The diagnosis and epidemiology of hepatitis C infection in Greater Manchester.

  • William Morton

Student thesis: Phd


Background: The burden of disease from Hepatitis C virus (HCV) remains a national public health priority in England. Guidance and policy recommend targeted testing of high-risk groups. Fragmented laboratory information systems mean that it is not possible to measure progress against this goal. This thesis aimed to investigate testing activity and the epidemiology of HCV infection in Greater Manchester GM). This thesis also aimed to assess the feasibility increasing the GP knowledge of HCV using an electronic awareness raising intervention. Methods: This study created the first individual-level testing dataset covering the entire population of a large conurbation, linking testing data collected from six laboratories. Descriptive statistics were used to calculate activity and positivity rates by time, person and setting of test. Using logistic regression odds ratios were calculated to explore differences between individuals tested and positivity rates between settings and method of test. A feasibility study was used to investigate knowledge of HCV in GPs in Practices in Manchester (n=8) pre- and post-awareness raising intervention. Results: Between 2008 and 2012 163,729 individuals were tested for HCV antibodies (anti-HCV) in 2,742 different locations across GM; 8,659 individuals (5.3%) tested anti-HCV positive. Males were 79% more likely to be anti-HCV positive than females. 39.4% of individuals tested in specialist drug services were anti-HCV positive and were 11 times more likely to be anti-HCV positive than individuals tested in General Practice. Total annual testing activity increased by 37% between 2008 and 2012. The highest positivity rates were observed in specialist drug services (40-44% annual rates). 20,443 individuals (12.5% of population) were tested on more than 1 occasion with 30,445(15.7%) ‘repeat testing’ costing in excess of £200,000. The positivity rate in individuals only tested using Dried Blood Spot Testing (DBST) was almost twice the rate observed in individuals tested using either method, with 66% and 39.4%. Individuals tested only using DBST were more than three times more likely to be anti-HCV positive than those tested using either method. In the GP study, overall, testing activity increased in intervention Practices by 8.67% in the 12 months post-intervention compared to the previous 12 months; accompanied by an increase in positivity rate from 5.5% at baseline to 11.4% post-intervention. Conclusions: It proved possible to quantify the demographic and behavioural characteristics of all individuals tested in a population of 2.6 million residents between 2008 and 2012. To my knowledge, this is the first study published to adopt this approach to surveillance of anti-HCV testing. This unique study has demonstrated the value of using validated methodology for local and regional level surveillance of anti-HCV testing. GM testing activity, positivity rates and HCV epidemiology were all found to differ from those observed at national level. The approach used in the GP study identified issues with this use of study design and barriers to recruitment; which should be consider before further research is completed. It also provided preliminary evidence of change in knowledge of HCV.
Date of Award1 Aug 2018
Original languageEnglish
Awarding Institution
  • The University of Manchester
SupervisorTimothy Millar (Supervisor), Raymond Agius (Supervisor) & Arpana Verma (Supervisor)


  • hepatitis C virus
  • epidemiology
  • diagnosis
  • surveillance
  • injecting drug user
  • migrant health

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