary multi-agency networks responsible for the planning, development and delivery of services. Initiatives ranged from the introduction of testing in specialist drug services through finger-prick blood sampling by non-clinical staff, to the setting of government targets to ensure rapid scale-up of antiviral therapy. The Plan was informed by comprehensive national monitoring systems, indicating the extent of the problem not just in terms of numbers infected, diagnosed and treated but also the more penetrative data on the number advancing to end-stage liver disease and death, and also through compelling modelling work demonstrating the potential beneficial impact of scaling-up therapy and the mounting cost of not acting. Achievements include around 50% increase in the proportion of the infected population diagnosed (38% to 55%); a sustained near two-and-a-half fold increase in the annual number of people initiated onto therapy (470 to 1050) with more pronounced increases among PWID (300 to 840) and prisoners (20 to 140); and reversing of an upward trend in the overall number of people living with chronic infection. The Action Plan has demonstrated that a Government-backed, coordinated and invested approach can transform services and rapidly improve the lives of thousands. Cited as "an impressive example of a national strategy" by the Global Commission on Drug Policy, the Scottish Plan has also provided fundamental insights of international relevance into the management of HCV among PWID.
authors.affiliation: School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, Glasgow, UK. Electronic address: sharon.hutchinson2@nhs.net.
authors.forename: Sharon J
authors.initials: SJ
authors.lastname: Hutchinson
authors.affiliation: Ninewells Hospital and Medical School, Dundee, UK.
authors.forename: John F
authors.initials: JF
authors.lastname: Dillon
authors.affiliation: Gartnavel General Hospital, Glasgow, UK.
authors.forename: Ray
authors.initials: R
authors.lastname: Fox
authors.affiliation: School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, Glasgow, UK.
authors.forename: Scott A
authors.initials: SA
authors.lastname: McDonald
authors.affiliation: School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, Glasgow, UK.
authors.forename: Hamish A
authors.initials: HA
authors.lastname: Innes
authors.affiliation: School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, Glasgow, UK.
authors.forename: Amanda
authors.initials: A
authors.lastname: Weir
authors.affiliation: Health Protection Scotland, Glasgow, UK.
authors.forename: Allan
authors.initials: A
authors.lastname: McLeod
authors.affiliation: School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, Glasgow, UK.
authors.forename: Esther J
authors.initials: EJ
authors.lastname: Aspinall
authors.affiliation: Health Protection Scotland, Glasgow, UK.
authors.forename: Norah E
authors.initials: NE
authors.lastname: Palmateer
authors.affiliation: Institute for Applied Social and Health Research, University of the West of Scotland, Paisley, UK.
authors.forename: Avril
authors.initials: A
authors.lastname: Taylor
authors.affiliation: Institute for Applied Social and Health Research, University of the West of Scotland, Paisley, UK.
authors.forename: Alison
authors.initials: A
authors.lastname: Munro
authors.affiliation: School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, Glasgow, UK.
authors.forename: Heather
authors.initials: H
authors.lastname: Valerio
authors.affiliation: Scottish Government, Edinburgh, UK.
authors.forename: Gareth
authors.initials: G
authors.lastname: Brown
authors.affiliation: School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, Glasgow, UK.
authors.forename: David J
authors.initials: DJ
authors.lastname: Goldberg
mesh_terms: D035843:Biomedical Research; D006291:Health Policy / Q000331:legislation & jurisprudence*; D006297:Health Services Accessibility / Q000331:legislation & jurisprudence*; D006526:Hepatitis C / Q000188:drug therapy / Q000209:etiology / Q000628:therapy*; D006801:Humans; D012606:Scotland; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000628:therapy*
keywords: HCV; PWID; Public health policy