Introduction The Hepatitis C action plan of 2004 identified a need to “reduce the level of undiagnosed infection and provide better, more co-ordinated pathways of care for people with hepatitis C, from their initial diagnosis to specialist care and treatment”(1). Our aim was to audit the outcome of Hepatitis C testing in a large secondary care facility in UK against the established management pathway (2).
Methods Using the hospital microbiology database, we identified 3166 requests for hepatitis C serology from January to December 2011. All positive results were retrospectively analysed at least 12 months after test requests, to include: referral source, demographics, route of acquisition etc. In addition, evidence of HCV PCR testing, outpatient referral and outcomes were sought from referrers and laboratory records.
Results Age range of Hepatitis C positives was from 10 months to 71 years. 41% referrals came from primary care and drug dependence services, 30% from medical service, 5% from obstetrics and 5% from GUM. 76% had acquired HCV from intravenous drug use. Alcohol dependence was recorded in 34%. Of 122 positive HCV antibodies requested, 49 (40%) were already known about. Of the remaining 73, 48 (66%) had no further investigation requested. Of these 48, 34 were not referred or investigated further (15 from primary care, 13 from secondary care, 6 from prisons). 13 were referred without PCR result, 11 did not attend (DNA’d) at first (6) or second (5) appointments, 2 have appointments outstanding and 1 had previously failed treatment but was not re-referred.
Conclusion The Hepatitis C action plan has failed to deliver. This audit demonstrates almost half the serology tests are unnecessary repeats, 2/3rd of true new positives never progress down the management pathway and only 3% access treatment.
Disclosure of Interest None Declared.
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