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Speaking at a seminar in Dublin on HCV, he said about 2,500 people “need to be found urgently, because they are going to show up in ambulances with advanced liver disease”.
He referenced a Health Protection Surveillance Centre (HPSC) study, which estimated that 20,000-to-30,000 people in Ireland have HCV, with up to 60 per cent undiagnosed.
Referring to a HSE target of treating 1,800 in 2018, he said: “I think we will run out of patients to see, to be perfectly honest, because they are not coming to the hospital…we have got the easy ones; the difficult ones we need to go find in the community.”
According to Dr Lambert, the hospital treatment paradigm “does not work” in respect of vulnerable populations with HCV. Often, these patients have a history of injecting-drug use and may still have substance misuse issues. He said they are “patients with problems” who “need support”.
The HSE has an annual €30 million budget for hepatitis C drugs, but “not one penny” for implementation. “As of today, I have been raising these issues for the past two years. I am on the Programme Advisory Board with the HSE; there has been no clarification on that.”
He said the drugs budget was welcome but some of those monies, or additional monies, were required for actions, including screening. The HSE says its goal is to meet or exceed the World Health Organisation (WHO) target of elimination by 2030.
According to Dr Lambert, approximately 2,000 people were treated through the HSE National Hepatitis C Treatment Programme between 2015 and 2017, but in the same period, there was a similar number of reported new infections. He said the HSE belatedly started community pilots last year but these remain on too small a scale.
Mr Killian McDonald, Associate Director with Gilead, which organised the seminar, said he expected that the HSE would have “among the most competitive prices for these drugs in Europe”.
A HSE spokesperson said that while no specific funding had been allocated to implementing the screening guideline, screening is “already carried out in many settings”.
They said the Executive is in the process of concluding the tender for the supply of direct-acting antivirals (DAAs) for 2018.
Over 600 patients have commenced treatment from 1 January-30 April, including around 30 patients in two addiction services clinics.