Determinants of successful chronic hepatitis C case finding among patients receiving opioid maintenance treatment in a primary care setting.
OBJECTIVE
Injection drug users are at high risk for chronic hepatitis C virus infection (CHC). Opioid maintenance treatment (OMT) offers a unique opportunity to screen for CHC. This study proposed the hypothesis that a general practitioner (GP) with special interest in addiction medicine can achieve CHC screening rates comparable to specialized centres and aimed to investigate determinants for a successful CHC case finding in a primary care setting.


METHODS
Retrospective medical record analysis of 387 patients who received opioid maintenance therapy between 1 January 2002 and 31 May 2008 in a general practice in Zurich, Switzerland.


METHODS
Successful CHC assessment was defined as performance of hepatitis C virus (HCV) serology with consecutive polymerase chain reaction-based RNA and genotype recordings. The association between screening success and patient characteristics was assessed using multiple logistic regression. findings: Median (interquartile range) age and duration of OMT of the 387 (268 males) patients was 38.5 (33.6-44.5) years and 34 (11.3-68.0) months, respectively. Fourteen patients (3.6%) denied HCV testing and informed consent about screening was missing in 13 patients (3.4%). In 327 of 360 patients (90.8%) with informed consent a successful CHC assessment has been performed. Screening for HCV antibodies was positive in 136 cases (41.6%) and in 86 of them (63.2%) a CHC was present. The duration of OMT was an independent determinant of a successful CHC assessment.


CONCLUSIONS
In addicted patients a high CHC assessment rate in a primary care setting in Switzerland is feasible and opioid substitution provides an optimal framework.
Senn
Oliver
O
Institute of General Practice and Health Services Research, University of Zurich, Rämistrasse, Zurich, Switzerland.
Seidenberg
André
A
Rosemann
Thomas
T
D000328:Adult; D000701:Analgesics, Opioid; D002047:Buprenorphine / Q000627:therapeutic use; D005194:Family Practice; D005260:Female; D016174:Hepacivirus / Q000276:immunology*; D019698:Hepatitis C, Chronic / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use; D009020:Morphine / Q000627:therapeutic use; D009294:Narcotics / Q000627:therapeutic use*; D016133:Polymerase Chain Reaction; D012044:Regression Analysis; D012189:Retrospective Studies; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000534:rehabilitation*; D013557:Switzerland
D000701:Analgesics, Opioid; D009294:Narcotics; D002047:Buprenorphine; D009020:Morphine; D008691:Methadone