Eliminating Hepatitis C in at risk groups - achieving 100% testing in city centre opioid agonist therapy cohort and ensuring successful linkage to treatment
National case finding recommendations for Scottish drug use services include minimum annual Hepatitis C (HCV) opt-out testing and suggest testing targets of 90% “ever tested” and 80% tested in past 12 months. 2018 audit of all Greater Glasgow and Clyde specialist service Opioid Agonist Therapy (OAT) patients showed 87.6% “ever tested” and 55.2% tested in past year.
In one local drug service with 241 OAT patients, HCV testing and access to treatment was managed by the pharmacist independent prescriber (PIP) who developed a system to target untested and untreated patients. Dry blood spot testing was completed at OAT initiation and quarterly prescribing reviews. Positive messages were reinforcing success of new treatments, minimal side-effects, a guarantee that test results would be given at next appointment and assurance that hospital attendance wasn’t necessary. For patients with positive results, OAT prescriptions were planned to coincide with outreach liver nurse appointments, facilitating attendance. Liver assessments including non-invasive fibrosis estimates were discussed at hospital multidisciplinary meeting and HCV treatment started within 5 weeks.
Testing rates within local service increased from 177(67%) in previous 12 months and 226(92.5%) patients ever tested in May 2018 to 100% of patients tested in 12 months to May 2019. Identified new cases: 15 HCV, 2 HIV. Treatment: May 2018 46(19%) HCV+ve reduced to 6(2.5%) by May 2019.
Conclusion and next steps:
The PIP having a “HCV champion” role in the drug service with overview of testing and access to care delivered high testing and treatment rates within current resource by use of a systematic approach, linking appointments to OAT and educating staff and patients. Other drug services should consider implementing a champion role.