Evaluation of a general practice based hepatitis C virus screening intervention.
BACKGROUND
In 2003 an estimated 37,500 of Scotland's population was chronically infected with HCV; 44% were undiagnosed former injecting drug users (IDU)--a priority group for antiviral therapy.


OBJECTIVE
To evaluate a hepatitis C virus (HCV) screening intervention.


METHODS
Outcome measures among two similar General Practice populations in an area of high HCV and drug use prevalence, one of which was exposed to an HCV screening intervention, were compared.


METHODS
Thirty to fifty four year old attendees of the intervention practice were opportunistically offered testing and counselling, where clinically appropriate, (November 2003-April 2004).


RESULTS
HCV test uptake, case detection, referral and treatment administration rates.


RESULTS
Of 584 eligible attendees, 421 (72%) were offered and 117 (28%) accepted testing in the intervention practice; no testing was undertaken in the comparison practice. Prevalences of HCV antibody were 13% (15/117), 75% (3/4) and 91% (10/11) among all tested persons, current IDUs and former IDUs respectively. For 4/15 (27%) evidence of binge drinking following the receipt of their positive result, was available. Of the 11 referred to specialist care because they were HCV RNA positive, nine attended at least one appointment. Two received treatment: one had achieved a sustained viral response as of February 2008.


CONCLUSIONS
While non targeted HCV screening in the general practice setting can detect infected former IDU, the low diagnostic yield among non IDUs limited the effectiveness of the intervention. A more targeted approach for identifying former IDUs is recommended. Additionally, the low uptake of treatment among chronically infected persons four years after diagnosis demonstrates the difficulties in clinically managing such individuals. Strategies, including support for those with a history of problem alcohol use, to improve treatment uptake are required.
Anderson
E M
EM
Public Health Protection Unit, NHS Greater Glasgow and Clyde, Glasgow, UK. eleanor.anderson@ggc.scot.nhs.uk
Mandeville
R P
RP
Hutchinson
S J
SJ
Cameron
S O
SO
Mills
P R
PR
Fox
R
R
Ahmed
S
S
Taylor
A
A
Spence
E
E
Goldberg
D J
DJ
D000328:Adult; D000367:Age Factors; D015331:Cohort Studies; D005194:Family Practice; D005260:Female; D006526:Hepatitis C / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D015995:Prevalence; D015397:Program Evaluation; D012189:Retrospective Studies; D012307:Risk Factors; D012606:Scotland; D012959:Socioeconomic Factors; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000523:psychology