University College Dublin (UCD) and the Dublin Academic Health Centre (the Mater Hospital and St Vincent’s Hospital) have successfully competed for an EU health care award funded by the Third EU Health Programme, which focuses on implementing the EU health strategy. The successful HepCare Europe project will develop community partnerships for tackling the hepatitis C virus (HCV), which causes significant morbidity and mortality in Ireland and the European Union (EU). 

The HepCare Europe project, submitted by Dr Jack Lambert (Mater Hospital) and Professor Walter Cullen (UCD School of Medicine), was approved in December 2015. It was the only successful application among four made under this call from across Europe for proposals focusing on community HCV partnerships.  It is a three-year project involving populations at risk of contracting HCV in four member states, specifically in the cities of Dublin, London, Seville, and Bucharest.  HCV is a major health threat in the EU, with the complications of undiagnosed and untreated HCV leading to end-stage cirrhosis and hepatocellular carcinoma. The grant awarded to UCD, totalling approximately €1.8 million from the EU and 'in kind' contributions from government health agencies, will target 'vulnerable' populations.

HCV is deemed a disease of the socially-deprived, affecting primarily those with a history of injecting drug use.  Many of these patients are not accessing care for a number of reasons, including active drug use, alcoholism, mental health issues and homelessness.  In the last two years a medical revolution has seen the development of HCV drugs, called direct-acting antivirals, which can cure almost all those who receive an evaluation and treatment. Treatment consists of one or two pills administered orally each day for a period of often just 12 weeks. The treatment has led to cures and reversals among those with advanced HCV-related liver disease.

The HepCare Europe project will focus on providing 'integrated care', a new model for HCV treatment based on a partnership between secondary caregivers ( the Hepatology and Infectious Diseases Services at the Mater and St Vincent’s hospitals) and primary caregivers, i.e. GPs and drug treatment centres in Dublin. The project will reach out to drug users and:

• identify those not accessing care, by using rapid HCV testing;
• provide peer support (using community-based organisations) to assist those identified with HCV to access care; and
• develop nurse liaison links so that the secondary caregivers will go to the patient, rather than the patients going to the secondary caregivers.   

Patients will be tested in the community and have their hepatitis C evaluated in the community by means of a novel fibroscan test, which has replaced liver biopsy, to assess the degree of hepatic impairment caused by HCV, and community-based treatments will be piloted.  Other supports to patients will include interventions to help reduce or cease alcohol consumption, which is a significant problem among these vulnerable individuals.

In addition to outreach, the project will involve education of caregivers and patient groups about HCV and the new curative treatments available. The University of Bristol in the UK, an institution that has championed cost-effectiveness studies and evaluations of interventions in HIV and HCV, are partners in the Hepcare Europe project, and will provide cost-effectiveness evaluations of the interventions planned as part of this EU-funded project.       

John S Lambert, MD, PhD

Consultant in Infectious Diseases, Medicine and Sexual Health (GUM ), Mater, Rotunda and UCD Telephone: + 353 1 716 4530 (office)

Mobile: + 353 87 261 3778