Sir Recently, there has been much discussion in the international medical literature regarding the screening of injecting drug users for hepatitis C (HCV)1,2. While some remain sceptical regarding the value in such screening, most now perceive it to be a sensible policy3-5. There has been less discussion and clarity concerning the clinical setting in which such testing should occur. HCV is a common, usually chronic and frequently serious complication of unsafe injecting. The process of assessment and treatment is slow and complex6. In view of their interest in all aspects of the patients health and the continuity of care provided, we perceive general practitioners to be uniquely positioned to initiate the assessment process and ensure that further referral occurs as appropriate. However, recent American research has found that primary care physicians demonstrate considerable confusion about the use of HCV tests7. In Dublin, injecting drug users have been demon strated to be a very high-risk group for HCV8. Drug treatment services have a policy of actively encouraging injecting drug users to test for HCV while attending addiction treatment. Unfortunately, many drop out of their addiction treatment program prior to undergoing HCV testing. The fate of these individuals regarding HCV testing has not previously been examined.

We wished to investigate whether or not other services were testing injecting drug users for HCV infection. We interviewed 43 injecting drug users who re-attended one addiction treatment centre having defaulted from treatment prior to HCV testing at their previous attendance. Testing had not been refused by any patient. A mean period of 26 months had elapsed since their last attendance. Thirty-five (81%) reported that they attended a general practitioner who was aware of their drug misuse and 17 (40%) attended such a GP six or more times in the preceding year. Only seven (16%) had been screened for HCV since their last attendance at the addiction treatment centre and the test was conducted by a GP in only two cases.

Our survey suggests that services other than specialist addiction treatment centres are not adequately examining injecting drug users for the presence of HCV infection. The reason for this is unclear. In particular, the failure of this high risk group to be tested for HCV in the primary care setting warrants exploration.

Bobby P Smyth,
Specialist registrar
Academic Unit,
Pine Lodge,
Liverpool Rd.,
Chester CH2 1AW.

References

1. Best D, Noble A, Finch E, Gossop M, Sidwell C, Strang J. Accuracy of perceptions of hepatitis B and C status: cross sectional investigation of opiate addicts in treatment. BMJ 1999; 319 :290-1
2. Suckling R, Perret K, McKendrick M. Value of screening Hepatitus C is still debatable. BMJ letter re the Best paper.
3. Leal P, Stein K, Rosenberg W. What is the cost utility of screening for hepatitis C virus in intravenous drug users? J Med Screen 1999; 6: 124-131.
4. Anonymous. French consensus conference on hepatitis C: screening and treatment. Gut 1998; 42: 892-8.
5. Gordon FD. Cost-effectiveness of screening patients for hepatitis C. Am J Med 1999; 107: 36S-40S.
6. Foster GR, Goldin RD, Main J, Murray-Lyon I, Hargreaves S, Thomas HC. Management of chronic hepatitis C: clinical audit of biopsy based management algorithm. BMJ 1997; 315: 453-8.
7. Shehab TM, Sonnad SS, Jeffries M, Gunartnum N, Lok AS. Current practice of primary care phtsicians in the management of patients with hepatitis C. Hepatology 1999; 30: 794-800.
8. Smyth BP, Keenan E, OConnor JJ. Reduced risk of hepatitis C among short-term injecting drug users in Dublin, Ireland. J Epid & Comm Health 1999; 53: 434-5.