Identifying former injecting drug users infected with hepatitis C: an evaluation of a general practice-based case-finding intervention

In Scotland, a general practice-based case-finding initiative, to diagnose and refer hepatitis C virus (HCV) chronically infected former injecting drug users (IDUs), was evaluated. Testing was offered in eight Glasgow general practices in areas of high deprivation and high HCV and IDU prevalence to attendees aged 3054 years with a history of IDU. Test uptake and diagnosis rates were compared with those in eight demographically similar control practices. Of 422 eligible intervention practice attendees, 218 (52) were offered an HCV test and, of these, 121 (56) accepted. Poor venous access in 13 individuals prevented testing. Of 105 tested, 70 (74/105) were antibody positive of which 58 (43/74) were RNA positive by PCR. Of 43 chronically infected individuals identified in intervention practices, 22 (51) had attended specialist care within 30 months of the study, while 9 (21) had defaulted. In control practices, 8 (22) of 36 individuals tested were antibody positive. Test uptake and case yield were approximately 3 and 10 times higher in intervention compared with control practices, respectively. Targeted case-finding in primary care demonstrated higher test uptake and diagnosis rates; however, to optimize diagnosis and referral of chronically infected individuals, alternative means of testing (e.g. dried blood spots) and retention in specialist care (e.g. outreach services) must be explored.