Introduction Chronic Hepatitis C virus (HCV) is a major cause of liver cirrhosis with a worldwide prevalence of 3%. The UK prevalence is between 0.4–1.0% however pockets of higher prevalence will exist in areas with large immigrant populations. Chronic liver disease in HCV infected patients is costly to the NHS. The Hepatitis C Action plan recommends all ethnic minorities from countries where HCV is endemic be offered screening; however testing of this group remains haphazard. Our aims were to determine the number of high risk individuals tested for HCV by interrogation of a Primary Care database in a single GP surgery located in an area with a large immigrant population. Secondary aims include establishing the reason for testing, prevalence of HCV in the tested population and treatment outcomes.
Methods We used 4 search terms in the primary care database SystmOne to identify our target population: age (>18), ethnic code, place of birth and language spoken. We then applied Read Codes pertaining to HCV to this population to determine the number already tested. The electronic medical records of all individuals tested positive for HCV were reviewed to answer secondary aims.
Results There were 4256 individuals registered age >18. 75% (3210) qualified as the target population, 18% (718) were excluded because of lack of demographic data, 7% (328) originated from low risk countries. We identified 16 read codes pertaining to HCV and these generated 247 ‘hits’ and identified that 6% of the target population had been tested for HCV (115M, 79F). Indications for testing were: isolated raised ALT/bilirubin/ALP/AST 45%, contact testing 12%, mixed raised LFTs 9%, generally unwell 9%, screening pre DMARD therapy 7%, illicit drug use 7%, patient request 3%, other indication 3%, indication unknown 2%, medical intervention overseas 1%, other abnormal bloods 1%. Proactive screening took place in 1%. The prevalence of HCV in the tested population was 7.7% (15/194 M9, F6). 73% (11/15) received treatment, 9/11 (82%) achieved an SVR, 1/11 (9%) was termed ‘responder-relapser’ but achieved SVR on re-treatment, 1/11 (9%) had no response to treatment and the course terminated prematurely, with subsequent spontaneous clearance of the virus. 4/15 had not received treatment: 2 patients were considered high risk for treatment in view of co-morbidities, 1 failed to attend appointments and 1 was recently diagnosed.
Conclusion This study confirms that testing is reactive rather than proactive highlighting the need for a screening programme dedicated to high risk populations. GP work load, prioritisation of chronic diseases forming part of QOF and poor understanding of HCV all exist as possible barriers to screening.
Disclosure of Interest None Declared.
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