PWE-118 An Audit of Hepatitis C Testing and Referral Patterns

Introduction The Hepatitis C action plan of 2004 identified a need to “reduce the level of undiagnosed infection and provide better, more co-ordinated pathways of care for people with hepatitis C, from their initial diagnosis to specialist care and treatment”(1). Our aim was to audit the outcome of Hepatitis C testing in a large secondary care facility in UK against the established management pathway (2). Methods Using the hospital microbiology database, we identified 3166 requests for hepatitis C serology from January to December 2011. All positive results were retrospectively analysed at least 12 months after test requests, to include: referral source, demographics, route of acquisition etc. In addition, evidence of HCV PCR testing, outpatient referral and outcomes were sought from referrers and laboratory records. Results Age range of Hepatitis C positives was from 10 months to 71 years. 41% referrals came from primary care and drug dependence services, 30% from medical service, 5% from obstetrics and 5% from GUM. 76% had acquired HCV from intravenous drug use. Alcohol dependence was recorded in 34%. Of 122 positive HCV antibodies requested, 49 (40%) were already known about. Of the remaining 73, 48 (66%) had no further investigation requested. Of these 48, 34 were not referred or investigated further (15 from primary care, 13 from secondary care, 6 from prisons). 13 were referred without PCR result, 11 did not attend (DNA’d) at first (6) or second (5) appointments, 2 have appointments outstanding and 1 had previously failed treatment but was not re-referred. Conclusion The Hepatitis C action plan has failed to deliver. This audit demonstrates almost half the serology tests are unnecessary repeats, 2/3rd of true new positives never progress down the management pathway and only 3% access treatment. Disclosure of Interest None Declared. References www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4084521 http://www.nhs.uk/hepatitisc/hcp/testing-for-hepatitis-c/Pages/from-diagnosis-to-treatment–a-flowchart.aspx