Background: Hepatitis C (HCV) infection is an important cause of mortality and morbidity among injecting drug users (IDUs). Despite increases in the safety and efficacy of HCV treatment, assessment and uptake has remained low, warranting improved integration between drug health and hepatitis services.
Objectives: To examine HCV treatment assessment, referral and uptake among HCV-positive IDUs attending a Needle/Syringe Program based nurse-run primary healthcare (PHC) service with direct links to a IDUs experienced tertiary liver clinic.
Methods: A clinic audit of the 206 client files opened in the first 18 months of clinic operation. Data were extracted from client files and entered into an SPSS database for descriptive analysis.
Results: Half the clients presented for blood-borne virus screening. Although only nine clients had not previously undergone HCV testing, one-third reported having been tested more than 12 months ago. Eighty-eight clients underwent anti-HCV testing, of whom 52% were positive, 83% of whom were RNA positive; liver function tests were elevated in 58%. Genotype testing was available for 34 clients: 18 were genotype 1 and 16 genotype 2/3. Nineteen clients were referred to the liver clinic; nine had attended at the time of the audit. Factors likely to have facilitated referral compliance included: (1) client readiness i.e. most of the clients were in residential rehabilitation; (2) extensive support provided by PHC nurses i.e. comprehensive client reminder system; (3) close networks with tertiary Liver Clinic nurses; (4) follow-up of failed attendance by the PHC nurses.
Conclusions: Referral pathways developed by the PHC service yielded good rates of referral uptake. Uptake may be partially explained by the high proportion of clients undergoing rehabilitation who were concurrently supported by the PHC clinic and the close networks with the Liver Clinic nurses, suggesting that this combination could optimise conditions for IDUs to undergo HCV treatment assessment.