Management of hepatitis C among drug users attending general practice in Ireland: baseline data from the Dublin area hepatitis C in general practice initiative

Abstract

Objective: In Ireland, general practice is increasingly providing long-term care for injecting drug users, 62-81% of whom are infected with hepatitis C (HCV). Clinical guidelines for the management of HCV among drug users have recently been developed in Ireland, and this study aimed to describe HCV care among drug users attending general practice in the greater Dublin area, prior to the implementation of the clinical practice guidelines.

Methods: The clinical records of 196 patients attending 25 general practices in the Eastern Regional Health Authority area of Ireland for methadone maintenance treatment were examined on site and anonymized data collected on HCV care processes.

Results: Patients had been attending general practice for methadone maintenance treatment for a mean of 30.7 months, 72% were male and 51% had provided a urine sample testing positive for metabolites of drugs of abuse other than methadone in the previous 3 months. There was evidence that 77%, 69% and 60% had been screened for HCV, human immunodeficiency virus (HIV) and hepatitis B (HBV), respectively. Among those who had been tested, the prevalence of HCV, HIV and HBV infection was 69%, 10% and 11%, respectively. Of those known to be HCV positive, 36 (35%) had been tested for HCV-RNA (29 testing positive), 31 (30%) had been referred to a hepatology clinic, 24 (23%) had attended a clinic, 13 (13%) had a liver biopsy performed and three (3%) had started treatment for HCV.

Conclusion: While the majority of patients have been screened for blood-borne viruses, a minority of those infected with HCV have had subsequent investigations or treatment. New interventions to facilitate optimum care in this regard need to be considered.