title: Rise in testing and diagnosis associated with Scotland's Action Plan on Hepatitis C and introduction of dried blood spot testing.
abstract: BACKGROUND
  A key aim of the Hepatitis C Action Plan for Scotland was to reduce the undiagnosed population through awareness-raising activities, for general practitioners and those at risk, and the introduction of dried blood spot (DBS) sampling in community drug services to overcome barriers to testing. This study evaluates the impact of these activities on testing and diagnosis.
  
  
  METHODS
  Data on hepatitis C virus (HCV) testing undertaken between January 1999 and December 2011 in Scotland's four largest health boards were analysed. Segmented regression analysis was used to examine changes in testing following the (1) launch of the Action Plan and (2) introduction of DBS testing.
  
  
  RESULTS
  Between the pre-Action Plan and Action Plan periods, increases were observed in the average number of HCV tests (19 058-29 045), positive tests (1993-2405) and new diagnoses (1221-1367). Since July 2009, 26% of new diagnoses were made in drug services. The trend in the number of positive tests was raised during the Action Plan, compared to pre-Action Plan, particularly in drug services (rate ratio (RR)=1.4, p<0.001) and prisons (RR=1.2, p<0.001); no change was observed in general practice. Following introduction of DBS testing, there was a 3-fold increase in testing (RR=3.5, p<0.001) and 12-fold increase in positives (RR=12.1, p<0.001) in drug services.
  
  
  CONCLUSIONS
  The introduction of DBS sampling in community drug services has made an appreciable contribution to efforts to diagnose the HCV-infected population in Scotland. These findings are important to other countries, with injecting-related HCV epidemics, needing to scale-up testing/case-finding initiatives.
authors.affiliation: BBV/STI Team, Health Protection Scotland, Glasgow, UK.
authors.forename: Allan
authors.initials: A
authors.lastname: McLeod
authors.affiliation: BBV/STI Team, Health Protection Scotland, Glasgow, UK School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
authors.forename: Amanda
authors.initials: A
authors.lastname: Weir
authors.affiliation: West of Scotland Specialist Virology Centre, Glasgow, UK.
authors.forename: Celia
authors.initials: C
authors.lastname: Aitken
authors.affiliation: West of Scotland Specialist Virology Centre, Glasgow, UK.
authors.forename: Rory
authors.initials: R
authors.lastname: Gunson
authors.affiliation: East of Scotland Specialist Virology Centre, Edinburgh, UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Templeton
authors.affiliation: Department of Medical Microbiology, Aberdeen Royal Infirmary, Aberdeen, UK.
authors.forename: Pamela
authors.initials: P
authors.lastname: Molyneaux
authors.affiliation: Department of Medical Microbiology, Ninewells Hospital & Medical School, Dundee, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: McIntyre
authors.affiliation: BBV/STI Team, Health Protection Scotland, Glasgow, UK School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
authors.forename: Scott
authors.initials: S
authors.lastname: McDonald
authors.affiliation: BBV/STI Team, Health Protection Scotland, Glasgow, UK.
authors.forename: David
authors.initials: D
authors.lastname: Goldberg
authors.affiliation: BBV/STI Team, Health Protection Scotland, Glasgow, UK School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
authors.forename: Sharon
authors.initials: S
authors.lastname: Hutchinson
mesh_terms: D000328:Adult; D059788:Dried Blood Spot Testing; D005260:Female; D016174:Hepacivirus / Q000302:isolation & purification*; D006526:Hepatitis C / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012307:Risk Factors; D012606:Scotland / Q000453:epidemiology; D013222:State Medicine; D055815:Young Adult
keywords: DRUG MISUSE; HEPATITIS; PUBLIC HEALTH POLICY; SURVEILLANCE