Aim and Methods: An ongoing audit for HCV assessment and management at an opioid substitution treatment (OST) centre, based on a protocol of blood testing offered to all patients twice-yearly, covering HCV/HBV/HIV serology, haematology, biochemistry, with clinical assessment and referral for HCV treatment where appropriate, under shared care arrangements with tertiary referral centres.

Results: During the period December 2002 to July 2008, 234 of 315 (74.3%) IDU patients treated with OST were HCV antibody seropositive. An estimated
164 (70.1%) had chronic HCV infection on the basis of HCV RNA positive assessment (n=145; genotype 1, 49%; g2, 7%; g3, 42%) or ALT elevation with no HCV RNA assessment (n=19). Based on risk factors for liver disease progression (including elevated ALT and longer duration of hepatitis C)
97/164 were prioritised for referral and treatment assessment. Of these 97 people, 68 (70.1%) were referred to, and 56 (57.7%) attended, a tertiary referral clinic. At July 2008, 31 patients have been commenced on standard anti-viral treatment, with 27 completing treatment and 4 currently on treatment. One patient stopped treatment early owing to lack of virological response and two due to side effects. In 20 cases the OST prescriber (RH) was also HCV prescriber. Sustained virological response (SVR) rates at 12 months post PEG/RBV are overall 20/27 (74%): for genotype 1, 6/9 (67%); genotypes 2 or 3, 14/18 (78%). There have been no HCV relapses after 3 months post-PEG/RBV, and no cases of apparent reinfection (mean follow up
22 months). The most common cause for not being referred or treated was loss to follow up (completed OST, 6; dropped out of OST, 7; transferred OST site, 14; gaol, 6; death, 1).

Conclusion: A majority of people with chronic HCV infection considered at higher risk for liver disease progression underwent tertiary-based HCV treatment assessment. Systematic HCV assessment and shared HCV care through this OST centre yielded promising treatment results.