title: Identifying former injecting drug users infected with hepatitis C: an evaluation of a general practice-based case-finding intervention.
abstract: BACKGROUND
  In Scotland, a general practice-based case-finding initiative, to diagnose and refer hepatitis C virus (HCV) chronically infected former injecting drug users (IDUs), was evaluated.
  
  
  METHODS
  Testing was offered in eight Glasgow general practices in areas of high deprivation and high HCV and IDU prevalence to attendees aged 30-54 years with a history of IDU. Test uptake and diagnosis rates were compared with those in eight demographically similar control practices.
  
  
  RESULTS
  Of 422 eligible intervention practice attendees, 218 (52%) were offered an HCV test and, of these, 121 (56%) accepted. Poor venous access in 13 individuals prevented testing. Of 105 tested, 70% (74/105) were antibody positive of which 58% (43/74) were RNA positive by PCR. Of 43 chronically infected individuals identified in intervention practices, 22 (51%) had attended specialist care within 30 months of the study, while 9 (21%) had defaulted. In control practices, 8 (22%) of 36 individuals tested were antibody positive. Test uptake and case yield were approximately 3 and 10 times higher in intervention compared with control practices, respectively.
  
  
  CONCLUSIONS
  Targeted case-finding in primary care demonstrated higher test uptake and diagnosis rates; however, to optimize diagnosis and referral of chronically infected individuals, alternative means of testing (e.g. dried blood spots) and retention in specialist care (e.g. outreach services) must be explored.
authors.affiliation: Health Protection Scotland, Clifton House, Clifton Place, Glasgow G3 7LN, UK. beth.cullen@nhs.net
authors.forename: B L
authors.initials: BL
authors.lastname: Cullen
authors.forename: S J
authors.initials: SJ
authors.lastname: Hutchinson
authors.forename: S O
authors.initials: SO
authors.lastname: Cameron
authors.forename: E
authors.initials: E
authors.lastname: Anderson
authors.forename: S
authors.initials: S
authors.lastname: Ahmed
authors.forename: E
authors.initials: E
authors.lastname: Spence
authors.forename: P R
authors.initials: PR
authors.lastname: Mills
authors.forename: R
authors.initials: R
authors.lastname: Mandeville
authors.forename: E
authors.initials: E
authors.lastname: Forrest
authors.forename: M
authors.initials: M
authors.lastname: Washington
authors.forename: R
authors.initials: R
authors.lastname: Wong
authors.forename: R
authors.initials: R
authors.lastname: Fox
authors.forename: D J
authors.initials: DJ
authors.lastname: Goldberg
mesh_terms: D000328:Adult; D005260:Female; D058006:General Practice / Q000379:methods / Q000706:statistics & numerical data*; D016174:Hepacivirus / Q000302:isolation & purification*; D019698:Hepatitis C, Chronic / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008403:Mass Screening / Q000592:standards / Q000706:statistics & numerical data; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011204:Poverty Areas; D015397:Program Evaluation; D012606:Scotland; D012698:Serologic Tests / Q000706:statistics & numerical data; D015819:Substance Abuse, Intravenous / Q000150:complications* / Q000453:epidemiology / Q000821:virology