Targets for Hepatitis C virus test uptake and case-finding among injecting drug users: In prisons and general practice

Abstract

We re-analyse data on new diagnoses of Hepatitis C virus (HCV) for injectors in prison or attending general practices which were relied on for the cost-effectiveness of HCV testing in injectors. We use these revised estimates to suggest readily achievable targets in Scottish general practices on HCV diagnoses for injectors born in 1956–1975. Using audit data from general practices around Edinburgh, we confirm that, with effort, the suggested targets are achievable. On re-analysis, we found that over 20% of HCV-undiagnosed injectors in English prisons accepted HCV testing, and half the injectors aged 30–54 years who attended a Glasgow general practice. On the basis of 30% HCV test uptake and 80% of ever-injectors having self-identified, a target of 2500 HCV diagnoses within a year in known ever-injectors born in 1956–1975 attending Scottish general practices is feasible. Its target of five new HCV diagnoses was achieved during an HCV testing intervention by Muirhouse Practice, Edinburgh. During a 2-year audit period, 86 other general practices around Edinburgh providing enhanced services for drug users increased HCV test uptake by known ever-injectors from 43% (314/727) to 62% (655/1062) in the 1956–1975 birth-cohort. Their new HCV diagnoses in ever-injectors were 171 over two years against a target of 166 within 1 year.

• Injectors
• Hepatitis C virus (HCV)
• HCV test uptake
• HCV diagnoses
• birth-cohort

Notes

1. Scotland had an estimated 80,000 ever-IDUs in 2000 (Hutchinson 2004): more by 2004, most aged 30–54 years, and 30–45% are undiagnosed HCV carriers. We assume 20,000 HCV-undiagnosed ever-IDUs aged 30–54 years, and so around 1.3% of the Scottish population aged 30–54 years. Prevalence may be two to four times greater in Possil Park, and ever-IDUs 50% more likely to attend their general practice than age-matched peers: hence the above 6% prevalence. Even if, rather implausibly, HCV-undiagnosed ever-IDUs had been 12% of 6-month attenders, their HCV test uptake would still have been 19/70 (27%: 95% CI from 17% to 38%).