Improving targeted screening for hepatitis C in the UK
BMJ 2012; 345 doi: https://doi.org/10.1136/bmj.e6525 (Published 03 October 2012) Cite this as: BMJ 2012;345:e6525
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I read with interest the recommendations of this weeks' Editorial, particularly the potential for engagement within Primary Care. At our hospital the success of the finger prick test has revolutionised the identification and management of our Hepatitis Cohort. Not only has this increased the detection rate, but provided an effective monitoring scheme.
Within Hywel Dda both official Social Service based centres and programmes, as well as those run the voluntary sectors have visits from the community Blood Bourne Virus nurse specialist. The allows for early engagement, education and screening in a non hostile environment, in the patients "own back yard" away from the stigma and stuffiness of traditional wards and clinics. The BBV nurse is also a crucial cog in bridging this community engagement with eventual hospital based assessments where patients can meet the Consultant for a more formal, detailed, and potentially treatment changing consultation. We would advocate increasing schemes such as these by involving the voluntary sector in primary care screening programmes.
Competing interests: No competing interests
Re: Improving targeted screening for hepatitis C in the UK
In the editorial entitled ‘Improving targeted screening for hepatitis C in the UK’ the authors discuss the need to ensure that all case finding is followed by referral to specialist care.
We scrutinised around 32,000 test results for HCV performed in our laboratory up to 2009 to see if the data indicates follow-up of those found positive.
651 patients were found anti-HCV positive in the local area of which 189 had died or moved out of area. 350 of the remaining 462 had viral load test results available. Of these 88 were undetectable, 110 had received treatment indicated by post treatment monitoring and 152 appeared to have no further laboratory follow up. Further information obtained from the Hepatitis Specialist Nurse showed that 69/152 (45%) had been referred but repeatedly ‘did not attend’, a further 39 (26%) were being monitored in secondary care and there were no records for 44 (29%).
112 had no evidence of an initial viral load. However, a recent check shows that, since 2009, 28/112 (25%) have been tested and 25 of the remaining 84 are no longer registered locally. In 9/28 the viral load is undetectable, 6 have been treated and 13 have detectable HCV RNA but have no further results. As suitability for treatment changes with time, the fact that there is often a delay between diagnosis and further testing is not unexpected but should be noted and accounted for.
Information from laboratory testing can provide total numbers of HCV positive cases in an area to aid in the development of care pathways and assist commissioning services particularly when combined with information from colleagues in hepatology units.
Competing interests: No competing interests