Professor John Dillon (2021)
You really need to make the steps smaller and simpler. Each step of the hepatitis C care cascade you lose people. People are too frightened, they can’t afford the bus fare, they have other commitments or can’t afford to be away from somewhere for the time.… And as that starts to be successful, we started to lift our eyes and think about how we can make this a place where there is no longer hepatitis C. Where it was just something that was a historical footnote in medical textbooks. That's a world I wanted to see and that's what drove my team and I to think about the ways we could do that.
Professor John Dillon is Professor of Hepatology and Gastroenterology and a principle investigator, in the Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, based at Ninewells hospital, Dundee. He is also an Honorary Consultant with NHS Tayside, leading a busy general hepatology service and a research group. He is Vice President for Hepatology of the British Society of Gastroenterology and was President of the Scottish Society of Gastroenterology. He graduated in medicine from St Georges Hospital Medical School, University of London, and subsequently gained his MD based on research performed in the University of Edinburgh while a lecturer in Gastroenterology and Hepatology.
His award winning research interests include; new pathways of care for patients with abnormal LFTs, for people infected with HCV, new therapies for HCV infection, as well as novel diagnostics and treatments for NAFLD. His research activities stretch from the bench to the bedside and out into the community. He has published over 200 peer reviewed original research papers. The impact of his research work includes the Tayside region of Scotland reaching WHO HCV elimination targets in 2020. He chairs the Scottish HCV Action Plan Clinical Leads Group, is a member of the Scottish Government’s Ministerial advisory board for Blood Borne viruses and sexual health. He previously led the development group of the UK consensus guidelines for HCV and has chaired the Hepatitis C SIGN guideline development group. He Chaired the SHAAP group that produced the recent “Alcohol-related liver disease: guidance for good practice” documents. He has delivered over 200 international lectures on liver disease.
Under Dr. Dillon’s leadership, a clinical team from the National Health Service (NHS) Tayside partnered with a research team from the University of Dundee to design a regional hepatitis C prevention, testing, and treatment program that was centered on meeting people where they are, particularly people who inject drugs who often face a history of stigma and poor access to care. Dr. Dillon’s work began with running a needle exchange program but soon evolved to provide HCV testing and treatment services through many existing services, including pharmacies delivering opioid substitution therapy, prisons, and drug treatment centers. Through it all, Dr. Dillon pushed to simplify the testing and treatment pathway by removing barriers to patients, such as making the setting of care inviting and welcoming, co-locating testing and treatment with other services, and reducing the number of visits.
One of the simplified pathways introduced by Dr. Dillon is described in the SuperDOT-C study. In this study, community pharmacists used dried blood spot testing to screen people who engaged in an opioid substitution therapy program. The pharmacists diagnosed their hepatitis C infection, assessed them for treatment, and then ultimately delivered the course of direct-acting antiviral drugs (DAAs). In this pathway, all care was delivered from the pharmacy and the pharmacy team was integrated into the multi-disciplinary team taking care of the patient’s holistic needs. This study was proposed as one of the six most influential papers in the topic area for 2020 by Nature Reviews.
To date, the program in Tayside has treated almost 2,000 people living with hepatitis C, more than 90% of the estimated number of people living with HCV. This reduction in prevalence met both the WHO and Scottish Government targets for HCV elimination ahead of schedule.