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Screening for hepatitis C (HCV) in specialist centres and in primary care   Back Bookmark and Share

Sir - Smyth et al have recently highlighted HCV screening as an important issue in the care of injecting drug users.1 Although the authors acknowledge that the process of testing is slow and complex,2 they conclude that services other than specialist addiction treatment centres are not adequately examining injecting drug users for the presence of HCV. This conclusion is based on interviews with 43 drug users attending one specialist treatment centre. This represents 0.3% of the estimated total population of drug users in the Dublin area.3 Furthermore, the sample was drawn from one specialist centre. As of late 1998, there were seven such centres in the Eastern Regional Health Authority area.4 Finally, the sample reported here had defaulted from methadone maintenance treatment two years previously and therefore may have been involved in chaotic drug use in the interim. For these reasons, this study can only make limited claims on the process of care in general practice.

A survey of more than 500 drug users in the Dublin area, attending GPs for methadone maintenance awaits publication.5 Its conclusions will conflict with the above. Data was also collected on a sample of drug users attending general practice for general medical care, of whom 30 met similar criteria to those selected by Smyth. The mean age was 27 years and 4.4 months was the mean time period since patients had last attended the practice (range 1-18). The HCV status was known in 23 cases (77%). The source of this information was a blood test performed by the GP (13 cases), self-reported data (8) and communication from a general medical clinic (2). None of the medical records contained communication from a specialist addiction centre on the HCV status of the patient concerned. Of 18 cases that were known by the GP to be seropositive, 13 had liver biochemistry assayed, one had HCV-RNA assayed, and eight had been referred for further investigations.

The reasons for the differences in HCV screening need to be clarified. However, issues such as GP registration, shared care protocols and good liaison arrangements may be important. While this study indicates that we can be optimistic about the role of GPs in managing this group of patients, we also acknowledge that management of this patient group has inherent difficulties, which make sector wide co-operation essential.

Walter Culleni, G Bury* FD O'Kelly*
1 Department of General Practice, University College Dublin. 2 Eastern Regional Vocational Training Programme in General Practice, Dr Steeven's Hospital, Dublin 8 and Department of Community Health and General Practice, Trinity College, Dublin.

References

  1. Smyth BP, McMahon J, O'Connor.JJ, Ryan j. HCV screening. IMJ 2000; 93(5): 154-155.
  2. Foster GR, Goldin RD, Main j, MurraHyon I, Hargreaves S, Thomas HC. Management of chronic hepatitis C: clinical audit of biopsy based management algorithm. BMJ 1997; 315: 453-458.
  3. Comiskey CM. Estimating the prevalence of opiate drug use in Dublin, Ireland during 1996. Report submitted to Department of Health. Dublin: Department of Health, 1998.
  4. Eastern Health Board. Public Health in the Eastern Health Board Region. Department of Public Health, Eastern Health Board, Dublin: 1998.
  5. Cullen W, Bury G, Barry J, O'Kelly FD. Drug users attending general practice in Eastern Regional Health Authority (ERHA) area. IMJ 2000; 93(7}:214-217.
   
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